passmed Flashcards
thrombectomy 6hr when might extend to 24hr
Advanced brain imaging (such as CT perfusion or diffusion-weighted MRI sequences) indicates substantial salvageable brain tissue is still present
1st line ix for vestibuarl schwannoma
Audiogram and gadolinium-enhanced MRI head
syringomyelia
classically presents with cape-like loss of pain and temperature sensation due to compression of the spinothalamic tract fibres decussating in the anterior white commissure of the spine
Fluctuating consciousness what stroke
subdural haemorrhage
1st line spasticity in MS
Baclofen and gabapentin are first-line for spasticity in multiple sclerosis
falls occur soon after the diagnosis of Parkinson’s disease, what should be considered
alternative dx such as paarkinson plus
the acute onset of respiratory distress in this case points towards a myasthenic crisis, which may have been triggered by the administration of beta-blockers
what do you need to give
- intravenous immunoglobulin, plasmapheresis
what does anticipation mean in huntingtons disease
Anticipation is a phenomenon where successive generations have more CAG repeats.
A 23-year-old man is admitted to the emergency department following an altercation. He was hit in the face using considerable force with a cricket bat. He has a Glasgow Coma Scale score of 13. On examination, there is extensive bruising around the left eye, you can see bruising behind the left mastoid. He has clear fluid dripping down his nose. What is a quick and easy bedside test to perform to confirm that the fluid is CSF?
chedk for glucose -
If a patient is on warfarin/a DOAC/ or has a bleeding disorder and they are suspected of having a TIA what shoudl you do
iamgiing to exclude haemorrhage
what tracts are affected in subacute combined degeneration of spinal cord
In subacute combined degeneration of the spinal cord, the dorsal columns and lateral corticospinal tracts are affected
This patient has diabetes insipidus due to a craniopharyngioma. This causes what type of visual field defect
causes a lower bitemporal hemianopia.
sx of subacute degeneration of the spinal cord
Subacute combined degeneration of the cord (SACD) causes a lesion of the dorsal columns, then later the corticospinal tracts and spinothalamic tract.
SACD occurs due to vitamin B12, vitamin E and copper deficiency.
It causes loss of vibration and proprioception (later other sensory modalities), sensory gait ataxia, distal muscle weakness and dementia.
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
A 60 year-old male presents with clumsy hands. He has been dropping cups around the house. His wife complains he doesnt answer his mobile as he struggles to use it. His symptoms have been gradually deteriorating over the preceding months.
Degenerative cervical myelopathy leads to loss of fine motor function in both upper limbs. There is a delay in diagnosis of degenerative cervical myelopathy, which is estimated to be >2 years in some studies [1]. It is most commonly misdiagnosed as carpal tunnel syndrome and in one study, 43% of patients who underwent surgery for degenerative cervical myelopathy, had been initially diagnosed with carpal tunnel syndrome [1]
Pain (affecting the neck, upper or lower limbs)
Loss of motor function (loss of digital dexterity, preventing simple tasks such as holding a fork or doing up their shirt buttons, arm or leg weakness/stiffness leading to impaired gait and imbalance
Loss of sensory function causing numbness
Loss of autonomic function (urinary or faecal incontinence and/or impotence) - these can occur and do not necessarily suggest cauda equina syndrome in the absence of other hallmarks of that condition
Hoffman’s sign: is a reflex test to assess for cervical myelopathy. It is performed by gently flicking one finger on a patient’s hand. A positive test results in reflex twitching of the other fingers on the same hand in response to the flick.
Patients with raised ICP may exhibit Cushing’s triad:
widening pulse pressure
bradycardia
irregular breathing
a late sign indicating impending brain herniation
carotid artery endarterectomy occurs when
recommend if the patient has suffered stroke or TIA in the carotid territory and is not severely disabled
should only be considered if
carotid stenosis > 70% according European Carotid Surgery Trialists’ Collaborative Group criteria or
> 50% according to North American Symptomatic Carotid Endarterectomy Trial criteria
tia driving condtions
stroke or TIA: 1 month off driving, may not need to inform DVLA if no residual neurological deficit
multiple TIAs over short period of times: 3 months off driving and inform DVLA
A 56-year-old female is being admitted to intensive care following a road collision where she sustained a head injury. She gradually becomes less responsive and you notice that her heart rate is beginning to fall whilst her blood pressure paradoxically increases. Concerned that she is displaying characteristic signs of raised intracranial pressure, the team elect to perform controlled hyperventilation.
What is the mechanism of the above intervention?
Reduce blood carbon dioxide to induce cerebral vasocons
1st -2nd line treatment for neuropathic pain
First-line treatment for neuropathic pain is amitriptyline, duloxetine, gabapentin or pregabalin. If one of these agents don’t work next line is to try one of the other remaining three drugs
