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Flashcards in Neurology Deck (14):
1

Headache | Differentials

Neurological
Non-neurological

[Neurological]
Tension headache; bilateral, tight-band, stress
Migraine; unilateral, pulsating, photophobia/phonophobia, aura, hours, caffeine, medication-overuse, menstruation
Cluster headache; unilateral, debilitating retro-orbital pain, eye redness/watering, minutes
Raised ICP; triggered by exertion/position, learning forward
SAH; thunderclap headache
Meningitis; fever, photophobia, neck stiffness, rash
Trigeminal neuralgia; brief, stabbing pain, brushing teeth/chewing

[Non-neurological]
Sinusitis; facial pain, rhinorrhoea, nasal obstruction
AACG; painful red eye, vision loss, haloes around lights
Temporal arteritis; unilateral, scalp tenderness, jaw claudication

2

Neurology | History taking

Headaches
Fits, faints, funny turns
Memory loss
Vision and hearing
Speech and swallowing
Numbness, tingling
Weakness
Balance
Coordinaton
Bladder disturbance, incontinence

3

CNS localisation | Syndromes

Hemisphere
Brainstem

Spinal cord syndromes;
Cervical
Thoracic
Hemisection

Hemisphere; contralateral hemiparesis + hemisensory loss
Brainstem; Ipsilateral CN palsies + trigeminal sensory loss, contralateral hemiparesis + hemisensory loss

[Spinal cord syndromes]
Cervical; UMN UL/LL, sensory loss to neck
Thoracic; UMN LL, sensory loss to abdomen
Hemisection; ipsilateral UMN + dorsal column, contralateral spinothalamic

4

Guillain-Barre Syndrome | Clinical features

Motor
Sensory
Autonomic

Autoimmune inflammatory polyneuropathy

Ascending symmetrical weakness UL/LL (distal to proximal)
LMN signs; areflexia
Dyspnoea
Bulbar involvement; facial palsy, slurred speech, dysphagia, diplopia, ptosis
Peripheral neuropathy
Autonomic dysfunction; tachycardia, hypotension
Preceding GI/URT infection; Campylobacter jejuni

5

Guillain-Barre Syndrome | Investigations

FBC, CRP, U&Es, LFTs

Nerve conductions studies; slowed
LP; elevated CSF protein
Spirometry

6

Guillain-Barre Syndrome | Management

IV immunoglobulin (IVIG)
Plasma exchange

Supportive Tx; BP, intubation/ventilation, neuropathic pain, rehabilitation

7

Facial nerve palsy | Management

Non-pharmacological
Pharmacological

[Non-pharmacological]
Self-limiting, resolves within 6/12
Eye protection; glasses during the day, artificial tears, thicker eye ointment at night, tape shut

[Pharmacological]
PO high-dose prednisolone
± acyclovir

8

Epilepsy | Management

Pharmacological
Surgical

Contraception
Pregnancy

[Pharmcological]
Focal; carbamazepine
Generalised; valproate, lamotrigine

[Surgical]
Lobectomy; if well-defined structural cause

[Contraception]
Carbamazepine decreases the efficacy of COCP
Advised to use alternative barrier method
COCP reduces efficacy of lamotrigine
Poor seizure control, consider alternative

[Pregnancy]
Preconception counselling, ↑x folic acid, higher risk of complications
Pregnancy reduces efficacy of lamotrigine
Dose titration and serum level initially
Optimal therapy; lowest dose for best seizure control and fewest SE

9

Epilepsy | DVLA standards

Syncope
Epileptic seizure
Breakthrough seizures

Counselling

Syncope; no restrictions
Epileptic seizures; stop driving until seizure free for 1yr
Breakthrough seizures; stop driving for 6/12

[Counselling]
Persuade patient to self-report
Patient's own safety
Safety of their own family and children
Doctor's duty to protect members of the public
Responsible for someone else's death
Criminal offence in the given circumstances
Invalidation of any insurance
Duty to breach confidentiality and inform the DVLA/police

10

Multiple sclerosis | Clinical features

Lesions;
Optic nerve
Cerebellum
Corpus callosum
Brainstem
Spinal cord

Motor
Sensory
Balance
Sphincters

Autoimmune inflammatory demyelinating disease
Episodic neurological dysfunction in ≥2x areas of CNS separated in time and space

Optic neuritis; unilateral, graying, blurred vision, impaired colour vision (red desaturation), painful EOM, RAPD

Peculiar sensory disturbance; hemibanding, Lhermitte's sign, patch of wetness/burning, neuropathic pain
Motor weakness; often foot, UMN signs, spasticity,
Ataxia; imbalance, poor coordination
Bladder/bowel dysfunction; frequency, constipation

11

Multiple sclerosis | Investigations

FBC, CRP, ESR
TFTs
Serum B12
Metabolic screen

LP and CSF analysis; OCB +ve
MR brain
MR spinal cord

12

Multiple sclerosis | Management

Acute relapse
Ongoing relapsing-remitting
Secondary progressive

[Acute relapse]
High-dose corticosteroids
1. IV methylprednisolone
2. PO methylprednisolone
3. ± plasma exchange

[Ongoing relapsing-remitting]
Disease-modifying drugs
1. SC/IM beta interferon

[Secondary progressive]
Antispasticity; baclofen
Neuropathic pain; gabapentin
Antidepressants; sertraline
Anticholinergics/overactive bladder; oxybutinin

13

Multiple sclerosis | Differentials

Neurological
Non-neurological

[Neurological]
Cervical spondylosis myelopathy (spinal cord compression)
GBS
MND
Vitamin B12 deficiency

[Non-neurological]
Fibroymyalgia
SLE

14

Investigations | CSF analysis

Herpes simplex
TB
GBS
Myelopathy
Raised ICP

Herpes simplex encephalitis; raised RBC, lymphocytosis
TB; Very high OP, very high protein, very low glucose, lymphocytosis
GBS; raised protein
Myelopathy (MS/transverse myelitis); OCB +ve
Raised ICP; high OP