Neurology Flashcards
What conditions are a contraindication to triptans?
Ischaemic heart disease, hypertension and previous stroke or TIA
First line prevention of uncomplicated migraine
Beta blocker e.g. atenolol, propanolol
Sensation of being hit in the back of head, smoking history, EDS
Ruptured berry aneurysm
Periorbital headache with ptosis, lacrimation, conjunctival inflammation
Cluster headache
History of TIA and AF with stepwise decline in memory
Vascular dementia
First line management of mild to moderate dementia
Donepezil, rivastigmine or galantamine
Management of moderate to severe dementia
Memantine (NMDA antagonist)
Why are people with Down syndrome more likely to get Alzheimer’s?
Amyloid precursor protein is found on chromosome 21
Drug to reduce severity of attacks in MS
3 day course oral methylprednisolone
Drug to reduce relapse rate in MS
Beta-interferon
Pt is unable to extend knee due to muscle spasm - should botox be injected into extensor or flexor muscles?
Flexors. e.g. biceps femoris if unable to extend knee
What would you see on CSF panel in MS patient?
<1 white cell, <1 red cell, CSF glucose:serum glucose=0.6, protein 0.5 (normal 0.2-0.45g/L), distinct bands of IgG on Western Blot
Pathological hallmark of MS on MRI
Plaques of gadolinium-enhancing T2 hyperintensity
What type of stroke is caused by small vessel infarction?
Lacunar stroke (no cortical signs e.g. hemianopia, speech problems)
First line investigation for suspected subarachnoid haemorrhage
CT non-contrast (detects 90% within48h onset)
WHich nerves are affected first in PNS pathology?
Long nerves e.g. legs before arms
Anticonvulsant causing elevated liver enzymes and hepatic dysfunction
Sodium valproate
How does phenytoin work?
By blocking voltage-gated sodium channels to prevent further action potentials
Pt’s plasma phenytoin level is 7mg (ref 10-20mg) after initial management of seizure with phenytoin, how can a further seizure be prevented?
Increase dose of phenytoin
(current levels are below therapeutic window)
Side effects of sodium valproate
Think VALPROATE
- Vomiting
- Appetite (increased, weight gain)
- Liver failure
- Pancreatitis
- Reversible hair loss
- Oedema
- Ataxia
- Teratogencity/tremor/thrombocytopenia
- Encephalopathy
What is Jacksonian march?
Leg starts twitching, and movement moves up her right trunk to involve right arm (or left)
In status epilepticus pts, what should be given after buccal diazepam?
IV midazolam
Jacksonian march and Todd’s palsy are features of what type of seizure?
Focal seizure without impairment of consciousness - frontal lobe origin
Features of temporal lobe seizures
Aura initially (e.g. feeling sick, a sense of anxiety or smelling unusual smells)
Followed by impaired awareness
- stare blankly
- automatisms (e.g. lip-smacking or fidgeting with their hands)
Post-ictal phase
- slightly confused
- unsure of what has happened.