Neuro part 2 Flashcards
1
Q
describe a migraine
A
unilateral throbbing worse with movement at least 2 of photophobia, phobophobia, osmophobia or nausea 4-72 hours
2
Q
acute migraine treatment
A
NSAIDs/paracetamol + oral triptan
consider nasal triptan in aged 12-17
3
Q
acute migraine treatment in pregnancy
A
paracetamol 1st line (NSAIDs can be used 2nd line in 1st and 2nd trim)
4
Q
treatment acute migraine if 1st line not working
A
non-oral preparation of metoclopramide or prochlorperazine + non-oral NSAID or triptan
5
Q
side effect of metoclopramide
A
acute dystonic reaction
6
Q
when are triptans CI
A
CVD
7
Q
1st line migraine prophylaxis
A
propranolol
8
Q
2nd line migraine prophylaxis
A
topiramate - teratogenic and reduces efficacy of hormonal contraceptive
9
Q
tx menstrual migraine
A
triptan in acute setting
mefenamic acid or aspirin + paracetamol + caffeine
10
Q
tension headache treatment
A
paracetamol / NSAID / aspirin
11
Q
how many cluster headahce for diagnosis
A
at least 5 attacks for diagnosis
12
Q
describe cluster headache
A
severe unilateral headache around the orbit with ipsilateral autonomic symptoms
multiple attacks most days over 1-3 month period
13
Q
tx acute attack cluster headache
A
100% O2 + triptan SC
14
Q
cluster headache prophylaxis
A
verapamil
15
Q
tx paroxysmal hemicrania continua
A
indomethacin
16
Q
describe medication overuse headache
A
someone who was experiencing episodic headaches so began regularly using analgesics and headache has now become chronic
17
Q
tx medication overuse headache caused by simple analgesia/triptans
A
stop abruptly
18
Q
tx medication overuse headache cause by opioid
A
withdraw gradually
19
Q
tx trigeminal neuralgia
A
carbamazepine
20
Q
facial nerve palsy UMN vs LMN
A
UMN: preservation of forehead wrinkling.
LMN: loss of forehead wrinkling on affected side. (forehead affected)
21
Q
bells palsy UMN or LMN
A
LMN
22
Q
tx bells palsy
A
if < 72 hours - 60mg prednisolone for 5 days
23
Q
dx of sleep disorders
A
history and overnight sleep studies
24
Q
non-REM sleep disorder - sleep paralysis - treatment if troublesome
A
clonazepam
25
dx of narcolepsy
multiple sleep latency test EEG
| + overnight sleep studies
26
tx day time somnolence in narcolepsy and night time cataplexy
modafinil
sodium oxybate
27
short term treatment insomnia
zopiclone
28
stroke: TACI
All three of the following:
• Unilateral weakness +/- sensory loss of face, arm or leg.
• Homonymous hemianopia.
• Higher cerebral dysfunction: dysphasia, visuospatial problems.
29
stroke: PACI
Two of the following present:
• Unilateral weakness +/- sensory loss of face, arm of leg.
• Homonymous hemianopia.
• Higher cerebral dysfunction: dysphasia, visuospatial problems
30
stroke: POCI
```
One of the following is present:
• Isolated homonymous hemianopia.
• Cerebellar or brainstem syndromes
(ataxia, facial weakness, Nystagmus, diplopia).
• Loss of consciousness
```
31
stroke: LACI
```
One of the following:
• Purely sensory stroke.
• Ataxic hemiparesis.
• Unilateral weakness +/- sensory symptoms in face, arms or legs.
High association with hypertension
```
32
vessels involved in TACI
anterior and middle cerebral
33
vessels involved in PACI
anterior or middle cerebral
34
vessels involved in POCI
vertebral basilar arteries
35
vessels involved in LACI
multiple small vessel infarcts in basal ganglia and thalamus and internal capsule
36
All three of the following:
• Unilateral weakness +/- sensory loss of face, arm or leg.
• Homonymous hemianopia.
• Higher cerebral dysfunction: dysphasia, visuospatial problems.
TACI
37
Two of the following present:
• Unilateral weakness +/- sensory loss of face, arm of leg.
• Homonymous hemianopia.
• Higher cerebral dysfunction: dysphasia, visuospatial problems
PACI
38
```
One of the following is present:
• Isolated homonymous hemianopia.
• Cerebellar or brainstem syndromes
(ataxia, facial weakness, Nystagmus, diplopia).
• Loss of consciousness
```
POCI
39
```
One of the following:
• Purely sensory stroke.
• Ataxic hemiparesis.
• Unilateral weakness +/- sensory symptoms in face, arms or legs.
High association with hypertension
```
LACI
40
clinical presentation of a stroke involving the ACA
Contra lateral weakness and sensory loss (hemiparesis), lower limb > upper limb
41
clinical presentation of a stroke involving the MCA
Contralateral weakness and sensory loss (hemiparesis), especially of arm and face.
Homonymous hemianopia (contralateral)
Aphasia
42
clinical presentation of a stroke involving the PCA
Contralateral homonymous hemianopia with macular sparing
43
clinical presentation of a stroke involving the ophthalmic artery
amaurosis fugax
44
clinical presentation of a stroke involving the Branches of the PCA that supply the midbrain (Webers syndrome)
Ipsilateral CN III palsy
| Contralateral weakness of upper and lower extremities
45
clinical presentation of a stroke involving the Posterior inferior cerebellar artery (PICA) Wallenberg syndrome/lateral medullary syndrome
Ipsilateral facial pain and temperature loss
Contralateral limb/torso pain and temperature loss
Ataxia
Nystagmus
Ipsilateral horners
46
clinical presentation of a stroke involving the Anterior inferior cerebellar artery / lateral pontine syndrome
Symptoms similar to Wallenberg’s but ipsilateral facial paralysis and deafness
47
basilar artery stroke
locked in syndrome
48
most common cause of haemorrhagic stroke
uncontrolled hypertension
49
what kind of stroke does sudden drop in BP cause e.g. sepsis
watershed
50
1st line investigation for stroke
non-contrast CT
51
investigation of stroke if presenting 1 week after or with mild deficits suggesting small lesion
MRI
52
time frame for thrombolysis
4.5 hours
53
time frame for thrombectomy
6 hours (varies)
54
tx stroke if ischaemic confirmed
300mg aspirin
| thrombolysis + thrombectomy - if within time frame
55
tx stroke > 4.5 hours and confirmed ischaemic
300mg aspirin
| thrombectomy (under 6 hours)
56
how long is aspirin continued after stroke
14 days
57
medication post ischaemic stroke
- aspirin for 14 days
- clopidogrel + dipyridamole
- aspirin + dipyridamole if clopidogrel not tolerated
- statin
- if patient also has AF - warfarin or a direct thrombin or factor Xa inhibitor
58
tx suspected TIA
aspirin 300mg
59
tx suspected TIA if already taking anticoagulant
admit for imaging to exclude haemorrhage
60
tx post stroke
clopidogrel
dont drink alcohol or drive for 1 months
cant drive bus or lorry for 1 year
if patient also has AF - warfarin or a direct thrombin or factor Xa inhibitor
61
do you need to tell DVLA if you have had a TIA
no but need to be symptom free after 1 month/speak to doctor before restarting
62
gold standard IX for intracranial venous thrombosis
MRI venography
| delta sign
63
Sudden onset, thunderclap headache that is usually occipital, develops within seconds and described as worst headache ever
SAH
64
ix SAH
CT brain
| - Acute blood (hyperdense/bright on CT) distributed in the basal cisterns, sulci and in severe cases the ventricles
65
when is LP done in SAH
12 hours post presentation
66
what is seen on LP of SAH
xanthochromic CSF - turns yellow due to breakdown of RBC
67
ix to find out cause of SAH
CT angiogram
68
tx SAH
IV saline
nimodipine for 21 days
may need neurosurgery - coil or clipping
69
what metabolic complication can SAH lead to
hyponatraemia due to SIADH
70
minor trauma, fluctuating consciousness, dull headache, can be over weeks to months
SDH
71
ix SDH
CT brain - crescent shaped haematoma
72
vessels affected in SDH
bridging veins
73
vessels affected in EDH
middle meningeal
74
presentation of EDH
notable trauma
lucid interval
increasingly severe headache with sudden decline in consciousness
75
fixed dilated pupil would be a sign of what in context of EDH
brain herniation
76
ix EDH
CT brain: lens shaped (biconvex) hematoma
77
EDH is/is not limited by suture lines
EDH is restricted by suture lines
78
SDH is/is not limited by suture lines
SDH is not limited by suture lines
79
dx brain tumour
MRI
80
most common primary brain tumour
astrocytoma / glioma
81
most common primary brain tumour in adults
glioblastoma multiform
82
benign tumour occuring in frontal lobe, younger patients, chemosensitive and presents with seizures most often
oligodendroma
83
aggressive tumours of cerebellum almost exclusively seen in children
medulloblastoma
84
how do medulloblastoma spread
through CSF - drop down mets
85
extra axial tumours of the arachnoid cap cells
meningioma
86
when would bilateral vestibular schwannomas be seen
Neurofibromatosis type 2
87
what cranial nerves can be affected in vestibular schwanoma
V
VII
VIII
(VEStibular)
V - five
E - eight
S - seven
88
ocular symptom seen in vestibular schwanoma
loss of corneal reflex
89
tumour that presents with lower bitemporal hemianopia
craniopharyngioma
90
most common type of brain tumour
mets
| - lung, breast, kidney, colon, melanoma
91
what tumour is sensitive to tenozolomide
glioblastoma
92
describe the headache of raised ICP
worse in morning
worse on lying down and coughing, bending
associated with N+V
93
what is cushings reflex
bradycardia
hypertension
wide pulse pressure
irregular breathing
94
1st line simple tx of raised ICP
elevate head to 30-40 degrees
95
treatment of raised ICP - reduce ICP
IV mannitol, hypertonic saline, intubate and hyperventilate
96
tx of raised ICP preventing cerebral oedema
dexamethasone
97
tx IIH
acetazolamide
2nd line - topiramate
repeated LP
98
brown sequard
Contralateral: loss of pain, temperature beginning 1-2 levels below the lesion
Ipsilateral: UMN paralysis – weakness, and loss of proprioception, vibration, light touch
99
central cord syndrome
Bilateral Upper limb weakness. (more than LL)
| Band like loss of pain, temperature and gross touch on the back in cape distribution.
100
anteiror cord syndrome
paralysis and loss of pain and temperature below the level of injury with preserved proprioception and vibration sensation
101
common complaints in cervical myelopathy
loss of digital dexterity / clumsiness
| imbalance and gait disturbance --> falls
102
gold standard IX for cervical myelopathy
MRI cervical spine
