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Flashcards in Neuro Deck (62)
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1

When do we prescribe Gabapentin?

Epilepsy. For seizures/ neuropathic pain.

2

What drug should you prescribe for aggression/ chorea?

Dopamine receptor Antagonist

eg Risperidone

3

Bacterial Meningitis causes

#1 Streptococcus pneumoniae - most common overall

Listeria monocytogenes - pregnant

Neisseria meningitidis

Streptococcus agalactiae - neonates

4

Migraine Mx:

Prophylactic: Topiramate/ propanolol

1L: NSAID, paracetamol, TRIPTAN

2L:

3L: Amitriptyline

5

Viral Meningitis causes

= more common than bacterial

Enteroviruses
- Echovirus
- Coxsackievirus
- Poliovirus

Herpes Simplex Virus

6

Management of viral meningitis

Nowt specific

Supportive.

Acyclovir for HSV

7

How to tell the difference between bacterial and viral meningitis?

Lumbar puncture:
- Viral: lymphocytosis, normal protein/ glucose
- Bacterial: low glucose, raised protein

Also bacterial: Kernig's + Brudzinski's signs

8

Management of bacterial meningitis

- in primary setting
- secondary setting
- >3months age
- <3months age

- prophylaxis

GP + non-blanching rash: IM Benzylpenicillin

Hospital:
IV 2g Ceftriaxone

or IV Cefotaxime + amoxicillin/ampicillin if <3months (listeria)
+
IV Dexamethasone if purulent CSF/ >3months with bacteria)

Prophylaxis: Ciprofloxacin or Rifampicin

Strep-resistant -Vancomycin

9

Define haemorrhagic stroke

Rupture of cerebrospinal artery

10

Management of an Ischaemic Stroke

ABCDE

IV Alteplase WITHIN 4.5hr onset - Thrombolysis

CT Head - new stroke?

Aspirin 24hr after tx

(Do not lower BP acutely UNLESS malignant; may impair cerebral perfusion)

11

Contraindications to Thrombolysis for Stroke

>4.5 hr since onset

Recent head trauma, GI/ intracranial haemorrhage, recent surgery. acceptable BP, platelet count/ INR/BP

12

When can a Mechanical Thrombectomy be formed in Ischaemic Stroke patients?

Anterior: within 6hr onset

Posterior: within 12hr onset

13

Stroke prevention/ Chronic stroke management?

HALTSS

Hypertension 2wk AFTER stroke
Antiplatelet: Clopidogrel/ Warfarin (AF)/ rivaroxaban
Lipid-lowering: Atorvastatin
Tobacco: stop smoking
Sugar: Diabetes screening
Surgery: Carotid endarterectomy IF carotid stenosis >50%

14

How are anterior strokes classified?

Anterior:
a) Contralateral hemiplegia/paresis AND
b) Contralateral homonymous hemianopia AND
c) Higher cerebral dysfunction (aphasia, neglect)

1. TACI = ACA + MCA
2. PACI = a+b OR c = ACA or MCA

LACI = pure motor/ pure sensory/ sensorimotor/ ataxic hemiparesis. NO higher dysfunction.

15

How are posterior strokes classified?

Posterior:
a) Cerebellar dysfunction OR
b) Conjugate eye movement disorder OR
c) Bilateral motor/sensory deficit OR
d) Ipsilateral cranial nerve palsy with contralateral motor/sensory deficit OR
e) cortical blindness/ isolated hemianopia

= POCI

16

Which arteries do POCIs involve?

Vertebrobasilar arteries + associated branches

> cerebellum, brainstem, occipital lobe

17

Define haemorrhagic stroke

Weakened cerebral vessels lead to rupture and haematoma formation.

18

What are the two types of haemorrhagic stroke?

Intracerebral haemorrhage - 75%

Subarachnoid haemorrhage - 25%

19

Strong risk factors for haemorrhagic stroke

Age, male, FHx, haemophilia, anticoagulation therapy, hypertension, vascular malformations.

Cocaine, amphetamines

20

Acute management of haemorrhagic stroke

Decompressive hemicraniectomy

BP Control <140/80

21

Pt presents with Lower back pain, saddle parasthesia and are incontinent.

Investigation? Other presentations Cause? Likely diagnosis? Mx?

Cauda Equina Syndrome

- sudden loss of sphincter control

Urgent MRI + Surgical decompression < 48hr

Cause: lumbar disc herniation L4-S1

22

Young pt presents with sudden severe back pain following a gymnastics competition.

Likely diagnosis?

Vertebral disc degeneration

23

Pt presents with severe pain and stiffness of their shoulder and neck.

Likely diagnosis? Where else could they be stiff?

Polymyalgia rheumatica

Affected areas: neck, shoulders, hips, lumbar spine

24

Management of Acute Cord Compression

Steroids - dexamethasone (if malignancy)

Surgical decompression

25

Cord compression presentations

Acute UMN signs + sensory disturbance below the lesion

Bladder/ bowel incontinence

"weak, hyperreflexive legs + paraesthesia "

26

Management of all seizures

Lamotrigine, Levetiracetam, Valproate

27

Mx of Focal Seizures

Carbamazepine, Gabapentin, Phenytoin

28

Mx of Absence seizures

Ethosuximide

29

Mx of epilepsy + heart problems

Digoxin (inhibits Na/K/ATPase)

30

Which epilepsy drug is CI in pregnancy

Valproate = teratogenic