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Year 3 Revision > Neurology Treatment Pathways > Flashcards

Neurology Treatment Pathways Flashcards

1
Q

Status epilepticus management

A

ABCDE
Emergency blood tests inc blood glucose and maybe CT
10mg buccal diazepam/IV lorazepam, then 5 mins, then another dose (only give 2 doses)
If seizures continue give phenytoin (monitor levels)
If drugs don’t work in 30 minutes send them to ITU

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2
Q

MS fatigue management

A

Amantadine (risk of heart failure)
Modafinil if sleepy
Hyperbaric oxygen

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3
Q

Mild MS exacerbation management

A

Symptomatic treatment

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4
Q

Moderate MS exacerbation management

A

Oral steroids

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5
Q

Severe MS exacerbation management

A

Admit/IV steroids

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6
Q

MS pyramidal dysfunction management

A

Physio
OT
Anti-spasmodic agents

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7
Q

MS spasticity management

A

Physio
Baclofen, tizanidine
Botulinum toxin
Intrathecal baclofen/phenol if bedbound

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8
Q

MS sensory symptoms management

A 
Anti-convulsant e.g. gabapentin
Anti-depressant e.g. amitriptyline
TENS machine
Acupuncture
Lignocaine infusion
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9
Q

MS lower urinary tract dysfunction management

A

Bladder drill (retraining)
Anti-cholinergics
Desmopressin (helps with frequent urination)
Catheterisation

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10
Q

MS disease modifying therapy first line

A

Interferon beta (avonex, rebif, betaseron, extavia)
Glitiramer acetate
Tecfedira (dimethyl fumarate)
Aubagio (teriflunomide)

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11
Q

MS disease modifying therapy second line

A

Monoclonal antibody (tysabri, ocrevus)
Fingolimod
Cladrabine

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12
Q

MS disease modifying therapy third line

A

Mitoxantrone
Lemtrada (alemtuzumab)
HSCT (stem cell transplantation)

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13
Q

How must interferons and glitiramer acetate be taken?

A

SC or IM

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14
Q

What MS treatment can cause multifocal leukoencephalopathy?

A

Tysabri (monoclonal antibody)

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15
Q

GBS management

A

Ig infusion and/or plasma exchange

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16
Q

Vasculitic peripheral neuropathy management

A

Pulsed IV methylprednisolone and cyclophosphamide

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17
Q

Demyelinating peripheral neuropathy management

A

IV Ig
Steroids
Azathioprine, mycophenalate, cyclophosphamide

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18
Q

Lambert-eaton myaesthenic syndrome management

A

3-4 diaminopyridine

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19
Q

Myaesthenia gravis acute management

A

Acetylcholinesterase inhibitor (pyridostigmine)
IV Ig
Thymectomy (even in absence of thymus abnormality)

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20
Q

Myaesthenia gravis immunomodulatory treatment

A

Steroids

Steroid sparing agents (azathioprine, mycophenolate)

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21
Q

Medical management of raised ICP

A

Sedation - propofol, benzos, barbiturates
Max venous drainage of brain - head of bed tilt of 30 degrees, cervical collars, ET tube ties
CO2 control
Osmotic diuretics (mannitol, hypertonic saline)
CSF release

22
Q

Management of raised ICP due to bleed that cannot be managed medically or surgically

A

Decompressive craniectomy (saves lives but does not improve outcomes)

23
Q

Management of late seizures after head injury.

A

anti-epileptics reduce early but not late seizures

No evidence for prophylactic antiepileptics

24
Q

Do steroids work in diffuse axonal injury?

A

No they make outcome worse (as it is a toxic swelling).

25
Q

Neuropathic pain agents for children

A 
Topical levomenthol
Topical capsaicin
Lidocaine patch
Tricyclics e.g. amitriptyline
Gabapentin/pregabalin
26
Q

Neuropathic pain agents for adults

A 
Tricyclics e.g. amitriptyline
Anticonvulsants e.g. gabapentin
Opioids 
NMDA antagonists (ketamine)
Sodium channel blockers e.g. lignocaine
Capsaicin
GABA agonists e.g. baclofen
27
Q

Non-pharmacological management of chronic pain

A 
AHPs
TENS
Acupuncture
Nerve blocks
Intrathecal drug delivery systems
Spinal cord stimulation
28
Q

Management of phantom limb pain

A

Mirror therapy

29
Q

Alzheimers medical management

A

ACh boosting meds e.g. rivastigmine (first line)

NMDA receptor blocker e.g. memantine (second line)

30
Q

Fronto-temporal dementia medical management

A

Trial of trazodone/antipsychotics to help behavioural features

31
Q

MND drug, effects and side effects

A

Riluzole
Prolongs life by 3 months at severe stage of disability
Can cause renal failure and liver failure

32
Q

Management of sialorrhoea (drooling) in MND

A

Hyoscine/buscopan
Glycopyrronium (esp in cognitive impairment)
Botox
Suction/humidification/carbocysteine

33
Q

Management of muscle cramps in MND

A

Quinine

Baclofen

34
Q

Management of muscle spasms in MND

A

Baclofen
Tizanidine
Dantrolene
Gabapentin

35
Q

Sub-arachnoid haemorrhage due to aneursym prevention of re-bleeding management first line.

A

Endovascular techniques (put metal coil in to seal of aneurysm)

36
Q

Sub-arachnoid haemorrhage due to aneursym prevention of re-bleeding management second line.

A

Surgical clipping

37
Q

Drug given to all SAH to prevent vasospasm and delayed ischaemia.

A

Nimodipine

38
Q

Management of delayed ischaemic neurological deficit in SAH

A

Triple H therapy - hypervolaemia (fluids), hypertension (inotropes), haemodilution (also fluids)

39
Q

Hydrocephalus after SAH management

A

1st line: lumbar puncture.
2nd line - external ventricular drain (up to 2 weeks)
3rd line - shunt

40
Q

Hyponatraemia/SIADH/cerebral salt wasting management after SAH.

A

No fluid restriction
Supplement sodium intake
Fludrocortisone (retains salt)

41
Q

Intra-cerebral haemorrhage with no decreased conscious level management

A

Non-surgical management

42
Q

Intra-cerebral haemorrhage with decreased conscious level management

A

Surgical evacuation of haematoma with maybe treatment of underlying abnormality

43
Q

Management of traumatic spinal cord compression

A

Immobilise
Investigate (x-ray/CT and MRI)
Decompress and stabilise (surgery, traction, external fixation)
Maybe methylprednisolone

44
Q

Management of AVMs

A 
Surgery with adjunct endovascular embolisation
OR
Stereotactic radiotherapy
OR
Conservative
45
Q

Management of spinal mets of tumours

A

Dexamethasone
Radiotherapy
Chemotherapy
Surgery

Depends on patient and tumour

46
Q

Management of primary spinal cord tumours

A

Surgical excision

47
Q

Medical management of raised ICP

A

Diuretics (mannitol, hypertonic saline, furosemide, urea)
Barbiturate coma - stops non-essential brain functions
Antiepileptics

48
Q

Surgical management of raised ICP

A

Surgical decompression (take off large part of frontal bone)
Remove mass lesions
CSF diversion

49
Q

Normal pressure hydrocephalus management

A

VP-shunt with medium-low or low-pressure valve.

50
Q

Idiopathic intracranial hypertension management

A

Weight loss
CA inhibitors (acetazolamide, topiramate)
Diuretics
LP or VP shunt
Interventional radiology (intracranial venous sinus plasty/stenting)
Optic nerve sheath fenestration (ONSF) - designed to save vision

51
Q

Sciatica management

A

Conservative as usually self-limiting

If not getting better then maybe surgery

52
Q

How long after stroke can you give thrombolysis and thrombectomy (once haemorrhage has been excluded)?

A

Thrombolysis - up to 4.5 hours after symptoms begin
Thrombectomy - up to 6 hours after symptoms begin
Should give both together if possible

Year 3 Revision (70 decks)

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