Neurology Flashcards
What should a GP initiate if they suspect a TIA?
300mg Aspirin STAT and referral to specialist within 24 hours
What is the triad of symptoms in Wernickes encephalopathy?
Opthalmoplegia/ confusion/ gait ataxia/ nystagmus - (acute presentation)
Following a TIA, what are the driving rules?
If symptom free at 1 month can start driving again as long as symptom free. no need to inform dvla
Cluster headache - what is the prophylaxis?
Veramapil
How does Ramsay Hunt syndrome present?
Facial nerve palsy/ vesicles in mouth or ear, ear pain.
Treatment of Ramsay Hunt syndrome?
Treatment= Oral aciclovir and oral prednisolone
How does spinal stenosis present?
Bilateral leg pain on walking/ relieved on crouching forward. Weakness
What is the management of trigeminal neuralgia?
Carbamazapine
What would be seen on a CT of herpes simplex encephalitis?
Temporal lobe changes (hypo densities)
Who does herpes simplex encephalitis affect?
ImmunoCOMPENENT individuals. Presents with confusion, irritability.
How to remember GCS?
654, MoVE
What is the time frame for providing thrombectomy within?
6 hours!
If symptoms of a stroke are presented within 4.5 hours what should be provided?
Thrombectomy AND thrombolysis
What is the first line treatment for motor symptoms in Parkinson’s?
Levodopa.
What is the management of TIA in GP setting if symptoms have resolved?
300mg Aspirin and referral to TIA clinic within 24 hours
What is Cataplexy?
Cataplexy- eg bouts of laughter produce muscle weakness
What is the ‘thrombolysis’ window?
4.5 hours!
What is the presentation of Wilsons disease?
Neurological symptoms (bradykinesa/ speech/ ataxia)/ Kayser-Fleischer rings, family history
What is the prophylaxis for preventing migranes?
Propanaolol
Topiramate- avoid in women of childbearing age
Post stroke what is the combination of antiplatlets?
Clopidogrel monotherapy
What drug choice for generalised tonic clonic seizures?
Males-Sodium valporate
Females- Lamotrigine
What is the drug choice for absent seizures?
Ethosuxamide
Focal seizures drug management 1st line
Lamotrigine
Cabergoline- what type of drug and what is the side effect?
Dopamine receptor agonist “dostinex”
Side effect: Pulmonary fibrosis
After an ischaemic stroke what antiplatelet/ anti platelets should be given?
Monotherapy with clopidogrel
Presentation of bulbar-onset amyotrophic lateral sclerosis (ALS) (part of motor neurone disease)
Difficulty swallowing liquids, facial weakness, hypophonic speech, fasciculation’s and eye movements spared
Bells palsy vs stroke
Bells palsy- complete facial nerve paralysis
Stroke (spare the forehead).
Lewy body dementia presents how?
Fluctuating cognition, visual hallunications
How does an extradural haemorrage present?
LOC followed by lucid period and then LOC again
What is an example of Dopamine receptor agonists?
ropinirole, Rotigine
What is first line in the management of Parkinson’s?
If motor symptoms then levodopa.
What does an Abducens nerve palsy present with?
Palsy results in defective abduction → horizontal diplopia
Eye looks inwards
Abducens is the 6th nerve
How does an oculomotor palsy present?
Eye is down and out
Ptosis
Dilated pupil
What is the most common cause of a Trochlear nerve lesion? and what would a palsy result in?
Head Trauma
Palsy results in downward gaze but at resting the eye looks up
How does an ANTERIOR cerebral artery stroke present?
Contralateral hemiparesis and sensory loss
How does a POSTERIOR cerebral artery stroke present?
Contralateral homonymous hemianopia with macular sparing
How does a MIDDLE cerebral artery stroke present?
-Contralateral hemiparesis and sensory loss
- Contralateral homonymous hemianopia
-Aphasia
Presentation of Acoustic neuroma?
Unilateral hearing loss
Affects cranial nerves so can get facial palsy, absent corneal reflex
How does Myasthenia Gravis present?
Females
Autoimmune
Extraocular muscle weakness, diplopia,
Slurred speech, Dysphagia
Ptosis
What are the classical features of Guillain Barre syndrome?
Ascending weakness
Bilateral and symmetrical
Reduced reflexes
Infantile spasm/ west syndrome- what is the presentation?
Spasms described as ‘drawing legs up’.
A/W birth asphyxia
Juvenille myoclonic epilepsy (Janz syndrome)
Most common
Myoclonic
Jerks in the morning
Subdural and extradural haemorrhage present how?
Subdural- elderly/ alcoholics. Bridging veins.Crescent shaped
Extradural- Head injury/ middle meningeal/ LUCID period/ lens shaped.
What is the treatment of Guillian Bare?
IV Immunoglobulin
What are the three features of Wernickes encephalopathy?
ophthalmoplegia/nystagmus, ataxia and encephalopathy
What are the features of Multisystem atrophy?
Parkinsons symptoms (gait)
Autonomic disturbance
Cerebellar symptoms
ORTHOSTATIC HYPOTENSION
Dry mouth and dry skin
Carpal tunnel affects which nerve?
Median nerve of hand
Foot drop is caused by injury to which nerve?
Common peroneal
DVLA and stroke rules?
1 month off driving
How may Neurofibromatosis type 2 present?
Acoustic neuroma (SNHL)
Meningioma
How does Charcot Marie Tooth Disease present?
Inverted Champagne bottle legs
Pes cavus
Foot drop
‘Inherited peripheral neuropathy’
What are the treatment principles of myasthenia Gravis?
Anticholinesterases
Thymectomy
First line for a focial seizure ?
Lamotrigine or Levetiracetam
Management of status epilepticus?
Pre hopsital: PR Diazepam/ Buccal Midazolam
In Hopsital: IV Lorazepam
Malignant spinal cord compression vs. cauda equina?
Cauda equina- sensory loss over buttocks. (motor loss in toes)
Spinal cord compression- depends where the lesion is.
What is Chiari malformation?
Cerebellum herniates through foramen magnum.
Presents with headache which is worse on movement
Antiganglioside antibodies are seen in which condition?
Guiline Barre
First line for absent seizure?
Ethosuxamide
First line for each of these seizures:
Absent
Generalised tonic-clonic
Focal
Absent - Ethosuxamide
Generalised tonic-clonic- males sodium valproate
females- lamotrigine/ levetriticam
Focal seizures- lamotrigine or levetraticam
What are the drugs indicated for Alzheimer’s dementia?
First line: Donepezil/ Galantamine/ Rivastigmine
Second line : Memantine (NMDA Antagonist)
What would show on the CSF of a bacterial meningitis?
Polymorphic cells
Protein +
LOW GLUCOSE IN CSF when compared to serum.
What would show on the CSF of a VIRAL meningitis?
Monomorphic cells
Normal or raised protein
Normal glucose
What would show on the CSF of a FUNGAL meningitis?
Raised protein
Low glucose
Adults- most common cause of bacteria meningitis?
Streptococcus pneumonia
Neiserria meningitis
(HIB)
How is Huntingtons disease inherited?
Autosomal dominant
What are the 2 diagnostic tests for Guilliane Barre?
Nerve conduction studies and Lumbar puncture
Cluster Headaches- acute and prophylaxis?
Acute- Triptans and O2
Prophylaxis- Vermapril
(Prednisolone)
What are the indications for a CT head within an hour
GCS less 13 at time of injury
GCS less than 15 at 2 hours
Suspected basal fracture
>1 episode of vomiting
CT scan within 1 hour
What is the triad for normal pressure hydrocephalus?
gait abnormalities/ urinary incontinence and dementia
Myathenia gravis - presentation
Investigations and management
Ptosis
Fatigabilty of muscles
Ix- acetylcholinesterase autoantibodies
Repetitive nerve conduction studies
Mx- Acetylcholinesterse inhibitors
Thymectomy
Parkinsons drugs Co-careldopa and Co-beneldopa are a mix of which drugs?
Co-beneldopa: levodopa and benserazide
Co-careldopa: levodopa and carbidopa
What is a Total Anterior Circulation Stroke (3 things)
Homogenous hemianopia and hemiparesis (on the same side, but contralateral to the lesion)
Dysphagia
What is classified as a PACI?
2 Of the following:
- homogenous hemiapnoa
- hemiparesis
-dysphagia
What is a lacunar infarct?
unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
pure sensory stroke.
ataxic hemiparesis
How does a posterior stroke present?
- Isolated homogenous hemianopia
- Cerebellar syndromes
- Loss of consciousness
