pass med neuro Flashcards by Lucy Miller

symptomatic subdural haemorrhgae mx

burr hole evacuation

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should aspirin be given right away if suspect stroke

no - should exlude haermorrhagic stroke first

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if suspect posterior inferior cerebellar artery stroke do what scan

non contrast CT

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investigation for subarachnoid haemorrhage

non contrast CT

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MS excaerbation affecting visison

IV steriods

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family history of VTe can suggest

venous sinus thrombosis

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if suspect TIA do

urgent carotid doppler

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severe hypertension flushing and sweating without an increase in heart rate

autonomic dysreflexia - has to occur above C6

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tests if have stroke under 55 with no obvious cause

thrombophilia and autoimmune screening

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subacute degeneration of the cord can cause

hypereflexia, loss of proprioception and vibration - SCD- spinocerebellar, corticospinal and dorsal column tratcs afected

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horner syndrome

brachial plexus - C8-T1

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erbs palsy - arm pronated and medialy rotated

c5 and 6

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The–index is a scale that measures disability or dependence in activities of daily living in stroke patients

barthel

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in anterior cerebella artery syndrome the ear he cannot hear from is the side its on

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when should receive aspirin immediately in TIA

if present within 7 days of suspected TIA

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If a patient is on warfarin/a DOAC/ or has a bleeding disorder and they are suspected of having a TIA, they should be admitted immediately for imaging to exclude a haemorrhage

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The drug being described is —. It is a 5-HT3 antagonist which acts at the chemoreceptor trigger zone (CTZ). Its common side effects include headache, constipation and, importantly, QTc prolongation.

ondansetron

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pain and temp loss on face is on what side in posterior inferior cerebella artery

same. the limb is affected contralaterally

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important cuase of status eplepticus to rule out first as they are easily treatable

hypoxia and hypoglycaemia

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alteplase (thrombolysis) should only be given is less than how many hours since stroke

4.5. if over give aspirin

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If a patient with Parkinson’s disease cannot take levodopa orally, they can be given a dopamine agonist patch as rescue medication to prevent acute dystonia

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ketogenic diet good for

epileptic children

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anti emetic that can cause extra pyramidal side effects

metoclopramide

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if got brain abscess give

ceftriaxone and metronidazole

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an absent what can be inidcative of an acoustic neuroma

corneal reflex

best tool for differentiating stroke from stroke mimic

ROSIER

abcd2 score

predicting likelohood of stroke following TIA

cha2ds2 vasc

likelihood of stroke secondary to af

stroke lesion is on opposite side to where the weakness is

bells palsy is on same side

The immediate treatment of choice is to load with aspirin 300mg (TIA). However, this question asks about the most appropriate treatment for secondary prevention. NICE guidelines recommend clopidogrel 75mg daily as the standard antiplatelet therapy for patients with a TIA.

Given the combination of a headache and third nerve palsy it is important to exclude a

posterior communicating artery aneurysm

brocas area is what side and inferior or superior

left and inferior

Distal sensory loss, tingling + absent ankle jerks/extensor plantars + gait abnormalities/Romberg's positive → subacute combined degeneration of the spinal cord

features of synringomyelia

spinothalamic only affected and affecting the neck, shoulder and arms

if suspect parkinsosn

refer urgently to neurology

carotid artery stenosis is diagnosed via

duplex US

when starting phenytoin what is required

cardiac monitoring

left middle cerebral artery stroke cuases

aphasia

All TIA patients should have an urgent carotid doppler unless they are not a candidate for carotid endarterectomy

intubate with with if GCS is less than 8

cuffed endotracheal tube

In the setting of functional B12 deficiency, this will be high. This is characterized by dorsal column abnormalities (impaired vibration and proprioception sense), absent ankle jerks, extensor plantar responses, and brisk knee reflexes.

cushings reflex also has a

wide pulse pressure

antiemetic if got parkinsons

Domperidone

what kind of tremor in parkinsosn

asymetrical

what tremor is more suggestive of drug induced parkinsonism

symmetrical

arnold chairi malfirmation is stromgly associated with

congenital hydrocephalus

key diagnostic test in guillian barre

lumbar puncture

remeber blood glucose measurement if suspect stroke to rule out

hypoglycaemai

mainstay of treatment for degnerative cervical myelopathy

decompressvie surgery

migraine the patietn wants to lie still and in cluster headahces its the opposite the patient cannot lie still

more linked to cluster headaches if the headahce happens at the same time each day

adduct the fingers

ulnar nerve

Iv mannitol can be used in pts with

raised ICP

tremor improves with movemetn

parkinsons

what medications are associated with drug induced parkinsonism

dopamine antagonists

common trigger for cluster headahces

alcohol

Focal seizures not responding to first-line drug - try lamotrigine or levetiracetam (i.e. the first-line drug not already tried) and if neither help then carbamazepine

Reduced visual acuity after exercise = Uhthoff's phenomenon.

The correct answer is Dopamine receptor agonists. Impulse control disorders (ICDs) are a recognised side effect of dopamine receptor agonists. The mechanism behind this is thought to be due to overstimulation of the dopaminergic reward pathways in the brain, leading to behaviours such as pathological gambling, hypersexuality, compulsive shopping and binge eating. A study published in JAMA Internal Medicine found that patients taking these medications had a two to three.5-fold higher risk of developing an ICD.

Not levodopa!!

Acute withdrawal of levodopa can precipitate neuroleptic malignant syndrome. This is a serious condition with a mortality of at least 10% and must be managed in ITU. As a result, levodopa is a critical medication, and must be given on time and not missed with acute admissions.

cerebellar stroke do

nasal discharge of clear fluid

basal skull fracture

Facial nerve palsy is the commonest neurological manifestation of sarcoid.

sarcoidosis

Tuberous sclerosis - roughened patches of skin over lumbar spine (Shagreen patches)

Tetracyclines increase the risk of idiopathic intracranial hypertension eg

lymecycline

pulsatile tinnitus whoosh siund

IIH

Transverse myelitis can be triggered by an infective or autoimmune process. Unlike Guillain-barre it involves the central nervous system and causes hyperreflexia and bladder and bowel dysfunction.

hyperventilating would reduce the ICP

reduced co2 - vasoconstriction of the cerebral arteries

Loss of dorsiflexion and eversion suggests a common peroneal nerve lesion as opposed to an L5 radiculopathy (in L5 radiculopathy, eversion tends to be spared while inversion is weak and sensory involvement tends to be greater). This is before the recent risk factor of knee surgery is considered, making common peroneal nerve palsy the more obvious answer.

proximal anterior clircuation stroke so can probs do and if presetn within 6 hrs

mechanical thrombectomy

In Guillain-Barre syndrome there is decreased motor nerve conduction velocity on nerve condution studies secondary to demyelination

For a patient with a Bell's palsy, if the paralysis shows no sign of improvement after 3 weeks, refer urgently to ENT

Tuberous sclerosis - subungual fibromata

degenerative cervical myelopathy

assessed by specialist spinal services

Following a first seizure, anti-epileptic drug treatment should only be started before specialist review in exceptional circumstances

Anterior cerebral artery stroke causes leg weakness but not face weakness or speech impairment

middle cerebral artery stroke would also present with aphasia

Carbamazepine may cause Steven-Johnson syndrome

Once an ischaemic stroke is confirmed the patient should be given aspirin 300 mg daily for 2 weeks then clopidogrel 75 mg daily long-term. A statin should also be offered if the patient is not already on statin therapy.

In general, carbamazepine and oxcarbazepine should be avoided in myoclonic seizures as they may aggravate myoclonic seizures.

For group 1 drivers, following a single TIA they can start driving if symptom-free for 1 month and there is no need for them to inform the DVLA.

According to NICE guidelines, doctors should refer all people with suspected Parkinson's disease urgently, and untreated, to a specialist with appropriate expertise in movement disorders.

This lady has developed post-herpetic neuralgia. NICE recommend using amitriptyline, duloxetine, gabapentin or pregabalin first-line.

Despite the patient's history of emotional dysregulation, the rise in serum prolactin should raise suspicion of a seizure (rather than a pseudoseizure).

Medication overuse headache simple analgesia + triptans: stop abruptly opioid analgesia: withdraw gradually

Baclofen and gabapentin are first-line for spasticity in multiple sclerosis

Multiple system atrophy is a cause of Parkinsonism which can be difficult to differentiate from idiopathic Parkinson's disease. Key features to help you differentiate are the presence of unilateral symptoms, and more severe/early onset autonomic dysfunction (postural hypotension/erectile dysfunction).

Epilepsy medication for males: generalised seizure: sodium valproate focal seizure: lamotrigine or levetiracetam

Painful third nerve palsy = posterior communicating artery aneurysm

Dexamethasone is used to treat cerebral oedema in patients with brain tumours

Patients taking levodopa may experience dyskinesias at peak dose: dystonia, chorea and athetosis (involuntary writhing movements)

Management of myasthenic crisis - intravenous immunoglobulin, plasmapheresis

Weber's syndrome is a form of midbrain stroke characterised by the an ipsilateral CN III palsy and contralateral hemiparesis

This patient is likely to have degenerative cervical myelopathy [DCM], which is associated with upper motor neuron signs.

hoffman sign can be associated with

MS is usually associated with only

upper motor neuron signs

Monoclonal antibodies such as natalizumab have the strongest evidence base for reducing relapse in multiple sclerosis

Idiopathic intracranial hypertension signs - papilloedema, 6th nerve palsy

Neuroleptic malignant syndrome often presents with raised CK and leukocytosis