Neurology Ix and Mx

Question 1

Ischaemic Stroke 1st Line Investigations

Answer 1

1st line:
• CT → to determine whether its an ishaemic or haemorrhagic stroke
• MRI
• Bloods + glucose
• Blood clotting → if patient is on warfarin and to exclude haemophilia or coagulopathy
• 24h ECG → look for AF

Question 2

Ischaemic Stroke 2nd Line Investigations

Answer 2

2nd line:
• CXR → may show enlarged left atrium
• Echocardiogram → look for a cardiac source of emboli e.g. endocarditis, or mural thrombus due to AF
• Carotid Doppler US → for stenosis >70% is significant

Question 3

Ischaemic Stroke Management

Answer 3

• ABCD approach → protect the airway

* Thrombolysis if onset of symptoms was

Question 4

Haemorrhagic stroke Management

Answer 4

• ABCD approach
• Take them off anticoagulants if on them
• Nimodipine
• CT angiopraphy

Question 5

TIA Investigations

Answer 5

• Bloods + glucose + lipids
• ESR + CRP
• CT
• CXR
• ECG
• Carotid Doppler US +- angiopraphy
• Echocardiogram

Question 6

TIA Management

Answer 6

• ABCD approach
• Cautiously lower BP
• Clopidogrel
• Put on warfarin if caused by cardiac emboli
• Carotid endarterectomy if > 70% stenosis at the origin of the carotid artery and operative risk is good.

Question 7

Menningitis Investigations

Answer 7

• FBC + glucose + coagulation screen
• U&Es
• LFTs
• CRP
• Blood culture
• Throat swabs
• Rectal swab
• Serology e.g. EBV, or HIV
• CT scan
• Lumbar puncture → after it if confirmed there is no raised Intercranial pressure
• Send CSF for MC&S, gram stain, protein, glucose, virology and lactate.
• CXR to look for signs of TB

Question 8

Menningitis Management

Answer 8

• Start Abx immediately
• Once organism is isolated, seek urgent microbiological advice.
• Look for signs of disease causing the meningitis
• If ICP raised → seek neurosurgeon advice
• Prophylaxis → discuss with public health. Give Abx (rifampicin or ciprofloxacin) to household contacts and anyone who may have kissed the patients mouth.