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
Diagnosis and treatment of Lewy Body Dementia?
Diagnosis; DaTscan/SPECT (Single-photon emission computed tomography), sens 90%, spec 100%
Management:
- Acetylcholinesterase inhibitors; donepezil, rivastigmine
- Levadopa: for motor symptoms
- SSRI’s Sertaline; for depression
What treatment is available for migraines
Firstly try mild pain relief
- Aspirin
- Paracetamol
- NSAIDs
- Indomethacin: Rectal supposittary that helps with nausea
If this doesn’t work, triptans are a stronger alternative
What are triptans, give some examples, and what are the benefits of them?
Specific 5-HT1 agonists used as acute anti-migraine drugs
Eg; Sumatriptan, zolmitriptan, rizatriptan.
They can be in oral or (some) nasal spray forms
- Most people get relief within the hour
- ‘Triptan sensations’ tingling, heat, tightness of chest and throat, heaviness, pressure
Contraindications of triptans?
Patients with a history of, or significant risk factors for, ischaemic heart disease
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
- Sharp, sudden, shooting pain like an electric shock unilateral to one side of the face, predominately the lower half*
- This occurs in paroxysms, and do not wake the patient at night*.
What is the most potential cause of this?
Trigeminal Neuralgia
Don’t mistake this for dental pain!
What are the most likely causes of Trigeminal Neuralgia, an what are the treatment options?
- Compression by an artery or vein are CNV exits the pons
- MS
- Tumor
- Carbmazapine is first line medication therapy.
- Surgical decompression
- Lethargy,
- optic neuritis and atrophy
- paraesthesia, pins and needles
- spastic weakness in one or both legs
- Diplopia
- Trigeminal Neuralgia
is likely going to indicate
Multiple Sclerosis
MRI is the best indication
What is used for MS attacks
- Corticosteroids
- Plasmapheresis
What specific therapies are used for PPMS and relapsing-remitting MS
PPMS:
- Ocrelizumab: recombinant human anti-CD20 monoclonal antibody that significantly slows disease progression
RR MS:
- Beta-inteferons
- Ocrelizumab
Overall management:
- CBT and mindfulness based therapy can have a benefit
How big of a role does genetics play in Alzheimers.
What do you see in the brain
Most are sporadic, 5% are inherited AD
You will get widespread cerebral atrophy of the cortex, notably the cortex and hippocampus
What specific type of memory loss do Alzheimers patients get and why?
Episodic memory loss, due to the deterioration of the hippocampus
This means that recalling memories from certain times/places/people cannot occur
Treatment for Alzheimers is?
Cholinesterase inhibitor:
- Donepezil, rivastigmine, galantamine
or
- Memantine (neuroprotective)
