Symptom treatment for MS: - fatigue - spasticity - bladder dysfunction - ossciloscopia

- fatigue = amantadine + CBT - spasticity = baclofen + gabapentin - bladder dysfunction - -> residual volume = self catherisation - -> no residual volume = anticholinergics - ossciloscopia = gabapentin

Neuro guidelines Flashcards by Marc Huttman

investigations following first seizure

EEG and brain MRI

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investigation to determine true from pseudoseizure

raised serum prolactin for a couple hours

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when do you NORMALLY start AEDs?

After second seizurE

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what would make you start AEDs after a first seizure

EEG shows unequivocal epileptiform activity
There is a structural abnormality on brain MRI
There is a persisting neurological deficit
Family or family considers risk of second seizure unacceptable

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driving ban after 1st seizure

6 months

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how long do you need to be seizure free for to drive if you have epilepsy

12 months

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1st line epilepsy meds:

generalised
absence
partial
pregnancy

generalised = valproate
absence = valproate or ethosuximide
partial = carbamazepine
pregnancy = lamotrigine (usually 2nd line as well)

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status epilepticus and timing

0m = O2 and ABCDE
5m = buccal midaz or IV loraz
10m = IV lorazepam
15m = escalate + phenytoin
45m = intubate

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Parkinson’s investigations

clinical diagnosis

Use DaT scan (SPECT) and MRI brian to exclude P+ syndromes and to ensure diagnosis if unsure

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1st line for PD and SE

if motor Sx = levodopa and carbidopa/benserazide
if no motor Sx predominate = can chose from any
SE = dyskinesia

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2nd line PD and SE

non-ergot derived dopamine agonists (bromocriptine, cabergoline, pergolide, ropinorole) SE = impulse, hallucinations
MAO-Bi = seleginine. SE = ?
COMTi = entacapone. SE = orange urine and diarrhoea

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Mx for drug induced parkinsonism

procyclidine

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investigations that help MS diagnosis

contrast brain MRI shows dawson fingers and periventricular plaques. McDonald criteria.
CSF shows oligoclonal bands (doesn’t NEED to be present for diagnosis)

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Acute relapse of MS Mx

IV methylprednisolone for 5d, shortens flares

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1st line DMARD for MS and criteria to get it

beta interferon

need 2 relapses in past 2 years and also be able to walk 10-100m unaided

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2nd line drugs for MS

glatiramer
natalizumab
fingolimod

glatiramer = immune decoy
natalizumab = alpha4beta1 inhibitor preventing leucocyte transmission through the BBB
fingolimod = sphingosine receptor modulator preventing lymphocytes leaving the lymph nodes

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Symptom treatment for MS:

fatigue
spasticity
bladder dysfunction
ossciloscopia

fatigue = amantadine + CBT
spasticity = baclofen + gabapentin
bladder dysfunction
-> residual volume = self catherisation
-> no residual volume = anticholinergics
ossciloscopia = gabapentin

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when are anticholinesterses CI in alzheimers

DONEPEZIL is CI bradycardia. not the others

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name 3 anticholinesterases for AD

galantaine
rivastigmine
donepezil

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what is 1st and 2nd line in AD

1st = anticholinesterases
2nd = memantine

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How do you treat FTD

You cant really. acetylcholinesterases/memantine don’t work because those systems aren’t affected the same way as AD and LBD

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Lewy body dementia Tx

same as AD

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ROSIER score

rule out of stroke in the emergency room
any score of >0 means stroke is likely
+1 = speech problem, face/arm/leg weakness, vision problem
-1 = TLOC, seizure, syncope

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Immediate Mx of ischaemic stroke

Always = 300mg aspirin for 2 weeks
within 4.5 hours = thrombolyse
within 6 hours (or 24 if have done scan and ischaemic bit is still small) if MCA/ACA proximal = thrombectomy ALONGSIDE thrombolysis

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Immediate Mx of haemorhagic stroke

control BP to 100-120 with labetolol and consult neurosurgery

Ongoing Mx of ischaemic stroke

After 2w, stop aspirin and give clopidogrel lifelong 75mg

What is clopidogrel is CI, what do you give for long term secondary preventions

aspirin + dipyridamole

DVT prophylaxis of stroke in hospital

intermitten pneumatic calf devices

when do you do a carotid endarterectomy after a stroke

if stenosis >50%

when do you start a statin after a stroke

if cholesterol >3.5

ABCD2 score

``` for TIA age >60 BP 140>90 clinical features = speech 1p, unilateral weakness 2p duration (10-59m, 60+m) = 1 and 2 points diabetes ```

immediate management of TIA

300mg aspirin

when do you NOT give 300mg aspirin in a TIA and what do you do in those cases

anti coagulated/bleeding disorder --> admit for head CT | already on low dose aspirin --> just continue at same dose until TIA appointment

when do you arrange TIA appointment

crescendo TIA = discuss admission now TIA in last 7d = assessment within 24 hours TIA >7d ago = assessment within 7d

drug for life in TIA?

Yes, clopidogrel 75mg as in stroke

first line sedative in delerium

0.5mg haloperidol | CI in PD so use lorazepam instead

investigation for meningitis

Serum PCR and blood culture | LP unless CI (meningococcal septicaemia or raised ICP)

think its meningitis and you're a GP?

Give IM benzylpenicillin as long as it doesn't delay transfer to hospital

empirical Abx for menignitis in hospital depending on age

``` <3m = cefotaxime + amoxicillin 3m-50y = ceftriaxone/cefotaxime >50y = ceftriaxone/cefotaxime + amoxicillin ```

IV antibiotic for specific meningitis bug: - meningiococcal - pneumococcal/hamophilus - listeria --what else do you give to everyone

- M = benzylpenicillin + cefotaxime - P/H = cefotaxime - L = amoxicillin + gentamicin You give dexamethasone alongside first dose of antibiotic to everyone to reduce neuro complication rate

how do you confirm a SAH has occurred

1st do CT head | if negative, check CSF for xanthchromia at least 12 hours later

management for SAH when waiting for surgery

strict bed rest, stool softness, no straining, BP control

medical management for SAH after surgery

21 days nimodipine (CCB) to prevent vasospasm

presentation and Mx of vasospasm post SAH

presents 4-9d after surgery for SAH with focal deficits +/- reduced cognitive function triple H therapy - hypervolaemia, induced hypertension, haemodilution

1st line Ix for Lyme disease

ELISA for antibodies against burrelia burgdorferi can diagnose clinically if symptoms present and bull eye erythema migrans present

Mx of Lyme: - early - disseminated

``` early = doxycycline disseminated = ceftriaxone ``` beware of Jarisch-Herxheimer reaction

Encephalitis best Ix | two other Ixs

Best = MRI shows hyperdensitiy in temporal lobe EEG shows lateralised periodic discharges at 2Hz CSF shows lymphocytosis and elevated protein

Mx of encephalitis

IV aciclovir as most common cause is HSV1

trigeminal neuralgia Mx when do you refer

carbamazepine refer if <50yo or fails to respond to above

Bells palsy Mx | time cutoff for Tx

1mg/kg 10d prednisolone eye care give within 72 hours for best effect

Best Ix for myasthenia gravis | other Ix needed

``` Best = single fibre EMG (trace decreases in amplitude with receptive stimulation) others = CT chest to exclude thymoma Tension test (IV edrophinium) NOT used anymore ```

Mx for Myaesthenia gravis | - flare

flare = prednisolone

Mx for Myaesthenia gravis - ongoing - how do you monitor respiratory function

ongoing = antcholinesterase inhibitor long acting pyridostigmine Monitor with FVC

Mx for Myaesthenia gravis | - crisis

plasmapheresis and IVIG

Guillain barre syndrome: - LP - nerve conduction studies - antibody

- LP shows isolated protein rise - nerve conduction studies (slow response due to demyelination) - anti-GM1

GBS Mx

IVIG

MND Ix

Normal nerve conduction study | EMG shows few APs with normal amplitude + fibrillation

Mx for MND

riluzole and BiPAP at night

acute Mx of migraine 1st and 2nd line

1st = NSAID + oral triptan + paracetamol -------> if <17yrs old use nasal triptan instead 2nd = non-ral metoclopromide/prochlorperazine (beware of dystonic reaction)

cutoff for migraine prophylaxis frequency

2+ per month

migraine prophylaxis Mx 1st and 2nd line adjunct?

1 = propranolol (or topiramate if not woman of childbearing age) 2 = acupuncture ---> can also use riboflavin as adjunct

cluster headache acute Mx

100% oxygen and subcut triptan

prophylaxis cluster headache

verapamil

tension headache acute Mx

NSAID, paracetamol

Tension headache propylaxis

acupuncture (NOT amitriptyline which is often used)

When do you do a head CT within 1 hour after a head injury

``` GCS <15 2 hours after injury GCS <13 on clerking focal neurological deficit post-traumatic seizure 2+ episodes of vomiting open or depressed skull fracture ```

when do you do a head CT within 8 hours after a head injury

Need to have some loss of consciousness and: - be over 65 - be on warfarin or have bleeding disorder - have 30mins amnesia before event - dangerous mechanism of injury (struck by vehicle, ejected from vehicle, fall >1m/5 stairs)

Neuro guidelines Flashcards

(67 cards)