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Neuro misc Flashcards

1
Q

treatment for Non-epileptic attacks?

A

rectal benzo/ buccal
midazolam to try and abort the attack.

Ambulance: another dose of
lorazepam?

A-E

If so can give one further dose of lorazepam IV
when reach hospital.

Then move onto IV phenobarbital or phenytoin,

Anaesthetic agents.

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2
Q

Treatment for tonic clonic siezure?

A

Sodium valproate and lamotrigine.

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3
Q

How do you treat focal siexures?

A

Carbamazepine and lamotrigine.

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4
Q

how do you treat an abscent seizure?

A

NOT CARBAMAZEPINE, valproate,

ethosuximide.

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5
Q

Treatment for GCA

A

Prednisolone (45mg) and Aspirin (75mg) with a PPI

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6
Q

Characteristic feature of GCA?

A

Scalp tenderness and palpabale tender and reducded pulsation temporal arteries. temporal loss of vision - maybe in one eye. temporaal artery educed pulsations

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7
Q

Investigations for GCA

A

Raise ESR and CRP
ANCA negative
Raise aLP (alkaline phosphotase)
reduced Hb

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8
Q

Who isGCA most common in?

A

over 50 females. if under 50, suspect takayshu

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9
Q

what is a seizure?

A

A paroxysmal event in which changes in behaviour, sensation or cognition are affected by excessive hypersynchronous neuronal discharges in the brain.

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10
Q

What is epilepsy?

A

A recurrent tendency to seizures:
2 unprovoked seizures
1 seizure and EEG evidence of a tendency towards seizures.

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11
Q

Investigations for seizures?

A

Focal or considering neurosurgery do MRI.
CT if secondary to an injury
EEG to support diagnosis.
ECG
Exclude other causes- glucose, U&E, calcium, LFT.

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12
Q

Alzheimer’s treatments?

A

anticholinesterases (donepazil)

memantine (anti glutamate

control RF
MDT

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13
Q

Signs of meningitis?

A 
Neck stiffness
Headache
Non blanching rash 
Photophobia
Vomiting
Reduction in level of consciousness/ seizures
Signs of shock 
Signs of raised ICP. 
Fever
If evidence of focal neurological deficit, think encephalitis instead.
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14
Q

CSF of viral meningitis

A

decrease WBC and protein
normal glucose
clear

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15
Q

CSF of bacterial meningitis?

A

Increase neutraphils and protein
decrease glucose
cloudy

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16
Q

treat a subarachnoid haemorrhage?

A

Nimodipine CCB to prevent ceberal artery bursting. fluids and rest

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17
Q

Treat GCA?

A

High dose oral prednisolone (40mg) + low dose aspirin (75mg)
+
PPI (both medications associated with gastrointestinal toxicity)

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18
Q

what is a focal seizure with consciousness?

A

jerk,y, seld aware, memory retained

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19
Q

Focal seizure with dysphagia and motor impairment?

A

proble with the frontal lobe

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20
Q

Focal seziure with numbeness, pain, tingling? (sensation impairent)

A

problem in parietal lobe

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21
Q

Wich siezure do u not treat with carbamazepine?

A

Absence - treat with Na Valporate and ethosuximide

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22
Q

Name the dementias?

A

Alzheimers
Vascular
Frontotemporal
Lewy body

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23
Q

What plaques would u find in alzheimers?

A

B amyloid. links to APP gene.

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24
Q

how do you test memory and alzheimers? (cognitive imparirment)

A

6CIT questions

ask about year, time, counting, address, current time etc, month, year and repetition. assess on confidence

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25
Treat Alzheimer's?
MDT, control vascular risk factors, anticholinesterases (donepazil) and memantine (anti glutamate).
26
What is Kernig's sign?
supine hip flexed. knee cant be fully extended
27
What is Brudzinski's sign?
neck rigidity. Flextion of nech causes flection of legs and thighs
28
What are the two signs of meningitis?
Kernig's and Brudzinski's
29
LP for TB?
clear, raised lymphoctyes, very raised protein, very low glucose
30
Encephalitis CSF?
clear, normal/raised protein and lymphocytes. normal or low gloucose
31
which meningisitse has cloudy CSF?
bacterial
32
Treat meningitis?
IV 3rd generation cephalosporin e.g. ceftriaxone | IM ben pen if community
33
Name a cephalosporin?
ceftriaxone
34
Features of cauda equina?
Urinary retention Loss of ankle and knee reflexes Severe radicular pain esp. down backs of legs, Saddle anaesthesia, perianal numbness Sexual dysfunction Areflexic flaccid weakness with fasciculations. Loss of anal tone- very late.
35
Treat cauda equina?
decompression surgery and high dose dex.
36
Cerebellar haemorrhage common features?
``` nystagmus gait disorder headache vomit dysarthia intention tremour - when guided to an object staccato speech ```
37
what disease presents with a resting tremour?
parkinsons
38
What is the most common cause of cerebellar haemorrhage?
``` Hypertension Use of anticoagulants Coagulopathies Arteriovenous malformation Metastatic tumour Cavernoma Trauma ```
39
name a prothrombin complex concentrate?
Beriplex
40
How do you treat cerebellar haemorrhage?
``` CT, rever warfarin Beriplex (prothrombin complex concentrate) fresh frozen plasma, vit K surgery BP control - BB ```
41
what makes up 80 percent of strokes?
ischaemic. the others are haemorrhagic
42
Signs of SAH?
Kernig’s sign Brudzinski’s sign sudden onset thunderclap headache (no nausea or associated symptoms)
43
Most common cause of non-traumatic SAH?
Berry aneurysms | AVM rupture
44
Treating SAH?
Lifestyle – stop smoking, HTN Medical – Nimodipine (reduces vasospasm – lowers risk of cerebral ischaemia) Surgical – Endovascular coiling/clipping
45
Complications of SAH
Hydrocephalus Cerebral ischaemia Seizures
46
Causes of sub-dural haemorrhage?
Trauma Dementia / Alcoholism Anticoagulation DM rupture to a bridging vein
47
Sub-duralheamorrage signs/
Loss of consciousness Seizure Nausea, vomiting Evolving neurological deficit
48
Treatment of EDH?
Burr hol craniotomy (drainage to decompress)
49
Cause of EDH?
Trauma to temporal bone and haemorrhage of middle meningeal artery. treated with craniotomy
50
What is GBS
Guillain-Barre Syndrome (GBS) . condition where there is a damamged meylin and exposes nerve fibres
51
Symptoms of GBS?
Symmetrical, Rapid onset, progressive muscle weakness and Paraesthesia starting at hands and feet and moving upwards. Autonomic Dysfunction – BP, HR, Sweating pain common in back, shoulders
52
Complication of GBS?
respiratory failure, moniter FVC every 4 hrs
53
CSF of GBS?
``` raised protein (igG ganglioside antibodies) Normal WCC ```
54
What investigations would u find in GBS
Nerve conduction studies – slow conduction velocity (demyelination) Anti-ganglioside antibodies LP and CSF analysis – raised proteins (IgG anti-ganglioside antibodies), normal WCC
55
What antibodies would u find in GBS?
anti-ganglioside antibodies
56
Treating GBS?
IVIG - Plasma exchange Mechanical Ventilation if respiratory failure
57
What does GBS usually precede?
GI or Resp infection like diarrhoea symptoms or sore throat
58
What causes GBS?
Campylobacter, CMV, VZV, HIV, EBV | causes an autoimmune respone 1-3 weeks infection
59
Pathophysiology of GBS?
Anti-ganglioside IgG due to molecular mimicry, binds to gangliosides in peripheral nerves = destruction of myelin sheath by T cells and macrophages
60
What can sensory loss indicate?
MS, myelopathy
61
What can disturbances in eye movements indicate?
MG or MS
62
What can disturbances in sphincter indicate?
MS not MND
63
What signs arent seen in MND
No sensory loss (MS, Myelopathy) No disturbances in eye movements (MG, MS) No sphincter disturbances (MS)
64
Mx for MND?
RILUZOLE (Anti glutaminergic
65
TReatment for drooling in MND
– Amitriptyline
66
Treatment for spasticity in MND
Baclofen (GABA agonist) or Dantrolene (Inhibits Ca2+ skeletal muscle contraction
67
treatment for joint pain
analgesiac ladder
68
Treatment for meningitis?
cefotaxime
69
Treatment for meng. caused by listeria mono.
add amoxacillin to cefotaxime
70
4 types of MS?
PRMS SPMS RRMS PPMS
71
Would you see nystagmus in MS?
yes
72
Demyelination for MS symptoms?
``` Diplopia Eye movement painful (Optic Neuritis) Motor weakness nYstagmus Elevated temperature (Uhthoff phenomenon) Lhermitte’s sign Intention tremor Neuropathic pain Ataxia Talking slurred Impotence Overactive bladder Numbness ```
73
Where would u see an intention tremou?
MS and Wilson's disease
74
What would u se in CSF electrophoresis of MS
oligoclonal bands igG. this is CNS infammation
75
What investifations would u do for MS?
MRI WITH CONTRAST – active lesions (able to receive appropriate treatment
76
Treatment for neuropathic pain in MS
Gabapentin
77
What would u give to treat sexual dysfunction?
Sildenafil

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