Neurology Flashcards
Common complications of COVID 19 vaccine who presented with headache
Sx
∆?
Ix?
SX: headache after 4-42 days post vaccine
∆: CSVT
Ix : d- Dimer, fibrinogen, plt
CT brain
Hemineglect
What?
Site?
Spatial neglect on contralateral post stroke as if the side does not exist
Eg shaving one side of face
Site: parietal cortex
Carotid artery stenosis
- CDUS initial choice
- Symptomatic: endarterectomy in 2 weeks (> 50%)
Brain tumour in elderly
nagging headaches in the morning and the associated vomiting not preceded by nausea (projectile vomiting) are highly suggestive of a space occupying lesion in the brain such as a tumor or an abscess
Temporal lobe epilepsy
PABAPA pneumonic SX
Aura
Autonomic dysfunction
Psychic sensation: jamais vu deja vu
Blank stare, pupil dilation
Post ictal drowsiness , confusion,amnesia
Automatism: chewing, fidgeting
Optic neuritis
SX?
Ix?
Pain on eye movement, reduced vision , reduced V/A ( retrobulbar)
Ix: Visual evoked potentials
Vertebro basilar insufficiency
Sx
Vertigo
Cerebellar signs
Diplopia
Horner syndrome: unilateral
Bppv
Sx
Ix
Rx
Vertigo, nausea, nystagmus
Dix halpike
Epley manoeuvre, ressurance and vestibular rehab
Acute labyrinthitis
Sx
Sudden acute vertigo, hearing loss and tinnitus with nausea+ vomiting
50% post urti
Vestibular neuronitis vs
Bppv
Similar vertigo, nausea and imbalance, nystagmus.. but more profound imbalance in VN
Caloric test : COWS ( cold opposite warm same)
PICA occlusion ( lateral medullary syndrome/ Wallenberg syndrome)
Part of vertebrobasillar artery:
Vertigo, hearing loss
Ipsilateral Horner syndrome, contralateral sensory loss of limb
PCA stroke
Acute confusion, memory, vision loss, posterior headache
Temporal lobe epilepsy
Rx
Carbamazepine
Syringomyelia
Fluid filled cavity
Tumor/trauma/congenital
Cape like distribution of deficits
Hand 👏 upwards progression
Sensory,motor pain+temperature
Syringomyelia
Ix
Rx
MRI
Tumor excise
Fluid : drainage
Ulnar nerve injury at elbow
Small muscles of of hand affected
Most: hypothenar, lumbricals, introssei muscle
Median: 2nd and 3rd lumbricals only
Anterior interosseous nerve
Branch of medial nerve
Supplies flexor digitorum profunda, pronator quadratus, flexor pollicis longus
Parkinson disease vs drug induced Parkinson
Sparing effect
Tremor absent in DIP
Unilateral in PD
ALS
Stephen Hawking
Umn + Lmn
20-40 yrs
Progressive loss of MOTOR function only !!!
Swallowing if bulbar involved
ALS
Complications?
Rx?
Ix?
Aspiration, pneumonia
Rituzole
EMG and NCS
SAH
Sudden, thunder ⚡ clap headache
Severe
Sciatic nerve root formed by
L4, L5, S1, S2, and S3 nerve roots.
Sciatic nerve injury specific
Weak or absent ankle reflex
Ankle jerk present+
Eversion,inversion , flexion and extension loss ( -)
Common peroneal nerve injury
Stroke less than 4.5 hrs
CT 🧠: not hemorrhage
rTPA
Stroke ( CT 🧠 negative) > 4.5 hrs
Aspirin+ Clopidogrel for 3 weeks
Carotid endarterectomy
Indicated?
Carotid endarterectomy (CEA) is considered for secondary prevention of ischemic stroke and TIA in selected patients. It prevents further ischemic eventsbut does not affect the outcomes of the patient’s current condition
Lung monitoring in GBS
Patient should always be managed in an inpatient setting. Vital capacity should be monitored 4-hourly and if it falls to less than 20 ml/kg or is declining rapidly, the patient should be transferred to an intensive care unit.
Amaurosis fugax
Emboli at retinal artery is likely which is originating from carotid
So CDUS is a priority
Transient monocular vision loss aka amaurosis fugax
Carotid bruit absent
Still perform CDUS as the embolization could be occurred at ICA or retinal arteries
Commonest brain tumour metastasis
Breast
Lung
Melanoma
Melanoma risk of metastasis
Male
Mucosal surfaces
Upper trunk, head or neck
Acral lentiginous, nodular
Wide, deep, thick, ulcerated lesions
Involvement of > 3 regional lymph nodes
Parkinson disease Rx
Mild
Mild: benztropine & trihexyphenidyl : anticholinergic to reduce tremor and rigidity
Amantadine: > 60 yrs not tolerate Ach (-)
Severe Parkinson disease Rx
Severe : levodopa + carbidopa
Prob: on & off phenomenon
COMT (-) Capone only used for those on Rx with levodopa+ carbidopa , reducing the on/off phenomenon
MAO (-) : sepegiline either as single or adjuvant
Deep brain stimulation: highly effective for tremor and rigidity
Huntington disease
Triad
Ix
Autosomal dominant
Dementia+chorea+behaviour ∆
Usually 30-50 yrs
Genetic testing ( CAG trinucleotide repeat) at 18yrs old
Multiple sclerosis
SX
Ix
Rx
Remember white matter, white lady
Usually focal sensory deficit and gait /imbalance
+ eye:optic neuritis+ internuclear opthalmoplegia
MRI best initial and most accurate
High dose steroids
Glatiramer
Charcot Marie Tooth
What?
SX?
Ix?
Rx?
Genetic loss of motor a d sensory
Distal weakness & sensory loss
Muscle leg wasting
Decreased DTR
Tremor
Pes cavus ( high arched foot)
EMG
Nil of Rx
