neurology Flashcards
features of generalised epilepsy
- Lack of aura
- Young age of onset
- Photosensitivity and myoclonus
- Seizures within 24hr of awakening
- History of alcohol or sleep deprivation
- Family history of IGS
features of focal epilepsy
focal aura automatisms - lip smacking, tongue biting, finger rolling post attack confusion nocturnal events history of perinatal injury
types of generalised seizures
absence - brief pause the carries on as normal
tonic clonic - LOC. limbs stiffen (tonic) then jerks (clonic)
myoclonic -sudden jerking of limb/face/truck
atonic - sudden loss of muscle tone causing fall, no LOC
types of focal seizures
simple - awareness unimpaired, no postictal symptoms
complex - awareness is impaired, aura
evolving to bilateral convulsive - starts focalliy but spreads and becomes convulsive (2/3 of all focal seizures)
treatment for epilepsy
focal - lamotrigine, levetiracetam, carbamazepine
generalised - valproate, lamotrigine, levetiracetam
define status epilepticus
repeated/prolonged seizure activity
defined as 2 or more seizures without full recovery in between or continuous activity for > 30 min
investigation of epilepsy
clinical history + eye witness ct head EEG glucose electrolytes
management of Status epilepticus
maintain airway
oxygen
IV access and bloods (FBC, U&Es, LFTs, glucose, Tox screen, anticonvulsant levels)
IV fluids
Lorazepam bolus (second dose if no response)
in seizures continue = IV phenytoin infusion
define MS
an inflammatory demyelinating disease characterised by the presence of episodic neurological dysfunction in at least 2 areas of the CNS separated in time and space
Risk factors of MS
genetics - HLA A3
Fhx
smoking
EBV infection
how might someone with MS present
optic neuritis transverse myelitis sensory changes (burning or wet sensation) leg weakness increased tone ataxia diplopia
define transverse myelitis
inflammation of the spinal cord most commonly in the thoracic (T1-12) region
features of transverse myelitis
weakness and sensory loss below the level affected
urinary incontinence
diagnosis of MS
MRI gadolinium brain
LP - CSF oligoclonal bands, raised IgG
rule out other causes (B12, lyme serology, TSH)
management of MS
IV methylprednisolone for relapses
Beta interferon to decrease frequency of relapses
biologics - natalizumab, alemtuzumab
fingolimod, dimethyl fumarate
symptom relief - muscle relaxants, anticholinergics
define myasthenia gravis
autoantibodies against ACh receptors causing destruction of post synaptic membrane therefore decreasing muscle fibre A.P
presentation of myasthenia gravis
muscle fatigue, worse with activity
limb weakness - difficulty standing up from chair, using stairs
ocular muscle weakness - squints and diplopia
dyspnoea
investigations for myasthenia gravis
ACh receptor antibodies
muscle specific tyrosine kinase antibodies
CT to look for thymoma
management of myasthenia gravis
cholinesterase inhibitor - pyridostigmine
corticosteroids for ocular symptoms
plasma exchange and IV IG
thymectomy
define a myasthenic crisis
development of respiratory failure due to weakness of respiratory muscles
what should be monitored in a myasthenic crisis
serial FVC and NIF
both low is an indication for ventilation
clinical features of TACS
hemiparesis + higher cortical dysfunction + homonymous hemianopia
clinical features of PACS
isolated higher cortical dysfunction
or
2 of hemiparesis, hemianopia, higher cortical dysfunction
clinical features of POCS
isolated hemianopia
cerebellar/brainstem symptoms (nystagmus, ataxia)
clinical features of LACS
pure motor stroke or pure sensory stroke or sensorimotor stroke or ataxic hemiparesis or clumsy hand dysarthria
vessel affected in TACS
proximal middle cerebral or internal carotid
vessel affected in PACS
MCA
vessel affected in POCS
vertebral/basilar artery
or posterior cerebral artery
vessel affected in LACS
small perforating arteries
list some investigations for a person presenting with stroke
CT head - rule out haemorrhagic stroke ECG - AF PT ant aPTT - coagulopathy carotid ultrasound glucose and serum electrolytes
management of ischaemic stroke
if presented <4.5hrs ago = thrombolysis (alteplase)
aspirin
endovascular stent
thrombectomy
secondary prevention of stroke
atorvastatin antihypertensive - Ramipril, thiazide, CCB antiplatelets - clopidogrel, aspirin warfarin if AF smoking cessation
management of TIA
control risk factors (smoking cessation, statins antihypertensive, aspirin)
clopidagrel or aspirin
carotid endarterectomy if >50% stenosed and symptomatic or >70% and aasymptomatic
what is the ABCD2 score
risk score for predicting stroke after a TIA
what makes up the ABCD2 score
a = age>60 (1)
b = BP>140/90 (1)
c = clinical feature - unilateral weakness (2), speech problems w/o weakness (1)
d = duration - >59min (2), <1hr (1)
d = diabetes (1)
score of 6 = high risk so >4 requires specialist review
Presentation of a subarachnoid haemorrhage
thunderclap headache
LOC
photophobia
nausea and vomiting
investigations for a subarachnoid haemorrhage
CT head ( confirms diagnosis, hydrocephalus, infarction) CT/MR angiogram (find bleeding source) LP (xanthochromia) electrolytes glucose ECG troponin
management of subarachnoid haemorrhage
aneurysm repair ( interventional radiology preferred to open)
nimodipine - prevents vasospasms
sodium replacement if needed
Presentation of Parkinson’s
non motor - loss of smell, constipation, erectile dysfunction, depression
TRAPS (tremor, rigidity, akinesia, postural/gait, speech and swallowing)
treatment for parkinson’s
encourage physical activity carbidopa (levedopa +dopa decarboxylase inhibitor) dopamine agonist (ropinirole) MAOB inhibitor (selegiline) COMT inhibitor (entacapone) deep brain stimulation
what is cervical spondylosis
OA of the cervical spine leading to MSK symptoms
osteophyte formation can irritate/damage/compress the spinal cord and/or nerve roots resulting in neurological symptoms
signs and symptoms of cervical spondylosis
neck pain, stiffness, crepitations stabbing/dull pain in UL decrease reflexes leg weakness, foot drop cervical muscle spasms
management of cervical spondylosis
physiotherapy NSAIDs muscle relaxants dexamethasone injections surgical nerve decompression
UMN signs
increase tone hyperreflexia spasticity positive babinski clonus
LMN signs
decrease tone hyporeflexia flaccid muscle weakness fasciculations muscle wasting
Management of MND
riluzole
symptom management - NG tube/blended food for dysphagia, antidepressant, muscle relaxants for spasticity,
types of MND
amyothrophic lateral sclerosis (cortex and ant. horn. UMN + LMN)
progressive bulbar palsy (CN 9-12. LMN)
progressive muscular atrophy (ant. horn. LMN)
primary lateral sclerosis (betz cells in motor cortex. UMN)
symptoms of hyper active delirium
heightened arousal hallucinations inappropriate behaviour agitation restlessness
symptoms of hypoactive delirium
lethargy
reduced motor activity
incoherent speech
lack of interest
what 4 features are required for a diagnosis of delirium
disturbance in attention
change in cognition
acute onset
evidence of a known cause
management of delirium
identify and manage precipitating cause
calm environment
haloperidol
symptoms of alzheimer’s
memory loss
personality change
speech and motor deficit
nominal dysphasia
symptoms of frontotemporal dementia
memory loss personality change language impairment change in social behaviour self neglect
symptoms of dementia with LB
parkinsonism
visual hallucinations
cognitive impairment
REM sleep disturbance
symptoms of vascular dementia
impaired executive functions
mood changes
disinhibition
poor attention
disadvantages of the MMSE
not sensitive to mild changes
unable to detect deficiency cause by a focal neurological lesion
insensitive in measuring progression in severe dementia
management of Alzheimer’s
cholinesterase inhibitor - donepezil
antidepressant - sertraline
antipsychotic - olanzapine
management of vascular dementia
aspirin
warfarin if embolic cause
BP. glycaemic, statin control
carotid endarterectomy
presentation of migraine
unilateral throbbing headache
aura (nausea, scotomas, flashing lights, limb sensory/motor disturbance)
photo/phono/osmophobia
treatment of migrains
NSAIDs/aspirin
anti emetic (metoclopramide)
sumatriptan
prophylaxis
propranolol
amitriptyline
valproate
what medications commonly cause headaches from overuse
NSAIDs
triptans
opioids
presentation of cluster headaches
severe unilateral ipsilateral autonomic features: red watery eye, constricted pupiil drooping eyelid absence of nausea, photophobia
management of cluster headaches
s/c sumatriptan
prophylaxis = verapamil
presentation of EDH
lucid period headache vomiting confusion if left untreated - ipsilateral pupil dilation. hemiparesis, coma, death
CT finding of EDH
lens shaped haemorrhage
presentation of SDH
elderly/alcoholics fluctuating consciousness headache seizures unsteadiness
CT finding of SDH
midline shift
crescent shaped haemorrhage
presentation of idiopathic intracranial hypertension
overweight
high pressure headache
visual disturbances (decrease acuity, loss of field, photophobia)
optic disc swelling
medications that may trgger idiopathic intracranial hypertension
tetracycline antibiotics isotretinoin contraceptives steroids levothyroxine
