Psychiatry/ Neurology Flashcards
Headache treatments:
What are the symptoms of idiopathic intracranial hypertension?
- Headache
- Visual disturbance: blurred vision/ double vision
What are the examination signs of idiopathic intracranial hypertension?
General:
- Obese young woman
Cranial nerve II:
- ↓Visual acuity
- Narrowed visual fields
- Fundoscopy: papilloedema
Cranial nerve III, IV, VI:
- 3rd nerve palsy
- 6th nerve palsy more common (this nerve has the longest intracranial course)
What investigations are done for idiopathic intracranial hypertension?
- CT/MRI of the brain (neuroimaging is required to exclude a structural or other cause e.g. cerebral venous sinus thrombosis)
- Lumbar puncture (confirms the diagnosis and shows raised normal CSF constituents at increased pressure)
What is the medical management for idiopathic intracranial hypertension?
Management can be difficult and there is no evidence to support any specific treatment:
- Weight loss
- Diuretics e.g. acetazolamide (helps to ↓ICP)
- Topiramate (helps to ↓ICP and causes weight loss in most patients)
- Repeated lumbar puncture (effective treatment for headache but may be technically difficult in obese individuals and is often poorly tolerated)
What are the risk factors of cerebral venous thrombosis?
Hypercoagulable state e.g.
- Pregnancy
- Antiphospholipid syndrome
What are the symptoms of cerebral venous thrombosis?
- Headache: may be sudden onset or build up over a few days
- Nausea and vomiting
- Reduced consiousness
What are the examination signs of cerebral venous thrombosis?
General:
- Somnolence/ ↓Levels of consciousness/ ↓GCS/ Cognitive impairment/ Seizures
In severe ↑ICP: Cushing’s triad
- HR: Bradycardia
- RR: Irregular breathing
- BP: Widening pulse pressure
Cranial nerve II:
- Visual field defects
- Fundoscopy: papilloedema
Cranial nerves III, IV, VI:
- 3rd nerve palsy
- 6th nerve palsy (this nerve has the longest intracranial course)
What investigations are done for cerebral venous thrombosis?
MRI venography is the gold standard (to detect the thrombus; MRI has the advantage of being better at detecting damage to the brain itself as a result of the increased pressure on the obstructed veins, but it is not readily available)
CT venography is an alternative (to detect the thrombus)
- non-contrast CT head is normal in around 70% of patients
- D-dimer levels may be elevated
What is the management for cerebral venous thrombosis?
- Anticoagulation with LMWH (even in the presence of venous haemorrhage)
- THEN anticoagulation with warfarin (even in the presence of venous haemorrhage)
- Endovascular thrombolysis (the removal of the thrombus/blood clot under image guidance)
- If associated with infection (e.g. Staphylococcus aureus): give antibiotics
- Management of underlying causes and complications, such as persistently ↑ICP, is important
What investigations are done for a subarachnoid haemorrhage?
AFTER A SAME DAY HOSPITAL ASSESSMENT
- Urgent non-contrast CT brain
IF CT head within 6 hours of symptom onset AND normal => don’t do a lumbar puncture AND consider alternative diagnosis
IF CT head >6 hours of symptom onset AND normal => lumbar puncture at least 12 hours following the onset of symptoms to allow the development of xanthochromia (the result of red blood cell breakdown). -
Lumbar puncture (must be >12 hours after headache onset to allow the formation of bilirubin if CT is negative but the history is very suggestive of SAH. Look for xanthochromia: analysis looks for the presence of oxyhaemoglobin and bilirubin; if present, then it indicates that there is ‘old’ blood in the CSF)
- CT/Cerebral Angiography (done after 2 weeks CT +/- LP unreliable art this point. Once a subarachnoid haemorrhage has been diagnosed, this will point towards the origin of the bleeding)
+/- Digital subtraction catheter angiography (fluoroscopy technique which is gold standard for diagnosis because it characterises vascular abnormalities)
Seizure treatments:
- Absence seizures (person loses and then quickly regains consciousness. Occurs for <10s and person carries on where they left off. Presents in childhood)
- Generalised tonic-clonic seizures (tonic phase – muscles suddenly tense up, clonic phase – muscles rapidly contract and relex)
- Myoclonic seizures (sudden, short-lasting jerks that can affect some or all of your body, like muscle twitches)
- Juvenile myoclonic epilepsy (sudden jerking of the limbs, face or trunk, occuring in childhood or teenage years)
-
Atonic seizures (sudden loss of muscle tone, causing a fall)
(https: //www.youtube.com/watch?v=_4RzT-Pup6Y)
Types of Parkinson’s
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