If more than 2 a month 1. Propranolol, topiramate 2. Valproate, pizotifen

Neuro Flashcards by Matthew Burrows

LMN signs

Wasting
Hypotonia
Hypo-reflexia
Fasciculations

Others: stocking sensory loss, loss of proprioception, high stepping gait, sensory ataxic gait, pes cavus

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UMN signs

Hypereflexia
Increased tone - spasticity 
Up going plantars - babinski
Hoffmans reflex 
Spastic gait

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Triptans

Constrict cranial arteries
Also inhibit release of neurotransmitters involved in pain

Ci: IHD, uncontrolled BP, lithium, SSRIs

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Migraine - international headache society

A - 5 attacks fulfilling criteria for b-d
B - 4-72 hours
C - characteristics, unilateral, pulsatile, moderate/severe pain, avoidance/aggravated by daily activities
D - during - nausea or vomiting, photphobia, phonophobia
E - exclude other causes

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Migraine prophylaxis

If more than 2 a month

Propranolol, topiramate
Valproate, pizotifen

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Essential tremor features

Familial - autosomal dominant
In both upper limbs
Worse if outstretched
Relieved by alcohol/rest

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Parkinson’s typical symptoms

Resting tremor
Bradykinesia
Rigidity

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ROSIER Score

Risk of stroke

Stroke is likely if score >0

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Carpal tunnel syndrome

Compression of median nerve

Shaking hands relieves pain

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Guillain-Barré syndrome

Campylobacter jejuni
CMV

CSF: increased protein

Signs: areflexia
Can have cranial nerve involvement and auto mind nervous system involvement

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NPH triad

Urinary incontinence
Gait disturbance
Dementia/bradykinesia

No papilloedema
Enlarged 4th ventricle on imaging

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Benign intracranial hypertension management

Weight loss
Diuretics
Topiramate
Repeated LP

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Epilepsy management

Partial - carbamazepine

Generalised tonic-clonic - sodium valproate, lamotrigine, carbamazepine

Absence: valproate, ethosuximide

Myoclonic: valproate, clonazepam, lamotrigine

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Valproate side effects

Appetite increase, weight gain 
Liver failure
Pancreatitis 
Reversible hair loss 
Oedema
Ataxia 
Teratogenic, tremor, thrombocytopenia
Encephalopathy

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Parkinson’s gait

Shuffling gait - festinance
Stooped
Reduced arm swing
Narrow base

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Features of Parkinson’s

Tremor
Bradykinesia
Rigidity
Posture and gait 
Speech
Face
Depression
Dementia 
Hallucinations

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L-dopa side effects

Nausea, diarrhoea, GI upset
Dyskinesias
Hypotension
Arrythmias
Psychosis - confusion, disorientation, insomnia, nightmares
Compulsive behaviours - gambling, spending, sexual
On-off effect

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Parkinson’s plus syndromes

Progressive supra nuclear palsy
Multi system atrophy 
Cortico-basal degeneration 
Lewy body dementia 
Vascular parkinsonism

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ABCD2 scoring system

Risk of stroke after TIA

A age >60 1 point 
B blood pressure at presentation >140/90 - 1 point
C clinical features
     - unilateral weakness - 2 points
     - speech disturbance without weakness - 1 point
Duration of symptoms:
   - >60 mins - 2 points
   - 10-59 minutes - 1 point
D diabetes - 1 point

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Causes of TIA

Atherothromboembolism - carotid
Cardio embolism - AF, mural thrombus, valve disease, prosthetic valve
Hyper viscosity - polycythaemia, sickle cell, wcc
Vasculitis

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Differentials of stroke

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Head injury 
Subdural 
Intracranial tumours
HypoglyCaemia
Wernickes
Drug overdose
Abscesses 
Epilepsy 
Hemiplegic migraine 
TIA
Bells palsy

Causes of polyneuropathies

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Metabolic 
Vasculitides
Malignancy 
Inflammatory 
Infections 
Nutritional 
Inherited syndromes 
Toxins 
Drugs 
Others

Autonomic neuropathy causes

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Diabetes 
Amyloid
GBS
HIV 
paraneoplastic syndromes 
Leprosy

Epilepsy driving requirements

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First seizure - 6 months off driving

Established epilepsy - fit free for one year

Epilepsy medications

Partial - carbamazepine Generalised tonic-clonic: valproate, lamotrigine, carbamazepine Absence: valproate, ethosuximide Myoclonus: valproate, clonazepam, lamotrigine

Epilepsy in pregnancy

5mg folic acid | Breastfeeding ok for most antiepileptics

Post-herpetic neuralgia

Amitriptyline Topical capsaicin Tramadol for rescue therapy

Trigeminal neuralgia management

MRI to exclude secondary cause Carbamazepine

Branches of trigeminal nerve

V1 ophthalmic - superior orbital fissure V2 maxillary - foremen rotundum V3 mandibular - foramen ovale

Types of tremor

``` Essential Postural Anxiety Thyrotoxicosis Co2 retention Drug withdrawal Hepatic encephalopathy Cerebellar disease ```

Complications of seizures

Injuries Hypoglycaemia Pulmonary hypertension and oedema Increase in ICP

When to consider stopping antiepileptics

If seizure free for more than two years, withdraw over 2-3 months

What is cataplexy?

Sudden and transient loss of muscular tone caused by strong emotion 2/3 of narcoleptic shave cataplexy

Causes of a LMN Facial palsy

``` Bell's palsy Ramsay hunt syndrome Acoustic neuroma Pontine tumours Middle ear problems Parotid problems ```

What causes a bilateral facial palsy?

Sarcoidosis

Tuberous sclerosis

AD Like neurofibromatosis Subungal fibromata

Stroke territory

ACA - contralteral hemiparesis and sensory loss, more in lower extremities MCA - contralateral hemiparesis sensory loss more in upper limbs. Contralateral homonymous hemianopia. Aphasia PCA - Contralateral homonymous hemianopia with macular sparing. Visual agnosia

Inheritance of duchennes

X-linked recessive

Grading muscle power

``` 0 total paralysis 1 palpable or visible contractions 2 movement with gravity eliminated 3 movement against gravity 4 weaker than usual 5 normal ```

Concussion management

``` Cold compression Rest Pain relief - paracetamol, avoid NSAIDs Avoid alcohol/drugs Avoid contact sports for about 3 weeks Return to school/driving when you feel recovered Someone to stay with them for 48 hours ```

Neuroleptic malignant syndrome

commonly young males antipsychotic medications Fever tachycardia Rigidity Management: - Stop medication - fluids to prevent renal failure - dantrolene/bromocriptine

Acute generalised weakness differentials

Stroke/TIA ``` GBS MG Tetanus MS Spinal cord compression Polymyositis Alcoholic myopathy Botulism Diptheria Lead poisoning ```

WFNS scale

``` scoring system for SAH Grades I - IV I GCS 15 no motor deficit II 13-14 and motor deficit III gcs 7-12 IV gcs 3-6 ``` Other grading systems: Fischer and Classen. Hunt & Hens

Migraine treatment

NSAIDs - ketoprofen, aspirin | Triptans

Migraine prophylaxis

>2 a month Propanolol/Topiramate Try for 3 months before changing 12-17 year olds - use nasal triptans

Migraine in pregnancy

Paracetamol 1g | Aspirin 300mg/Ibuprofen 400mg (1st and 2nd trimester)

Features of Parkinsonian gait

``` Loss of arm swing Hesitancy Shuffling Festination Clock face turning ```

Most common type of ms

Relapse remitting

CSF results for ms

Oligoclonal bands

Key places to look on an MRI in ms

Peri ventricular Juxtacortical Infratentorial Spinal cord

How does sulfasalazine work?

Inhibits output of Tnf and cytokines

CSF analysis meningitis

Bacteria - polymorphs | Viral - lymphocytes

Neuro Flashcards

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