Neurology Flashcards
1
Q
what is syncope
A
an abrupt and transient loss of consciousness associated with loss of postural tone that follows a sudden fall in cerebral perfusion.
2
Q
types of syncope
A
neurogenic, orthostatic (autonomic: drugs, autonomic failure), cardiac (arrythmias, valvular heart disease)
3
Q
what is neurogenic syncope
A
inappropriate activitation of cardio-inhibitory and vasodepressor reflex leading to hypotension
4
Q
types of neurogenic syncope
A
Vasovagal syncope Reflex syncope with specific precipitants - Micturition syncope - Cough syncope Carotid sinus hypersensitivity
5
Q
what is epilepsy
A
Tendency to have recurrent seizures
6
Q
what is a seizure
A
Clinical manifestation of disordered electrical activity in the brain (paroxysmal discharge of cerebral neurones)
7
Q
syncope triggers
A
Stress/fear, prolonged standing, heat, venepuncuture,
cough, micturition
8
Q
seizure trigger
A
Sleep deprivation, flashing lights, menstruation,
alcohol and alcohol withdrawal
9
Q
syncope prodrome
A
Hot, visual crowding and loss, feel faint, can feel dizzy (looks pale)
10
Q
seizure prodromes
A
Aura gustatory, auditory,
11
Q
features of syncope
A
quick onset short duration rare/brief convulsions pale no incontinence/ tongue biting unless full bladder quick recovery
12
Q
features of seizure
A
may have aura 2 - 3 minutes duration convulsions - GTC, myotonic jerks, focal motor fits incontinence/tongue biting
recovery: confusion, headache, not recognise family/friends, needs rest
13
Q
feature of non epileptic attack
A
can last for 30 minutes
convulsions: wild shaking, wax and wane, pelvic thrusting, closed eyes
recovery: atypically quick for prolonged seizure time
14
Q
PMH syncope
A
Previous faints
Cardiac causes include bradycardias (heart block), tachycardias (eg VT) and obstructive lesions eg aortic stenosis.
15
Q
PMH seizure
A
Perinatal illnesses, education achievements, previous serious head injury/neurosurgery, neonatal seizures (prolonged), meningitis. If late onset (age >40) think stroke or tumours
16
Q
NEAD PMH
A
previous Hx of unexplained medical symptoms
hx childhood abuse
17
Q
investigations for blackout
A
heart exam: aortic stenosis ECG blood tests (FBC) brain imaging EEG
syncope: 24hr tape, tilt table, autonomic function tests
18
Q
types of EEG in seizure investigation
A
inter-ictal provocation (hyperventilation, photosensitivity) sleep deprive EEG prolonged EEG video telemetry
19
Q
when is imaging used in seizures
A
focal onset
new onset + >25
MRI 1st line
20
Q
pathophysiology of seizures
A
During a seizure there is a prolonged depolarisation of a group of neurones, which spreads to adjacent or connected neurones
There is a failure of inhibitory (GABA) neurotransmission
21
Q
class of seizure
A
focal
simple partial
complex partial, secondary generalised tonic clonic
22
Q
types of generalised seizures
A
idiopathic generalised
myoclonic jerks
absence
primary generalised tonic clonic
23
Q
pathophysiology of NEA
A
often a manifestation of stress, may be associated with childhood abuse; other medically unexplained symptoms
24
Q
types of focal seizures and their aetiology
A
simple partial seizure (remains conscious)
- strange sensations (aura)
- jerking movements
- Jacksonian march
complex partial seizure (impaired consciousness)
secondary generalised tonic clonic seizures
usually have a structural cause
25
types of general seizures
tonic: fall backwards
atonic: fall forwards
clonic: convulsions
tonic-clonic
myoclonic: muscle twitches
absence seizure: associated with 3/s spike + wave o EEG
26
cardiac syncope aetiology
Conditions that predispose to transient tachyarrhythmias
Bradyarhythmias
Cardiac ischaemia
Structural heart disease
27
ECG signs of cardiac syncope
long QT interval
Wollf-Parkinson-White syndrome: short PR interval, delta wave
Brugada Syndrome
arrythmogenic right ventricular dysplasia
Heart block
28
other causes of transient loss of consciousness
hypoglycaemia
| acute hydrocephalus
29
investigations for transient loss of consciousness
```
ECG
CT acute assessment of seizures
MRI epilepsy
EEG
record an event
```
30
Management of epilepsy
anticonvulsant medication
Blood monitoring
<1y reviews
vagus nerve stimulation/deep brain stimulation
inform DVLA
31
anticonvulsants used for generalised seizures
1st line sodium valproate
| 2nd line lamotrigine (if pregnant)
32
anticonvulsants for focal seizures
carbamazepine or lamotrigine
| 2nd line: sodium valproate
33
classification of tension headache
episodic: <15/month
chronic: more than 15 days each month; likely to be medication induced or associated with depression
34
presentation of tension headache
generalised headache
pressure or tightness
may radiate to neck
35
differential diagnosis for headache
```
migraine
giant cell arteritis (temporal arteritis)
trigeminal neuralgia
cluster headache
subarachnoid haemorrhage
encephalitis
space occupying lesion
cervical spondylosis
sinusitis
idiopathic intracranial hypertension
carbon monoxide poisoning
```
36
management of tension headache
reassurance, manage any underlying stress/depression, physiotherapy
simple analgesics:
1. ibuprofen
2. other NSAIDs e.g. naproxen as a rescue course
tricyclic antidepressants: amitryptiline
37
side effects of tricyclic antidepressants
can't see, can't pee, can't spit, can't shit
- blurry vision
- problems passing urine
- DRY MOUTH
- constipation
38
classifications of migraine
migraine without aura
migraine with aura
hemiplegic migraine
chronic migraine
39
epidemiology of migraine
6% of men
| 18% of women
40
presentation of migraine
lasts between 4 and 72 hours
```
2 of:
unilateral
pulsating
moderate-severe pain
aggravated by routine activity
```
+ at least one of:
nausea/vomiting
photophobia/ phonophobia
aura: visual or sensory disturbance
premonitory phase
tiredness, irritability, depression and problems concentration
41
examinations in headache
optic fundi
blood pressure
head and neck
head circumference in children
42
red flag symptoms in headache requiring urgent investigation
papilloedema
new seizure
significant PMH (cancer esp. lung and breast, neurofibromatosis, immunodeficiency)
other neurological signs: confusion/LOC
43
complications of migraine
associated with ischaemic or haemorrhagic stroke
44
management of migraine
1. simple analgesics+/- antiemetics (aspirin, ibuprofen, prochlorperazine)
2. rectal analgesia/ rectal anti-emetic
3. triptans (5HT1-receptor agonists) e.g. sumatriptan, naratriptan
45
contraindication to triptans
uncontrolled hypertension
| coronary heart disease or cerebrovascular disease
46
epidemiology of cluster headaches
1 in 1000
47
difference between episodic and chronic cluster headaches
episodic CH have pain free periods lasting a month or longer/ year
48
features of cluster headaches
occur in bouts; typically at night
intense pain which comes suddenly and reaches full intensity in ~10 minutes
usually centered behind/around the eye, temple or forehead
unilateral
typically lasts 45-90minutes
causes restlessness, associated features: ipsilateral lacrimation, rhinorrhoea, swelling, sweating, partial Horner's, oedema
49
triggers for cluster headaches
alcohol
histamine
heat, excercise, solvents
disruption to sleep patterns
50
management of cluster headaches
general: abstain from alcohol, stop smoking, good sleep hygiene
acute attack: subcutaneous sumatriptan, oxygen
prophylaxis: verapamil (ECG monitoring), prednisolone
surgery: trigeminal nerve blockade
51
what is giant cell arteritis
systemic immune-mediated vasculitis affecting medium-sized and large-sized arteries, particularly the carotid artery and its extracranial branches
52
epidemiology of giant cell arteritis
M:F 2/3:1
0.2% of population
peak incidence is in 60-80years
53
risk factors for GCA
personal or family history of polymyalgia rheumatica
european descent
over 60
54
presentation of GCA
temporal headache
scalp tenderness
jaw claudication
visual disturbances: blurred vision, diplopia, amaurosis fugax, visual loss
systemic symptoms: anorexia, weight loss, fatigue, malaise etc.
55
signs of GCA
fundoscopic evidence of ischaemic disease
temporary artery tenderness on palpation, decreased pulsation
56
investigations in GCA
ESR/CRP
FBC: anaemia, thrombocytosis
LFTs may be elevated
temporal artery biopsy
57
management of GCA
high dose prednisolone or IV methylprednisolone if there are visual symptoms
low dose aspirin + PPI (+ osteoporosis prophylaxis)
58
complications of GCA
loss of vision
aneurysms
CNS disease e.g. seizures + cerebral vascular accidents
steroid related complications
59
what are steroid related complications
```
osteoporosis
corticosteroid myopathy
bruising
insomnia/restlessness/hypomania
hypertension
diabetes
fluid retention
```
60
risk factors for stroke/TIA
```
hypertension
smoking
diabetes mellitus
heart disease e.g. AF
peripheral arterial disease
polycythaemia
carotid artery occlusion
combined oral contraceptive pill
excessive alcohol
clotting disorders
hyperlipidaemia
```
61
aetiology of TIA
emboli usually from carotid bifurcation
62
examinations and investigations in TIA
neurological exams
(attentiveness and verbal fluency)
BP in both arms, listen for carotid bruits, check peripheral pulses
Bloods: FBC, ESR, U+E, fasting lipids and glucose, LFTs, TSH, coagulation studies
ECG: AF, MI or myocardial ischaemia
CT imaging
Carotid imaging
63
management of TIA
lifestyle advice
clopidogrel: 300mg loading dose; 75mg daily
statin therapy: atorvastatin
BP lowering therapy: thiazide like diuretic, calcium channel blocker or ACE inhibitor
carotid endarterectomy
64
DVLA management for TIA
1st TIA: do not drive for 1 month
| 2nd TIA in short period: 3 months free from attacks + inform DVLA
65
features that influence risk of stroke after TIA
```
ABCD2 score
age > 60
high blood pressure
clinical features of weakness
duration of symptoms > 60 minutes
diabetes
```
66
what is a stroke
clinical syndrome caused by disruption of blood supply to the brain, characterised by rapidly developing signs of focal or global disturbance of cerebral functions, lasting for more than 24 hours or leading to death
67
types of strokes
infarction: 85%; 80% of these are anterior circulation
haemorrhagic: 10% primary; 5% SAH
68
differential diagnosis for stroke
Todd's paresis
TIA
hypoglycaemia
69
screening tool for stroke
FAST
70
Stroke presentation
cerebral hemisphere
- contralateral hemiplegia/sensory loss
- homonymous hemianopia
- dysphagia
posterior circulation
- motor deficits
- ipsilateral cranial nerve dysfunction; contralateral motor/sensory tract dysfunction
- ataxia, imbalance, vertigo, nausea/vomiting
- diplopia
- locked in syndrome: complete infarction of pons
lacunar infarcts
- basal ganglia, internal capsule, thalamus and pons
71
stroke investigations
FBC - polycythaemia, thrombocytopenia
sickle cell disease test
ESR
hypo/hyperglycaemia, hyperlipidaemia
ECG
CT/Brain imaging
CT contrast angiography
72
when should a CT be done
within 24 hours
immediately if:
on anticoagulants/bleeding tendency
GCS<13
unexplained progressive or fluctuating symptoms
papilloedema, neck stiffness or fever; severe headache
73
acute stroke management
stabilise
anti-platelet therapy: aspirin once haemorrhagic stroke has been excluded
thrombolytic treatment within 4.5 hrs (alteplase)
thrombectomy (within 6 hours of symptom onset)
74
what are requirements for alteplase and what are contraindications
1. within 4.5 hr window
2. haemorrhagic stroke has been excluded
3. access to neuroimaging to monitor progress
```
contraindications
- seizure + stroke
- stroke/head trauma in 3 months
-SAH symptoms
- previous Intracranial haemorrhage
-intracranial neoplasm or surgery
arteriovenous malformatiom or anuerysm
bleeding disorder/anticoagulation treatment
```
75
characteristic features of parkinsons
bradykinesia
tremor at rest
rigidity
76
pathogenesis of PD
degeneration of dopaminergic neurons in substantia nigra
77
epidemiology and risk factors for PD
1-2% of over 60
RF: age, male, pesticide exposure
78
other features of PD
shuffling gait, trouble turning, stoop
fixed facial expression + infrequent blinking
micrograthia
non-motor disturbance: sleep disorder, orthostatic hypotension, constipation and urinary disturbance, quiet voice
79
complications of PD
```
falls
bed sores
contractures
bowel and bladder disorders
poor nutrition
depression
dementia
```
80
specialists involved in PD management
```
neurologist
GP
PD specialist nurses
physiotherapists
occupational therapists
speech and language therapists
psychologists/psychiatrists
nutritionists
```
81
management of PD
symptoms that don't affect QoL/early disease: dopamine agonists, monoamine-oxidase-B inhibitors, amantadine or anticholinergics
symptoms that affect quality of life: levodopa
Deep brain stimulation
comorbidities
- psychotherapy/support groups
- TCA for sleep disturbance (nortriptyline)
- SSRI for apathy (not used if using selegiline)
dementia: cholinesterase inhibitor
82
side effects of levodopa
nausea and dizziness; rare
83
examples of dopamine agonists and their side effects
pramipexole, ropinirole
nausea/diziness
compulsive behaviours
84
example of monoamine-oxidase-B inhibitors
rasagiline
| selegiline
85
what is dementia
Syndrome caused by various brain disorders leading to memory loss and decline in other aspects of cognition and leading to difficulties with ADL
86
symptom categories in dementia
o Cognitive impairment: (short term) memory, language, attention, thinking, orientation, calculation and problem-solving difficulties
o Psychiatric and behavioural disturbances: changes in personality, emotional control, social behaviour; depression, agitation, hallucination and delusions
o Difficulties with ADL: e.g. driving, shopping, eating, dressing
symptoms should go back at least several months
87
what is mild cognitive impairment
decline in cognitive function but does not affect ADL, often a pre-dementia state
88
epidemiology of dementia
7% in over 65
89
common causes of dementia
```
o Alzheimer’s disease 50%
o Vascular dementia 25%
o Dementia with Lewy bodies 15%
o Frontotemporal dementia <5%
o Mixed dementia
o Parkinson’s disease (Preceded by Parkinson symptoms)
```
o Potentially treatable causes (substance misuse, hypothyroidism, space occupying intracranial lesion, syphilis, vitamin B12 deficiency, normal pressure hydrocephalus, folate deficiency, pellagra)
o Genetic causes e.g. familial autosomal dominant AD
90
what needs to be done for a dementia diagnosis
comprehensive history + exam; collateral history
assess attention + concentration, orientation to time, place and person; short and long term memory; praxis; language function; executive function; psychiatric symptoms
exclude medicine related causes or reversible organic causes
cognitive impairment screen: mini mental state exam, montreal cognitive assessment test
6 item cognitive impairment test, GP assessment of cognition, 7 minute screen
91
diagnostic criteria for dementia
Affects ADL
Represents decline from previous level of function
Cannot be explained by delirium or major psychiatric disorder
Established using history, collateral history and cognitive impairment assessment
Involve impairment in at least 2 of:
Ability to acquire and remember new information
Judgement, ability to reason or handle complex tasks
Visuospatial ability
Language functions
Personality and behaviour
92
investigtions in dementia
o Bloods (exclude other causes): FBC, ESR, CRP, U+E, LFT, glucose, TFT, B12 and folate
o MSU
o Consider blood cultures, CXR, MRI scans and psychometric testing
o CSF examination for rapidly progressing dementia e.g. Creutzfeldt-Jakob disease
93
legal aspects of dementia management
o Advances statements or decisions, lasting power of attorney and preferred place of care plans early on if possible
o Obliged to inform DVLA
94
non-pharmacological dementia management
cognitive stimulation programmes, multisensory stimulation, music therapy, art therapy, pet therapy, aromatherapy, dance therapy, massage, structured exercise programmes
95
pharmacological dementia management
acetylcholinesterase-inhibitors for mild and moderate AD (donepezil, galantamine or rivastigmine)
NMDA antagonists: memantine
oral/IM benzodiazepines for severe agitation, risperidone for psychotic symptoms
96
dementia prevention
reduce smoking, alcohol consumption, obesity and other cerebrovascular disease risk factors e.g. hypertension + hyperlipaemia
97
dementia prevention
reduce smoking, alcohol consumption, obesity and other cerebrovascular disease risk factors e.g. hypertension + hyperlipaemia
98
what is multiple sclerosis
cell mediated autoimmune conditions with repeated episodes of CNS inflammation and loss of the myelin sheath
99
types of MS
relapsing-remitting: 80%
secondary progressive MS
primary progressive MS: 10 - 15%
100
MS epidemiology
peak incidence: 40 - 50
101
McDonald criteria for MS
disseminated in space and tine
102
presentation of MS
visual problems or abnormal eye movements (e.g. optic neuritis + nystagmus)
facial weakness (e.g. Bell's Palsy)
cognitive dysfunction
paraesthesia, numbness, sensory and balance problems
autonomic dysfunction: bladder, sexual
Lhermitte's sign and Uhthoff's phenomenon
103
MS investigations
bloods: FBC, inflammatory markers, HIV, B12 etc
electrophysiology: e.g. visual evoked potential
MRI: periventricular lesions, plaques, white matter abnormalities
CSF: increased immunoglobulin + oligoclonal bands
104
MS management
inform DVLA
relapse: methylprednisolone
maintenance: interferon beta
2nd line: natalizumab
105
causes of foot drop
most common: L5 radiculopathy
anterior horn cell disorder (e.g. MND)
peroneal nerve palsy
106
main tracts in the spinal cord
spinothalamic: crosses in spine
- anterior tract: crude touch
- lateral tract: pain + temperature
fasciculus gracilis + cuneatus: crosses in brainstem
pressure, vibration, fine touch + proprioreception
corticospinal tract: crosses in brain stem
voluntary muscle movements
107
presentation of brown sequard syndrome
ipsilateral hemiplegia
ipsilateral loss of proprioreception, vibration, fine touch and pressure
contralateral loss of pain temperature and crude touch 1 or 2 levels below lesion
108
Horner's syndrome
miosis (constriction of pupil)
ptosis (drooping of upper eyelid)
anhidrosis (absence of sweating of face)
due to damage to sympathetic nerves of the face
109
upper motor neuron signs and conditions
spastic paresis
increased tone
increased reflexes + babinski +
MND, Stroke, spinal cord section
110
lower motor neuron signs and conditions
flaccid paresis
decreased tone
decreased reflexes
muscle wasting, fasciculations
MND, spinal cord injury, poliomyelitis, peripheral nerve dysfunction, myasthenia gravis
111
causes of spinal cord compression
```
trauma
tumour
prolapsed intervertebral disc (L4/L5, L5/S1)
epidural or subdural haematoma
inflammatory disease
infection
cervical spondylitic myelopathy
```
112
spinal cord compression presentation
muscle weakness/ paralysis
sensory loss, Lhermitte's sign
abnormal tendon reflexes
sphincter and autonomic disturbances
113
spinal cord compression investigations
MRI
114
Management of spinal cord compression
lie patient flat in neutral alignment
dexamethasone
symptomatic treatment
surgery/radiotherapy
115
what is a dermatome
an area of skin supplied by a single spinal nerve
116
cranial nerve 5 dermatomes
CN5: V1 – ophthalmic branch – top of the head
V2 – maxillary branch – nares to the top lip
V3 – mandibular branch – bottom lip to jaw
117
C5 - T1 dermatomes
```
C5 – lateral antecubital fossa
C6 – thumb
C7 – middle finger
C8 – little finger
T1 – medial antecubital fossa
```
118
L1 - S1 dermatomes
```
L2 – mid anterior thigh
L3 – medial femoral condyle
L4 – medial malleolus
L5 – dorsum of 3rd metatarsal phalangeal joint
S1 – lateral heel
```
119
myotomes
```
C4 – shoulder shrugs
C5 – shoulder abduction and external rotation; elbow flexion
C6 – wrist extension
C7 – elbow extension and wrist flexion
C8 – thumb extension and finger flexion
T1 – finger abduction
L2 – hip flexion
L3 – knee extension
L4 – ankle dorsiflexion
L5 – great toe extension
S1 – ankle plantarflexion
S4 – bladder and rectum motor supply
```
120
causes of mononeuropathy
```
mechanical
entrapment
diabetes
hypothyroidism
rheumatoid arthritis
vitamin deficiency
vasculitis
```
121
types of mononeuropathies
```
carpal tunnel syndrome
ulnar neuropathy
thoracic outlet syndrome
tarsal tunnel syndrome
radial nerve compression
lateral femoral cutaneous nerve compression
sciatic nerve damage
common peroneal nerve
```
122
S1 dermatome, myotome and reflex
myotome: plantar flexion; stand on toes
dermatome: little toe, lateral side of foot, sole
reflex: ankle jerk
123
C5/C6 dermatome myotome reflex
elbow flexion
thumb
biceps
124
C7 dermatome myotome reflex
elbow extension
middle finger
triceps
125
C8. T1 dermatome myotome
little finger, + forearm
| hand
126
C8. T1 dermatome myotome
little finger, + forearm
| hand
127
investigations for mononeuropathies
nerve conduction studies
electromyography
USS
128
management of mononeuropathies
conservative: NSAIDs, splinting, local steroid injections
surgery
129
common causes of peripheral neuropathy
diabetes
| idiopathic
130
uncommon causes of peripheral neuropathy
```
Deficiency states e.g. B12 /Folate
Alcohol/Toxins/Drugs
Hereditary Neuropathies
Paraneoplastic Syndromes
Metabolic abnormalities e.g. uraemia/thyroid
```
131
what is mononeuritis multiplex and what are potential causes
Individual nerves picked off randomly
Subacute presentation
Inflammatory/Immune mediated
Causes
Vasculitides
Connective tissue disorders
e.g Sarcoid
132
commmon mononeuropathies and their entrapment
Median nerve entrapment at the wrist most common (Carpal Tunnel Syndrome)
Ulnar nerve at elbow common
Radial nerve in axilla common
Common peroneal nerve in leg most common
133
neuropathy investigation
```
History and examination
+/-Neuropathy screen
+/-Vasculitic screen
+/-EMG/NCS
+/-CSF study
+/-nerve biopsy
```
134
what tests are part of a neuropathy screen
```
FBC ESR
U+E, glucose, TFT, CRP, Serum electorophoresis
B12 Folate
Anti Gliadin
(TPHA, HIV)
```
135
what tests are part of a vasculitic screen
FBC, ESR
U+ECr, CRP
ANA, ENA, ANCA, anti dsDNA, RhF, Complement, Cryoglobulins
136
neuropathy treatment
```
20% idiopathic with no treatment
Neuropathic analgesic (gabapentin,pregabalin amitrptyline)
```
Treat/remove underlying cause e.g. DM/gluten
```
Inflammatory neuropathy (e.g CIDP)
Prednisolone with steroid sparing agents e.g. azathioprine
```
```
Vascultic neuropathy (e.g with Wegners)
Prednisolone with immunosupressant e.g. cyclophosphamide
```
137
migraine prophylaxis
1st line: beta blockers or amitryptilline
2nd line: topiramate or sodium valproate
3rd line: pizotifen (weight gain)
138
percentage of recurrence after first seizure
20 - 45% (50%)
139
organisms that can cause GBS
campylobacter jejuni
EBV
CMV
140
presentation of GBS
weakness approximately 3 weeks after viral infection
ascending pattern of progressive symmetrical weakness starting from lower extremities; maximum severity in 2 weeks and onset stops
141
risk factors for MS
previous infectious mononucleosis
vitamin D deficiency
genetics
smoking
142
migraine triggers
CHOCOLATE: chocolate, hangovers, orgasms, cheese/caffeine, oral contraceptives, lie-ins, alcohol, travel, exercise
143
what is normal pressure hydrocephalus and how does it present
ventricular dilatation in the absence of raised CSF pressure on lumbar puncture
wet wacky wobbly
144
causes of NPH
subarachnoid haemorrhage
meningitis
head injury
CNS tumour
145
management of NPH and complications
surgical insertion of CSF shunt
complications: shunt occlusions, headaches, infarct, haemorrhage, infection
146
what is hydrocephalus
increase in CSF occupying the ventricles either due to problems of absorption or too much secretion
147
symptoms of hydrocephalus
headache + vomiting
papilloedema
unsteady gait
6th nerve palsy
large head
148
investigations and management for hydrocephalus
CT
surgical insertion of a shunt or external ventricular drain
149
most common type of brain metastases sites
```
breast
lung
kidney
melanoma
bowel
```
150
types of brain tumours
secondary tumours are 10x more common than primary
high grade: glioma, glioblastoma multiforme, medulloblastoma
low grade: acoustic neuroma, pituitary tumor, craniopharyngioma
151
what is horner's syndrome
disruption to sympathetic nerves supplying the eye:
anhidrosis
ptosis
miosis
152
Bell's palsy
LMN: can't wrinkle forehead
UMN: forehead sparing
management: steroids
153
risk factors for status epilepticus
under 5, elderly
genetic predisposition
intellectual disability
hypoglycaemia, alcohol withdrawal
154
management of status epilepticus
community
ABCDE
buccal midazolam (rectal diazepam)
hospital
ABCDE
IV lorazepam (x 2 if needed)
IV phenytoin or phenobarbital
155
3rd nerve palsy
down and out
156
4th nerve palsy
up
157
6th nerve palsy
unable to abduct
158
drugs that exacerbate myasthenia gravis
```
antibiotics e.g. ciprofloxacin
beta-blockers
anti-arrhytmic drugs
lithium
statins
```
159
investigations in MG
Ach-R antibody serum levels
thyroid function tests
thymus CT/MRI
160
management of MG
pyridostigmine
corticosteroids, immunosupressives e.g. azathioprine, thymectomy
161
subarachnoid haemorrhage cause and RF
bleeding from berry aneurysm
cocaine, smoking, hypertension, excessive alcohol
162
SAH: investigation + management
CT: hyper- dense appearance of blood around basal cisterns
cerebral panangiography
surgical clipping or coiling
163
SDH cause, RF, investigation and management
bridging veins
infants, elderly, alcoholism
CT
craniotomy + clot evacuation
164
EDH
middle meningeal artery
| surgical evacuation
