Neurology Conditions Management

Question 1

Ischaemic Stroke - Management (5/4/1)

Answer 1

conservative 1) nil by mouth until swallowing assessment (aspiration pneumonia) 2) maintain oxygen (>95%) 3) maintain hydration 4) head CT post thrombolysis (24 hours later) 5) CVS risk factor control medical 1) thrombolysis (IV alteplase) (<4.5 hours of onset) 2) aspirin (24 hours after IV alteplase) (2 weeks) 3) clopidogrel (unknown onset or >4.5 hours of onset) (lifelong) 4) prophylactic anticoagulant (DVT) surgery 1) thrombectomy (large artery occlusion)

Question 2

Haemorrhagic Stroke - Management (5/3/2)

Answer 2

conservative 1) monitor GCS 2) nil by mouth until swallowing assessment (aspiration pneumonia) 3) maintain oxygen (>95%) 4) maintain hydration 5) CVS risk factor control medical 1) IV prothrombin complex concentrate + vitamin K (anticoagulant reversal) 2) diuretic (mannitol) (lower ICP) 3) prophylactic anticoagulant (DVT) (once haemorrhage controlled) surgery 1) craniotomy + drainage (severe) 2) cerebral shunt (hydrocephalus)

Question 3

Transient Ischaemic Attack - Management (3/3/1)

Answer 3

conservative 1) specialist referral (<1 week minimum) 2) no driving (4 weeks) 3) CVS risk factor control medical 1) aspirin (first 2 weeks) 2) clopidogrel (after 2 weeks) 3) anticoagulant (if cardioembolism) surgery 1) carotid endarterectomy or stent (>50% stenosis)

Question 4

Subarachnoid Haemorrhage - Management (0/3/2)

Answer 4

medical 1) IV fluids (maintain cerebral perfusion) 2) nimpdipine (CCB) (reduce vasospasm —> cerebral ischaemia risk) 3) dexamethasone (corticosteroid) (reduce cerebral oedema) surgery 1) endovascular coiling* 2) surgical clipping

Question 5

Subdural Haematoma - Management (1/2/1)

Answer 5

conservative 1) anticoagulant/antiplatelet cessation medical 1) IV mannitol (high ICP) 2) IV prothrombin complex concentrate + vitamin K (anticoagulation reversal) surgery 1) craniotomy (haematoma evacuation)

Question 6

Extradural Haematoma - Management (1/2/1)

Answer 6

conservative 1) anticoagulant/antiplatelet cessation medical 1) intubation + ventilation 2) IV mannitol (high ICP) surgery 1) craniotomy (haemotoma evacuation ± blood vessel ligation)

Question 7

Depression - Management (5/3/0)

Answer 7

conservative 1) watchful waiting (2 week GP follow-up) 2) regular exercise (inc. yoga) 3) self-help books 4) psychotherapy 5) cognitive behavioural therapy (inc. computer based) medical 1) SSRI (e.g. fluoxetine) 2) TCA (e.g. amitriptyline) 3) St. John’s wort

Question 8

Epilepsy - Management (4/4/2)

Answer 8

conservative 1) ABCDE (esp. maintain airways) 2) protect from injury 3) check glucose 4) inform DVLA medical 1) IV diazepam or IV lorazepam x2 (1st line, during seizure) 2) IV phenytoin (2nd line, during seizure) 3) carbamazepine (focal) 4) sodium valproate (generalised) surgery 1) surgical resection (hippocampal sclerosis or tumour) (70% resolution) 2) neurostimulation system (e.g. vagal nerve stimulation or deep brain stimulation)

Question 9

Parkinson’s Disease - Management (3/2/1)

Answer 9

conservative 1) SALT (speech and language therapy) 2) physiotherapy (balance, gait) 3) physical activity medical 1) levodopa* (>70 years old or severe) 2) decarboxylase inhibitor (e.g. co-careldopa) (decreases levodopa SEs, increases levodopa efficacy) surgery 1) deep brain stimulation (refractory, party DA responsive)

Question 10

Parkinson’s Disease - Management (Delay Levodopa) (3)

Answer 10

1) dopamine agonist (e.g. ropinirole) 2) monomanie oxidase b inhibitors (e.g. selegiline) 3) catechol-o-methyl transferase inhibitors (e.g. tolcapone)