Neurology Flashcards by Jackson Barrett

Risk Factors for stroke?

A Fib

Coronary Artery disease

Hypertension

Smoking

Diabetes

Vasculitis

Contraceptive Pill

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Tool for assesing Stroke?

Face
Arm
Speech
Time (call 999)

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Imaging/Management of stroke?

Exlude hypoglycemia

Imaging:
- CT brain to exclude intracerebral hemorrage
- Carotid ultrasound to asses fort stenosis

Aspirin stat (after CT) 2 weeks

Thrombolysis w/ alteplase (tissue plasminogen activator)
- Must be given within 4.5 hours

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Glasgow Coma Score Categories

Eyes
- Spontaenous =4
- Speech= 3
- Pain = 2
- None= 1

Verbal Response
- Oriented = 5
- COnfused conversation = 4
- Innaproprate words =3
- Incomprehensible sounds =2
- None=1

Motor Response
- Obeys commands 6
- Localizes pain = 5
- Normal flexion=4
- Abnormal Flexion= 3
- Extends= 2
- None=1

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Type of Intracranial bleed?

Vesell Damaged?

Location/Shape?

Demographics/Associations?

Subdural Hemorrhage
- Rupture of bridging vein (Outermost meningeal layer)
- Between dura mater and Arachnoid mater
- Crescent Shape, not limitied by cranial sutures
- Elderly and Alchoholics (More atrophy in brains)

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Type of Intracranial bleed?

Vesell Damaged?

Location/Shape?

Demographics/Associations?

Extra Hemorrhage
- Rupture of middle meningeal artery
- Fracture of temporal bone
- Bi-convex shape, limitied by cranial sutures

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Investigations for Subarachnoid Hemmorage:

CT Head
Lumbar Punture
- Red cell ocunt
- Color (Xanthocrhomia due to billirubin)
Angiography (CT or MRI)

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Key phrase to remeber with MS symptoms?

DIsseminated in time and space

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Signs/Symptoms of MS?

Optic Neuritis
Double Vision (6th cranial nerve) - intrernuclear opthalmoplegia
Focal Weakness (Horner Sndrome, Trigeminal Neuralgia)
Ataxia

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Diagnosis of MS?

Neruologist based on clincal picture. Must be progressive over 1 year
MRI: typical lesions
Lumbar Puncture: Oligoclonal bands”

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MS Management?

MDT TEam
Disease modifying drugs
Methhylprednisone
Excersise, Neuroparthic pain (gabapentine)

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Signs of lower motot neurone disease?

Muscle wasting
Reduced tone
Fasciculations
Reduced Reflexes

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Signs of Upper Motor Neuron Disease?

Increased Tone or spacicity
Brish Reflexes
Upgoing plantar reflex

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Pathophysiology of Parkinson’s Disease?

Progresive reduction of dopamine in the basal ganglia

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Triad of Symptoms in Parkinson’s?

Resting Tremmor (Pill Rolling)- worsened if pt is distracted. Ask them to do a task w/ other hand such as painting a fence
Rigigity (Cogweheel): resistance to passive movement of joiunt. Take hanf and passivelyt flex/extendwill feel tension that gives way in small incremenets
Bradykinesia: Handwriting smaller, shuffling gait, difficulty turning, reduced facial expression (Hypomimia)

ALso: Depression, Sleep disturbances, Anosmia

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Perkinsons Tremor vs Benign Essential Tremor?

Parkinsons:
- Asymetrical
- Worse at rest
- Improves with intentional movement
- No change w/ alchohol

Benign Essential Tremor:
- Symmetrial
- Improves at rest
- worse with intentional movement
- Improves w/ alchohol

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Management of Parkinsons?

Pts are ON when medications acting, OFF when not

Levadopa (synthetic dopamine) is givine in tandem with peripheral decearboxylase inhibitors (Carbidopa), Monoamine oxidase-B inhibiots (Selegiline), or COMT Inhibitors (Etacapone) that stops levadopa from being broken down. Less effective over time. Pts can develop dyskinseia (Dystonia/chorea), hypersexuality and gambling issues

Managment of Tonic Clonic Seizure:

Sodium Valproate
or
Lamatorpgine/Carbamazepine

Management of Focal Seizure

Start in temporal lobes, affect hearing, speach and memory

Carbamazepine/Lamotrgine
or
Sodium Valproate

Oposite order of clonic tonic!

Atonic Seizures Management?

Sodium Valproate
or
Lamotragine

Epilepsy maintencence medication?

Side effects?

Sodium Valproate

Works by increasing GABA. First line for most excpet focal seizure

Side effects: teratonogenic, liver damage + hepatitis, Hair loss

Carbamazapine side effects?

Agranulocytosis
Aplastic ANemia
P450 drug interactions

First line for focal seizures

Management of Status Epilepticus?

Secure the Airway
High concentration O2
Axsses cardiac/resp function
Check blood glucose levels
Gain IV acess
IV Lorazepam (4mg) repeated after 10 minutes if seizure continues
If seizure persists: IV Phenytoin

In community: Bucal Midazolam, Rectal Diazepam

Definition of status epilepticus?

Seizures lasting more than 5 minutes or more than 3 seizure in a hour

MEDICAL EMERGENCY

Treatment of Neuropathic Pain?

Amitryptiline (Tricyclic Antidepresant) Duloxetine (SNRI) Gapapentin (anticonvulsant) Pregabilin (anticonvulsant) Carbamezapine for Trigmeninal Neuralgia

Upper vs lower motor lesion facial palsy

Upper motor lesion: Forehead spared Lower motor lesion: Forehead NOT spared

Raise Intracranial Pressure Pathologies

Brain Tumour Intracranial Hemorrhage Idiopathic Intracranial Hypertension Abscess or infection

Pathophysiology of Huntingtons?

Autosomal dominant, trinucleotide repeast in HTT gene on Chr 4 Anticipation generationally (Earlier onset and worset severity) Presentation: - Chorea - Eye movement disoreders - Disarthria and Dysphagia

Management of Huntinton's?

No treatment Breaking bad news MDT Speach/language therapy Genetic Counseling Advanced directives

Presentation of Myasthenia Gravis?

Autoimmune conditions that cuases muscle weakness progressively WORSE with activity adn IMPROVES with rest | Woman <40 and men 60<

Pathophysiology of Myasthenia Gravis?

Aceytlcholoine receptor antibodies

Treatment of Myashnia Gravis?

Neostigmine (reversible acythcholinersase inhbitor) Rituximab (targets B cells producing antibodies)

Classical features of Charcot-Marie-Tooth Disease?

Autosomal Dominant inheritance: - High foot arches (Pez Cavus) - Distal Muscle wasting - Loss of ankle dorsiflexion - Reduced tendon reflexes - Reduced muscle tone - Peripheral sensory loss

Causes of Peripheral Neuropathy?

**A**lchohol **B**12 Deficiency **C**ancer and **C**hronic kidney disease **D**iabetes and **D**rugs (amiodarone/cisplatin) **E**very vasculities

Infections that often precede Guillain-Barre Syndrome?

Camplobacter Jejuni Cytomegalovirus Epstein Barr Virus

Presentation/Pathophysiology of Guillain-Barre Syndrome?

Acute, symetrical ascending weakness (Starting at feet and moving up) => refudec refles and peripheral loss of sensation or pain. Within 4 weeks of preceding infection (Camplobacter Jejuni, Cytomegalovirus, Epstein Barr Virus) Due to molecular mimickry: B-cells of immune system create antibodies against antigens on pathofen that also match proteins on nerve cells

Management of Guillain-Barre Syndrome?

IV Imunoglobulins Plasma Exchange VTE Prohylaxis

NF1 Diagnositc Criteria?

Autosomal dominant mutation of NF1 gene on Ch17 Criteria: - **C**afe au laite spots - **A**xillary or inguinal freckles - **BB**ony displasia/bowing of legs - **I**ris Hammartomas - **N**F1 Relative - **G**lioma of optic nerve

Differential Diagnosis of Headaches?

* Tension Headache * Migraine * Giant Cell Arteritis * Glaucoma * Intracranial Hemmorage * CO Poisioning * Trigemninal Neuralgia * Raised ICP * Brain Tumor * Meningitis * Encephalitis

Red Flags from headahce history

* Fever/Photophobia/Neck stiffness (minigitis/encephalitis) * Neew Neurological symtoms (hemorage, malignancy, stroke) * Disiness (Stroke) * Vicusal Disturbance (giant cell arteritis/glaucoma) * Sudden onset occipital headache (subarachnoid hemmorage) * Wose of coughing/straining (Raised ICP) * Postoral, worse on staning , lying or bending (Raised ICP) * Vomitting (Raised ICP or CO Poisioning) * History of Trauma (INtracranial Hemmorage) * Pregnancy (Pre-eclampsia) * Fundoscopy to look for Papliodema!! (Raised ICP)

Managment of Migrains?

Paracetamol/NSAIDs Triptains (5HT Receptor agonists) Antiemetics

Prophylaxis for Migraines?

Propanolol Amitryptiline