Neurology pass med

Question 1

Features of intracranial venous thrombosis

Answer 1

Common features
headache (may be sudden onset)
nausea & vomiting
reduced consciousness

Question 2

Ix of intracranial venous thrombosis

Answer 2

MRI venography is the gold standard
CT venography is an alternative

Question 3

Tx of intracranial venous thrombosis

Answer 3

typically with low molecular weight heparin acutely
warfarin is still generally used for longer term anticoagulation

Question 4

What is cushings triad

Answer 4

widening pulse pressure
bradycardia
irregular breathing

Question 5

Tx of raised ICP

Answer 5

Management
investigate and treat the underlying cause
head elevation to 30º
IV mannitol may be used as an osmotic diuretic
controlled hyperventilation
aim is to reduce pCO2 → vasoconstriction of the cerebral arteries → reduced ICP
leads to rapid, temporary lowering of ICP. However, caution needed as may reduce blood flow to already ischaemic parts of the brain
removal of CSF, different techniques include:
drain from intraventricular monitor (see above)
repeated lumbar puncture (e.g. idiopathic intracranial hypertension)
ventriculoperitoneal shunt (for hydrocephalus)

Question 6

What is Amaurosis fugax

Answer 6

Painless, transient loss of vision in one or both eyes.
= is a form of stroke that affects the retinal/ophthalmic artery (branch of internal carotid)

Question 7

Sx + causes of neuroleptic syndrome

Answer 7

Fever, Encelopathy, Vitals dysregulation - irregular pulse, accelerated heartbeat , increased rate of respiration
Enzymes elevation - myoglobin, creatinine kinase, Rigidity + Hyperreflexia
- antispychotic’s reaction
- rapid withdrawal of dopaminergic (parkinsons) drugs

Question 8

Where does herpes simplex encephalitis typically affect and what are some unique characteristics

Answer 8

Temporal lobe - e.g. aphasia, hemiparesis, memory loss

Question 9

Medication overuse headache management

Answer 9

• simple analgesia + triptans: stop abruptly
• opioid analgesia: withdraw gradually

Question 10

What is an RAPD

Answer 10

Relative Afferent Pupillary Defect (RAPD) is a condition in which pupils respond differently to light stimuli shone in one eye at a time due to unilateral or asymmetrical disease of the retina or optic nerve

Question 11

Causes of RAPD

Answer 11

• Acute glaucoma -> aqueous humour drainage becomes occluded. Severe pain, N+V, red eye, reduced vision. (usually bilateral)
• Vitreous haemmorhage -> Haemorrhage into vitreous humour. Painless, unilateral floaters. +/- visual loss.
• Retinal detachment -> painless flashes, floaters, curtain over part of vision
• Optic neuritis -> reduced acuity, pain