Neurology Flashcards
What scoring system is used to stratify the risk of stroke after a TIA?
ABCD2
- Age (>60) - 1 point
- BP (>140/90) - 1 point
- Clinical features (Unilateral weakness - 2 points) (Speech deficit no weakness - 1 point)
- Duration (>60mins - 2 points) (10-60mins - 1 point)
- Diabetes - 1 point
What is high risk on ABCD2 score and what does it mean?
6-7 points is high risk
8.1% two-day recurrent stroke risk
Gold standard treatment for stroke due to thrombus?
Alteplase - recombinant tissue plasminogen activator
WITHIN 3 HOURS (or 4.5hrs if >80yrs)
Treatment for haemorrhagic stroke?
- Reduce blood pressure (CCB, nitrites)
- Correct clotting if off
Raised lymphocytes (Monocytes)
Normal protein
Normal glucose
CSF of which meningitis?
VIRAL
Lyme disease in neuro disease?
Neuroborreliosis
Long term lyme disease. Presentation is varied
Contra indication to lumbar puncture?
Raised global CNS pressure due to risk of coning. Purely intracranial pressure is not a contraindication.
Treatment of suspected meningococcal disease in secondary care. <3 months and >3 months old?
< 3 months = cefotaxime + amoxicillin/ampicillin
> 3 months = ceftriaxone
Raised lymphocytes (PMN)
Raised protein
Low glucose
CSF of which meningitis?
Bacterial
Initial morphine dose?
10mg (elderly/frail = 5mg)
Every 4 hrs
WHO analgesic ladder?
- Paracetamol
- ADD mild opiod e.g. co-codamol
- Substitute morphine 10mg/4hrs titrate up
Septic shock unresponsive to fluid resuscitation?
Epinephrine/norepinephrine
When to add Vancomycin for bacterial meningitis?
Young people/children who have:
- Recently travelled outside of UK
- Multiple/prolongued exposure to antibiotics in last 3 months
When to use corticosteroids in bacterial meningitis?
Dexamethasone upto 10mg QD
- Frankly purulent CSF
- CSF WBC >1000/mcl
- Bacteria on gram stain
- Raised protein (>1g/L) and WBC
Analgesia in children?
< 16yrs Not together, but can be administered alternately - Paracetamol OR - Ibuprofen
Other NSAIDs and aspirin and codeine are not
- NB codeine can be used 3rd line if > 12 yrs
When to treat epileptic seizure?
After 5 minutes of tonic-clonic
OR
3 seizures in 1 hour
What to treat epileptic seizure with in community?
Buccal midazolam
OR
Rectal diazepam
Other treatment for epileptic seizure?
IV Lorazepam (in hospital)
Anti-epileptic drugs?
Taken everyday to prevent seizure Eg. Sodium valproate Carbemazapine Phenytoin Phenobarbital Lamotrigine
What nociceptors are there? And what are they responsible for?
A-delta fibres - FAST, non-specific involved in reflex arc (unmyelinated)
C-fibres - SLOW, (myelinated)
AED drugs for absence seizures?
Ethosuximide or sodium valproate
lamotrigine if unsuitable, not tolerated etc
General tonic-clonic seizures AED drugs?
Sodium valproate
Lamotrigine 2nd
Focal seizures AED drugs?
Carbemazapine or lamotrigine
Myoclonic seizures AED drugs?
Sodium valproate
