Neurology Flashcards
Partial/focal seizures - Def, Mx. Simple partial, complex partial, partial with secondary generalisation.
Def - Sezuire with a warning due to focal onset, will have aura such as dejavu, adbo discomfort, smells, or flashing lights.
Mx - Carbemazepine, lamotrigine.
Simple partial - Awareness unimpaired, no post-ictal.
Complex partial - Awareness impaired, usually temporal.
Partial with secondary gen - most common, disturbance starts focally and then spreads to the whole brain.
Generalised - Def, Mx, Absence, tonic-clonic, myoclonic. Atonic, infantile spasms.
Def - no localising features relating to one hemisphere.
Mx - sodium valporate.or lamotrigine if CI.
Absence - Breif <10s pauses in concentration, childhood. Mx - ethosuximide.
Tonic-clonic seizures - LOC, stiff then clonus, post-ictal and drowsiness.
Myoclonic seizures - Sudden jerk of a limb face or trunk.
Atonic - sudden loss of tone, no LOC.
Infantile spasms - associated with tuberous sclerosis. Poor prognosis - West syndrome. N.B Blue breath holding attack (after crying), reflex anoxic (vagal/pain/fear).
Epilepsy - Ix, DDX, driving, pregnancy.
Ix - Do MRI brain and EEG. Epilepsy = 2 unprovoked seizures or single seizure with abnormal EEG?MRI. Can do SPECT scan. EEG sum of the pyramidal cells of the cortex - spikes, sharp, or slow waves in epilepsy.
DDX - Provoked seizure e.g. trauma, ICP, alcohol/benzo withdrawal, drugs. NEA - atypical features, MH Hx, eyes closed, pelvic thrusting, back arching, drop arm test, no raise in WCC/CK after.
Driving - 6m post isolated seizure, 12m after last seizure if epileptic.
Pregnancy - Avoid valproate lamotrigine instead. Others still have 2% risk, start folic acid 5mg/d 3m pre-pregnancy, present in milk but lamotrigine ok.
PD - Triad, additional sy, path, Ix, Parkinsons plus syndromes, essential tremor.
Triad - bradykinesia (slow movement, low blink rate, monotonous speech, micrographia, hypomimesis, no arm swing, festinance, freezing). Rigidity (with tremor is cogwheel). Tremor - worse at rest, pil-rolling, asymmetrical.
Ad Sy - anosmia, autonomic (constipation, ortho hypotension, ED), depression, dementia, REM sleep disorder.
Path - Degeneration of dopa neurones in substantia nigra pars compacta with Lewy body (alpha synuclein).
Ix - usually clinical, can do DAT scan.
Parkinsons Plus Syndromes - PSP - supranuclear gaze palsy (reflex fix and follow movements intact) usually vertically (dirty tie sign).
MSA - autonomic (postural drop) and ataxia.
Normal pressure hydrocephalus - triad of wet (incontinence) wacky (dementia) and wonky (gait).
Essential tremor - symmetrical, worse om action/postural, no other signs, Mx propanolol.
Parkinsons management - levodopa, entacapone, pramipexole, resagiline, amantadine, apomorphine.
Levodopa - combined with dopa-decarboxylase. MR has slower onset and offset so can be used overnight or to reduce freezing.
COMT inhib - entacapone, given with dopa, reduces breakdown in the cleft.
Dopa ag - ropi-nirole, prami-pexole and roti-gotine.
MOA - B inhib - resagiline, selegiline. Stops breakdown of endogenous dopamine.
Amantadine - weak DA used for drug induced dyskinesias.
Apomorphine - potent DA ag, used SC in late patients or rescue for sudden freezing. Or duodopa via PEG.
MS - Path, presentation, Ix, Mx.
Def - descrete plaques of demyelination delimited by space and time, causing relapse and remitting sy. More common in increasing latitude and low vit D.
Pres - Unilateral optic neuritis (pain on eye movement and decrease in vision), numbness or tingling in limbs, leg weakness.
Ix - Plaque on MRI, IgG on LP not serum.
Mx - low stress, vit D supplements. Methylpred in relapse. Interferons and azathioprine reduce freq or relapses, mAb such as alemtuzumab and natalizumab for T cells.
SOL - Signs, causes, management of tumours.
Signs - ICP (headache on waking or lying down), vomiting, papilloedema, low GCS), seizures, focal neurology, personality change.
C - tumour, aneurysm, abscess. Tumours if benign usually meningiomas, if malignant usually mets or glioblastomas.
Mx - Benign remove if possible. Mal - excision of gliomas is difficult as margins are ambiguous but can debulk pre radiotherapy. Chemo is used post-op or sole therapy if inoperable. VP shunts for hydrocephalus and dexamethasone and mannitol used for acute raise in ICP.
Dementia - def, reversible causes, driving.
D - Cog and behavioural sy that interfere in life, decline from baseline, not delirium and psych and 2/5 of domains - memory, higher functioning, visual-spatial, language, personality.
RC - Normal pressure hydrocephalus, alcohol abuse, neurosyphillis, hypothyroidism, B12 def, depression, brain tumour.
D - Must stop driving, not if mild cognitive impairment.
Dementia subtypes (non Alzheimers) - Vascular, SDLT, fronto-temporal dementia.
Vascular - Mental impairement from CVD, second most common type. Stepwise decline. Ix - head CT. Mx - treat HTN and diabetes, consider aspirin and ACEi.
SDLT - Lewy bodies in the cortex. Fluctuating mental state that changes day to day, with PD features (PD sy within 1y of dementia considered PD). Mx - rivastigmine and PD drugs, AVOID NEUROLEPTICS - causes NML (lead pipe rigidity, pyrexia, rhabdo).
FTD - younger, personality changes, language problems, don’t give antiChE.
Alzheimer’s - path, RF, Mx.
P - neurofibrillary tangles and amyloid plaques causes depletion of the Ach neurones and atrophy of the brain esp temporal lobe.
RF - apo E4 gene, obesity, diabetes, drinking, low exercise, head injury.
Mx - Cholinesterase inhibitors - galantamine, donepezil, rivastigmine. SE - QT elongation, bradycardia, GI bleed. Memantine 2nd line or in severe AD.
Diabetic polyneuropathy - key sy, autonomic, Mx.
Sy - Sensory loss in a glove and stocking dist, may have pins and needles, typically painful.
Auto - postural hypotension, ED, anhydrosis, constipation and retention.
Mx - manage sugars, if pain give amitryptyline or gabapentin/pregabalin if this fails.
Cervical spondylosis - Path, Si, Ix, Mx.
Path - degeneration of annulus fibrosus of disc causing cord damage, may progress to cord compression or root compression.
Si - Neck stiffness, creps, arm pain. If cord compression - leg weakness, numbness in hands, foot drop, gait diturbances, incontinence. Root=radiculopathy - pain at the level of compression with dull reflexes, muscle wasting.
Ix - MRI.
Mx - Firm neck collar and transforaminal steroid injection. If severe or progressing surgery - laminectomy or laminoplasty.
Stroke - Ix, immidiate Mx, Mx if no thrombolysis, Mx if haemorrhagic.
Ix - CT head (80% ischaemic). Angiography.
Mx - If present within 4.5hrs and NIHSS >4 IV thrombolysis with tPA, some centres do thrombectomy within 6hrs. If no thrombolysis give aspirin 300mg for 2 weeks, then switch to clopidogrel 75mg.
Look for cause. If AF wait 2weeks before anticoagulate. USS corotid arteries. SALT assessment.
Mx haem - correct anticoagulation - if warfarin give PT conc and vit K. Surgery if hydrocephalus.
Stroke classification
TACI - hemiparesis (2/3 areas), homonomous hemianopia, and higher cortical dysfunction - on left (aphasia -Broca ex, Wernicke rec, dysphagia), right - dyspraxia and inattention.
PACI - only partial of TACI, often emboli.
LACS - Small lesions deep within the brain which are either pure motor/sensory, sensorimotor or ataxic. Best prognosis.
POCI - Vetebrobasilar, DANISH - dysdiadochokinesia, ataxia, nystagmus, intention tremor, slurred speech, hypotonia.
TIA - score, Ix, Mx.
Score - if 4 or more r/v within 24hrs. Not used now.
Age - >60
BP - >140/90
Clinical - 1=dysphasia, 2=hemiparesis
Duration - 1=10m, 2=1h
Diabetes - 1point
Ix - Carotid doppler. MRI if vascular territory or pathology uncertain.
Mx - Immediately - give aspirin. If more than one TIA hospital now. If within last week see specialist within 24hrs, if >7dys within 7dys.
75mg clopidogrel, perindopril 4mg and indapamide 1.5mg, atorvastatin, endarterectomy if >50% stenosis within 2wks.
ACS / delerium - def, RF, causes, Ix,
Def - Acute and fluctuating mental imparment with inattention and altered conciousness or disordered thinking. Most hypoactive (lethargy), also hypoactive (agitation, psychosis) and mixed.
RF - >65, cog impairment, hip fracture, severe illness.
Causes - infection, cardiac, hypoxia, dehydration, metabolic imbalance, drugs (obybutanyne, trammadol, amitryptaline), drug withdrawal, constipation, pain, neuro injury.
Ix - CAM score (3/4 of acute/fluctuating, inattention, disordered thinking, altered conciousness), bloods and cultures, CXR, urine dipstick.
Mx - Identify and treat cause. If at risk use small doses of phenothiazine, haloperidol or onlanzipine (not in PD).
