Neurology Conditions investigation

Question 1

Ischaemic Stroke - Investigations (5/1)

Answer 1

initial

1) urgent head CT (brain parenchyma hypoattenuation, dark)
2) brain diffusion weighted imaging MRI (infarct hyperattenuation, bright)
3) serum glucose (exclude hypoglycaemia/hyperglycaemia)

consider

1) CT/MRI angiogram (identify stenosis/occlusion)

Question 2

Haemorrhagic Stroke - Investigations (4/1)

Answer 2

initial

1) urgent head CT (brain parenchyma hyperattenuation, bright) 2) serum glucose (exclude hypoglycaemia/hyperglycaemia)
3) ECG + BP 4) FBC

consider

1) CT/MRI angiogram (identify aneurysm, arteriovenous malformation)

Question 3

Transient Ischaemic Attack - Investigations (5/2)

Answer 3

initial

1) brain diffusion weighted imaging MRI (exclude haemorrhage) 2) serum glucose (exclude hypoglycaemia/hyperglycaemia) 3) ECG + BP 4) FBC 5) carotid artery Doppler ultrasound (stenosis)

consider

1) carotid CT/MRI angiogram (if stenosis)
2) echocardiogram (cardioembolism)

Question 4

Subarachnoid Haemorrhage - Investigations (1/2)

Answer 4

initial

1) head CT* (star shaped lesion)

consider

1) lumbar puncture (if CT negative) (xanthochromic - yellow)
2) CT angiogram (number/extent of aneurysms)

Question 5

Subdural Haematoma - Investigations (1/0)

Answer 5

initial

1) head CT (diffuse hyperdense crescent shaped mass, shifting of midline structures)

Question 6

Extradural Haematoma - Investigations (2/0)

Answer 6

initial

1) head CT* (hyperdense lemon shaped mass adjacent to skull) 2) skull x-ray

Question 7

Epilepsy - Investigations (3/2)

Answer 7

initial

1) head CT
2) electroencephalogram (not diagnostic)
3) serum glucose (exclude hypoglycaemia/hyperglycaemia)

consider

1) head MRI (identify causative lesion) 2) genetic testing

Question 8

Parkinson’s Disease - Investigations (0/2)

Answer 8

consider

1) levodopa trial (symptoms improve) (if unclear clinical diagnosis, confirmation)
2) MRI brain