Neurology Flashcards
How to treat acute delerium of an unknown cause?
- Establish normal hydration, electrolyte balance and nutrition
- Be aware this could be alcohol withdrawal, administer Thiamine
Medication may be required if behaviour becomes psychotic:
- Haloperidol 2.5-5mg or
- Olanzapine 2.5-10mg
If someone is increasingly agitated, what medications would you use to calm them.
What would you avoid
Diazepam or midazolam 2.5-5mg IV increments
Avoid benzodiazipines in those with respiratory insufficiency (Haloperidol is an alternativ)
What are the main features of Presenile Dementia- Alzheimers Type
- Onset 50s-60s
- Insidious onset
- early short term memory loss
- progressive decline in intellect
- death ~5-10 yrs
- more common in Down syndrome
Delusions rare, hallucinations uncommon
What are your first and second options for treatment of absense seizures?
- Ethosuximide
- Sodium Valporate
Features of Essential tremor?
How is it inherited?
- postural tremor (worse if outstretched)
- Improved with alcohol and rest
- Main cause of titubation (head tremor)
An Autosomal Dominant Condition
Treatment of an Essential tremor is?
Propanolol
Primidone is sometimes used firstline.
What three main criteria are commonly seen and assessed in a stroke?
- unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
- homonymous hemianopia
- higher cognitive dysfunction e.g. dysphasia
involves middle and anterior cerebral arteries
all 3 of the above criteria
This is…
Total anterior circulation infarct (25%) TACI
involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery
2 of the above criteria are present
Partial Anterior circulation infarct (25%) PACI
Involves perforating vessels around the thymus, basal ganglia and internal capsule
Presents with one of the following
- Unilateral weakness (and/or sensory deficit) of the face and arm, arm and leg, or all three
- Pure sensory stroke
- ataxic hemiparesis
Lacunar Infarcts (25%) LACI
Innvolves vertbrobasilar arteries
Presents with one of the following
- cerebellar or brainstem syndromes
- LOC
- Isolated homonymous hemianopia
Posterior circulation infarct (POCI)
What is the Lateral Medullary (Wallenburgs) Syndrome
Due to an infarct in the PICA coming off the vertebral artery, different nucleus and nerve tracks are damaged leading to a strange variety of symptoms
- Abducens nuclei (CN9,10) → hoarsness of the voice
- Vestibular nuclei → loss of balance/incoordination
- Spinocerebellar fibers → ataxia
- Anterolateral system fibers . → contralateral pain/temp less
- Trigeminal nucelus . → ipsilateral pain/temp loss of face
- Hypothalamospinal fibers → Horners Syndrome
WHat is Webers Syndrome?
A type of stroke characterised by an oculomotors palsy (ipsilateral) and contralateral weakness of face, arm and body
What medication should be avoided in Lewy body dementia and why?
Neuroleptics (eg; Haloperidol, olanzapine, risperadine, clozapine) may cause irreversible parkonsonism.
What are the characteristic features of Lewy body dementia, and the one diagnostic feature
- Progressive Cognitive Impairment
- Parkinsonism
- Visual Hallucinations (also delusions and non-visual hallucinations may occur)
- Alpha-synuclein cytoplasmic inclusions (lewy bodies) in the substanstia nigra, paralimbic and neocortical areas
What would you see with a cranial nerve lesion of CN IV?
Vertical diplopia and a defective down gaze,
‘gaze is upward and outward’
What would you see with a cranial nerve lesion of CN III
‘Down and Out eye’, with a fixed pupil and ptosis
What would you see with a cranial nerve lesion of CN VI
Right eye turned in medially
LR6 SO4 3
