Neurology Flashcards
Neuropathic pain Mx
1st - amitriptyline, duloxetine, gabapentin or pregabalin. If one of these agents don’t work next line is to try one of the other remaining three drugs
Tramadol may also be useful
DVLA rules
Epilepsy/ seizures
first seizure
chronic epilepsy
withdrawal of medication
Epilepsy/ seizures - No driving, inform DVLA
- first seizure - 6 months
- must be seizure free for 12 months to start again
- withdrawal of medication - 6 months after last dose
DVLA rules syncope
simple faint
single episode, explained
single episode, unexplained
two or more episodes
simple faint - no restriction
single episode, explained - 4 weeks
single episode, unexplained - 6 months
two or more episodes - 12 months
DVLA rules
stroke/ TIA
Multiple TIAs
narcolepsy/ cataplexy
Stroke/ TIA - 1 month
Multiple TIA - 3 months, inform DVLA
Narco - stop driving, start again when symptoms under control
Cabergoline (for Parkinsons) main side effect
Pulmonary fibrosis
Anti platelet Mx of Stroke
1st - clopidogrel
2nd - Aspirin + Dipyridamol lifelong
3rd - Aspirin OR Dipyridamol monotherapy
Trigeminal neuralgia Mx
1st - Carbemazepine#
2nd - refer Neuro
Neurogenic thoracic outlet syndrome Fx
muscle wasting of hands
numbness and tingling
worse when raising arm above head
Tension-type headaches Mx
Prophylaxis
Mx
Prophylaxis - acupuncture, low dose amitriptyline
Mx - Aspirin, paracetamol, nsaid
Bells palsy mx
Prednisolone
>3 weeks no improvement = ENT Urgent refer
>6 months no improvement = Plastics refer
TIA Acute Mx
300mg Aspirin
- unless:
- known bleeding disorder or on anticoagulant
- already taking aspirin (then continue low dose)
- aspirin contraindicated - need specialist input
Specialist review
- more than 1 TIA
- TIA <7 days - admission <24 hrs
- TIA > 7 days - admission <7 days
CT Head - exclude other pathology
Carotid doppler
Not to drive until specialist review
TIA secondary prevention Mx
Clopidogrel (or Aspirin + Dipyridamole)
Statin - aim reduce non-HDL >40%
Phenytoin side effects
Peripheral neuropathy
bleeding gums (gingival hyperplasia)
lymphadenopathy
osteomalacia
hirsutism
hepatitis
Reye’s syndrome Fx
rash
fever
vomiting
can lead to encephalopathy
this is why aspirin is contraindicated in children
Acoustic neuroma (vestibular schwannoma) Fx
CN VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus
CN V: absent corneal reflex
CN VII: facial palsy
Cluster headaches Mx
first episode - neurology review
acute - 100% O2, Subcut Triptan + admission
Prophylaxis - verapamil
essential tremor mx
propranolol
Migraine prophylaxis
Riboflavin (vit B2)
1st Topiramate or propranolol
If menstrual migraine - Frovatriptan/ zolmitriptan
3rd Acupuncture
Stopping anti epileptic medication criteria
seizure free >2 years
AEDs stopped over 2-3 months
Lamotrigine serious side effects (rare)
Steven johnson syndrome
Degenerative cervical myolopathy Fx
Upper motor neuron signs
Hoffmans positive - flick distal phalynx causes momentary flexion (positive sign)
Acute Seizure management
Neonate
1 month - 1 yo
2 - 11 yo
12 - 17 yo
adult
elderly
- Rectal Diazepam
Neonate 1.25 - 2.5 mg
Child 1 month - 1 year 5 mg
Child 2 years - 11 years 5 - 10 mg
Child 12 years - 17 years 10 mg
Adult 10 - 20 mg (max. 30 mg)
Elderly 10 mg (max. 15 mg)
Parkinsons related dementia Mx
Rivastigmine
Common peroneal nerve lesion Fx
weakness of foot dorsiflexion
weakness of foot eversion
weakness of extensor hallucis longus
sensory loss over the dorsum of the foot and the lower lateral part of the leg
wasting of the anterior tibial and peroneal muscles
Complex regional pain syndrome Mx
Amitriptyline + Physiotherapy
Focal Seizure Mx
Lamotrigine or levetiracetam
Normal pressure hydrocephalus Fx
Urinary incontinence + gait abnormality + dementia
Drugs causing peripheral neuropathy
Amiodarone
Isoniazid
Vincristine
Metronidazole
Nitrofurantoin
Absence seizure Mx
Ethosuximide
Triptans common side effect
tightness of throat and chest
Restless legs syndrome Mx
1st - Ropinirole/ Pramipexole
2nd - Pregabalin/ Gabapentin
Restless legs syndrome ix
Ferritin - most commonly associated with iron deficiency
Syringomyelia Fx
Cape like (neck, shoulders, arm) - loss of sensation and temperature
fine touch is normal
associated with chiari malformation
Focal seizure Mx
Lamotrigine or levetiracetam
Motor neuron disease - Amyotrophic lateral sclerosis Mx
Riluzole - prolongs life by roughly 3 months
Respiratory care - Bipap at night
Nutrition - PEG feeding
Third nerve palsy Fx
“down and out” eye
ptosis
dilated pupil
