Random neuro stuff to remember

Question 1

Patient with vision worse looking down e.g. struggles climbing downstairs or reading.
Inability to depress both eyes from an adducted position and vertical diplopia.

Answer 1

4th nerve palsy - Trochlear

LR6 SO4 AO3

Question 2

What are indications of a more sinister headache which then indicate the need for an Urgent CT head scan?

Answer 2

• Vomiting more than once with no other cause.
• New neurological deficit (motor or sensory).
• Reduction in conscious level (measured using GCS).
• Valsalva (associated with coughing or sneezing) or positional headaches.
• Progressive headache with a fever.

NICE suggest 2 or more of the “red-flag” criteria indicate the need for an urgent CT scan.
likelyhood of serious Intracranial pathology.

Question 3

When should each of the following medications be used for Nausea management?
- Ondansetron (serotonin receptor antagonist)
- Haloperidol (Antipsychotic)
- Prochlorperazine (Dopamine Receptor Antagonist)
- Metoclopramide (Central dopamine antagonist)

Answer 3

Ondansetron for chemotherapy-induced nausea. (5-HT3-receptor antagonist in combination with dexamethasone)

Haloperidol for intracranial causes (raised ICP, direct effect of tumour)

Prochlorperazine for Vestibular causes.

Metoclopramide for Gastrointestinal causes.

Question 4

An acute headache reaching maximal intensity <5mins. Occuring in occipital location of the head.
Described as the worst headache of patients life.

Answer 4

Subarachnoid haemorrhage.

Urgent Non contrast CT first line.