Neurology Flashcards
Six Neurological causes of SIADH
1) Stroke
2) SDH/SAH
3) Encephalitis, Meningitis, Abscess
How do you treat Viral Meningitis
Supportive management
How do you Diagnose Viral Meningitis
Lumbar Puncture will show:
- Raised WCC
- Predominantly Lymphocytic response
- Raised Serum Glucose compared to CSF Glucose (>66% DIFFERENCE)
- GRAM Stain -VE
How would you characterize the causes of vertigo
Peripheral vs Central
What are the peripheral causes of Vertigo
BPPV
Menier’s disease
Labrynthitis
Vestibular neuritis
What are the central causes of vertigo
Stroke - TIA/Stroke affecting the brainstem
Tumours - Acoustic Neuroma
Multiple sclerosis - Demyelination of the vestibular tract
Migrain assosciated vertigo
What are the characteristics of BPPV
30-60Second sensation of the room spinning, self terminates, exacerbated by head turning
How do you Dx BPPV
Dix-Hallpike manouvre
How do you treat BPPV
Epley manouvre - 1st line
Betahistine - 2nd line
Pathophysiology of BPPV
Otolith deposition - Calcium stones block the flow of endolymph in the labrynths
Characteristics of Labrynthitis
Preceeding infection:
Tinnitus
Sensorineural hearing loss
Aural fullness
Vertigo
Characteristics of Vestibular nueritis
Preceeding infection - Usually URTI
Vertigo
Characteristics of Meniers disease
Progressively worsening Vertigo, Sensorineural hearing loss, Tinnitus and aural fullness
How to distinguish between Meniers vs Labrynthitis
1) Post infectious
2) Progressive vs acute
Pathophysiology of Meniers disease
Endolymph Hydrops - Build up on endolymph fluid
How to distinguish Labrynthitis from vestibular neuritits
Both are post infectious
- Labrynthitis affects both cochlea and labrynth hence hearing loss + Vertigo
- Vestibular neuritis only affects the vestibular system hence only vertigo
When to start treatment for epilepsy
1) After 2nd epileptiform seizure
When is it acceptable to start antiepileptic medications after a first seizure
- neurological defecit
- structural brain abnormality
- unequivocal epileptiform acitivity on EEG
Management of generalized tonic clonic seizure in Males
1st line - Sodium valproate
2nd line: Lamotrigine/Levetiracetam
Management of generalized tonic clonic seizures in women of child bearing age
1st line - Lamotrigine/Levetiracetam
Management of focal/partial seizures
1st line - Lamotrigine/levetiracetam
2nd line - Carbamazepine
Management of Absence seizures
1st line - Ethosuximide
2nd line:
- Males - Sodium valproate
- Females - Lamotrgine/levetiracetam
What AED can exacerbate absence seizures
Carbamazepine
Management of Myoclonic seizures
Males - Sodium valproate
Females - Levetiracetam
Management of tonic/atonic seizures
Males - Sodium valproate
Females - Lamotrigine
Community management for suspected meningococcal meningitis
IM BenPen
Criteria for senior review - warning signs of severe meningitis
Rapidly progressing rash
CRT >2Seconds
Resp <8/>30
hr <40 >140
pH<7.3
Lac>4
GCS <12/ Dropped 2 points since arrival
Indications to DELAY LP for suspected meningitis
cardiorespiratory compromise
severe bleeding risk
Signs of cerebral oedema:
- Focal neurology
- GCS <12
- Papilloedema
- Seizure
Gold standard investigation for Dx of Meningitis
Lumbar puncture
- Sent for CSFR Glucose paired with serum glucose
- MCS, Gram staining
- PCR
- Lactate levels
- ?TB if from high risk region
Abx management for patients who have suspected Meningitis ages <3 mo old
IV Cefotaxime + Amox
Abx Mx for patients with suspected Meningitis aged > 3mo - 50 YO
IV cefotaxin (Ceftriaxone)
Abx Mx for for patients with suspected Meningitis aged >50
Iv Ceftriaxone + Amoxicillin
Abx Mx for Meningitis caused by Pneumococcus, Meningococcal, Haemophilus
IV Ceftriaxone (Cefotaxime)
Abx Mx for meningitis caused by listeria
IV Amoxicillin + Gentamicin
Apart from Abx what are the indications of giving IV dexamethasone in Meningitis
If known/strong suspicion of Pneumococcal Meningitis
Signs of cerebral oedema
Abx management for patients with Pencillin allergy causing anaphylaxis
IV CHLORAMPHENICOL
Post exposure prophylaxis for Meningococcal Meningitis
Ciprofloxacin (One off dose) or Rifampicin (Oral)
What is optic neuritis
It is an inflammatory condition of the optic nerve
Hallmarks cahracteristics of optic neuritis
- Retrobulbar occular pain - worse on movement
- Visual loss
-Visual field defec - Central scotoma
- Defective colour perception - specically red-green
Causes of optic neuritis
Multiple sclerosis
- Ulthoff’s sign - Vision is worse when exposed to warm temps
- Iatrogenic: Ethambutol (TB Mx)
Ix to diagnose Optic neuritis
MRI
Mx of optic neuritis
High dose corticosteroids
If visual loss - then for IV METHYLPRED
