Neuro 2 Flashcards Preview

2A - Stuff i just cannot remember > Neuro 2 > Flashcards

Flashcards in Neuro 2 Deck (79)
Loading flashcards...
1

65-M presents with 12hr Hx sudden headache + difficulty walking (balance problem). He feels nauseous and has vomited. His speech is slurred.

Likely diagnosis? Cardinal symptoms?

Cerebellar stroke

Cardinal symptoms:
- ataxia
- headache
- vertigo
- vomiting

2

Pt presents with complete paralysis of facial muscles on one side.

Mouth droop, flattened nasolabial fold, cannot close eye, smoothened brow.

Likely diagnosis?

CNVII Palsy

- ipsilateral side

3

Pt presents with dizziness, and feel faint when they get up from standing. They are on medication for their recently diagnosed BPH.

Likely diagnosis and cause?

Postural Hypotension 2o to Tamsulosin

4

65-M presents complaining of a Hx sudden headache + difficulty walking (balance problem). He felt nauseous and has vomited. He noticed his speech was slurred. This resolved within 1 hour.

Likely diagnosis? Cardinal symptoms?

TIA

5

Presentations of Subarachnoid haemorrhage

Sudden thunderclap headache, 10/10 severity

Neck stiffness, meningism

6

Pt presents with stroke symptoms. Full acute management plan?

ABCDE

Within 4.5hr window:

1. CT Head (within time-frame)

If confirmed Ischaemic stroke:
1. IV Alteplase (within time-frame)
2. Thrombectomy
- w/in 6hr anterior circulation
- w/in 12hrs posterior circulation
3. a) 2wks Aspirin 300mg
b) Long-term Clopidogrel
4. Carotid US, CT Angiography, Echo.


CI to Alteplase: head trauma, GI/brain bleed, recent surgery, normal BP, plt count, INR

If confirmed Haemorrhagic stroke (ICH, SAH):
1. SAH - Nimodipine, IV fluid
2. Endovascular coiling, stent, Decompressive hemicraniectomy
3. Serum toxicology screen (cocaine)

7

Chronic stroke management

HALTSS

Hypertension*, 2-wks after

Antiplatelet - Clopidogrel. If Ischaemic, 2o to AF then Warfarin/ Rivaroxaban

Lipid-lowering - Atorvastatin

Tobacco - stop smoking
Sugar - Diabetes screening
Surgery - if ipsilateral carotid stenosis >50% > carotid endarterectomy

*No benefit in lowering acutely :: reduces brain perfusion UNLESS malignant

8

Focal seizure of the frontal lobe presentations

MOTOR features
- posturing
- pedalling of legs
- Jacksonian march
- behavioural change

9

Myoclonic seizure

Sudden jerk of limb, face, trunk; violent, disobedient limb

10

Tonic seizure

Sudden limb stiffness

11

Jason is a 34yr old builder. He developed sudden intense back pain at work + weakness and sensory loss in both limbs

Likely diagnosis? Possible underlying causes?

Spinal Cord compression
- BILATERAL sensory loss

Possible causes:
- disc herniation
- congenital stenosis

12

Subarachnoid haemorrhage mx

IV Fluid + Nimodipine (Ca2B - reduces vasospasms - reduces cerebral ischaemia)

Endovascular coiling, intravascular stent

13

Subdural haemorrhage mx

ABCDE + IV Mannitol

Burr-twist irrigation/ craniotomy

14

Extradural haemorrhage mx

ABCDE + IV Mannitol

Clot evac/ ligation

15

Drug used to lower intracranial pressure

Mannitol

16

Which artery is commonly affected in an extradural (epidural) haemorrhage?

Middle meningeal artery

17

Main types of seizures, presentations and their proportions

Primary generalised (40%)
- LOC
- BILATERAL, SYMMETRICAL

Partial/focal (60%)
- depends on lobe location

18

Epilepsy causes

Epilepsy RF

Epilepsy causes:
2/3 IDIOPATHIC.
Tumour, stroke, cortical scarring.

Epilepsy RF:
FHx, abnormal cerebral perfusion, cocaine

19

Epilepsy management
- uncomplicated
- F child-bearing age

1L Valproate

If F child-bearing age - LAMOTRIGINE

20

Simple vs Complex partial seizure

Complex affects awareness

21

Temporal partial/focal seizure px

Lip smacking, chewing, fiddling

22

Frontal partial/focal seizure px

Motor: Jacksonian, peddling,

23

Parkinson's RF

Parkinson's associations

55 - 65 M, pesticide exposure

Associated with LEWY-BODY dementia

24

Parkinson's diagnosis

Parkinson's management

Clinical diagnosis - response to L-dopa

Mx: MDT care
1. Levodopa + Co-Careldopa
2. Cabergoline/Rantipole - DA agonist
3. Selegline - MAO-B inhibitor
4. Entacaopone - COMT i

25

Parkinson's presentations

Parkinson's pathophysiology

Resting tremor
Bradykinesia
Cogwheeling

Rigidity, foot drop, insidious onset

Pathophysiology: reduced DA in Substantia Nigra

26

Migraine management

What should you avoid?

Prophylaxis: Propranolol, Topiramate, TCAs, Bockulinum toxin A

Acute attack:
NSAIDs, Paracetamol > Triptan. Metoclopramide (antiemetic)

Avoid opiates and the pill

27

Cluster headache management

Prophylaxis:
Verapamil

Acute attack:
High flow O2 > Nasal Triptan

28

Trigeminal neuralgia mx

Carbamazepine

29

Tension headache triggers

Stress, sleep deprivation, hunger, anxiety, eye strain

NOT DEHYDRATION

30

Tension headache mx

Avoid triggers
Aspirin
Paracetamol, NSAIDs