Neurology Flashcards
1
Q
List the advantage of MRI head over CT head
List the CIs of MRI
A
No ionising radiation in MRI
Any metal containing implants / bullets + shrapnel
Claustrophobic
2
Q
What are the CSF findings seen in MS? (3)
A
Lymphocytes upto 50
Protein - moderately raised (<1g)
Oligoclonal IgG bands on electrophoresis
3
Q
List the Irreversible (6) + Reversible (9) RFs for ischaemic stroke
A
Age/Gender
PMH/FH
Hypercoagulable state / AF
Poor diet / exercise Smoking / alcohol HTN / Hyperchol DM / Obese COC
4
Q
List some rarer RFs for ischaemic stroke (6)
A
Endocarditis / Vasculitis
Migraine / Polycythaemia
Antiphospholipid syndrome / Amyloidosis
5
Q
List some RFs for haemorrhagic stroke (5)
A
FH Vascular abns (aneurysm / AVM / HHT) Uncontrolled HTN Coagulopathies / anticoags Heavy recent alcohol intake
6
Q
What are the 3 diff types of cerebral ischaemia
A
Regional (affects cortical areas)
Lacunar (subcortical - from microinfarcts/small vessel disease)
Global ischaemia (post-arrest: can reverse/transient sx but risk reperfusion injury // severe can cause cortical laminar necrosis = vegetative)
7
Q
What are the 3 zones in cerebral ischaemia called?
A
Infarct core - defo will die
Oligaemic periphery - survives from collaterals
Ischaemic penumbra - uncertain outcome
8
Q
List the main clinical features of an ischaemic stroke (4)
A
Contralateral mm weakness / hemiplegia Facial weakness Higher dysfunction Visual disturbance Rare - epileptic fit
9
Q
List some examples of higher dysfunction (6)
A
Agnosia Asterognosis Receptive aphasia Expressive aphasia Apraxia Inattention (neglect)
10
Q
Describe the practical management of ?Stroke coming onto the ward
A
Quick focussed Hx / NIHSS score
Assess for CIs (fam/GP/Notis)
IV access + baselines (FBC, clotting, Glucose, UEs)
Weight (estimate)
Catheterise (if required)
Consultant review + urgent CT / thrombolysis
11
Q
Post-thrombolysis, what features would indicate complications/haemorrhage?
What aspects of management should be delayed during thrombolysis infusion?
A
Acute HTN
Severe headache
Nausea/vomiting
-> discontinue infusion + urgent CT
During 1st 24hrs/ during infusion:
Avoid catherisation
Avoid NG
Avoid aspirin
12
Q
What are the secondary prevention measures post-stroke? (5)
A
Antihypertensive therapy Statin Antiplatelet therapy Identify/tackle RFs Manage co-morbidities e.g. AF/DM
13
Q
What are the laws regarding driving after a stroke?
A
Cannot drive for 4wks post stroke
After 4wks if clinical improvement satisfactory, may return to driving w/o having to inform DVLA
14
Q
List some post-stroke complications (8)
A
Post-stroke pain
Incontinence
Pressure sores
Depression
DVT/PE
Aspiration/hydrostatic pneumonia
Malignant MCA syndrome
Seizure
15
Q
What is malignant MCA syndrome and its features / Tx
A
Neuro deterioration due to cerebral oedema following middle cerebral aa stroke
Variable but: Increased agitation Reducing GCS Haemodynamic / thermal instability Signs of raised ICP
Decompressive hemicraniectomy
16
Q
What are some high-risk features of a further stroke post-TIA?
A
Recurrent TIAs in short period
TIA on anticoag / AF
ABCDD score of ≥4
Age >60
BP at presentation (>140/90)
Clinical features - unilateral weakness (2) / speech disturbance w/o weakness (1)
Duration of Sx - 60mins+ (2) / <60mins (1)
Diabetes - pre-existing (1)
17
Q
How are high-risk and low-risk TIAs managed?
A
High-risk: Statin (e.g. simva 40mg) 300mg aspirin (unless CI) Arrange 24hr urgent clinic Advise don't drive until seen specialist
Low risk:
Same but less urgent clinic referral (1wk)
18
Q
What further Ix / prophylactic interventions can be done after TIAs (1+2)
A
Carotid USS in specialist clinic
Carotid endarterectomy if stenosed >50%
OR
Percutaneous luminal angioplasty ± stenting
19
Q
List the RFs for venous sinus thrombosis (7)
A
Pro-thrombotic state (85%): Pregnancy / puerperium Oral contraceptive Malignancy Genetic thrombophilia
Head injury
Recent LP
Infection
20
Q
What are the clinical features for cortical (5) / dural (5) / sagittal lateral (5) venous sinus thrombosis
A
Cortical: Thunderclap headache Fever Focal signs Seizures Encephalopathy
Dural: (ophthal signs + fever) Proptosis/chemosis Ocular pain Ophthalmoplegia Papilloedema Fever
Sagittal lateral: (raised ICP signs) Headache Vomiting Fever Papilloedema Seizures
21
Q
What are the diff types of intra-cerebral haemorrhage?
A
Deep intra-cerebral: subcortical
from micro aneurysms (Charcot-Bouchard) and degen of small penetrating aa’s
Lobar intra-cerebral: in cerebral cortex
Normotensive / >60
22
Q
Describe the immediate management for intra-cerebral haemorrhage
A
Reverse anticoag
Lower BP to <140/90 within 1hr (IV betolol)
Neurosurgical intervention possibly
23
Q
What are the presenting features of a SAH? (5 + 3)
A
Thunderclap headache (after transient HTN) Vomiting Photophobia Drowsiness / coma Focal signs
Neck stiffness
+ve Kernig’s
Papilloedema
24
Q
What are the predisposing abnormalities causing SAH? (3)
A
Berry (saccular) aneurysm (70%)
AVM (10%)
No lesion found (20%)
25
What are the RFs for berry aneurysm development?
| What is the most common site of berry aneurysm?
```
Polycystic kidney disease
FH
HTN
Smoking
Ehlers-Danlos / Marfans
```
Commonest site is anterior communicating aa
26
What are some complications of SAH (4)
Death (30% immediate)
Rebleed
Hydrocephalus (from CSF pathway fibrosis)
Cerebral vasospasm (poss -> ischaemic damage)
27
What investigations are done in SAH? (4)
Bloods: FBC, clotting, UEs, LFTs, ESR
CT*
LP if CT normal
CT angio - for all pts fit for surgery
28
How is SAH managed? (7)
```
4wks bed rest
HTN control
Nimodipine - prevents vasospasm
IV fluids - prevents further vasospasm
Analgesia
Stool-softeners (prevent straining)
Neurosurgical referral/discussion
```
29
What pt groups are subdural haemorrhages seen in?
Acute: major trauma pts
Subacute/Chronic:
Elderly
Coagulopathy
Alcoholics (clotting)
30
How do subacute/chronic subdurals present? (4)
```
S/O raised ICP 3wks post-insult:
Headache
Drowsy/confusion
Focal neuro signs
Stupor/coma (late: coning)
```
31
How do acute / chronic subdurals look on CT?
```
Acute:
Crescenteric
White (increased density)
Midline shift
Ventricular compression
```
Subacute: isodensity
Chronic:
Lentiform shape (convex lens)
Darker (radiolucent)
32
How are subdurals managed?
Serial CT imaging
Neurosurgery
Chronics may self-resolve
33
How does an extradural (epidural) haemorrhage present?
Young pt minor injury (sports/assault)
Blow to side → middle meningeal aa tear
Brief unconsciousness → lucid recovery period
Over mins-hrs:
Progressive hemiparesis / stupor
Ipsilateral dilated pupil → then bilateral
Resp arrest (untreated)
34
What is seen on CT in extradural haemorrhage?
How is it managed?
Lentiform shape
Midline shift
Ventricular compression
Urgent neurosurgery – burr hole (release pressure)
If v. minor – conservative/monitoring
35
What are the 3 cardinal features of Parkinsonism
Resting tremor
Bradykinesia
Rigidity
36
List some detailed features of the tremor in Parkinsonism
4-7Hz pill rolling
Increases in: rest / anxiety / clenching opposite
Decreases in: movement / finger-nose
37
List some other detailed features of Parkinsonism
+ve Glabellar tap reflex
↓ Spontaneous blinking
'Lead pipe' rigidity
'Cog wheeling' effect
Hypersalivation
Hypomimia
Micrographia
'Walking' thumb along fingers
38
List the Parkinson plus syndromes + how they are different
```
Progressive supranuclear palsy:
Early dementia / Early speech probs
Postural instability
Vertical gaze palsy
VS PD - symmetrical / no tremor
```
Multisystem atrophy:
Autonomic / Cerebellar / Pyramidal
Cortico-basal degen:
Akinetic rigid 1 limb
Cortical sensory loss e.g. astereognosis
Vascular: BG strokes
Pyramidal / Legs worse
LBD:
Early dementia / Visual hallucinations
Symmetrical motor signs later
39
List features of Parkinsons DISEASE (other than Parkinsonism) (14)
```
Characteristic stoop
Fixed flexed joints (all except PIP/DIP)
Dysphagia
Constipation
Urological
Sweating
Shuffling (festinant) gait
Slurring/monotonous (eventually anarthria)
No arm swing
Unsteady turning
Depression (1/3rd)
Dementia/cognition problems (later)
Insomnia (later)
REM behavioural sleep
```
40
What are the SEs of levodopa?(4+3)
N+V (→ domperidone alleviates)
Confusion
Visual hallucinations (→ atypicals alleviate)
Chorea
Later SEs (2-5yrs):
Motor fluctuations (akinesia switching on/off)
Dyskinesia
Dystonia
41
List other Parkinsons drugs/Tx used (5) (give examples of drug names)
D-r agonists: bromocriptine / cabergoline / ropinirole
MOA-B inhibs: selegeline / rasagiline
COMT inhibs: entacapone
Anticholinergics: procyclidine
Surgery: thalotomy / deep brain stimulation
42
List the diff patterns of MND (4)
Amylotrophic lateral sclerosis**
Progressive muscular atrophy
Primary lateral sclerosis (rare)
Bulbar presentation
43
Which areas are affected in MS? (+ what effects does it have)
```
Optic nn → optic neuritis
CST → hemi/mono/para-paresis
DST → paraesthesia/proprioceptive loss
Cerebellar peduncles → cerebellar signs inc. vertigo
Brainstem → bladder/bowel/sexual
Cognition → (late) IQ/language
```
44
List the classifications of MS (3)
Primary progressive (10-20%)
Relapsing/remitting (80-90%) (to 2o progressive)
Fulminant (<10%)
45
List the diagnostic tools for MS (5)
Clinical Dx (2+ characteristic episodes)
Bloods before neuro referral:
FBC/UE/LFT/TFT / B12 / Ca / Gluc / ESR / HIV
MRI confirms Dx
CSF: raised WCC/protein / oligoclonal IgG
VER (visual evoked responses) – prev optic nn lesion
46
List the DDx for MS:
Relapsing-remitting (3)
Primary progressive (3)
Relapsing-remitting:
TIA
SLE w. neuro involvement
CNS sarcoidosis
Primary progressive:
MND
CNS mass
Spinal/cerebellar degen e.g. Alz/Hunt/Park
47
Outline the general management of MS (6)
```
MDT
Annual R/V
Lifestyle (exercise/smoking)
Pt education (prompt recog sx / tx)
Manage comps
Modifying therapy (dimethyl fumarate / teriflunomide / natalizumab for severe)
```
48
List the complications of MS (9)
```
Mental health
Fatigue
Mobility issues
Pressure sores
Constipation
Bladder dysfunc
Sexual dysfunc
Ataxia
Spasticity
```
49
What are good/poor prognostic factors in MS?
Good: sensory onset
Poor: older at presentation / early cerebellar / cognition
50
How does ALS present?
Progressive spastic tetra-paresis
± Bulbar/pseudo-bulbar
Fronto-temporal dementia
LMN signs: hands → arms + down
UMN signs: legs → up
51
How does progressive muscular atrophy present?
Painless wasting in small hand mm's + spreads
| Just spinal LMNs
52
How does primary lateral sclerosis present?
Progressive tetraparesis
| Just cortical UMNs
53
List the diagnostic tools for MND (4)
Clinical (mixed UMN/LMN)
Bloods: exclude DDx
MRI: exclude myelopathy/radiculopathy
Dx – EMG: denervation
54
Outline the general management of MND (5)
```
MDT
Nutritional support / gastrostomy
Resp support (NIPPV)
Manage comps (as per MS)
Modifying therapy: Riluzole
```
55
List possible causes for Dementia (surgical sieve)
V: Multi-infarct / Cerebral infarcts / Binswangers / Lupus
I: HIV / syphillis / CJD / Cryptococcus
T: major head / repetitives
Toxins: Alc / Drugs / heavy metals inc. Wilsons
M: B1/B12/Fol defc / Uraemia / Liver failure / Hypothyroid
Mechanical: Hydroceph (inc. NPH) / Haematomas
N: primary/secondarys
D: Alz (62%) / LBD (4%) / FTD (2%) / PD+ (2%) / Hunt's
56
List + describe the diff types of vascular dementia (4)
Post-stroke (25% stroke pts within 1yr)
Multi-infarct (cortical): stepwise decline
Subcortical: h/o HTN
Mixed cortical/subcortical
57
List the features of LBD (3+5)
Core:
Fluctuating cognition
Visual hallucinations
Parkinsonism
```
Supporting:
Syncope
Autonomic e.g. post hypo
Falls
Neuroleptic sensitivity
REM sleep behaviour
```
58
List the early features of FTD (7)
```
Emotional blunting / loss inhibition
Personal hygiene
Hyperorality
Word finding difficulties / less speech
Echolalia / aphasia
Loss insight
Primitive reflexes e.g. grasp
```
59
What are the features of CJD? (3)
| How is it Dx?
Middle aged dementia
UMN signs limbs
Visual disturbances
Dx; EEG
60
What are the features of Huntington's? (2)
Middle aged dementia
| Progressive chorea
61
List the DDx of peripheral neuropathy
V: vasculitic
I: HIV/syphillis / CIDP / GBS
Toxins: Alc / Lead / Chronic liver disease
A: RA / CTDs / Myxoedema
M: DM / B12+Folate / Thiamine defc / Uraemia
I: amio / statins / pheny / hydralazine / abx
N: paraprot (myeloma) paraneoplastic
C: Charcot-Marie Tooth / Friedrich's ataxia
62
List the causes of peripheral neuropathy with predominately motor loss (6)
```
Guillain-Barre syndrome
Porphyria
Lead poisoning
Charcot-Marie-Tooth
Chronic inflamm demyelinating polyneuropathy (CIDP)
Diphtheria
```
63
List the causes of peripheral neuropathy with predominately sensory loss (6)
```
DM
Alcohol
B12 defc
Uraemia
Amyloidosis
Leprosy
```
64
Describe the difference b/wn demye + axonal neuropathy
List some other nerve damage patterns + what happens
Demyelination: only schwanns / immune-med / regrow
↓ Conduction velocity
Axonal: neuronal bodies degen from axon / can't regrow
↓ Amplitude
Wallerian: post-section / microinfarction
Compression: focal demye
Infiltration: malignancy / granulomatous
65
What are the features of GBS? (4)
1-3wks post trivial infection (campylo/CMV)
Ascending paralysis
Loss tendon reflexes
Proximal mm involvement (20%) - Resp/CN
NB sensory loss uncommon
66
List some complications of GBS
```
LRTI
Pressure sores
VTE
BP instability / arrhythmia (autonomic involvement)
Residual weakness post-recovery (10-20%)
Mortality (10% in acute phase)
```
67
How is GBS managed?
```
HDU nursing
Monitor FVC ± Ventilation
SC heparin / TEDS
Prevent complications
High-dose IVIG within 2wks (NB steroids useless)
```
68
Describe the presentation/progression of shingles
Pain/paraesthesia (days)
Erythema / vesicles / burning / itching / dermatomal
2-3d later become pustular
69
List poss complications of shingles
Post-herpetic neuralgia (10%)
Corneal scarring / uveitis / panophthalmitis
Facial palsy / sensorineural loss / CN5,9,10 neuropathy
70
How is shingles managed?
5-7d oral aciclovir
| Paracetamol / amitriptyline
71
How is post-herpetic neuralgia managed?
Amitriptyline
Topical capsaicin
(Gradual recovery over 2yrs)
72
What are the possible features of MG (4)
```
Weakness/fatiguability of:
Extra-ocular
Proximal mm (limb/face/neck)
→ Ptosis
→ Dysphagia
→ Speech difficulties / chewing (facial exp mm)
→ Proximal mm weakness (arms >legs)
```
73
List some conditions assoc w. MG (5)
```
Pernicious
Autoimm thyroid
SLE
Rheumatoid
Thyroid hyperplasia / thymoma
```
74
What Ix can be done if suspecting MG? (4)
Anti-ACh-R IgG autoAbs
EMG
TFTs / CT thorax (exclude thymoma)
75
Describe the management of MG (3+3)
Long-term:
Initial immunosupp – oral pred
Long-acting anticholinesterases e.g. neo/pyridostigmine
Thymectomy
Relapses:
Corticosteroid/Azathioprine
FVC monitoring ± ventilation
Severe: Plasmaphoresis/IVIG
76
Describe the pathology behind:
1. Duchenne's
2. Becker's
3. Myotonic dystrophy
1. Duchenne's: X-linked recessive dystrophin gene mutation
2. Becker's: partially func dystrophin
3. MD: autosom dom Cl- channelopathy
77
What is the difference b/wn:
Muscular dystrophies
Myopathues
Neurogenic disease
Muscular dystrophy: genetic progressive deterioration
Myopathies: predominant effect on mm
Neurogenic: peripheral nn / LMNs → SkM atrophy
78
What Ix can be done for a suspected myopathy? (3)
CK (serum mm enzyme):
Raised in – dystrophy / inflamm mm disorder
Normal in – MG
EMG – classic traces in:
Myopathy / denervation / myotonic discharge / MG
Mm biopsy: ddx b/wn denervation + mm disease
79
List the management options for spasticity related motor problems (Con/Med/Surg) (3/4/4)
Conservative:
Physio
Gait retraining
Remove exac stim e.g. constipation
Medical:
Baclofen / Dantrolene / BZDs / Botox
```
Surg:
Tendon lengthening
Fixed deformity release
Electrostim
Orthopaedic referral for contractures
```
80
What is the pathological difference b/wn bulbar palsy + pseudo-bulbar palsy?
What neuro disease may present with a mix?
Bulbar: LMN weakness from medullary CNs (9/10/12)
Pseudobulbar: bilateral UMN weakness from medullary CNs (9/10/12)
MND: mixed bulbar/pseudo
81
What are the features of a bulbar palsy? (6)
```
LMN tongue (wasted/fascic/flaccid)
Speech: quiet/nasal
Poor soft palate elevation (ahh)
Jaw jerk absent
Gag absent
Dysphagia
```
82
What are the features of a pseudo bulbar palsy? (6)
```
UMN tongue (stiff/spastic/not wasted)
Speech: donald duck/high-pitched/slurred (dysarthria)
Normal soft palate elevation (ahh)
Jaw jerk exaggerated
Gag present
Dysphagia
```
83
What are the main causes for bulbar/pseudobulbar palsy? (2)
What are some rarer causes? (4+2)
V: Stroke
D: MND
```
BULBAR:
GBS
Botulism
Brainstem tumours
Congenital
```
PSEUDO:
Trauma
MS
84
What features may be present in a cerebral lesion in:
1. Frontal (5)
2. Temp-Par L (dom) (3)
3. Temp-Par R (2)
4. Occipital (1)
Frontal:
Intellect / personality / Urinary / hemiparesis / Broca's
L T-P (dom): Contralat neglect / Wernicke's / Agraphia
R T-P: Contralat neglect / Agnosia
Occipital: Visual field/spatial defects
85
What are features of a cerebellar lesion? (6)
+ of a midline cerebellar lesion? (4)
```
Disdiadokinesia / Dysmetria
Ataxia
Nystagmus
Intention tremor
Slurred staccato speech
Hypotonia
```
Broad gait
Romberg's (unsteady when close eyes)
sUpport needed (sit/standing)
Vertigo/vom (sitting forward + arms across chest)
86
List some causes of unilateral (3) + bilateral (4) cerebellar dysfunc
Unilateral:
Stroke
MS
Tumour (acoustic neuroma, meningioma)
```
Bilateral:
Alcohol
Anti-epileptics
Severe hypothyroid
Paraneoplastic degen (breast, small cell lung)
```
87
What is the func of the BG?
| What are the BG structures? (7)
Modulates cortical motor activity
Corpus striatum: caudate / globus pallidum / putamen
Subthalamic nucleus
Substantia nigra
Parts of thalamus
88
What are the features of BG dysfunction? (7)
```
Bradykinesia (→ akinesia)
Mm rigidity
Tremor
Dystonia (spasms)
Athetosis (writhing)
Chorea
Hemiballismus (violent invol prox arm mm)
```
89
Where does the lesion lie in:
Central scotoma
Monocular loss of vision
Bitemporal hemi/quadrantanopia (superficial + inferior)
Homomymous hemianopia
Homonymous quadrantanopia (superficial + inferior)
Central scotoma → macular
Monocular → ipsilateral optic nn
Bitemp hemi/quad:
Superfic = pituitary tumour (below chiasm)
Inf = craniopharyngioma, meningioma, carotid aneurysm
Homonymous hemi = contralateral optic tract
Homonymous quad:
Superfic = Temporal contralat optic tract
Inf = Parietal
90
What is the difference b/wn Broca's + Wernicke's aphasia? How does each manifest
What are some other types of aphasia? (2)
Broca's = motor speech; expressive
Non-fluent / good comprehension / poor repetition
Wernicke's = understanding speech; receptive
Fluent / poor comprehension / poor repetition
```
Global = both
Nominal = word finding difficulty
```
91
List the different causes of DYSARTHRIA + their different manifestations in speech (5)
```
Bulbar = high-pitched, nasal
Pseudobulbar = donald duck 'gravelly' (UMN)
```
MG = speech fatigues / dies away
```
Extrapyramidal = soft / indistinct / monotonous
Cerebellar = slow / staccato / slurred
```
92
What are the features of Horner's?
MioSIS (unilateral constriction)
PtoSIS (partial) - just Mullers mm
AnhidroSIS
93
List the 1st / 2nd / 3rd order causes of Horner's?
| How are they differentiated clinically?
1st order: BRAINSTEM stroke / syphilis / MS / tumour
2nd order:
INTRATHORACIC pancoast / cervical rib / TB
NECK lymphadenopathy / trauma / thyroid surg
3rd order: ICA aneurysm / transient migraine / idiopathic
94
List the DDx for pathology of a LMN lesion (4)
Ventral horn: MND / Post-polio
Peripheral nn: neuropathy
NMJ: MG
Muscular
95
List the DDx for a UMN lesion (6)
```
V: stroke / AVM / haemorrhage
I: post-meningitis
T: traumatic brain injury
A: MS / MND
I: drugs
N: SOL
D: Parkinson's
```
96
How would a unilateral cord lesion (hemisection) present? (3)
What is the Eponymous name for it?
List some possible causes (3)
Ipsilateral weakness (CST)
Ipsilateral loss vibration/proprio (DC)
Contralateral loss pain/temp/light (STT)
Brown-Sequard
RTA
Penetrating injury
Facet dislocation
97
How would a dorsal column lesion present? (3)
| What is the Eponymous name for it?
Clumsiness
Electric-shock like sensations / tingling / numbness
Sensory ataxia (loss 2-point discrimination)
98
List the indications for LP (5)
```
Dx: Meningitis/Encephalitis
Dx: Neurosyph / MS / Behcet's
Dx: SAH (if CT normal)
Intrathecal drugs
Measure CSF pressure ± drain
```
99
List the contraindications for LP (5)
```
Local infection
Clotting problems
?Raised ICP (if unconscious → CT first)
Haemodynamically unstable
Congenital e.g. NTD
```
100
List the complications of LP (5)
Infection
Cerebellar tonsillar coning
```
Spinal nn damage
Dry tap (not worked)
Spinal tap (post-LP headache: 30%)
```
101
List the differentials for causes of secondary headaches
```
V: Raised ICP / IIH / HTN
I: meningitis / sinusitis / SAH
T: post-traumatic
A: giant cell arteritis
M: metabolic disturbances
I: nitrates / vasoactives
N: SOL
```
102
Describe the classic presentation of tension headaches
| How are they treated?
```
Middle-aged woman
Depression
Band-like (occiput/vertex)
Non-pulsatile
Episodic
```
```
OTC analgesia (NB caution overuse)
If >2/wk: low-dose amitriptyline
```
103
Describe the classic presentation of cluster headaches
Male
After drinking
Wakes from sleep
Mins-hrs
Severe unilateral pain around eye / poss BG pain
Aura (20%)
Autonomics: ptosis / watering / red eye / vom
104
How are cluster headaches managed?
| What is the main DDx to exclude
Start of attack – SC/Nasal Triptans
During attack – 12L O2 non-rebreather
Prophylaxis – alc avoidance / verapamil (off-licence)
Main DDx: acute angle closure glaucoma
105
List some common triggers for migraines (6)
Stress / emotional states
Alcohol
Physical exercise
Menstruation
OCP
Specific food groups
106
Outline the management for migraines
Headache diary
Avoid triggers
Acute:
NSAIDs / para / anti-emetics
(Severe) Sumatriptan / nasal triptan if vom
Prophylaxis:
Menses related: mefanamic acid / triptans 2d prior
1st – topiramate / propanolol (for child bearing)
2nd - amitriptyline / carba
107
List some possible features of IIH
| How is it treated? (2)
```
Young obese woman OCP
Headache
Pulsatile tinnitus
Diplopia / CN6 palsy
Visual disturbances
Bilateral papilloedema
```
```
Trial corticosteroids
VP shunt (to prevent optic atrophy)
```
108
How does trigeminal neuralgia typically present?
What is it caused by?
How is it treated?
Sudden severe pain across facial distrib
Sensory trigger
Ageing / Compression / MS
TCAs / Carba
109
What are the 2 diff types of hydrocephalus
| Who are the at risk groups for hydrocephalus (3)
Non-communicating (obstructive)
Communication (non-resorptive)
Congenital malformations
Post-insult (trauma/SAH)
Meningitis
110
What are the features of hydrocephalus
```
Headache
Vomiting
Papilloedema
UMN pyramidal signs
Cognitive disturbance
Ataxia
```
111
How is hydrocephalus managed?
Acetozolamide ± furosemide
VA/VP shunt
Endoscopic 3rd ventriculostomy
Brain tumour removal
112
What are the 3 features of NPH?
| How is it treated?
Dementia
Ataxic gait
Urinary incontinence
LP trials (of improvement) + VP shunt
113
What are the 3 main types of primary brain tumours?
| + their natural progression
Malignant glioma – rapid growth (6m)
Meningioma – slow growth benign
Astrocytoma – slow growth benign
114
List the commonest locations of origin for brain mets (6)
Thyroid
Melanoma
Kidney
Breast
Bronchus
Bum (colon)
115
List 4 paraneoplastic syndromes
Myasthenia Gravis
Lambert-Eaton Myasthenic syndrome
Paraneoplastic sensory neuropathy
Paraneoplastic cerebellar degeneration
116
What types of cancer assoc w. paraneoplastic cerebellar degeneration? (4)
Small cell lung
Hodgkins
Breast
Ovarian
117
List some viral causative organisms of meningitis (4)
Enteroviruses:
Coxsackie A/B
Echoviruses
HIV
HSV
118
What features indicate complications in meningitis (4)
What acute neuro complications could these indicate? (3)
What are some other (systemic) acute complications
Progressive drowsiness / LOC
Lateralising signs
CN lesions
Seizures
Hydrocephalus
Severe cerebral oedema
Venous sinus thrombosis
Sepsis
DIC
Adrenal haemorrhage (Waterhouse-Friderichsen)
119
How does TB meningitis present in contrast to normal?
| How is it treated?
More gradual + wt loss
| Same as resp (RIPE 12m) + Dexa
120
List necessary Ix for ?Meningitis (6)
```
Bloods: FBC / UEs / LFTs / Clotting / Glucose / Lactate
LP
CT
Blood cultures
Serum PCR
Throat swabs
```
121
List possible long-term complications of bacterial meningitis (5)
Brain abscess
Hydrocephalus
Hypotonia
CN palsy (e.g. sensorineural deafness)
122
List some causes of brain abscess (5)
```
Paranasal sinus infection
Otitis media
BActerial endocarditis
Neurosurg
Trauma
```
123
What are the meningitis empirical Abx in:
1. Non-blanching rash
2. Immunosupp (inc. DM) / >60
3. Non-immunosupp / <60
1. Ben-pen / PA-cefotaxime (IM + IV)
2. Ceftriax / Amoxi / dexa (IV) (PA-chloramphenicol)
3. Ceftriax / Dexa (IV)
124
List the diff types of syncope (7)
Situational: post-prandial / micturition / defacation
Vasovagal: transient parasymp (heat/noxious)
Neurogenic: TIA/Stroke /subclav steal syndrome
Cardiogenic: structural / arrhythmia
Orthostatic: post hypo
Psychogenic
Endocrine: hypogly / anaemic
125
List the Ix for recurrent syncope
```
FBC / UE / Gluc
ECG
LSBP
CT head / EEG
ECHO
```
126
What is subacute combined degeneration of cord (SCDC) due to?
What are the features (4 ± 2)
Due to B12 defc
Can be precipitated by folate
```
Peripheral sensory neuropathy (vibration/proprio)
UMN signs in legs, classic ∆:
• +ve Babinski
• Brisk knee reflex
• Absent ankle reflex
```
Plus poss also:
Normal tone/power
Ataxic gait
