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Neurology and psychiatry (IHD) > Neurology symposium > Flashcards

Neurology symposium Flashcards

1
Q

Epilepsy vs NEAD

A 
Stand back and observe:
-Shaking? Amplitude, frequency, evolution
-Eyes?
-incontinence?
-O2 Zats an other other obs
-Unpleasant bites?
-Resonsiveness?
-Estimated duration?
-Speed of recovery?
(spells seizures)
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2
Q

Less reliable signs for epilepsy vs NEAD

A

Injuries
Pelvic thrusting
Incontinence
Twiching

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3
Q

TLOC signs

A

Episodes of daydreaming since teens
Always clumsy and dropping things in mornings
Worse when tired??**

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4
Q

TLOC differential

A

Epilepsy
Syncope
NEAD

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5
Q

Epilepsy signs

A

Perinatal trauma
Febrile convulsions
Family history
CNS infections

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6
Q

Syncope signs

A

Preceding symptoms
Postural
Negative signs
CV rheumatoid factors

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7
Q

NEAD signs

A

Psychosocial substrate
Contextual
Awareness
Fluctuant

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8
Q

Emergency management of generalised tonic-clonic seizures

A

Most self-limiting
If prolonged, iv lorazepam 2-4mg, repeat if necessary
If not settling, iv phenytoin 1g over 20mins with cardiac monitor
If still fitting, need anaesthetic help
(In dentist’s chair): 999, document what you see

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9
Q

Epilepsy syndrome classification

A 
Idiopathic generalised epilepsy JME
-photosensitivity
-sleep deprivation
-alcohol
Localisation-related epilepsy
-aura
-focal neurology 
-age
-PMH
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10
Q

Is a brain MRI likely to show a brain tumour?

A

False

**

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11
Q

Does a pt require treatment after a single tonic-clonic fit?

A

Yes if:

  • previous myoclonic seizures or absences
  • congenital neurological deficit
  • unequivocal epileptiform changes on EEG
  • risk of recurrence unacceptable to pt
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12
Q

Tonic/ clonic/ tonic-clonic seizures

A

Tonic seizures involve sudden stiffening & contraction of muscles
Clonic seizures involve rhythmic twitching or jerking of one or several muscles
Tonic-clonic seizures are a combination of these two types in a specific pattern
-type of generalized seizure

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13
Q

What is the best anticonvulsant

A 
Valproate in a young man with JME or IGE
Lamotrigine in women with IGE
Levetiracetam???
Localisation related epilepsy:
-lamotrigine
-carbamezapine
-levetirecetam
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14
Q

Electroencephalograms

A

Only 30% sensitive
Epileptiform activities seen in 0.5% healthy adults and much higher in learning disabled
–>do an ECG

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15
Q

What to do if someone fits in your chair

A 
Watch carefully, document what you saw
Protect from injury, O2, recovery position
If not self limiting, lorazepam
Refer to first fit clinic
ECG, listen to heart
Driving advice
Treatment: consider syndrome and sex
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16
Q

Trigeminal neuralgia symptoms

A 
Localised to one side of face
Sudden onset
Electric/ sharp character
Radiates around face/ mouth
No associations
Paroxysmal (suddenly intensely recurs)
Exacerbated by touch, cold, wind, E&D???
Excruciating
17
Q

Likeliest cause of trigeminal neuralgia

A 
Cerebellopontine angle tumour
Demyelination
-this is her reason but why?
Nasopharyngeal carcinoma
Vascular loop
Viral infection
Pontine tumour
18
Q

Vascular loops?

A

??

MRI brain

19
Q

Diagnosis of MS

A 
Clinical evidence of 2 attacks
Previous episodes, objective lesions
MRI can now be used to demonstrate dissemination in time and space after 1 attack
(CSF)
(VEP - visual evoked potential)
20
Q

Treatment of MS

A 
2 relapses in 2 years
Interferons and glatiramer 
Natalizumab
Fingolimod
(Fumarate, alemtuzumab)
21
Q

Treatment of trigeminal neuralgia

A

Carbamazepine- Start low, uptitrate
SE’s: Dizziness, diplopia, rash, deranged LFT’s
Oxcarbazepine- Lower SE profile
Phenytoin- Particularly effective as push
LMTG/Gabapentin
Microvascular Decompression
Stereotactic Radiosurgery, Nerve Blocks etc.
Need to eat and drink!

22
Q

Symptoms of stroke

A

Face
Arm
Speech
Time

23
Q

Priority if someone has a stroke

A

Transfer to hospital as soon as possible

***

24
Q

Appropriate next step if stroke pt does not get better after arrival to hospital

  • FBC, ESR, U/Es, LFTs, glucose and clotting are normal
  • cholesterol is 3.4mmol/L
  • brain CT performed an hour after onset
A

Consider for thrombolysis

25
Q

After considering for thrombolysis, what are the next important questions?

A

Age/persistent/CT
Is he taking warfarin?
End stage illness/surgery/gi bleed/ trauma 3/52?
Retinopathy/pericarditis/pancreatitis/childbirth/CPR/recent stroke?
Blood pressure >185/100?
Are bloods normal (Plats, LFTs)?

26
Q

Parkinson’s diagnosis

A 
Clinical
Idiopathic
Triad of features- Tremor, Rigidity, Bradykinesia
Other symptoms
Parkinson’s plus
27
Q

Management of Parkinson’s Disease

A 
L-dopa (dyskinesias, wearing off)
Dopamine agonists (neuropsychiatric side effects)
Amantadine
MAO-B  inhibitors (Selegiline)
COMT inhibitor (Entacapone) 
Apomorphine pump, Duodopa
Surgery
28
Q

Long-term complications of Parkinson’s

A 
Wearing off
Dyskinesias
Off and on freezing
Falls
Constipation
Neuropsychiatric
29
Q

Motor neuron disease

A

Slurred speech and swallowing problems
Slow tongue movements
Jaw jerk is brisk

30
Q

Parksinson’s pt freezes and can’t get out of chair.

  • pt takes Sinemet, Rotigine, Madopar
  • O/E cogwheeling, resting tremor, bradykinesia and some dyskinesia
A

Try giving Madopar dispersible 62.5mg

31
Q

Most important diagnostic test for MND

A

Electromyography

-records electrical activity produced by skeletal muscles

32
Q

Diagnosis of MND

A 
El-Escorial criteria
-progressive
-mixed UMN and LMN signs
-regions involved
-exclude other causes
-definite/ probable/ possible
Sensory signs
Eyes
Sphincters
33
Q

Bulbar onset MND

A

Bulbar onset motor neurone disease occurs in about 20% of those affected. The first sign is usually slurring of the speech, caused by impaired tongue movement, which may be accompanied by obvious wasting and fasciculation of the tongue
Prognosis is not better

34
Q

Treatment for MND

A

Riluzole is indicated
-amyotrophic lateral sclerosis
-delays onset of ventilator-dependence or tracheostomy in selected pts
-may > survival by approximately 2-3 months
Other meds are available***

Neurology and psychiatry (IHD) (6 decks)

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