neurology Flashcards
which PD drug causes hallucinations
Ropinirole, pramipexole (dopamine agonists)
What 1st line drug would you use for PD if motor sx affecting QOL
levodopa
What should levodopa be combined with
Peripheral decarboxylase inhibitor e.g. carbidopa
examples of dopamine receptor agonists?
Common side effects?
cabergoline, ropinirole, apomorphine, bromocriptine,
Pulmonary, retroperitoneal and cardiac fibrosis (cabergoline and bromocriptine only)
Impulsive behaviour, hallucinations, sleepiness, postural hypotension, nasal congestion
examples of MAO B inhibitors
selegiline
COMT inhibitor examples
entacapone, tolcapone
What is De clerambault syndrome
delusional idea that a person whom they consider to be of higher social and/or professional standing is in love with her.
How to remember GCS M bit
NEF
no response - 1
Abnormal Extension - 2
Abnormal flexion 3
(Flex to withdraw from pain 4)
Localises to pain 5
Obeys command 6
What vessel is affected in a subdural haemorrhage
Bridging veins
What vessel is affected in an extradural haemorrhage?
How might this present?
Middle meningeal artery
Lucid period.
What would you see on CT with Herpes simplex encephalitis
bilateral temporal lobe changes - these are pathognomic
How long can’t you drive for after a seizure?
12 months if diagnosis of epilepsy or EEG/imaging abnormality
6 months if imaging/EEG ok
How long can’t you drive for after a stroke/TIA
1 month if no neuropathy deficit or if isolated
3 months if multiple TIAs
If lorry/ bus driver - 1 yr
What vessels are affected in an anterior stroke?
Middle cerebral and anterior cerebral
When would you do thrombolysis and thrombectomy
If you have an ischaemic proximal anterior stroke and
within 4.5h for thrombolysis
within 6 hours for thrombectomy.
Consider if posterior circulation
when would you do thrombectomy
if they have had a stroke within 24h of symptom onset and the scan suggests there’s salvageable brain tissue
Can be anterior or posterior circulation
When would you refer for TIA in what scenarios
Immediate admission if on a blood thinner (exclude haemorrhage)
Refer to specialist within 24h if symptoms within the last 7 days and give 300mgs aspirin
Refer to specialist within 7 days if symptoms happened over a week ago
Where is Broca and Wernike area
Broca - near mouth at front so frontal
Wernike near ears so temporal
What would you worry about with an absent corneal reflex?
What condition do you get these with
Acoustic neuroma
Neurofibromatosis type 2 get bilateral acoustic neuroma
How can you treat an acute MS relapse?
High dose steroids
How to treat fatigue in MS
amantadine (once other causes e.g. anaemia ruled out).
How to treat spasticity in MS?
baclofen and gabapentin are first-line.
Other options include diazepam, dantrolene and tizanidine
How to treat bladder dysfunction in MS? what should you be careful with
be careful with anticholinergics - could worsen sx. Used if low residual vol. Otherwise ISC
How to treat Oscillopsia in MS
gabapentin
What is used for cluster headache prophylaxis?
What can trigger attacks?
Verapamil
Alcohol can trigger
First line management of absence seizures
ethosuximide
First line management of tonic clonics
males: sodium valproate
females: lamotrigine or levetiracetam
First line management of focal seizures
Lamotrigine or levetiracetam
What’s the first line anti platelet after a stroke/TIA
clopidogrel
Most common GBS trigger
Campylobacter jejuni
What is Miller Fisher syndrome
A type of guillan barre where the eye muscles are affected first and weakness travels down .
Usually with GBS get ascending paralysis
Migraine prophylaxis
Propranolol.
Topirimate can be used but not in women of childbearing age.
Amitriptyline can also be used
Trigeminal neuralgia management
carbamazepine
Neuroleptic malignant syndrome features and management
Usually after starting antipsychotics.
Onset - days (hours in serotonin syndrome)
Decreased reflexes (increased in serotonin syndrome).
Pyrexia, rigidity, tachy, high RR (same as serotonin syndrome)
High CK
Dantrolene
Serotonin syndrome
Onset = hours
POCI vessel
vertebrobasilar
Total Anterior Circulation Infarct - Vessels affected and presentation?
Anterior and middle cerebral arteries
- unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
- homonymous hemianopia
- higher cognitive dysfunction e.g. dysphasia
Partial Anterior circulation stroke - vessels and features
involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery
Need 2 of:
1. Homonymous hemianopia
2. Unilateral Hemiparesis+/- hemisensory loss
3. Higher cognitive dysfunction e.g. speech impaired
Lacunar circulation stroke - vessels and features
Perforating arteries around the internal capsule, thalamus and basal ganglia
presents with 1 of the following:
1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis
Posterior circulation stroke - vessels and features
involves vertebrobasilar arteries
presents with 1 of the following:
1. cerebellar or brainstem syndromes
2. loss of consciousness
3. isolated homonymous hemianopia
