Neuro Flashcards
(33 cards)
Ant Stroke Features
Unilat weakness +/- sensory loss (full homunculus unilaterally) Homonymous hemianopia Cerebral dysfunction (dysphasia, visual spatial defect)
Post Stroke Features
Isolated homonymous hemianopia (with macula sparing) Cerebellar dysfunction (DANISH, Horners syndrome) CN Palsy Bilateral motor/sensory loss Conjugate eye movement disorder
Lacunar Stroke Features
Motor/sensory/motor-sensory Loss
Ataxia
(Gen) Epilepsy Mx
Tonic-Clonic:
New diagnosis: Sodium-Valporate, Lamotrigine
Established: Lamotrigine
Absence:
Ethosuximide, Sodium-Valproate
Myoclonic:
Sodium-Valproate
Tonic/Atonic:
Sodium-Valproate
(Focal) Epilepsy Mx
Carbamazepine, Lamotrigine
Status Epilepticus Mx: Pre-Hosp Early Established Refractory
Pre-hospital:
PR Diazepam 10mg,
Buccal Midazolam 10mg
(Repeat every 15mins)
Early:
IV Lorazepam 4mg Bolus
(Repeat every 10mins)
Established:
IV Phenytoin
IV Phenobarbital
Refractory (ICU):
IV Gen Anaesthesia
(Propofol, Midazolam, Thiopental-Na+)
Headache Red Flags - 8
Thunderclap Meningism (Rash, Neck stiffness, Photophobia, Fever) New Neurological Def/Cog Dysfunct Papilloedema Loss of consciousness, Head injury New onset (esp w/ elderly) History of Malignancy/Immunosuppression Positional
Headache Mx: Tension Migraine Cluster Subarachnoid Haem
Tension:
Acute: NSAIDs, Paracetamol, Aspirin (Prophylaxis: Amitriptyline)
Migraine:
Acute: Sumatriptan
Prophylaxis: Propanolol, Topiramate, Amitriptylline
Cluster:
Acute: 100% O2, Sumatriptan, IN Lidocaine
Prophylaxis: Verapamil (CCB)
Sub-arachnoid Haem:
Nimodipine 60mg, (Surg clipping, Endovasc Embolisation)
Cranial Bleeds Features Intraparenchymal/Intracerebral Intraventricular Subarachnoid Subdural Extradural
Intraparenchymal/Intracerebral:
Round w/in Hemisphere
=> Acute Headache w/ N+V
Intraventricular:
Confined to Ventricles
=> Acute Headache w/ N+V
Subarachnoid: (Arterial Aneurysms)
Tracks along Sulci + Fissures
=> Thunderclap H
Subdural: (Bridging V)
Crescent (Not limited by Sutures)
=> Grad worsening H
Extradural: (Skull # => Middle Meningeal A)
Biconvex (limited by Sutures)
=> Acute Cog changes
GCS
Motor (6): Obeys commands Localises Normal Flexion Abnormal Flexion Extension None
Verbal (5): Orientated Confused Words Sounds None
Eye (4): Spontaneous Sound Press None
Benign IC HT Sx - 4
General throbbing headache (Positional: relieved on standing, worse while straining)
Gradual vision defects and papilloedema
Nausea and vomiting,
Drowsiness
Benign IC HT Ix + Mx:
Cure
Acute
Chronic
CT/MRI (Reduced size of ventricles)
LP (Increased opening pressure)
Mx:
Therapeutic LP: Relieve pressure
Acute:
Prednisolone (Reduce headache and papilloedema)
Chronic:
Acetazolamide (Reduce ICP),
CSF shunt
LP Indications + Contraindications
Indications:
Subarachnoid haemorrhage
Meningitis/encephalitis
Autoimmune Neuro diseases (MS, GBS)
Contraindications:
Focal neurological deficit
Raised ICP
PD Patho
Lewy-body formation w/in Neurones
Loss of neurones w/in Brainstem and basal ganglia (esp w/in Substantia nigra)
=> Reduced Dopamine transmission
PD Criteria
Bradykinesia (Micrographia, Hypophonia)
Muscular rigidity (Lead-pipe)
Resting (inactive) tremor
(postural instability)
PD (+) Sx
Asymmetrical (Unilat Onset),
Progressive (=> Bilat),
Responds to Levodopa
PD Mx
Levodopa (Exogenous Dopamine)
+ DOPA Decarboxylase Inhib:
(Benserazide: Co-beneldopa)
(Carbidopa: Co-careldopa)
Dopamine Agonists:
Pramipexole, Ropinirole
Rotigotine (TD Patch)
MAOi-B:
Rasagiline, Selegiline
COMTi:
Entacapone
PD Mx SE
Sedation/Drowsiness, Dizziness, N+V Hallucinations Impulse control D (Shopping, Gambling, Sex)
MND Patho + Sx
Degeneration of Ant horn cells within spinal-cord and brainstem
=>
Mix of upper/lower motor neuron signs
(No affect on Senses or Bladder/Bowel)
Types of MND: ALS PMA PLS PBP
Amyotrophic lateral sclerosis (Mixed):
M wasting + Stiffness/Spasticity (-> Severe Weakness)
Progressive muscular atrophy (LMND): M wasting Primary lateral sclerosis (UMND): Stiffness/Spasticity
Progressive Bulbar Palsy:
Diff talking/swallowing/breathing (+/- => ALS)
MND Ix
Electromyography:
Spontaneous Electrical Act (Progress M Atrophy)
Normal (Primary Lat Sclerosis)
Nerve Conduction Studies (Normal)
MND Mx:
Tx - 3
Supp - 3
Riluzole (Anti-glutamate)
Baclofen (Muscle spasms)
Anticholinergics (Drooling/Sialorrheoa)
Support:
NIV (Prevent T2 Resp Fail)
PEG tube (Nutrition)
Speech and language therapist, Dietician
MS Patho + Sx
Auto-Immune demyelination of nerves w/in Brain + Spinal cord (CNS)
=> Asc Sens Disturbances, Desc Motor Weakness, Neuropathic Pain
=> Neuro Dysfunction (Ataxia, Bulbar palsy/Dysarthria, Diplopia)
=> Cog Impairment (Fatigue, Incontinence, Emotional lability)
MS Criteria - 5
(McDonald 2010):
Inflamm lesions Multiple lesions in time (Recurrent), Multiple lesions in place (MRI) Progressive Neuro Deterioration (> 1yr) No Alt Diagnosis
