Neuro Flashcards by Kate Lambert

ddx for adolescent syncope
metabolic disturbance (3)
neuro (4)
cvd (1)
tox (1)

metabolic disturbance

hypoglycaemia
hypotension secondary to dehydration
hyponatraemia

neuro

epilepsy
head trauma
subarachnoid haemorrhage
meningitis

cardiac arrhythmia
recreational drug use

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key features of history for adolescent syncope
personal (3)
neuro (6)
CVD (3)
vitals (1)

personal

fhx epilepsy
food intake that day, water intake that day
recreational drug use

fever

neuro sx.

tongue biting during syncope
post ictal confusion following period of unconsciousness
urinary incontinence during syncope
neurological weaknesses or sensation changes
recent head trauma
headache

CVD

chest pain immediately prior
sob immediately prior
palpitations

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peripheral neuropathy - ddx

‘DAMIT BITCH’

diabetic neuropathy
alcohol abuse
medication SE - amiodarone, nitrofurantoin, phenytoin, CTX, levodopa
Inflammatory - Guilliane barre syndrome
Tumours - paraneoplastic syndrome
B12 deficiency - alcoholics, pernicious anaemia, coeliacs, sleeve gastrectomy
Infection - HIV, Hep C, leprosy
Trauma
Connective tissue disorders - SLE, polyarteritis nodosa
Hereditary - Charcot marie tooth

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diabetic autonomic neuropathy - key features
CVD (2)
GI (2)
urology(2)

CVD

orthostatic hypotension
cardiac autonomic neuropathy - resting tachycardia, bradycardia

gastroparesis
diarrhoea

urology

erectile dysfunction
urinary retention

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Rx for painful diabetic peripheral neuropathy

amitriptyline 25mg nocte increase to 150mg
duloxetine 60mg mane, increase to 60mg bd
gabapentin 300mg up to 1200mg per day
pregabalin 75mg bd, increase to 300mg bd

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fits, faints, funny turns - key features on hx

any preceding symptoms - sob, headache, recent illness, heart palps, recent head trauma, auras
onset - sudden, slow
does patient remember event
did they lose consciousness
events after episode - urine incontinence, tongue biting, post ictal drowsiness or confusion
PMHx - epilepsy fainting, cvd, dmt, CVD, previous TIA/CVA
Fhx epilepsy

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ddx for epilepsy
psych (2)
gen med (2)
neuro (3)

psych

vasovagal
pseudoseizure

cardiac arrhythmia
metabolic disturbance

neuro

TIA
migraine
narcolepsy

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causes of provoked seizures
brain (3)
systemic (3)
tox (2)
wildcard (1)

brain
- CVA
- trauma
- meningitis (infection)
systemic
- hyponatramia
- hypoglycaemia
- hypercalcaemia
tox
- ETOH withdrawal
- synthetic cannabinoids (and probably other drugs)

pregnancy - eclampsia

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things to look for in examination post fit faint funny turn

general (3)
neuro (3)
CVD (4)

general
- fever
- cervical spine tenderness on examination
neuro
- neck stiffness
- papillodema
- CN exam abnormalities
CVD
- carotid bruit
- orthostatic hypotension (BP, sitting/standing)
- irregular pulse
- murmurs (heart sounds)

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Initial ix for fit faint funny turns

BSL
FBC
UEC
\+/- ECG
CT head
MRI brain
EEG

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nonmedication management advice following seizure (7)

no driving until 6/12 episode free
no driving 12/12 if dx epilepsy
no bathe or swimming alone
no working at heights
no abseiling, water sports, operating heavy machinery
seizure 1st aid education
mx of status epilepticus

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Multiple sclerosis - key features examination
optic (3)
general neuro (2)
motor neuron (4)
brainstem (2)

optic
- reduced monoocular blurred vision VA 
- central scotomata
- loss of red color vision
general
- unilateral neuro SOS
- unilateral numbness parasthesia

UMN

unilateral spastic paresis - weakness, no muscle atrophy
increased tone no fasiculations or fibrillations
hyperreflexia - deep tendon reflexes
positive babinski/upgoing plantar reflex

brainstem

ataxic gait
internuclear opthalmoplegia

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multiple sclerosis - key investigations

MRI brain + spine with contrast - MS lesions
CSF electrophoresis - oligoclonal bands raised IgG
Evoked vision potential studies

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Multiple sclerosis - McDonald dx criteria (4)

objective evidence of 2 or more lesions
disseminated in time and space
with no better explanation for cause
2 x separate episodes, 2 separate CNS regions

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Multiple sclerosis - ddx for clinically isolated syndrome (acute demyelination)

neuro (3)
nutritional (1)
infection (2)
other (2)

neuro

migraine
cerebral tumour
spinal cord compression

nutritional
- b12 deficiency
infection
- HIV
- syphilis

other

paraneoplastic syndromes
psychiatric distress/somatisation

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myasthenia gravis - key investigations (3)

anti-acetylcholine receptor antibodies +ve
CT scan chest/thorax - detect thyoma or thyroid tumour
Electromyography - EMG

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myasthenia gravis - key features Hx

painless fatigue with exercise
weakness precipitated by stress - cyesis, infection, surgery, emotional
fluctuating symptoms
variable severity of muscle weakness
variable distribution of muscle weakness:
ocular - diplopia,
dysphagia, difficulty chewing, dysphonia/speech, difficulty whistling
limbs proximal to distal, generalised weakness
resp - sob, breathlessness
a/w other autoimmune diseases - SLE, RA, thyroid, pernicious anaemia
FHx
PMHx

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myasthenia gravis - nonmedical management

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referral to consultant neurologist
detect thyoma with ct chest
exclude associated autoimmune disease

myasthenia gravis - treatment

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anticholinesterase inhibitors - pyridostigmine 30mg tds, titrate weekly up to 120mg 4hrly
prednisolone 5mg od, titrate up to 1mg/kg/day max 75mg mane
azathioprine 1.5-2.5mg/kg po od

multiple sclerosis - key features history

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onset of symptoms over days to weeks of:
blurred vision, diplopia
painful eye movement
motor weakness
sensory weakness/parasthesia
unsteady gait
bowel or bladder dysfunction
FHx MS
previous episodes
head trauma
headache
vertigo

Vertigo - central causes (3):

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CVA
cerebral tumour
MS

Vertigo - peripheral causes (4):

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Meniere’s diease
labyrinthitis
Benign paroxsymal postional vertigo
vestibular neuronitis

Vertigo - key features Hx

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any associated tinnitus or hearing loss
preceding viral illness
provoked from change in position
duration of episode
any associated neurological symptoms - weakness, ataxia, confusion, paraesthesia
any associated N+V
medications - ototoxic drugs, antihypertensives
stress/panic attacks
recent head trauma

Headaches red flags

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Age >50yrs
pmhx active or past malignancy
thunderclap headache
1st ever headache with focal neurology
hx recent head trauma
increasing severity or frequency of headache
positional - increases when lying, bending, coughing, straining, valsalva
associated systemic illness - fever, neck stiffness, rash
PMHx - HIV, cancer, immunocompromise
Papilodema
FHX berry aneurysm

headache - history

``` is this worse than previous headaches? severity of headache? where is the pain? does it radiate anywhere? onset - sudden, slowly? any prodromal symptoms? is it made worse by coughing bending straining any fevers, rashes, neck stiffness any vomiting any vertigo or dizziness any vision changes any photophobia PMhx medications any recent trauma ```

Headache - examination

``` vital signs face and scalp - masses, neck stiffness neuro exam - perrla, cn exam, RAPD, fundoscopy for papilloedema CVS exam - HS, carotid bruits ```

headache Ix

CT/MRI for chronic heaache with ?intracranial pathology | CT head/mri for chronic headache with associated neuro SOS

Headache - indication for neurology referral

``` dx uncertain inadequate or no response to treatment condition or disability worsens irretractable or daily headaches urgent t/f to ED if ?CVA/TIA, head trauma, meningitis ```

Ramsay hunt syndrome - key features

Typically presents with a triad of otalgia, cutaneous vesicles in a dermatomal distribution and unilateral facial nerve palsy. cutaneous vesicles in external auditory canal diffuse otitis externa, crusting preauricular ln swelling Pmhx - chicken pox as child

Ramsay hunt syndrome - mx

‘facial nerve recovery’ - aciclovir 800mg 5 times per day for 7-10days prednisolone - 1mg/kg <75mg po mane for 7-14days ‘management of postherpetic neuralgia’ - pregabalin 75mg - 300mg po bd, gabapentin 100-300mg po tds ‘eye care’ - regular lubricating eye drops throughut day, taping eye shut at night clinical review at 7 days to check response to treatment educate on sos of opthalmic complications

facial weakness - ddx

``` Stroke/TIA multiple sclerosis otitis media, schwannoma Bells palsy(idiopathic) Ramsay Hunt Syndrome Myasthenia gravis head trauma temporal bone fracture cerebral tumour, parotid tumour, lymphoma neurofibromatosis ```

facial weakness - Peripheral nerve palsy - key features examination

``` weakness of forehead, eye and mouth weakness in raising and furrowing brow smooth forehead/no wrinkles weakness in blinking/closing eye weakness in grimacing and smiling flattening of nasolabial fold ```

facial weakness - upper motor neuron/CNS - CVA key features examination

lower face only nasolabial fold flattening weakness in smiling and grimacing sparing forehead, brows and eyes

Bells palsy - mx

Advise patients that facial nerve recovery can take several weeks or months. eye care - drops and tape shut eyelid at night cover and protect eye in windy and dusty conditions prednisolone 1mg/kg <75mg po mane for 5 days educate on sos corneal abrasion/ulcer

Stroke risk assessment after suspected TIA (ABCD2)

age> 60 (1) bp >140/90 (1) Clinical features - unilat weakness (2) speech disturbance only (1) duration <10min (0), 10-59mins (1), >60mins (2) diabetes mellitus (1)

Management of chillblains

``` betamethsone 0.05% topically bd keep warm and dry peripheries exercise indoors avoid cold exposure nifedipine CR 20mg od ```

Raynaud's phenomenon management

``` avoid cold exposure keep warm and dry peripheries quit smoking avoid b-blockers of if severe trial nifedepine 20-30mg ```

DEMENTIA mnemonic - causes of cognitive decline

Drugs Eyes and Ears (cant see/hear properly) Metabolic - hypo/hyper - Na, Ca, Thyroid, UEC Emotion - depression Nutrition - vit b12 def Trauma or Tumour - Intracranial bleed or mass Infection - uti, pneumonia Alcohol, Alzheimers, atherosclerosis(CVA)

Indication for geris referral

unclear diagnosis atypical presentation psychotic or severe behavioural issues commencement of anti dementia medications

Dementia - ddx (4 Ds)

depression delerium drugs

Dementia/cognitive decline - Ix

``` FBC ESR LFT Calcium TFT B12 CT brain ```

HINTS exam

Head impulse test - positive = eyes saccade to refocus = peripheral nystagmus = unilateral, horizontal - peripheral test of skew = cover/uncover = eye remains motionless after uncover = peripheral

oligoclonal bands + raised IgG in CSF electrophoresis suggests what disease

multiple sclerosis

myasthenia gravis - pathohysiology

autoimmune disease, destroys nicotiniv acetylcholine receptors

Neuro Flashcards

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