Neurology Symposium Flashcards
Indications of a seizure?
Shaking Stiffness Absences - daydreaming Dropping things Biting tongue - usually the sides
Indications of syncope?
Shaking and stiffness
Define NEAD
Non-epileptic attack disorder
Features of epilepsy?
Perinatal trauma Febrile convulsions Head injury Family history CNS infec Usually lasts 5 mins
Features of syncope?
Prodrome - sweat Postural - usually upright Provoking factors - pain Negative signs CV RF Usually lasts a few secs
Features of NAED?
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
Syncope warning signs?
Lightheaded Hot Sweaty Whooshing noises Dizziness
How to differentiate epilepsy and NEAD?
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
Emergency management of GTC (generalised tonic clonic) seizures?
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
Syndrome classification
Idiopathic generalised epilepsy JME (juvenile myoclonic epilepsy)
- photosensitivity before fit
- sleep deprivation, alcohol = trigger fit
Localisation-related epilepsy
- Aura, focal neurology, age, PMH
What is the best anticonvulsant for a young male with JME?
Valproate (but not in young women)
Types of anticonvulsants and when to use them?
IGE - valproate in men, lamotrigine in women (levetiracetam)
Localisation related epilepsy - lamotrigine, carbamezapine, levetiracetam
What to do if someone is having a seizure?
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
Characteristics of trigeminal neuralgia?
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
Causes of trigeminal neuralgia?
Cerebellopontine angle tumour Demyelination Nasopharyngeal carcinoma Vascular loop = most common Viral infec Pontine tumour
How to diagnose MS?
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
How to treat MS?
2 relapses in 2 yrs Interferons and glatiramer Natalizumab Fingolimod Fumarate
How to treat trigeminal neuralgia?
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!
Side effects of carbamazepine?
Dizziness, diplopia, rash, deranged LFT’s
70 year old man suddenly collapses. Unable to speak. Dense weakness of right side of face, arm and leg.
What is the priority?
= Stroke - of left hemisphere
Transfer to hospital asap
How to diagnose Parkinson’s?
Clinical
Idiopathic
Triad of features - tremor, rigidity, bradykinesia
Parkinson’s plus
How to manage parkinsons?
L-dopa (dyskinesias, wearing off) Dopamine agonists (neuropsychiatric side effects) Amantadine MAO-B inhibitors COMT inhibitor Apomorphine pup, duodopa Surgery
Long term complications of parkinson’s?
Wearing off Dyskinesias Off and on freezing Falls Constipation Neuropsychiatric
45yr old man
Slurred speech and swallowing problems for 2 months
Tongue movements are very slow, jaw jerk is brisk
Likely diagnosis?
Motor neuron disease
How to diagnose motor neuron disease - El-escorial criteria?
Progressive - gets worse Mixed UMN (stiffness, arms fixed in flextion) and LMN signs (reduced reflexes) Regions involved Exclude other causes Definite/probable/possible
Signs of motor neuron disease?
Sensory signs - none
Eye signs - can stop moving
No sphincters
What treats motor neuron disease?
Riluzole
Non-invasive ventilation
