Neurology 2

Question 1

If someone has episodic memory loss what is the likely diagnosis?

Answer 1

Alzheimers

Question 2

If someone has semantic memory loss, what is the likely diagnosis?

Answer 2

Semantic memory dementia: Frontal lobe variant

Question 3

If someone is unable to maintain attention, what is the likely cause?

Answer 3

Delirium

Question 4

How are SAHs graded?

Answer 4

Via the GCS score

Question 5

What is the product being looked for in the CSF to diagnose a SAH?

Answer 5

Xanthochromia

Question 6

Outwith a CT, what other investigations should be carried out in a SAH?

Answer 6

U&Es
- hyponatremia usually present - more brain swelling

ECG
- catecholamine release

Troponin levels
- in case of cardio damage

Echo of heart

Question 7

What drug is given in SAH to prevent delayed ischemia?

Answer 7

Nimodipine

- Ca2+ channel blocker

Question 8

out with a thunderclap headache, what other features are found in SAH?

Answer 8

Meningism

Seizures

Vomiting

Photophobia

Terson’s Syndrome
- vitreous hemorrhage

Papilledema

Question 9

What nerves can the brain sense itself?

Answer 9

5th

9th

Question 10

What are the major types of headache?

Answer 10

Primary

• headache and underlying features are cause
• migraine
• tension

Secondary

• subarachnoid
• meningitis

Question 11

What are the stages of a migraine?

Answer 11

Prodrome

• mood disturbance
• photophobia

Aura

• scotoma
• flashing lughts

Migraine attack
- pain

Postdrome
- mild headache following

Question 12

What is the pathophysiology of migraines?

Answer 12

Aura:
- wave of cortical depression causing depressed activity from the occipital lobe moving anteriorly

Migraine pain:

• trigeminovascular system
• large intracranial vessels supplied by V1.

release of:

• CGRP
• Substance P
• Serotonin

Question 13

What is the management of migraines?

Answer 13

Avoid triggers

High dose aspirin

Triptans

Anti - emetics
- metoclopramide

Prophylaxis

• propranolol
• amitriptyline
• valproate

Question 14

What are the red flag symptoms for headaches?

Answer 14

> 50 years old

Thunderclap

Focal/ Non-focal symptoms

Intracranial pressure signs

Early morning headaches

Previous history of cancer

Systemic symptoms
- weight loss

Temporal artery
- jae claudication

Question 15

What is the risk with using opioids in headache pain?

Answer 15

Medication overuse headaches

Question 16

Whats the medical term for cluster headaches?

Answer 16

Trigeminal Autonomic Cephalgias

Question 17

Where are most berry aneurysms located?

Answer 17

Anterior communication/ anterior cerebral artery junction

Question 18

Where is second most common area for berry aneurysm?

Answer 18

Bifurcation of the middle cerebral artery

Question 19

What are some other causes of SAH outwith berry aneurysm?

Answer 19

AVM

Coagulopathies

Trauma

Question 20

What are some risk factors for SAH?

Answer 20

Smoking

Female

Hypertension

Polycystic disease

Question 21

What are some complications following a SAH?

Answer 21

Hemorrhage
- within 72 hours

Delayed ischemia
- blood vessel constriction

Hyponatremia

Hydrocephalus
- obstruction to CFS

seizures

DVT

Question 22

Whats the causes of hyponatremia in SAH patients?

Answer 22

Cerebral salt wasting

SIADH

to do with the total body weight of the patients.

Question 23

What the management of SAH?

Answer 23

Referral to neurosurgical unit

Supportive stockings

Fluids - saline

Nimodipine

dihydrocodeine

Phenytoin if seizures