Neurology Stuff Flashcards
(22 cards)
when should oral prednisolone be given in a patient with suspected bells palsy?
Within 3 days (72 hours) of symptom onset.
Patients should also be given artificial tears.
what is the difference between Penumococcal and Meningococcal meningitis?
Both are bacterial types of meningitis.
Pneumococcal is caused by Streptococcus Pneumonia ( Gram +ve Diplococci)
Meningococcal is caused by Neisseria Meningitidis ( Gram -ve Diplococci)
What is the Initial empirical Tx for suspected bacterial meningitis in patients <3 months old?
IV Cefotaxime + Amoxicillin
What is the Initial empirical Tx for suspected bacterial meningitis in patients 3 months - 60 years old?
IV Ceftriaxone
What is the initial empirical therapy for suspected bacterial meningitis in patients >60 yrs old?
IV Ceftriaxone + amoxicillin (or ampicillin)
How is confirmed Meningococcal Meningitis treated?
IV benzylpenicillin or IV ceftriaxone
How is confirmed Pneumococcal Meningitis treated?
IV Ceftriaxone
In the treatment of suspected bacterial meningitis when is IV dexamethasone contraindicated?
- septic shock
- meningococcal septicaemia
- immunocompromised patients
- meningitis following surgery
IV dex must be given within 12 hours of starting Abx.
If suspected meningococcal meningitis yet the patient has had previous rash with penicillins - should IM Benpen be administered before transition to hospital?
Yes, as long as there is no history of anaphylaxis then give IM Benzylpenicillin.
What is a TIA defined by time or tissue?
New definition is Tissue based.
refers to a transient episode of dysfunction without acute infarction on imaging.
What are some Examples of TIA mimics?
Hypoglycaemia
Intracranial Haemorrhage (all px on anticoags should be admitted for imaging to exclude)
When should Imaging be carried out in patients with suspected TIA?
- which imaging should be done?
suspected TIA? –> assessed by stroke specialist clinician before decision on imaging.
NICE recommends that CT brains should not be done unless there is clinical suspicion of an alternative diagnosis that a CT could detect.
MRI is preferred to determine the territory of ischaemia, or to detect haemorrhage.
What is the management of TIA for patients within 24 hours of onset of TIA?
DAPT (dual antiplatelet therapy) regimes:
- Clopidogrel + aspirin (for first 21 days) then clopidogrel monotherapy.
or
- Clopidogrel + Ticagrelor as an alternative.
What is Pregabalin used for?
Its a GABA analogue which is used for Neuropathic pain.
First or second line in
- Diabetic peripheral neuropathy
- Postherpetic neuralgia
- spinal cord injury-related pain
(Often used when amitriptyline or duloxetine are ineffective or contraindicated)
What is Amytriptyline used for?
Tricyclic antidepressant used for its Analgesia and sedative properties.
Neuropathic pain - commonly used first line in
- Diabetic neuropathy
- Post-herpetic neuralgia
- Post-stroke pain
- Radiculopathy or spinal nerve root pain.
NICE recommends it alongside duloxetine, pregabalin or gabapentin.
What are the similarities between an Anterior Inferior Cerebellar Artery stroke (AICA) and a Posterior Inferior Cerebellar Artery Stroke (PICA)?
Similarities include:
- Ipsilateral loss of pain and temperature sensation to the FACE
- Contralateral loss of pain and temperature sensation to the LIMBS and TRUNK.
- Slurring of speech
- Ataxic gait
What are the differences between an AICA and PICA stroke and why is there this difference anatomically?
AICA affects the Pons
PICA affects the Medulla
The Midbrain, pons and medulla contain 4 CNs each (roughly in that order)
So anything affecting CN 5, 6, 7, 8 (facial weakness for 7, deafness for 8) would be AICA.
AND
Anything affecting CN 9, 10, 11, 12 (hoarse voice for 10, tongue / swallowing issues for 9 & 11) would be PICA.
How would a AICA stroke present?
Temperature and pain sensation loss over Ipsilateral FACE and contralateral LIMBS + TRUNK alongside slurring of speech and ataxic gait. Also with ipsilateral Facial WEAKNESS and Ipsilateral HEARING LOSS.
How would a PICA Stroke present?
Temperature and pain sensation loss over Ipsilateral FACE and contralateral LIMBS + TRUNK alongside slurring of speech and ataxic gait. Also with Hoarseness of voice and Difficulty swallowing + Nystagmus.
What causes Wernicke’s Encephalopathy?
thymine deficiency which is most commonly seen in alcoholics.
What does Wernickie’s present with and how is it treated?
- Occulomotor dysfunction (nystagmus, opthalmoplegia)
- Gait Ataxia
- Encephalopathy : confusion, disorientation, inattentiveness
- peripheral sensory neuropathy.
Treatment is with urgent replacement with thiamine.
What features are common with korsakoff’s syndrome and how does it occur?
Occurs when Wernickie’s is left untreated.
Features include amnesia (antegrate + retrograde) and confabulation (where a patient generates a false memory).
