pass med neuro Flashcards
symptomatic subdural haemorrhgae mx
burr hole evacuation
should aspirin be given right away if suspect stroke
no - should exlude haermorrhagic stroke first
if suspect posterior inferior cerebellar artery stroke do what scan
non contrast CT
investigation for subarachnoid haemorrhage
non contrast CT
MS excaerbation affecting visison
IV steriods
family history of VTe can suggest
venous sinus thrombosis
if suspect TIA do
urgent carotid doppler
severe hypertension flushing and sweating without an increase in heart rate
autonomic dysreflexia - has to occur above C6
tests if have stroke under 55 with no obvious cause
thrombophilia and autoimmune screening
subacute degeneration of the cord can cause
hypereflexia, loss of proprioception and vibration - SCD- spinocerebellar, corticospinal and dorsal column tratcs afected
horner syndrome
brachial plexus - C8-T1
erbs palsy - arm pronated and medialy rotated
c5 and 6
The–index is a scale that measures disability or dependence in activities of daily living in stroke patients
barthel
in anterior cerebella artery syndrome the ear he cannot hear from is the side its on
when should receive aspirin immediately in TIA
if present within 7 days of suspected TIA
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
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
pain and temp loss on face is on what side in posterior inferior cerebella artery
same. the limb is affected contralaterally
important cuase of status eplepticus to rule out first as they are easily treatable
hypoxia and hypoglycaemia
alteplase (thrombolysis) should only be given is less than how many hours since stroke
4.5. if over give aspirin
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
ketogenic diet good for
epileptic children
anti emetic that can cause extra pyramidal side effects
metoclopramide
if got brain abscess give
ceftriaxone and metronidazole
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.
MS
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
CT
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
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
