Neuro Flashcards by Kevin Zhang

Medical management of meningitis

IM benzylpenicillin in community

Cefotaxime

amoxicillin/ampicillin for listeria cover if elderly/neonate

Dexamethasone (not for <3m or paediatric meningococcal)

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Management of chronic cvryptococcus meningitis

ambisome +/- flucytosine

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treatment of encephalitis

IV aciclovir 10mg/kg + IV ceftriaxone

IV amoxicillin if immunocompromised/>50y

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acute management of meningitis other than antibiotics

blood cultures
check for raised ICP
airway support/fluid support/vasopressors

if no raised ICP, LP <1h
dexamethasone 10mg

if raised ICP, IV antibiotics, A-E, dexamethasone

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Status management

Oxygen 100%, bloods, toxicology screen +/- fluids

buccal midazolam OR pr diazepam OR IV lorazepam

10 mins: IV lorazepam

30 mins: IV phenytoin/phenobarbitone

60 mins: rapid induction anaesthesia e.g. propofol

consider thiamine at 30m if alcohol/malnourished

glucose treatment

treat acidosis if severe
consider dex if cerebral tumour/vasculitis after senior consultation

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Trauma guidelines for CT head immediately

GCS<13 or <15 2h-post
skull fracture
seizure
focal neurology
vomiting >1

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Trauma guidelines for CT head within 8h

Warfarin

LOC AND either
Age >65
bleeding/clotting problem
30m retrograde amnesia
dangerous mechanism of injury

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Trauma guidelines for CT spine immediately

GCS <13
pt intubated
?surgery
Clinical suspicion AND:
age 65/high impact injury/focal neurology/paraesthesia

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Management for ischaemic stroke

antiplatelet immediately once confirmed for 2w

alteplase <4.5h
thromboectomy if alteplase not indicated <6h

statin after 48h

no AF: Clopidogrel long-term
AF: Apixaban long-term

Slowly lower any HTN

catheterise
hold anti-coagulation for AF for 14d
find cause e.g. AF, carotid artery stenosis

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Management for haemorrhagic stroke

Rapid blood pressure lowering if SBP >150 and no CI

reverse anticoagulation
refer to neurosurgeons e..g decompressive hemicraniectomy

Stroke rehab

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Management for SAH

CT
LP if CT inconclusive after 12h

nimodipine ASAP after confirmation for vasospasm
can use normal saline as well

monitor GCS for rebleed and Na for SIADH

coiling with IR or surgical clipping

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Management for raised ICP

sit up to 30 degrees
if intubated hyperventilate them
mannitol OR hypertonic saline used with caution
steroids (if oedema surrounding tumours)
fluid restriction

refractory disease = pentobarbital coma, hypothermia and decompressive hemicraniectomy

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management of cauda equina

PO dex if metastatic

decompressive laminectomy/discectomy if <48h

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Management of spinal compression

PO dex +/- external beam radiotherapy OR surgery

think if unfit for surgery

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Management of TIA

aspirin 300mg for 2w

no af: clopidogrel + statin long-term

af: apixaban + statin

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Management of subdural haematoma

reverse clotting abnormalities
ICP management

neurosurgery for evacuation if large

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Management of extradural haematoma

urgent neurosurgical intervention (clot evacuation and ligation)

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Management of Parkinson’s

MDT approach
Home environment review
OT/PT

memory clinic
levodopa + carbidopa
antiemetic e.g. domperidone

consider rasagiline (MAO-B),

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Management of Alzheimer’s

MDT approach
community organisation e.g. Alzheimer’s Association
Home environment review
OT/PT

anticholinersterase:
donepezil, galantamine, rivastigmine

memantine if severe (NMDAr antagonist)

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management for MS

acutely: steroids
chronically: beta-interferon, natalizumab for MS

Life optimisation:
anti-spasmodics
pain (gabapentin, pregabalin)
laxatives
catheter/oxybutinin

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Management for Myaesthenia Gravis

long-acting AChE inhibitors (pyridostigmine, neostigmine)
immunosuppression (pred, azathioprine)

check for thymoma

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Management for myasthenic crisis

plasmapharesis/IVIG

intubation

Management for Lambert Eaton Syndrome

treat cancer

immunosuppression (pred +/- azathioprine)

management for MND

MDT (PT/OT, dietician, specialist nurse)
riluzole extends life by 3m

supportive management e.g. PEG feeding, analgesia, antispasmodics, NIV

Management for BPPV

Epley Semont manoeuvre consider: lorazepam consider surgery

Management of Meniere's

salt restrict less: caffeine alcohol, smoking, stress meclozine or promethazine consider oral steroids or intratympanic injection if sudden hearing loss: oral pred tinnitus maskers consider hearing aid, endolymph sac surgery

GBS management

spiro (FVC measurements 6hly) IVIG OR plasma exchange ``` DVT prophylaxis ?mechanical management neuropathic pain management fluids antihypertensives ```

migraine management

prophylaxis: propanolol, CCB, antiepileptics, amitriptylline consider menstrual cycle control ongoing: NSAIDs, antiemetic 2nd line paracetamol monotherapy + antiemetic 3rd: triptan + antiemetic avoid triggers: chocolate, wine, alcohol, smoking, stress, sleep deprivation

causes of peripheral neuropathy

``` Alcohol B12 Thiamine Diabetic Amyloidosis CMT Infections: Botulinum, diphtheria, lyme disease ```

difference between polymyositis and polymyalgia rheumatica

polymyositis = tenderness/weakness polymyalgia = pain and stiffness without weakness

polymyalgia management

pred

polymyalgia investigation

CK Biopsy antibodies malignancy screen

contraindications to thrombolysis

``` LP in last week, GI haemorrhage 3w, stroke last 3m HTN >200 Ongoing bleeding Pregnant ICH Seizure at onset Brain cancer Varices ```

what is false localising sign

6th nerve palsy doesn't actually tell you where the lesion is as it takes a really long route

paediatric guidelines for CT head within 1h

NAI Post-traumatic seizure but no history of epilepsy GCS <14 GCS <15 after 2h base of skull fracture Focal neurology <1yo, bruise/swelling/laceration >5cm on head

CT SAH sensitivity

>95% if done within 6h | if negative but high clinical suspicion, do LP after 12h of onset

MCA stroke symptoms

Motor: upper body, facial droop Visual: Eyes deviate towards lesion (looking at it), contralateral homonymous hemianopia Other: verbal deficits -Broca's aphasia or Wernicke's

ACA stroke symptoms

Motor: lower body, pelvis Other Urinary incontinence, personality change, aphasia

PCA stroke symptoms

Visual: contralateral homonymous hemianopia, visual hallucinations, visual agnosia Other: Dysphagia, dysarthria, cerebellar signs

lacunar stroke symptoms

pure contralateral motor (branches of ACA and MCA)

absence seizure drugs

ethosuxamide, lamotrigine, valproate

partial seizure drugs

carbamazepine, valproate, lamotrigine, levetiracetam

tonic clonic seizure drugs

valproate, lamotrigine, carbamazepine

tonic/atonic seizures drugs

valproate

myoclonic seizure drugs

valproate, topiramate, levetiracetam

Bamford TACS

triad of 1) homonymous hemianopia 2) hemiplegia +/- sensory deficit 3) higher cerebral dysfunction (speech)

Bamford PACS

2 of 1) homonymous hemianopia 2) hemiplegia +/- sensory deficit 3) higher cerebral dysfunction (speech)

Bamford POCS

Any of 1) Cranial nerve dysfunction 2) Bilateral motor/sensory dysfunction 3) Conjugate eye movement disorder 4) Isolated hemianopia 5) Cerebellar signs

Bamford Lacunar

``` No loss of higher cerebral function + 1 of: Pure sensory Pure motor Sensorimotor Ataxic hemiparesis ```

carotid endarterectomy indications

stenosis >50% + stroke/TIA Carried out within 2w stenosis >70%

stroke scoring systems on admission

NIHSS ROSIER CT-ASPECT

``` Dermatomes Back of head Shoulder 3rd finger Nipple Umbilicus Hip Big Toe Little Toe ```

``` Back of head C2 Shoulder C4 3rd finger C7 Nipple T4 Umbilicus T10 Hip L2 Big Toe L5 Little Toe S1 ```

Management of cluster headaches

acute: SC sumitriptan and 100% high flow oxygen | prevent recurrence: verapamil

lesions to optic radiations in temporal and parietal lobes lead to what type of visual defect

quadrantanopia PITS = Parietal inferior, Temporal Superior