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NEUROLOGY & Psychiatry 303 > Neurology Symposium > Flashcards

Neurology Symposium Flashcards

1
Q

Indications of a seizure?

A 
Shaking
Stiffness
Absences - daydreaming
Dropping things 
Biting tongue - usually the sides
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2
Q

Indications of syncope?

A

Shaking and stiffness

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3
Q

Define NEAD

A

Non-epileptic attack disorder

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4
Q

Features of epilepsy?

A 
Perinatal trauma
Febrile convulsions
Head injury
Family history
CNS infec
Usually lasts 5 mins
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5
Q

Features of syncope?

A 
Prodrome - sweat
Postural - usually upright
Provoking factors - pain
Negative signs
CV RF
Usually lasts a few secs
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6
Q

Features of NAED?

A

Pychosocial substrate
Contextual
Awareness
Fluctuant
= People will dissociate and experience unconsciousness even though they’re not
Usually a response from a painful memory
Usually lasts a lot longer

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7
Q

Syncope warning signs?

A 
Lightheaded
Hot
Sweaty
Whooshing noises
Dizziness
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8
Q

How to differentiate epilepsy and NEAD?

A

Shaking - amplitude, freq, evolution (epilepsy large movements)
Eyes - tightly shut in non-epileptic
Incontinence = in epilepsy become hypoxic and tachycardic
O2 saturation
Unpleasant bites = epilepsy - side of tongues
Responsiveness = epilepsy will not response until it’s over, will be confused and drowsy after, non-epileptic - sometimes can response
Estimated duration - non-epilepsy = longer, epilepsy 10 mins
Speed of recovery - non-epilepsy come round very quickly

= SEIZURES

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9
Q

Emergency management of GTC (generalised tonic clonic) seizures?

A

Most self-limiting
If prolonged (5mins plus), iv lorazepam 2-4mg, repeat if neccesary
If not settling, iv phenytoin 1g over 20mins with cardiac monitor
If still fitting, anaesthetic help
In dentists chair - 999, document what you see

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10
Q

Syndrome classification

A

Idiopathic generalised epilepsy JME (juvenile myoclonic epilepsy)

  • photosensitivity before fit
  • sleep deprivation, alcohol = trigger fit

Localisation-related epilepsy
- Aura, focal neurology, age, PMH

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11
Q

What is the best anticonvulsant for a young male with JME?

A

Valproate (but not in young women)

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12
Q

Types of anticonvulsants and when to use them?

A

IGE - valproate in men, lamotrigine in women (levetiracetam)

Localisation related epilepsy - lamotrigine, carbamezapine, levetiracetam

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13
Q

What to do if someone is having a seizure?

A

Watch carefully, document what seen
Protect from injury, O2, recovery position
If not self limiting, lorazepam
Refer to 1st fit clinic
ECG, listen to heart
Driving advice - cannot drive after attack
Tx - consider syndrome and sex

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14
Q

Characteristics of trigeminal neuralgia?

A 
Brough on by a light touch
Pain is electric/sharp
Sudden onset
Comes on for a few seconds and then stops
Exacerbated by touch, cold, wind
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15
Q

Causes of trigeminal neuralgia?

A 
Cerebellopontine angle tumour
Demyelination
Nasopharyngeal carcinoma
Vascular loop = most common
Viral infec
Pontine tumour
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16
Q

How to diagnose MS?

A 
Clinical evidence of 2 attacks
Associated with demyelination
Previous episodes, objective lesions
MRI can be used to demonstrate dissemination in time and space after 1 attack
CSF
VEP
17
Q

How to treat MS?

A 
2 relapses in 2 yrs
Interferons and glatiramer
Natalizumab
Fingolimod
Fumarate
18
Q

How to treat trigeminal neuralgia?

A

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

19
Q

Side effects of carbamazepine?

A

Dizziness, diplopia, rash, deranged LFT’s

20
Q

70 year old man suddenly collapses. Unable to speak. Dense weakness of right side of face, arm and leg.
What is the priority?

A

= Stroke - of left hemisphere

Transfer to hospital asap

21
Q

How to diagnose Parkinson’s?

A

Clinical
Idiopathic
Triad of features - tremor, rigidity, bradykinesia
Parkinson’s plus

22
Q

How to manage parkinsons?

A 
L-dopa (dyskinesias, wearing off)
Dopamine agonists (neuropsychiatric side effects)
Amantadine
MAO-B inhibitors
COMT inhibitor
Apomorphine pup, duodopa
Surgery
23
Q

Long term complications of parkinson’s?

A 
Wearing off
Dyskinesias
Off and on freezing
Falls
Constipation
Neuropsychiatric
24
Q

45yr old man
Slurred speech and swallowing problems for 2 months
Tongue movements are very slow, jaw jerk is brisk

Likely diagnosis?

A

Motor neuron disease

25
Q

How to diagnose motor neuron disease - El-escorial criteria?

A 
Progressive - gets worse
Mixed UMN (stiffness, arms fixed in flextion) and LMN signs (reduced reflexes)
Regions involved
Exclude other causes
Definite/probable/possible
26
Q

Signs of motor neuron disease?

A

Sensory signs - none
Eye signs - can stop moving
No sphincters

27
Q

What treats motor neuron disease?

A

Riluzole

Non-invasive ventilation

NEUROLOGY & Psychiatry 303 (5 decks)

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