NEUROLOGY Flashcards
Epilepsy.
Red flags headaches
Headache:
Red flags: thunderclap headache, associated fever,
meningism +/- non-blanching skin rash, RICP, new
neurological deficit, new cognitive dysfunction, personality
change, impaired consciousness, recent head injury, new
onset headache in elderly, history of malignancy/impaired
immunity,_postural_headaches.
headache investigations and mnx
Investigations: LP, CT head, biopsy (GCA).
Management: Analgesics, dexamethasone (RICP),
high dose
prednisolone (GCA),
carbamezapine (trigeminal neuralgia),
sumatriptan (cluster), high flow oxygen (cluster),
propranolol (prophylaxis of migraines).
parkinsons
Parkinson’s Disease: loss of dopaminergic neurons in
substantia_nigra.
S+S: Bradykinesia, hypertonia, muscular rigidity, resting pillrolling tremor, postural instability, unilateral
onset/asymmetry, shuffling gait, slow to start.
Management: levodopa for motor symptoms (reduces in
efficacy over time), dopamine agonist ropinirole or
cabergoline (SE: compulsive behaviours), selegiline
(monamine oxidase inhibitor),
MND
Motor Neuron Disease: degeneration of anterior horn cells
of spinal cord (mixed upper and lower motor neurone).
S+S: Bulbar palsy (speech, swallowing, respiratory
problems).
Investigations:_EMG.
Management: riluzole (glutamate inhibitor) slows
progression.
MS
Multiple sclerosis: immune demyelination of central
nervous_system.
S+S: Optic neuritis, double vision, sensory disturbance,
weakness, impaired balance, clumsiness, trigeminal
neuralgia, bladder symptoms, cognitive impairment.
Relapsing remitting/secondary progressive/primary
progressive.
Investigations: McDonald criteria (inflammatory lesions, no
other diagnosis, multiple lesions in time and space,
progressive >1y), MRI (plaques), CSF immunoelectrophoresis
(oligoclonal_IgG)
Management: IV methylprednisolone (acute), disease
modifying drugs (beta-interferon, alemtuzumab), CBT,
tremor = botulinum, spastic = gabapentin, incontinence =
catheter.
Optic neuritis
Optic_neuritis:
S+S: unilateral reduced acuity, red desaturation, pain on eye
movement,_central_scotoma.
Management: High dose prednisolone
MS
Trigeminal neuralgia
Trigeminal_neuralgia:
S+S: electric shock pains, other symptoms e.g. sensory
disturbance_are_a_red_flag.
Management: carbamazepine.
MG
Myasthenia gravis: antibodies against nAChR on postsynaptic_NMJ.
Investigations: Antibodies, muscle specific tyrosine kinase
inhibitors,CT(thyroma),EMG(↓).
Management: thymectomy, prednisolone (relapse),
pyridostigmine (anticholinesterase), plasmapheresis or IVIg
(crisis)
Bells palsy
Bell’s_palsy:_facial_nerve_palsy.
S+S: unilateral facial weakness, ipsilateral pain/numbness,
sound hypersensitivity, can’t close eye, sagging of mouth.
Investigations: CT/MRI, ESR, glucose, VZZ antibodies.
Management: prednisolone if <72h, eye drops, tape eye
closed at nigh
carpal tunnel
Carpal tunnel syndrome: median nerve compression, LOAF
(2 lumbricals, opponens pollicis, abductor pollicis brevis,
flexor_pollicis_brevis).
Investigations:_EMG,_USS_wrist.
Management: steroid injection, wrist splint, decompression.
subdural haematoma
Subdural hematoma: bleeding from bridging veins,
hematoma between dura and arachnoid (banana).
Investigations: CT/MRIcraniotomy or burr hole washout,
reverse clotting abnormalities.
extradural haemorrhage
Extradural hematoma: tear in dural venous sinuses, blood
between bone and dura (lemon) or damage to middle
meningeal artery (traumatic skill fracture temporal/parietal
bone).
Investigations:_CT,_skull_x-ray.
Management: clot evacuation +/- ligation of bleeding vessel
gbs
Guillain-Barre_syndrome:
Management: IgG, plasaphoresis, DVT prophylaxis
stroke
Total anterior circulation stroke: middle and anterior
cerebral arteries. All 3 of: unilateral weakness and/or
sensory deficit of face, arm and leg; homonymous
hemianopia; higher cortical dysfunction (dysphasia,
visuospatial_disorder).
Partial anterior circulation stroke: 2 of the above.
Posterior circulation syndrome: posterior cerebral artery
(cerebellum, brainstem). 1 of: cranial nerve palsy and
contralateral motor/sensory deficit; bilateral motor/sensory
deficit; conjugate eye movement disorder; cerebellar
dysfunction (vertigo, nystagmus, ataxia); isolated
homonymous_hemianopia. Mi
Lacunar stroke: small vessels. Pure sensory or pure motor;
sensorimotor;_ataxic_hemiparesis.
Management (ischemic): alteplase <4.5h, 2w aspirin,
clopidogrel_for_life
Management (hemorrhagic)
investigations
