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CP3 Management > Neurology > Flashcards

Neurology Flashcards

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1
Q

indications for a lumbar puncture

A

Diagnosis of meningitis/encephalitis

Diagnosis of SAH - If clinically suspected but no abnormalities on CT

Measurement of CSF pressure (Idiopathic intracranial hypertension)

Therapeutic removal of CSF (Idiopathic intracranial hypertension)

Intrathecal drug administration

Diagnosis of miscellaneous conditions (behcets, MS, neurosyphillis)

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2
Q

where do you do an LP

A

L4/L5 space

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3
Q

csf finding in MS

A

Moderately raised protein levels - <1g/L

Up to 50 lymphocytes/mm3

Oligoclonal IgG bands on electrophoresis

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4
Q

complications of LP

A

Post LP headache
Occurs in 30%, onset within 24 hours with resolution over 2 weeks
Classically a constant bilateral dull ache
Worse when upright, as due to intracranial hypertension
Treat with analgesics +/- blood patch (Re-injection of a patients own blood to form a clot)

Dry-tap
Usually due to poor technique

Infection

Damage to spinal nerves
Causes weakness/paresthesia

Coning of cerebellar tonsils

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5
Q

contraindications for LP

A

Suspicion of mass in the brain/spinal cord/raised ICP
This can lead to coning of the cerebellar tonsils
Any unconscious patient must have a CT prior to LP

Overlying/local infection

Congenital lesions in the area
Meningomyelocele

Problems with haemostasis
Platelets <40
Clotting abnormalities
Anticoagulation

Haemodynamic instability

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6
Q

what does xanthochromia in the CSF indicate

A

bleeding in the brain

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7
Q

contraindications for an MRI

A

Electrically, magnetically or mechanically activated implants
Pacemakers, cochlear implants, drug infusion pumps

Implants containing ferrous material
Aneurysm clips
Surgical staples

Bullets, shrapnel, metal

Screen patients with XR if they have a history of metal foreign bodies in the eye

Some implants are now MRI safe

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8
Q

acute management of a head injury

A

Ensure C-spine is secured

A-E resus
A: some level of intubation usually required
Record GCS prior to intubation
B: chest injuries often co-exist and lead to an additional secondary brian injury from hypoxia
C: shock occurs in polytrauma patients – ensure cross match is done ASAP

Record GCS

Brief history if conscious

Neurological exam

Check for signs of deterioration
Most important - Changing pupillary responsiveness
As ICP rises there is initially a progressive dilation on the side of the lesion, with sluggish response to light
If bilateral it is a pre-terminal sign

Falling pulse/rising BP
Cushings reflex: late sign

Manage appropriately if signs of rising ICP

Appropriate imaging

CT head if indicated

C spine radiography if indicated
Always indiated if there is a TBI with LOC

Prevent secondary insults
Hypoxia

Hypercapnia leads to cerebral vasodilation –
increasing cerebral blood volume and raising ICP
Raied ICP patients may be hyperventilated in ICU

Hypoxaemia also leads to cerebral vasodilation, as well as causing profuse lactic acidosis which damaged cerebral neurones – not breathing for 4 minutes starts to cause irreversible brain damage

Hypovolaemia
MABP between 60-160 mmHg is autoregulated
Following a head injury this autoregulation goes and therefore cerebral perfusion relies on SBP

As such , this resus is vital to regulate SBP and therefore brain perfusion

Hypoglycaemia

GCS 15 and haemodynamically stable = patients can be discharged

Period of unconciousness after a head trauma = head Xr required before discharge

Discharge with a head injury warning card

If intoxicated they need to be admitted as its hard to differentiate between intoxication and brain injury

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9
Q

indications for CT head within 1 hour during a head injury

A

GCS <13 at the time, or <15 2 hours after the injury

Focal neurological deficit

Signs of increasing ICP:
Headache  
Blurred vision  
Vomiting  
Decreased awakeness 
Seizure 
Weakness 
Anergy

Suspected skull #

Post-traumatic seizure

Vomiting >1 times

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10
Q

indications for a CT head within 8 hours after a head injury

A

Anticoagulated patients

LOC + >65/Dangerous mechanism of injury (fall from a height)/Retrograde amnesia >30 mins/Inability to recall events before injury

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11
Q

when should you admit a patient following a TBI

A

If imaging show pathology

If GCS <15
If this is the case monitor them every 30 minutes

Continuous worrying signs

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12
Q

Tx status epilepticus

A

A-E
100% oxygen
Oral/nasal airway

IV access

Bloods 
Glucose 
Calcium  
Magnesium  
FBC 
U+E 
LFT 
clotting

CXR to rule out aspiration

Take urine sample if possible

ABG

Set up ECG

if >5 mins
IV lorazepam
4mg bolus repeated after 5 mins if no response

Finger prick glucose
If hypoglycaemia 50ml 50% glucose IV

Any suspicion of alcoholism
IV pabrinex – 2 ampoules over 10 mins

In females of childbearing age do a pregnancy test

If seizure activity persists despite 8mg of lorazepam
IV phenytoin 15mg/kg slow infusion (50mg/min)with ECG monitoring

EEG monitoring useful if unsure about nature of status

> 10 mins = call ICU

They may intubate under thiopentone (GA)

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13
Q

Tx neuromuscular ventilatory compromise

A

CALL FOR HELP – CRIT CARE

Ensure airway is safe

Sit up, O2 monitoring, HR and saturations (90-92)

Suctioning If secretions

NBM

Blood gases

IV access

CXR for ?infection

Further investigation for critical care and neurology

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14
Q

characteristic finding on CT with extradural haematoma

A

lentiform lesion

midline shift

ventricle compression

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15
Q

Tx extradural haematoma

A

Urgent neurosurgical referral
Burr hole to release pressure

Prognosis very good if this is performed early

Very minor it may be managed conservatively with regular monitoring

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16
Q

in base of the skull fractures what are given if there is a csf leakage

A

prophylactic antibiotics

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17
Q

Tx for base of skull fractures

A

urgent neurosurgical referral

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18
Q

Tx for acute hydrocephalus

A

Only definitive management is surgery so medical management exists to delay that

Azetazolamide +/- furosemide
Azetazolamide is a carbonic anhydrase inhibitor and is usually used in glaucoma to prevent the production of intraocular fluid, but in this case it reduces the amount of CSF produced

Surgical management
Ventriculoatrial, or ventriculo-peritoneal shunting for progressive symptoms
Valves open at certain pressures to allow release of CSF

Neurosurgical removal of tumours if necessary

Endoscopic 3rd ventriculostomy is an alternative procedure for obstructive hydrocephalus
Hole is made in 3rd ventricle so the CSF can bypass the cerebeal aquaduct (most common site of malformation) and drain into the interpeduncular cistern

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19
Q

GCS components

A

Motor

1 – no response

2 – extensor response to pain

3 – flexor response to pain

4 – withdraws from pain, pulls limb away

5 – localises to pain, responds towards painful stimuli

6 - Obeys commands

Voice

1 – no speech

2 – incomprehensible muffled speech

3 – inappropriate speech, understandable but no conversational effort

4 – confused orientation, answers questions with some confusion

5 – oriented

Eyes

1 – no eye opening

2 – eyes open in response to pain

3 – eyes opening in response to speech

4 – eyes open spontaneously

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20
Q

how is GCS score roughly stratified

A

13-15 = mild injury

9-12 = moderate injury

<9 = severe injury

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21
Q

what is cheyne-stokes breathing and what does it indicate

A

rapid breathing following by apnoea

coning

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22
Q

what does a unilaterally enlarged pupil indicate in the context of a semi concious patient

A

raised ICP

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23
Q

what does a bilaterally enlarged fixed pupil indicate in the context of a semi-concious patient

A

Deep coma

Brainstem death

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24
Q

what does a bilateral pinprick indicate in the context of a semi-concious patient

A

opiate overdose

pontine lesions causing sympathetic interruption

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25
what are some important points in the history of a ?stroke
Exact time of onset Speed of symptom onset Body parts affected Seizure? Previous history of stroke? Diabetic? Tumours? AF/MI? On anticoagulants? Drugs/smoking/alcohol?
26
how should you examine a ?stroke patient
GCS NHISS National institute of health stroke scale Combines several parts of a clerking exam into a single scale evaluating possible location, thrombolysis benefit and severity stratification ``` CVS Murmurs (endocarditis) Signs of dissection BP HR ``` Respiratory SpO2 RR Crackles? Neuro LMN/UMN CNS Cerebellar
27
indications for urgent (<1 hour) brain CT in ?stroke
If considering thrombolysis If bleeding risk If decreased consciousness Neck stiffness
28
Tx of confirmed embolic stroke
A-E management Withold antiplatelet therapy until haemorrhage excluded If ischaemic stroke confirmed administer 300mg aspirin If <4.5 hours including at least 30 minutes of symptoms start thrombolysis Thrombolysis First check for contraindications (see table below) Must have lab results back (clotting + platelets) 0.9mg/kg alteplase as per clinical pathway in hospital 10% bolus over 1 minute, remainder over 60minutes
29
post thrombolysis Tx for strokes
SALT Swallow assessment within 2 hours – also helps with communication ``` Physiotherapy Relieves spasticity Prevents contractures Baclofen may be used to relieve spasticity Early mobilisation is vital ``` Occupational therapy Limb splinting, ward groups ``` Nursing Implement SSKIN bundle Early nutrition required if NBM LMWH anticoagulation started on day 3 post-ischaemic stroke Ensure TED stockings are being worn ```
30
post thrombolysis Tx for strokes
SALT Swallow assessment within 2 hours – also helps with communication ``` Physiotherapy Relieves spasticity Prevents contractures Baclofen may be used to relieve spasticity Early mobilisation is vital ``` Occupational therapy Limb splinting, ward groups ``` Nursing Implement SSKIN bundle Early nutrition required if NBM LMWH anticoagulation started on day 3 post-ischaemic stroke Ensure TED stockings are being worn ```
31
post discharge stroke management
``` Lifestyle Cardioprotective diet Stop smoking Reduce drinking Exercise more ``` Antihypertensive therapy Most importantly Start 2 weeks post stroke if there is elevated BP BP should be lowered slowly as autoregulation is likely impaired Antiplatelet therapy Aspirin 300mg daily for 2 weeks Clopidogrel 75mg therafter Statin Offer 48 hours post stroke independent of cholesterol levels Manage comorbidities Strict diabetes management Control AF well Carotid USS will also be undertaken
32
post-stroke complications
Malignant MCA syndrome (Rapid neurological deterioration due to cerebral oedema associated with MCA infarcts ) DVT/PE Aspiration + hydrostatic pneumonia Pressure sores Depression Seizures Incontinence Post-stroke pain Worsens outcomes Multifactorial in nature Often requires pain team input
33
Tx of Malignant MCA syndrome
NICE recommends empirical treatment in any patient <60 with a CT/MRI showing an infarct of at least 50% in the MCA with decreasing GCS Treatment = rapid decompressive hemicraniectomy
34
what factors make a patient 'high risk' for stroke post TIA
TIA when anticoagulated Multiple TIAs (especially in a short period of time) ABCDD score >3 Age >60 is 1 point Blood Pressure >140/90 = 1 point Clinical features Unilateral weakness = 2 points Speech disturbance without weakness = 1 point Duration of symptoms >60 mins = 2 points 10-59 minutes = 1 point Diabetes 1 point
35
Tx for patients that have had a TIA and have been determined high risk for stroke
Statin 300mg aspirin Unless currently taking low dose aspirin Arrange referral to a specialist clinic in 24 hours Advice patients not to drive until seen by specialist
36
Tx for patients that have had a TIA and have been determined low risk for stroke
Statin 300mg aspirin Unless currently taking low dose aspirin Arrange referral to a specialist clinic within a week Advice patients not to drive until seen by specialist
37
what is required to diagnose a venous sinus thrombosis
MRI angiography
38
Tx of haemorrhagic stroke
Antiplatelets/anticoagulation CONTRAINDICATED Reverse anticoagulation Lower BP to <140/90 in 1 hour IV labetolol Neurosurgical intervention may be required If GCS is falling and there is evidence of coning
39
complications of subarachnoid haemorrhage
Death 30% die immediately Rebleed Aneurysms - Inital bleed may be fatal but with sufficient vasospasm a clot may form This usually holds for 3-4 days before rebleeding AVMs Generally rebleed within a few years rather than days Hydrocephalus Due to fibrosis of CSF pathways from the insult Cerebral vasospams May be severe leading to delayed vascular damage
40
investigation of ?SAH
``` Bloods FBC U+E LFT ESR Clotting G+S ``` ``` CT Initial investigation of choice Usually seen within 48 hours Quantity of blood should be estimated for prognosis AVM usually visible on CT ``` LP - if CT normal Should be done >12 hours after symptom onset CSF will become xanthochromic (yellow from bilirubin) – visual inspection is sufficient for diagnosis CT/MRI Angio - for surgery
41
Tx for SAH
4 weeks bed rest Hypertension control Nimodipene – reduces vasospasm, reduces mortality Give to all if BP allows IV fluids – may also prevent further vasospasm Analgesia, anti emetics Stool-softners to prevent straining Discuss with neurosurgery 10-20% will rebleed within a few weeks Aneurysms will usually be coiled by interventional radiology due to imminent risk of rebleed Some will require neurosurgical clipping AVMs usually rebleed within years rather than days but are generally dealt with at the time of presentation Coiling by IR more common but gamma knife therapy may also be done 11% of patients develop hydrocephalus and require a shunt
42
what is the sign of an acute subdural hematoma on CT head
crescent shape pool of blood with midline shift and ventricle occlusion
43
management of acute subdural haematoma
craniotomy
44
what are the signs of a chronic subdural hematoma on CT head
blood becomes dark and assumed a more lentiform shape (like extradural)
45
Tx tension headache
``` If episodic (<15d/month) Paracetamol Aspirin NSAIDS Advice not to overuse the medication ``` If medication is used more than twice a week consider preventative treatment Low dose amitryptaline 75mg initally, titrated upwards if there is a partial response Chronic tension headache is more difficult to treat Reassurance, relaxation techniques and addressing underlying stressors are important Medication overuse headaches and clinical depression should be excluded and/or treated
46
Tx cluster headaches
Exclude secondary causes and other causes of eye pain e.g. acute angle closure glaucoma Subcutaneous triptan to take at the start of an attack Home oxygen for use during the attack At least 12/L min through non rebreathe Not for COPD Oral triptans/oral analgesia not effective for the acute attack Prophylactic treatment is with alcohol avoidance and verapamil (off-license)
47
Tx Migraines
``` Examine to rule out other differentials Signs of focal neurology Raised ICP Meningism Temporal arteritis Retinal haemorrhage (SAH) ``` ``` Headache diary Frequency Severity of attacks Precipitants Exacerbating/relieving factors Avoidance of external triggers ``` In the acute attack First line is an oral NSAID or paracetamol + anti emetic (metclopramide) 2nd line is a triptan (oral, sumutriptan) taken as soon as possible on the onset of symptoms Can be intranasal if vomiting prevents oral treatment Opioids should not be used Follow up, as repeated unsuccessful triptan treatment therapy is rare (10%) if the underlying diagnosis is actually migraines Preventative treatment Consider if migraine attacks are causing significant disability >2 a month Topiramate or propanolol are first line Propanolol in women of child bearing age Amitryptiline/anticonvulsants if these arent successful/ tolerated
48
what patient population should you avoid triptans in
Avoid if IHD, uncontrolled HTN, coronary artery spasm
49
why is the COCP avoided in women that have migraines
Slight increase in stroke risk in those on COCP greater if migraine sufferers
50
Tx menstrual related migraine
mefanamic acid from the first day or menses throughout menstruation, or triptans 2 days before the expected time of period
51
presentation of idiopathic intracranial hypertension
visual disturbance + headaches in a younger obese woman may be a pulsatile tinnitus and a 6th nerve palsy
52
Tx idiopathic intracranial hypertension
weight loss generally causes spontaneous remission definitive management is a surgical shunt trial of corticosteroids may also be successful
53
Tx trigeminal neuralgia
Simple analgesics are ineffective, with carbamazepine offering good symptom control
54
Tx atypical face pain
anti-depressants (if patient has depression/anxiety)
55
Tx newly diagnosed brain cancer
Dexamethasone 5-6mg QDS If any neurological deteriation or drowsiness Anticonvulsants If presented with epilepsy Refer to neuro-oncology MDT Neurosurgical intervention if accessible, often with adjunctive therapy
56
give examples of paraneoplastic syndromes
Myasthenia gravis Lambert-eaton myasthenic syndrome Paraneoplastic sensory neuropathy Paraneoplastic cerebellar degeneration
57
signs of paraneplastic cerebellar degeneration
Gives classical cerebellar signs Ataxic gait Dizziness Dysarthria
58
what cancers typically cause paraneoplastic cerebellar degeneration
Frequently associated with hodgkin lymphoma, breast cancer, small cell lung cancer and ovarian cancer
59
what is the triad of normal pressure hydrocephalus
Dementia - (wacky) Urinary incontinence (wet) Apraxic gait (wide, shuffling, short gait with difficulty beginning and turning whilst walking) - (wobbly)
60
Tx for normal pressure hydrocephalus
Some patients respond to ventriculoperitoneal shunting Only indicated if they respond to trials of lumbar drainage
61
what does an indian ink stain test for whilst investigating CSF
fungi
62
Empirical treatment of ?meningitis in a non-blanching rash
1. 2g IM benzylpenicillin STAT 2. 4mg 4 hourly following this cefotaxime can then be used in the tx of penicillin allergic patients
63
Tx of confirmed bacterial meningitis
If <60 and not immunocompromised IV ceftriaxone 2g BD Cloramphenicol used in pen allergic patients (25mg/kg IV) IV dexamethasone 2 doses 6 hours apart given with first Abx dose >60 or immunosuppressed (this includes diabetes) IV ceftriaxone 2gBD IV amoxicillin 2g 4 hourly IV dexamethasone
64
Tx of herpes encephalitis
IV aciclovir for 10 days
65
what Abx is used as a prophylactic dose for close contacts in a confirmed case of meningococcal disease
Ciprofloxacin
66
acute complications of meningitis
Sepsis/DIC Hydrocephalus Adrenal haemorrhage: waterhouse-friedeerichsen syndrome
67
chronic complications of meningitis
Seizures Brain abscesses (Generally very rare) Cranial nerve palsies Ataxia/muscle hypotonia
68
Tx brain abscess
Tx = surgical drainage, broad spectrum Abx and high dose corticosteroids
69
what organism is most likely to cause an acute spinal abscess
staph aureus
70
Tx for acute spinal abscess
emergency imaging, ABx and decompression
71
what type of herpes zoster virus causes encephalitis over meningitis
HSV-1 (HSV-2 causes meningitis most commonly)
72
prognosis of viral encephalitis
mortality is 20%
73
what is Todd's paralysis
temporary paralysis of the limb post partial seizure
74
what are features of temporal lobe epilepsy
Classic aura with a sense of fear/deja-vu and hallucinations Confusion/anxiety and automatisms Lip smacking Chewing
75
what stimulates absence seizures
hyperventilation or glashing lights
76
Tx Generalised seizures
1st line is valproate or lamotrigine in females of childbearing age Adjuncts may be clozabam, carbamazepine or levetiracetam
77
Tx absent seizures
Ethosuximide
78
Tx partial seizures
Carbamazepine or lamotrigine in females of childbearing age Multiple adjuncts used
79
side effects of sodium valproate
rash, sedation, weight gain, hair loss or tremor Also associated with birth defects, thrombocytopenia, increased risk of pancreatitis and liver damage
80
main risk of lamotrigine
bone marrow suppression
81
main risk of carbamazepine
agranulocytosis
82
side effects of phenytoin
Gum overgrowth Nyastagmus
83
what are some overall principles to stick by when treating epilepsy
All can cause leucopenia, rashes, SJS, TEN Refractory cases require adherence and alcohol/drug use checking, as well as considering a SOL Withdrawal may be allowed is the patient is seizure free for 2-4 years and the drug should be reduced in dose every 4 weeks with the patient stopping driving during withdrawal
84
what are the driving laws surrounding epilepsy
If a patient has had a seizure they should inform the DVLA and stop driving immediately If the attack was whilst they were awake and there was LOC their license is revoked Patients may apply again if they are seizure-free for 6 months after 1 seizure, 1 year after multiple seizures Patients with sleep-related epilepsy can drive If the past 3 years have had only sleep-related seizures
85
what are the rules around treating epilepsy and pregnancy
Majority of epilepsy drugs are associated with neural tube defects It still must be treated in pregnancy as risk of neural tube defects is still preferable to hypoxic seizures Lamotrigine is first line in women of childbearing age Any woman with epilepsy that is pregnant should be taking 5mg folic acid during the first trimester and should be seen by a consultant throughout the pregnancy They should also have vitamin K in the 3rd trimester due to risk of foetal bleeding
86
What tests are most helpful to diagnose MS
MRI - gold standard CSF - oligoclonal bands on electrophoresis in 80% Visual evoked responses (95%)
87
management of acute MS attack
Investigate any cause Infection Consider admission if the relapse is severe or the patient cannot meet their social care needs at home High dose corticosteroids Oral methylprednisolone 0.5g/day for 5 days May reduce severity of attack but no effect on long term course of disease Start as soon as possible Assess any increase in social care Patient education Steroids help symptoms but may cause confusion/depression Significant recovery expected within 2-3 months there may be residual symptoms
88
General management of MS
Should be under a specialised MDT Lifestyle Stop smoking Exercise Prompt recognition and treatment of co-existing infections UTIs in particular are a bit exacerbator Assess for and treat complications Offer disease modifying therapy Interferon beta and glamatier no longer reccomended by NICE Relapsing remitting Demethyl fumarate/teriflunomide Natalizumab for severe MS (2 or more disabling relapses in a year) Decreases relapses by 2/3
89
complications of MS
Fatigue Spasticity Constipation/pressure sores Ataxia/tremor Depression Urianation Sexual dysfunction
90
Tx for complications of MS
Fatigue Poorly understood Cognitive approaches and amantidine may be helpful Spasticity Baclofen and physiotherapy is first line Consider factors affecting spasticity Dantrolene/botox injections for refractory spasticity Ataxia/tremor No pharmacological treatment recommended Physiotherapy/OT referral should be considered Mobility issues Aids if required Aim for physio or vestibular rehabilitation Depression CBT Marked depression is common Urination Post void bladder scan <100ml = training/oxycontin/tolteradine Post void bladder scan >100ml = teach intermittent catheterisation Sexual dysfunction Siladefenil for men Pressure sores Encourage movement/physio and regular checking for sores
91
Prognosis of MS
Average life expectancy from diagnosis is 20-30 years May be a long latent episode (15-30 years) from an episode of optic neuritis before further symptoms occur Prognosis is better if there is a sensory onset
92
poor prognostic features of MS
Increase age of presentation Early cerebellar involvement Loss of mental functions
93
Causes of cerebellar dysfunction
``` MS Alcohol Vascular disease Iatrogenic/infective/inherited (freidrich's ataxia) SOL ```
94
Tx parkinsons
Specialist MDT Social care important Levodopa + COPA Decarboxylase to delay L-Dopa therapy (as there is a wearing off effect) these drugs may be used: Dopamine agonists (bromocriptine/cabergoline/ropinarole) MAOIs (selegine) COMT-is (entacapone)
95
side effects of levodopa
Nausea Vomiting Confusion Visual hallucinations Chorea
96
what anti-emetic can be used for parkinsons disease
domperidone
97
what are ergot derivatives (bromocriptine/cabergoline) associated with and what should be done about it
pericardial/pulmonary/retroperitoneal fibrosis should be monitored via Echos, pulmonary function tests and ESR
98
surgical options for parkinsons
Deep brain stimulation Thalotomy
99
prognosis parkinsons
Progressive disease and most patients will succumb to complications within 10 years
100
Tx Dementia
MDT Social care very important Carer assessment Occupational therapy functional and home assessment ``` Reduce vascular risks BP Lipid profile Glycaemic control Particularly in VD – but do for all ``` Cognitive stimulation therapy Group classes May slow decline ``` Mild-moderate AD/LBD ACh inhibitors (Donepezil/Galantamine/Rivastigmine) ``` ``` Severe NMDA receptors (Memantin) ] ``` Manage the behavioural and psychological symptoms of dementia (BPSD) Non-pharmalogical as much as possible Antipsychotics increase risk of stroke and therefore should only be prescribed by a specialist
101
symptomatic control of delirium
1 to 1 nursing Hydration Promote orientation Control pain but avoid any sedative drugs
102
management of motor neurone disease
Specialist MDT management Social and carer assessment important Disease-modifying therapy Riluzole Increases presynaptic glutamate increases survival in ALS patients by an average of 3-4 months Nutritional support From an early stage, it can produce increases in QOL Gastrostomy tubes may be placed late in the disease if the swallowing function is lost Respiratory support NIPPV considered if respiratory weakness is still an issue
103
prognosis of motor neurone disease
Remission from MND is not known Death is eventually from bronchopneumonia or respiratory failure from weakness of respiratory muscles
104
4 most common causes for peripheral neuropathy
Diabetes Carcinomatous B vitamin deficiency Drugs
105
management of guillan barre syndrome
Severe cases progress rapidly over hours-days Nurse on high dependency units Pay attention to pressure sores, chest infections and DVTs Cases involving respiratory muscles require intubation FVC should be regularly monitored SC heparin + pressure sores reduce risk of DVT If presenting within the first 2 weeks, high dose IV immunoglobins will reduce the severity and duration of paralysis Corticosteroids have no therapeutic benefit
106
prognosis of guillan barre syndrome
In mild cases there is little disability before spontaneous recovery Complete recovery occurs over months – 80-90% recover completely Some left with residual weakness
107
Tx of shingles
5-7 days oral acyclovir Paracetamol/amitryptaline for pain
108
what is a sensitive indicator for opthalmic herpes and why Is it important to recognise
opthalmic herpes may lead to May lead to Uveitis, Corneal scarring, Secondary panopthalmitis and is potentially light threatening Heralded by shingles on the tip of the nose – most sensitive factor This is called hutchinsons sign
109
post-herpetic neuralgia Tx
like any neuropathic pain amitrypatline and topical capsaicin for example
110
Tx myathenia gravis
Avoidance of certain Abx that induce NM blockade Aminoglycosides (Gentamicin, Neomycin, Vancomycin) Lifelong long-acting oral ACh-esterase Neostigmine, Pyridostigmine Corticosteroids for relapses Starting in hospital as increasing weakness early on Simultaneous identification + treatment of the trigger Weakness of respiratory muscles can be life-threatening Monitor FVC May need a ventilator Severe cases need IVIg/plasmaphoresis Alternate-day regimen at discharge Steroid sparing agent is azathioprine Thymemectomy Performed at any age increases chance of remission
111
prognosis opthalmoplgeia
MG may never progress beyond opthalmoplgeia and periods of remission for up to 3 years may occur Outlook is poor if there is respiratory muscle involvement
112
most common musclular dystrophy
duchennes
113
management of a patient with an impaired motor function
Manage as per the REPAIR mnemonic Spasticity Physical management - Physio, Gait training Removal of exacerbating stimuli Surgical management Tendon lengthening Releases for fixed deformities Electrostimulation therapy ``` Medical management Baclofen Dantrolene Benzodiazepines Botulinum Toxin injection ``` Contractures Aim to prevent development

CP3 Management (11 decks)

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