Neurology Treatment Pathways Flashcards by William MacDonald

Status epilepticus management

ABCDE
Emergency blood tests inc blood glucose and maybe CT
10mg buccal diazepam/IV lorazepam, then 5 mins, then another dose (only give 2 doses)
If seizures continue give phenytoin (monitor levels)
If drugs don’t work in 30 minutes send them to ITU

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MS fatigue management

Amantadine (risk of heart failure)
Modafinil if sleepy
Hyperbaric oxygen

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Mild MS exacerbation management

Symptomatic treatment

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Moderate MS exacerbation management

Oral steroids

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Severe MS exacerbation management

Admit/IV steroids

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MS pyramidal dysfunction management

Physio
OT
Anti-spasmodic agents

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MS spasticity management

Physio
Baclofen, tizanidine
Botulinum toxin
Intrathecal baclofen/phenol if bedbound

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MS sensory symptoms management

Anti-convulsant e.g. gabapentin
Anti-depressant e.g. amitriptyline
TENS machine
Acupuncture
Lignocaine infusion

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MS lower urinary tract dysfunction management

Bladder drill (retraining)
Anti-cholinergics
Desmopressin (helps with frequent urination)
Catheterisation

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MS disease modifying therapy first line

Interferon beta (avonex, rebif, betaseron, extavia)
Glitiramer acetate
Tecfedira (dimethyl fumarate)
Aubagio (teriflunomide)

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MS disease modifying therapy second line

Monoclonal antibody (tysabri, ocrevus)
Fingolimod
Cladrabine

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MS disease modifying therapy third line

Mitoxantrone
Lemtrada (alemtuzumab)
HSCT (stem cell transplantation)

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How must interferons and glitiramer acetate be taken?

SC or IM

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What MS treatment can cause multifocal leukoencephalopathy?

Tysabri (monoclonal antibody)

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GBS management

Ig infusion and/or plasma exchange

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Vasculitic peripheral neuropathy management

Pulsed IV methylprednisolone and cyclophosphamide

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Demyelinating peripheral neuropathy management

IV Ig
Steroids
Azathioprine, mycophenalate, cyclophosphamide

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Lambert-eaton myaesthenic syndrome management

3-4 diaminopyridine

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Myaesthenia gravis acute management

Acetylcholinesterase inhibitor (pyridostigmine)
IV Ig
Thymectomy (even in absence of thymus abnormality)

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Myaesthenia gravis immunomodulatory treatment

Steroids

Steroid sparing agents (azathioprine, mycophenolate)

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Medical management of raised ICP

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Sedation - propofol, benzos, barbiturates
Max venous drainage of brain - head of bed tilt of 30 degrees, cervical collars, ET tube ties
CO2 control
Osmotic diuretics (mannitol, hypertonic saline)
CSF release

Management of raised ICP due to bleed that cannot be managed medically or surgically

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Decompressive craniectomy (saves lives but does not improve outcomes)

Management of late seizures after head injury.

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anti-epileptics reduce early but not late seizures

No evidence for prophylactic antiepileptics

Do steroids work in diffuse axonal injury?

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No they make outcome worse (as it is a toxic swelling).

Neuropathic pain agents for children

``` Topical levomenthol Topical capsaicin Lidocaine patch Tricyclics e.g. amitriptyline Gabapentin/pregabalin ```

Neuropathic pain agents for adults

``` Tricyclics e.g. amitriptyline Anticonvulsants e.g. gabapentin Opioids NMDA antagonists (ketamine) Sodium channel blockers e.g. lignocaine Capsaicin GABA agonists e.g. baclofen ```

Non-pharmacological management of chronic pain

``` AHPs TENS Acupuncture Nerve blocks Intrathecal drug delivery systems Spinal cord stimulation ```

Management of phantom limb pain

Mirror therapy

Alzheimers medical management

ACh boosting meds e.g. rivastigmine (first line) | NMDA receptor blocker e.g. memantine (second line)

Fronto-temporal dementia medical management

Trial of trazodone/antipsychotics to help behavioural features

MND drug, effects and side effects

Riluzole Prolongs life by 3 months at severe stage of disability Can cause renal failure and liver failure

Management of sialorrhoea (drooling) in MND

Hyoscine/buscopan Glycopyrronium (esp in cognitive impairment) Botox Suction/humidification/carbocysteine

Management of muscle cramps in MND

Quinine | Baclofen

Management of muscle spasms in MND

Baclofen Tizanidine Dantrolene Gabapentin

Sub-arachnoid haemorrhage due to aneursym prevention of re-bleeding management first line.

Endovascular techniques (put metal coil in to seal of aneurysm)

Sub-arachnoid haemorrhage due to aneursym prevention of re-bleeding management second line.

Surgical clipping

Drug given to all SAH to prevent vasospasm and delayed ischaemia.

Nimodipine

Management of delayed ischaemic neurological deficit in SAH

Triple H therapy - hypervolaemia (fluids), hypertension (inotropes), haemodilution (also fluids)

Hydrocephalus after SAH management

1st line: lumbar puncture. 2nd line - external ventricular drain (up to 2 weeks) 3rd line - shunt

Hyponatraemia/SIADH/cerebral salt wasting management after SAH.

No fluid restriction Supplement sodium intake Fludrocortisone (retains salt)

Intra-cerebral haemorrhage with no decreased conscious level management

Non-surgical management

Intra-cerebral haemorrhage with decreased conscious level management

Surgical evacuation of haematoma with maybe treatment of underlying abnormality

Management of traumatic spinal cord compression

Immobilise Investigate (x-ray/CT and MRI) Decompress and stabilise (surgery, traction, external fixation) Maybe methylprednisolone

Management of AVMs

``` Surgery with adjunct endovascular embolisation OR Stereotactic radiotherapy OR Conservative ```

Management of spinal mets of tumours

Dexamethasone Radiotherapy Chemotherapy Surgery Depends on patient and tumour

Management of primary spinal cord tumours

Surgical excision

Medical management of raised ICP

Diuretics (mannitol, hypertonic saline, furosemide, urea) Barbiturate coma - stops non-essential brain functions Antiepileptics

Surgical management of raised ICP

Surgical decompression (take off large part of frontal bone) Remove mass lesions CSF diversion

Normal pressure hydrocephalus management

VP-shunt with medium-low or low-pressure valve.

Idiopathic intracranial hypertension management

Weight loss CA inhibitors (acetazolamide, topiramate) Diuretics LP or VP shunt Interventional radiology (intracranial venous sinus plasty/stenting) Optic nerve sheath fenestration (ONSF) - designed to save vision

Sciatica management

Conservative as usually self-limiting | If not getting better then maybe surgery

How long after stroke can you give thrombolysis and thrombectomy (once haemorrhage has been excluded)?

Thrombolysis - up to 4.5 hours after symptoms begin Thrombectomy - up to 6 hours after symptoms begin Should give both together if possible

Neurology Treatment Pathways Flashcards

(52 cards)