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Neuro Flashcards

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1
Q

What are lateralising signs?

A

Reflect a problem with 1 hemisphere versus the other

  • Inattention
  • Gaze paresis
  • Upper limb drift with arms outstretched and eyes closed
  • Slower localising/flexion response 1 side
  • Asymmetric motor response
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2
Q

Causes of Coma

A

AEIOUTIPS

  • Acidosis/Alcohol
  • Epilepsy
  • Infection- HSE/Meningitis
  • Overdose
  • Uraemia
  • Trauma to head- SAH
  • Insulin- hyper/hypo/DKA
  • Psychogenic
  • Stroke
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3
Q

Who can diagnose brainstem death?

A

2 medical practitioners who have been registered for at least 2 years, at least one consultant

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4
Q

What conditions need to be met in order to diagnose brainstem death?

A

Body temp > 34
MAP > 60 with no hypoxia
Acidaemia or alkalaemia

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5
Q

What are the criteria for brainstem death?

A

Pupils fixed & dilated & unresponsive
No corneal reflex
Oculovestibular reflexes absent- no eye mvmts on injection of ice cold water into ear
No motor responses by adequate stimulation
No cough reflex to bronchial stimulation
No evidence of spontaneous respiration or respiratory effort

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6
Q

Causes of brainstem death

A

Tumour, MS, metabolic (central pontine myelonecrosis), trauma, spontaneous haemorrhage, infarction, infection

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7
Q

Causes of cerebellar syndrome

A

MS, stroke, tumour, drugs (eg phenytoin), thiamine deficiency, paraneoplastic, hypothyroidism, infections

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8
Q

Signs of cerebellar syndrome

A 
DANISH
- Dysdiadokinesia
- Ataxia
- Nystagmus
- Intention tremor
- Slurred speech
- Hypotonia
(reduced reflexes)
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9
Q

What type of gait is seen in cerebellar syndrome?

A

Broad-based gait

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10
Q

Define epilepsy

A

Recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain, manifesting as seizures

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11
Q

Causes of epilepsy

A

Idiopathic

SOL, stroke, vascular malformation, tuberous sclerosis, SLE

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12
Q

Localising features of epilepsy

A

Temporal- automatisms, deja vu, emotional disturbance, taste/smell, auditory hallucinations
Frontal- motor features, motor arrest, speech arrest, post-ictal Todd’s palsy
Parietal- sensory disturbance, motor symptoms
Occipital- visual phenomena

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13
Q

A person has epilepsy with the following features: automatisms, deja vu, emotional disturbance, taste/smell, auditory hallucinations.
What lobe is the epilepsy affecting?

A

Temporal

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14
Q

A person has epilepsy with the following features: motor features, motor arrest, speech arrest, post-ictal Todd’s palsy.
What lobe is the epilepsy affecting?

A

Frontal

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15
Q

A person has epilepsy with the following features: visual phenomena.
What lobe is the epilepsy affecting?

A

Occipital

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16
Q

A person has epilepsy with the following features: sensory disturbane and motor symptoms.
What lobe is the epilepsy most likely affecting?

A

Parietal

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17
Q

What are myoclonic seizures?

A

Seizures involving sudden jerk of a limb, face or trunk

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18
Q

What are atonic seizures?

A

Seizures where there is sudden loss of muscle tone

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19
Q

Management of generalised tonic-clonic seizures?

A

Sodium Valproate
Lamotrigine
Carbamazepine

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20
Q

Management of absence seizures

A

Sodium Valproate/Lamotrigine

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21
Q

Which drug should be avoided in management of tonic/aclonic/myoclonic seizures?

A

Carbamazepine

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22
Q

Management of partial seizures

A

Carbamazepine

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23
Q

How long should somebody not drive after a seizure?

A

Avoid driving until 1 year seizure-free

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24
Q

Side effects of Carbamazepine

A

Leukopenia, diplopia, blurred vision, impaired balance, rash

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25
Side effects of Lamotrigine
Diplopia, blurred vision, photosensitivity, tremor, agitation
26
Side effects of Sodium Valproate
VALPROATE: - Appetite lost - Liver failure - Pancreatitis - Reversible hair loss - Oedema - Ataxia - Teratogenic/Tremor/Thrombocytopenia - Encephalopathy
27
Which anti-epileptic should be used in pregnancy?
Lamotrigine | Supplement with folic acid
28
What is status epilepticus?
Non-self-limiting manifestation of epileptic seizure
29
What is the most common cause of status epilepticus in in people without epilepsy?
Alcohol
30
Stages of status epilepticus
T0: seizure starts T1: point at which seizure is not self-limiting T2: point at which there will be some physiological damage
31
Management of status epilepticus
``` IV Benzodiazepine - Diazepam Oxygen Bloods for hypoglycaemia/hypercalcaemia Cultures Sodium valproate to prevent further seizures ```
32
What are psychogenic non-epileptic seizures?
Episodes of movement, sensation or experience that resemble epileptic seizures but without ictal cerebral dischaarges
33
Typical features of psychogenic non-epileptic seizures
``` Eyes closed Partially responsive Very prolonged Gradual onset Can be emotional Violent thrashing Usually tired post-seizure ```
34
Gold standard for diagnosis of psychogenic non-epileptic seizures
Video electroencephalogram
35
Management of psychogenic non-epileptic seizures
CBT, Hypnotherapy, anti-anxiety/depressants
36
What is primary vs secondary head injury?
PRIMARY: damage at time of impact SECONDARY: injury as a result of changes following primary insult eg oedema, haematoma
37
What are the criteria for C-spine immobilisation?
- GCS < 15 at any point - Neck pain/tenderness - Focal neurological deficit - Paraesthesia in extremities - Any other clinical suspicion of C-spine injuries
38
Criteria for CT head within 1 hour
- GCS < 13 initially or < 15 after 2hrs - Suspected open/depressed skull # - Signs of basal skull # - Post-traumatic seizure - >1 episode vomiting
39
Signs of basal skull fracture
``` Echymosis behind ear (battle sign) Epistaxis Subconjunctival haemorrhage Periorbital haemorrhage (raccoon eyes) Loss of sensation to face Haemotympanum ```
40
Define stroke
Sudden onset of focal neurological signs of presumed vascular origin lasting > 24hrs
41
Risk factors for stroke
Hypertension, hypercholesterolaemia, smoking, diabetes, obesity, alcohol, carotid artery disease, recreational drugs eg cocaine, age, male, FH
42
What is the most common site of ischaemic stroke?
Middle cerebral artery
43
What are the different classifications in Bamford Stroke classification?
Total Anterior Circulation Stroke Partial Anterior Circulation Stroke Posterior Circulation Stroke Lacunar Stroke
44
What is a Total Anterior Circulation Stroke as defined by Bamford Stroke classification?
ALL of... 1. Unilateral weakness +/- sensory deficit 2. Homonymous Hemianopia 3. Higher cerebral dysfunction- dysphasia, visuospatial disorder
45
What is a Partial Anterior Circulation Stroke as defined by Bamford Stroke classification?
2 of... 1. Unilateral weakness +/- sensory deficit 2. Homonymous Hemianopia 3. Higher cerebral dysfunction- dysphasia, visuospatial disorder
46
What is a Posterior Circulation Stroke as defined by Bamford Stroke classification?
1 of... 1. Cerebellar or brainstem syndromes 2. Loss of consciousness 3. Isolated homonymous hemianopia
47
What is a Lacunar Stroke as defined by Bamford Stroke Classification?
No evidence of higher cerebral dysfunction and 1 of... 1. Unilateral weakness +/- sensory deficit 2. Pure sensory stroke 3. Ataxis hemiparesis
48
Investigations of Stroke
CT head scan within 24hrs of onset MRI head if unsure/possible haemorrhagic Carotid Dopplers if anterior circulation
49
Management of Stroke (ischaemic)
Aspirin Thrombolysis- Alteplase <4.5hrs Thrombectomy if NIHSS score > 10 Anticoagulation from 2wks after event
50
Management of Stroke (haemorrhagic) in a person on Warfarin
Reverse Warfarin: - Vitamin K takes 6-8hrs - Prothrombinex-VF if immediate
51
Features of Tension Headache
``` Generalised headache- bilateral pressure + tightness around head Non-pulsating No nausea Spreads into or arises from neck Mild-moderate ```
52
Most common trigger of tension headaches
Stress
53
How long do tension headaches typically last?
30 mins - 7 days
54
Management of tension headaches
1. Simple analgesia + reassurance 2. Alternative to NSAID eg Naproxen 3. Alternative therapies eg Acupuncture 4. Amitriptylline
55
Which is the only headache more common in men?
Cluster headache
56
Risk factors for cluster headache
Alcohol, smoking, brain injury, FH, histamine, GTN
57
Features of cluster headache
Severe unilateral orbital, supraorbital, temporal pain Lasting 15 mins - 3hrs Abrupt onset and cessation Associated with lacrimation, nasal congestion, rhinorrhoea, miosis, ptosis, eyelid oedema Can't sit still
58
Management of cluster headache (acute)
Subcut Sumatriptan 100% O2 Topical lidocaine IN
59
Prevention of cluster headache
During cluster: Prednisolone, Ergotamine | Prevention of cluster: Verapamil, Lithium
60
What is Hydrocephalus?
Accumulation of CSF within the brain --> raised ICP
61
What is the aetiology of Hydrocephalus?
Accumulation of CSF within the brain --> raised ICP Due to obstruction of ventricular drainage Pus- bacterial meningitis Blood- SAH or intraventricular haemorrhage Posterior fossa tumours Spina Bifida
62
Investigations of Hydrocephalus
CT/MRI | LP CONTRAINDICATED
63
Management of Hydrocephalus
CSF diversion- external ventricular drain, CSF shunt etc
64
Causes of raised Intracranial pressure
Mass- haematoma, tumour, abscess Oedema Increased CSF Increased cerebral blood volume- vasodilatation, venous obstruction
65
Presentation of raised intracranial pressure
Headache, vomiting, diplopia, blurred vision, drowsiness, papilloedema, limitation of upward gaze, fixed dilated pupil
66
Management of raised intracranial pressure (immediate)
Mannitol- osmotic diuresis | Burr hole/craniotomy
67
What is cushing's triad?
Signs of raised intracranial pressure 1. Hypoventilation 2. Bradycardia 3. Hypertension
68
What is the equation for cerebral perfusion pressure?
Cerebral perfusion pressure = MAP - intracranial pressure
69
What is Syncope?
Transient global cerebral hypoperfusion
70
Types of syncope (3)
- Reflex- vasovagal, situational, carotid sinus hypersensitivty - Cardiogenic- arrhythmias, cardiac ischaemia, structural heart disease - Orthostatic hypotension
71
Investigations of syncope
ECG, CT/MRI, EEG
72
GCS Scoring
``` Eye opening /4 1. None 2. To pain 3. To voice 4. Spontaneously Verbal response /5 1. None 2. Groans 3. Inappropriate words 4. Confused speech 5. Orientated Motor response /6 1. None 2. Extension to pain 3. Flexion to pain 4. Withdraws from pain 5. Localises to pain 6. Obeys commands ```
73
Describe MRC Power grading
``` 0 = no muscular contraction 1 = visible muscular contraction but no mvmt 2 = mvmt at joint but not against gravity 3 = mvmt against gravity but not resistance 4 = mvmt against some resistance but not full strength 5 = full strength ```
74
Describe reflex grading
``` 0 = Absent 1 = Hypoactive 2 = Normal 3 = Brisk/Hyperactive 4 = Markedly hyperactive with clonus ```
75
Causes of UMN signs
Tumour, masses, inflammation, MS, stroke, myelopathy
76
UMN signs
Spastic gait Hypertonia Hyperreflexia Babinski- upgoing plantars Ankle clonus Hoffman's sign (flicking middle finger makes index finger twitch) Pyramidal weakness- flexors > extensors in arms, opposite in legs
77
Causes of LMN signs
GBS, peripheral neuropathy, myasthenia gravis, meningitis
78
LMN signs
``` Flaccid weakness Hyporeflexia Hypotonia Fasciculations Wasting ```
79
``` Nerve root for the following reflexes: Biceps Triceps Knee jerk Ankle jerk ```
Biceps- C5/6 Triceps- C6/7 Knee jerk- L3/4 Ankle jerk- S1
80
What is the dorsal column medial lemniscal pathway responsible for?
Fine touch Vibration Proprioception
81
What is the anterior spinothalamic pathway responsible for?
Crude touch | Pressure
82
What is the lateral spinothalamic pathway responsible for?
Pain | Temperature
83
What is the spinocerebellar pathway responsible for?
Proprioception
84
What is the pyramidal tract responsible for?
Voluntary muscle control of body and face
85
What are the extra-pyramidal tracts responsible for?
Involuntary and automatic control of muscle
86
What is the vestibulo-spinal tract responsible for?
Balance + posture
87
What are the extra-pyramidal tracts?
1. Vestibulospinal 2. Reticulospinal 3. Rubrospinal 4. Tectospinal
88
What is the reticulospinal tract responsible for?
Voluntary movements and muscle tone
89
What is the rubrospinal tract responsible for?
Fine control of hand movements
90
What is the tectospinal tract responsible for?
Movements of head in response to visual stimuli
91
What are the 12 Cranial nerves?
1. Olfactory 2. Optic 3. Oculomotor 4. Trochlear 5. Trigeminal 6. Abducens 7. Facial 8. Vestibulocochlear 9. Glossopharyngeal 10. Vagus 11. Accessory 12. Hypoglossal
92
What is the function of the Olfactory nerve?
Smell
93
What is the function of the Optic nerve?
Visual acuity, colour vision, visual fields, visual inattention
94
What is the function of the Oculomotor nerve?
Eye movements | Pupil constriction
95
What is the function of the Trochlear nerve?
Superior oblique- depresses and internally rotates the eye
96
What are the components of the Trigeminal nerve?
Opthalmic, maxillary and mandibular branches
97
What is the function of the Abducens nerve?
Lateral rectus- abducts
98
What is the function of the Facial nerve?
Motor to face, taste to anterior 2/3 tongue
99
What is the function of the Vestibulocochlear nerve?
Hearing
100
What is the function of the Vagus nerve?
Motor to palate
101
What is the function of the Accessory nerve?
Sternocleidomastoid + trapezius
102
What is the function of the Hypoglossal nerve?
Tongue motor
103
Red Flags of Headache
- Thunderclap - Jaw claudication - Atypical dural- >1hr or motor weakness - Associated with postural change/coughing - New onset headache with Hx of cancer - Unilateral red eye - Rapid progression of neuro deficit/cognitive impairment/personality change - Hx of HIV/immunosuppression - New onset headache age > 50 - Waking from sleep - Worsening over weeks or longer
104
Features of migraine
``` +/- aura Unilateral, pulsating, moderate pain N&V Photophobia/Phonophobia Lasts 4-72hrs untreated ```
105
Triggers for migraine
``` CHOCOLATE Chocolate Hangovers Orgasms Cheese OCP Lie-ins Alcohol Tumult (loud noise) Exercise (Menstruation + stress) ```
106
Management of migraines
1. Simple analgesia + Sumatriptan 2. Propranolol +/- Amitriptylline 3. Topiramate
107
Management of nausea and vomiting in migraine
Metoclopramide
108
Organism causing Meningococcal disease
Neisseria meningitidis
109
Risk Factors for meningitis
Young, immunosuppression, smoking, spinal procedures, diabetes, crowding
110
Most common cause of meningitis
Viral infection
111
Presentation of Meningitis
``` Non-blanching petechial/purpuric rash Cold extremities, skin mottling Fever Neck stiffness Bulging fontanelle Photophobia Kernig's sign Brudzinski's sign ```
112
What is Kernig's sign?
Seen in Meningitis | Pain and resistance on passive knee extension with hips fully flexed
113
What is Brudzinski's sign?
Seen in Meningitis | Hips flex on bending head forward
114
What is tested on Lumbar puncture in Meningitis?
WCC, Gram stain, Glucose, protein, lactate, culture, Meningococcal + Pneumococcal PCR
115
What does lumbar puncture show in bacterial meningitis? (appearance, opening pressure, WBC, glucose, protein)
``` A: Cloudy/turbid Opening pressure elevated WBC elevated > 100- primarily lymphocytes Glucose low Protein elevated ```
116
What does lumbar puncture show in viral meningitis? (appearance, opening pressure, WBC, glucose, protein)
``` A: Clear Opening pressure normal (or elevated) WBC elevated- primarily lymphocytes Glucose normal Protein elevated ```
117
hat does lumbar puncture show in fungal meningitis? (appearance, opening pressure, WBC, glucose, protein)
``` A: Clear or cloudy Opening pressure elevated WBC elevated Glucose low Protein elevated ```
118
hat does lumbar puncture show in TB meningitis? (appearance, opening pressure, WBC, glucose, protein)
``` A: Opaque, if left settles to form a fibrin web Opening pressure elevated WBC elevated Glucose low Protein elevated ```
119
Management of meningitis
Immediate: IM Benzylpenicillin Viral: Aciclovir for herpes/encephalitis, Ganciclovir for CMV Bacterial: Ceftriaxone IV 7 days Dexamethasone
120
Management of close contacts in meningitis
Ciprofloxacin/Rifampicin
121
Risk factors for a brain tumour
Ionising radiation, immunosuppression, Neurofibromatosis, Tuberous sclerosis, Li-Fraumeni syndrome
122
What are the most common primary sites of brain mets?
``` Brain Mets Can Kill Lots Breast Melanoma Colon Kidney Lung ```
123
Clinical features of brain tumour
``` Headaches worse in the morning N&V Seizures Focal neurological deficits Behavioural change Papilloedema Raised ICP ```
124
Investigation of suspect brain tumour
Urgent MRI within 2 weeks
125
Management of brain tumour
Surgical resection External beam radiotherapy- 1st line for mets Chemo Corticosteroids for raised ICP
126
What is the first line treatment for brain mets?
External beam radiotherapy
127
Differentials of a ring-enhancing lesion on CT brain
DR MAGICAL D: demyelinating disease (classically incomplete rim of enhancement) R: radiation necrosis or resolving haematoma M: metastasis A: abscess G: glioblastoma I: infarct (subacute phase), inflammatory - neurocysticercosis (NCC), tuberculoma C: contusion A: AIDS L: lymphoma (this appearance more common in immunocompromised)
128
Define vertigo
An illusion of movement, of the patient or surrondng, always worsened by movement
129
Causes of vertigo
Central: MS, migraine, alcohol, acoustic neuroma, cerebellar infarct Peripheral: Labyrinthitis, Vestibular neuritis, BPPV, Meniere's, Ototoxicity
130
General Management of vertigo
Prochlorperazine, Cyclizine, Promethazine
131
What is the most common cause of vertigo?
Benign Paroxysmal Positional Vertigo
132
What is the peak age for Benign Paroxysmal Positional Vertigo?
Age 40-60
133
What is the aetiology behind Benign Paroxysmal Positional Vertigo?
Otoliths detach and stimulate hair cells
134
Causes of Benign Paroxysmal Positional Vertigo
Idiopathic | Head injury, post-viral, surgery
135
Presentation of Benign Paroxysmal Positional Vertigo
Episodes of vertigo provoked by head movement Worse to one side Attacks sudden onset and last 20-30 seconds Resolve once head is kept still Worse in mornings Nausea
136
Diagnosis of Benign Paroxysmal Positional Vertigo
Dix-Hallpike maneouvre
137
Management of Benign Paroxysmal Positional Vertigo
Epley maneouvre | Self-limiting in weeks
138
Can people drive with Benign Paroxysmal Positional Vertigo?
Only once symptoms controlled
139
Causes of encephalitis
HIV, Herpes simplex, CMV, TB, Lyme disease, parasite
140
Presentation of encephalitis
Classic triad: 1. Fever 2. Headache 3. Altered mental status
141
Management of encephalitis
Urgent hospital admission | Aciclovir IV
142
What risk score is used for risk of stroke after TIA?
``` ABCD2 score Age > 60 BP > 140/90 Clinical features: - Unilateral weakness (2) - Speech disturbance (1) Duration: - > 60 mins (2) - 10-60 mins (1) - < 10 mins (0) Diabetes (1) ```
143
What is ABCD2 score?
``` Risk of stroke after TIA: Age > 60 BP > 140/90 Clinical features: - Unilateral weakness (2) - Speech disturbance (1) Duration: - > 60 mins (2) - 10-60 mins (1) - < 10 mins (0) Diabetes (1) ```
144
What is a TIA?
Sudden onset of focal neurological signs of vascular origin lasting < 24hrs
145
Investigations after TIA
MRI Carotid dopplers 24hr ECG
146
Management of TIA
Aspirin Clopidogrel if high-risk Carotid endarterectomy + stenting for 70-99% stenosis
147
What is the most common aetiology of a subarachnoid haemorrhage?
Rupture of a saccular/berry aneurysm in the circle of willis
148
Risk factors for subarachnoid haemorrhage
Hypertension, smoking, cocaine, alcohol, PKD, Ehler-Danlos, coarctation of the aorta
149
Presentation of subarachnoid haemorrhage
``` Thunderclap headache Sudden death/reduced GCS Meningism Seizures Can have 3rd nerve palsy and extensor plantar response ```
150
Investigations of subarachnoid haemorrhage
CT then angiography | LP- xanthochromia
151
Lumbar puncture findings in SAH
Xanthochromia
152
Management of Subarachnoid haemorrhage
Nimodipine for vasospasm Surgical clipping, endovascular coiling Ventricular drainage
153
Causes of Extradural haemorrhage
Traumatic: fractured temporal/parietal bone after trauma to temple- damage to middle meningeal artery/vein Non-traumatic: coagulopathy, thrombolysis, vascular malformation
154
What is the aetiology of traumatic extradural haemorrhage?
Fractured temporal/parietal bone after trauma to temple --> damage to middle meningeal artery/vein
155
Presentation of extradural haemorrhage
Trauma to head --> LOC --> lucid interval after which patient deteriorates Headache, N&V, seizures, raised ICP, Cushing's triad, Unequal pupils, CSF otorrhoea/rhinorrhoea with tear of dura
156
Investigations of extradural haemorrhage
X-ray skull- shows fracture | CT- haematoma/air- biconvex/lentiform
157
Management extradural haemorrhage
ABC, fluids Mannitol for raised ICP Burrholes
158
What is the most common aetiology of subdural haemorrhage?
Traumatic- tearing of bridging veins- mainly rapid deceleration of head (RTA)
159
Causes of subdural haemorrhage
Rapid deceleration of head in RTA Shaken baby Non-traumatic- vascular malformations, meningitis
160
Risk factors for subdural haemorrhage
``` Cerebral atrophy (elderly) Alcoholism ```
161
Presentation of subdural haemorrhage
Acute LOC then lucid interval then LOC when haematoma forms | Chronic progressive symptoms 2-3wks later
162
Investigations of subdural haemorrhage
CT for acute, with contrast if subacute - crescent shaped haematoma
163
Management of subdural haemorrhage
ABC Emergency craniotomy + clot evacuation Burr holes
164
Which disease is associated with temporal arteritis?
Polymyalgia rheumatica
165
Presentation of temporal arteritis
``` Pain with eating/brushing hair Temporal headache Scalp tenderness, facial pain Jaw claudication Fever, Malaise ```
166
Features of temporal arteritis on examination
On palpation of the temporal artery- absent, beaded pulse, tender and enlarged
167
Investigations for temporal arteritis
Raised ESR | Temporal artery biopsy: predominance of mononuclear cells or granulomatous inflammation, multinucleated giant cells
168
What is found on temporal artery biopsy in temporal arteritis?
Predominance of mononuclear cells or granulomatous inflammation, multinucleated giant cells
169
Management of temporal arteritis
40mg Prednisolone daily 60mg if claudication or visual Sx Low dose aspirin + PPI
170
3 Key features of Parkinsonism
1. Resting tremor 2. Rigidity 3. Bradykinesia
171
What is the aetiology of Parkinson's in the brain?
Lewy bodies + neuronal cell death in the pars compacta of substantia nigra causing slowing of the basal ganglia
172
What is the average age of onset of Parkinson's?
Age 60yrs
173
What 2 things reduce the risk of Parkinson's?
1. Smoking | 2. Caffeine
174
Causes of peripheral neuropathy
DAVID: - Diabetes Mellitus - Alcohol - Vitamin deficiency (B12/B1) / Vasculitis - Immune- Guillain-Barre / Inherited- Charcot-Marie-Tooth - Drugs- Isoniazid, Vincristine
175
Patient has hyperacute limb and facial weakness, pronator drift and upgoing plantars, what is the pathology?
Vascular UMN In the brain --> Stroke
176
Patient has insidious onset weakness in both legs, with a sensory level, upgoing plantars and brisk reflexes, what is the pathology?
Compression/degeneration UMN In the spine --> Spinal tumour
177
Patient has insidious onset sensory change in the hand (lateral 3 fingers), wasting, what is the pathology?
Compression/degeneration LMN Peripheral nerve --> Carpal tunnel syndrome
178
Patient has subacute onset weakness in both shoulders and thighs and a raised CK, what is the pathology?
Inflammatory Muscle problem --> Polymyositis
179
Causes of seizure
``` Hypoglycaemia Alcohol withdrawal Metabolic disturbance Infection (meningitis/encephalitis) Stroke Neoplasm Drug overdose/toxicity Inadequate anticonvulsant levels ```
180
Investigations of seizure
``` FBC, U&E, LFT, Ca2+, MG2+, glucose, clotting ECG Toxicology? ABG? CT head? ```
181
Management of a seizure- <5mins
Time, monitor, oxygen, supportive care
182
Management of a seizure- >5mins
``` Benzodiazepines: - IV Lorazepam 4mg - Buccal/IM Midazolam - PR Diazepam If unresponsive- load on anticonvulsant- Levetiracetam ```
183
Neurological examination findings in Parkinson's
1. Inspection: mask-like facies, tremor (asymmetrical coarse pill-rolling resting tremor) 2. Tone: increased, cogwheel rigidity 3. Gait: shuffling, loss of arm swing, difficulty turning 4. Voice: slow, faint, monotonous speech 5. Bradykinesia Power, coordination, sensation and reflexes all normal
184
Options for a NBM Parkinson's patient
Timing of Parkinson's meds is critical 1. NG tube insertion for meds 2. Rotigotine patch
185
Which anti-emetics are safe to use in Parkinson's?
Domperidone and Ondansetron are safe Prochlorperazine and Metochlopramide contraindicated Cyclizine can worsen symptoms
186
What drugs are contraindicated in myasthenia gravis?
MANY Beta blockers Many antibiotics Psych drugs
187
Management of Vestibular neuritis
Vestibular sedatives- Betahistine | Will resolve in a few days
188
What is the time frame of onset of Vestibular neuritis?
Subacute onset over a few hours
189
Presentation of Meniere's disease
Vertigo N&V Associated with hearing loss, tinnitus and sense of fullness in ear
190
What does audiogram show in Meniere's disease?
Low-frequency hearing loss
191
Management of Meniere's disease
Decrease sodium intake | Thiazides
192
Contraindications to thrombolysis in stroke
``` Haemorrhage High BP Major surgery Anticoagulants Recent stroke Seizure at onset Head injury ```
193
What investigation needs to be done after thrombolysis?
CT 24hrs after thrombolysis to exclude haemorrhage before starting aspirin
194
What type of stroke must somebody have to be considered for thrombectomy?
Anterior circulation large vessel occlusion
195
How long after a stroke can somebody not drive for?
1 month then may need further assessment

Finals Revision (13 decks)

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