Neurology - head problems

Question 1

What are some symptoms of optic neuritis?

Answer 1

decreased acuity in few days pain, pain on moving eye, made worse by heat and exercise, afferent pupil reflex (RAPD), colour blindness

Question 2

What are the signs of cerebellar disease?

Answer 2

DANISH
Dysdiadodochokinesis
Ataxia
Nystagmus
Intention tremor
Speech
Hypotonia 
Reflexes (pendular)

Question 3

What is hydrocephalus?

Answer 3

excess CSF in intracranial cavity - caused by bacterial meningitis, haemorrhage post fossa tumours, spina bifida

Question 4

How do you treat hydrocephalus?

Answer 4

CT head - surgical drainage

if untreated there is likely to be irreversible brain damage

Question 5

How do you diagnose giant cell arteritis?

Answer 5

temporal artery biopsy
PET scan
ESR/CRP

Question 6

How do you treat giant cell arteritis?

Answer 6

steroids

immunosuppressants/biologicals

Question 7

Name 3 signs of encephalitis

Answer 7

fever, headache, lethargy
photophobia, neck stiffness
behaviour change 
seizure
decreased consciousness

Question 8

What is the treatment of encephalitis?

Answer 8

30 minutes after arrival - acyclovir

Question 9

How do you treat meningitis?

Answer 9

bacterial - cefotaxime, ceftriaxone

Viral - acicylovir

Question 10

What tests would you do for meningitis?

Answer 10

Blood culture - gram - diplococcus 
LP - between L3 and S1 
CT of head 
throat swap 
serum PCR - for viral, meningococcal, pneumococcal 
check retina for raised ICP

Question 11

What is the treatment for a cluster headache?

Answer 11

100% O2, 7-15 L for 15 mins

Question 12

What is a cluster headache?

Answer 12

5 attacks of facepain (15-180 mins), upsilateral cranial autonomic features, restlessness 1-8 day

Question 13

Who is most at risk of a cluster headache?

Answer 13

Risk increases with smokers, more alcohol,

Question 14

Prophylaxis for migraine

Answer 14

primary - beta blocker, e.g. propanolol
amytriptyline
topiramirate, sumatriptan

Question 15

What symptoms indicate temporal arteritis?

Answer 15

Headache, scalp tenderness, jaw caludication, malaise, acute blindness (curtain coming down)

Question 16

Name 3 symptoms of a brain tumour

Answer 16

Signs of raised ICP - vomiting, headache 
progressive neurological deficit 
epilepsy 
tiredness 
papilloedema

Question 17

What disease is associated with trigeminal neuralgia?

Answer 17

MS

Question 18

What are the diagnostic criteria for trigeminal neuralgia?

Answer 18

3 of - recurrent very short attacks, severe electric shock, shooting or stabbing triggered by normal stimuli

Question 19

How would you test for glucoma?

Answer 19

tonometry

Question 20

What is Uthoff’s phenomenon?

Answer 20

precipatation of symptoms of optic neuritis by heat

Question 21

What is prophylaxis for cluster headaches?

Answer 21

veramapril - calcium channel blocker

Question 22

How would you manage idiopathic intracranial hypertension?

Answer 22

weight loss, serial LPs
acetazolomide and furesomide to lower CSF production
surgical decompression but only if eyesight is affected

Question 23

What are the long term effects of bacterial meningits?

Answer 23

hearing loss

Question 24

How who are the ‘contacts’ of someone with meningitis and how do you treat them?

Answer 24

Contact = household or kissing partner

ciprofloxacin 500mg

Question 25

What are some causes of optic neuritis?

Answer 25

MS, GCA, diabetic papillopathy, autoimmune, post-infection, post-vaccination, TB, syphillis, B12 deficiency, ethamutol, viral

Question 26

How would you treat a migraine?

Answer 26

``` Triptains e.g. sumatriptain NSAIDs/paracetamol antiemetics physiological and behavioural therapy lifestyle modification ```

Question 27

What are the 3 most common cancers to cause secondary brain tumours?

Answer 27

breast, lung, melanoma

Question 28

How would you treat a brain tumour?

Answer 28

radio | debulking surgery

Question 29

What is the prognosis of a brain tumour?

Answer 29

13.4 months

Question 30

What are the 3 most common types of headache?

Answer 30

cluster, tension, migraine

Question 31

What are the arteries affected in a TACS and what are the symptoms?

Answer 31

total anterior circulation stroke - ACA and MCA need 3 of: unilateral weakness +/- sensory deficit of face, arm and leg homonymous hemianopia high cerebral dysfunction

Question 32

What are the arteries affected in PACS and what are the symptoms?

Answer 32

partial anterior circulation stroke - ACA and MCA need 2 of: unilateral weakness +/- sensory deficit of face, arm and leg homonymous hemianopia high cerebral dysfunction

Question 33

What are the arteries affected in POCS and what are the symptoms?

Answer 33

``` posterior circulation stroke one of the following: cranial nerve palsy with contralateral motor sensory deficit bilateral motor/sensory deficit conjugate eye movements cerebellar dysfunction isolated homonymous hemianopia ```

Question 34

What are the arteries affected in a LACS and what are the symptoms?

Answer 34

``` lacunar circulation stroke no loss to higher cerebellar function one of the following: pure sensory pure motor sensorimotor ataxic hemiparesis ```

Question 35

What are some symptoms of low pressure headaches?

Answer 35

post LP | worse on standing, better in morning

Question 36

How would you treat low pressure headaches?

Answer 36

caffeine | blood patch

Question 37

What can cause some carotid artery dissection?

Answer 37

sudden jolts or head turning e.g. rollercoasters | associated with Horner's syndrome

Question 38

What is the risk with carotid artery dissection and how do you treat it?

Answer 38

Big risk is a stroke as clot forms on flap of carotid artery - give them anticoagulants

Question 39

What are the symptoms of venous sinus thrombosis?

Answer 39

sudden onset headache which gradually gets worse, a seizure can happen

Question 40

How does trigeminal autonomic cephalgia present?

Answer 40

similar to cluster headaches, F>M, more frequent episodes than cluster headaches

Question 41

How do you treat trigeminal autonomic cephalgia?

Answer 41

indomethacin (an NSAID) cures them