Neurology Flashcards
How should you refer to a stroke?
As a cerebrovascular accident
What are the two types of cerebrovascular accidentws CVA??
Ischeamic
or
haemorrhagic (intracranial haemorrhage)
What is a TIA?
Transient ischaemic attack, symptoms which reslove after 24 hours. On imaging there is ischaemia but no infarction
What are the symptoms of a stroke?
Sudden onsent asymmetrical
weakness of limbs
facial weakness
dysphagia
visual or sensory loss
How do you manage stroke?
Managed at stroke centre
ABCDE
exclude hypoglyceamia, review drugs for bleeding risk
CT Head
aspirin 300mg for 2 weeks
Alteplase thrombolysis
What drugs should somone who has had a stroke be on for secondary prevention?
clopidogrel 75mg
atorvastatin 80mg
What percentage of strokes are bleeds and which are thrombotic?
80% thrombotic
20% ischaemic
How is the GCS scored?
Eyes
Spontaneous -4
Speech - 3
Pain - 2
None -1
Verbal response
Orientated - 5
confused - 4
single strange words - 3
sounds - 2
none =1
Motor
obeys commands -6
Localises pain - 5
Normal flexion - 4
abnormal flexion -3
extends - 2
none - 1
How do intracranial bleeds present?
sudden onset headache
seizures
weakness
vomiting
altered consciousness
What are the eye components of GCS?
Sponaneous - 4
Speech - 3
Pain - 2
None - 1
What are the motor components of GCS?
Motor
obeys commands -6
Localises pain - 5
Normal flexion - 4
abnormal flexion -3
extends - 2
none - 1
What are the verbal components of GCS?
5 verbal
oriented speech 5
confused speech 4
inapproriate words 3
sounds 2
none 1
Where does a subdural haemorrhage occour?
between the dura mater and arachnoid mater
What do extra dural haemorrhages look like on CT?
bi-convex and are limited by cranial sutures?
What does a subdural heamrrohage look like on CT scan?
cresent shape not limited by cranial sutures
What is a intracerebrall haemorrhage and how does it present?
Bleeding into the brain tissue, presents similar to a haemorrhagic stroke
What does a extradural haemorrhage occour?
Between the skull and the dura matter.
What is the subarachnoid space?
it is where cerebrospinal fluid is located, between the Pia and arachnoid mater
What causes an extradural heamorrhage?
Rupture of the middle meningeal artery
How does a subarrachnoid haemorrhage present?
sudden onset occipital headache during stress associated with neurological symptoms
What are the risk factos for a subarachnoid haemorrage?
cocaine
alcohol
hypertension
How do you investigate for a subarachnoid haemorrhage?
CT Head
Lumbar puncture
Describe multiple sclerosis
Chronic and progresive condition invloving demyelination of the myelinated neurones in the central nervous system. It is an inflammatory disease.
How can MS present?
Eye movement disorders
eye movement abnormality
focal weakness
focal sensory symptoms
ataxia
How is MS diagnosed?
made by a neurologist and is a diagonsis of exclusion
How are MS relapses treated?
steroids - methylprednisolone
What are the DVLA requirements for MS
Patient must inform the DVLA of their condition and recieve an assesment
How does Motor neurone disease present?
60 year old man with insidious, progressive weakness of the muscles throughout the body affecting limbs trunk face and speech
What is parkinson’s disease?
progressive reducition of dopamine in basal ganglia resulting in disordered movements and coordination
What is a parkinsons tremour like?
resting tremour 4-6hertz worse at rest. unliateral
What is an benging essential tremor like?
bilateral, worse with intention
How is parkinsons disease treated?
MDT
levadopa
Monoamine Oxidase-B Inhibitors
What do monoamine oxidase enzymes do?
breakdown dopamine, seritonin and adrenaline
What are seizures?
transient episodes of abnormal electical activity in the brain
How is epilepsy investigated?
EEG
MRI brain
ECG
what is the classic shaking seizure called?
Tonic clonic seizure
What is the first line treatment for tonic clonic seizure?
sodium valporate
what are the 6 types of seizures
Tonic Clonic seizure
Focal seizure
Absence seizure
Atonic seizure
Myoclonic seizure
Infantile spasms
What are the notable side effects of the epilepsy medications
sodium valporate - teratogenic
Carbamazepine - agranulocytosis
Lamotrogine - safe in pregnancy
What happens when a seizure lasts more than 5 minutes
Status Epilepticus
How do you manage status epilepticus
ABCDE
IV lorazepam 4mg, repeated after 10 minutes
Phenytoin
or Buccal midazolam or diazepam
What are the four analgesics for use in neuropathic pain?
amitriptyline
Duloxetine
Gabapentin
Pregabalin
How do you differnetiate between an upper motor neurone or lower motor neurone lesion in the facial nerve and why?
if Upper motor neuron suspect stroke, if lower then manage in community
If forehead is spare then upper motor neuron
What is Bell’s palsy?
unilateral lower motor neurone facial nerve palsy
What should you check in suspected Bell’s palsy?
Forehead should not be spared
How is Bell’s palsy managed?
Prednisolone
