Neurology Akt

Front 1

Head Injury - Immediate CT Head

Back 1

GCS < 13 on initial assessment

CGS < 15 2 hours post injury

Suspected open or depressed skull fracture

Any sign of basal skull fracture

Post-traumatic seizure

Focal neurological deficit

> 1 episode of vomiting

Front 2

Head Injury - CT Head within 8 hours

Back 2

>= 65 years

History of bleeding/clotting disorders

Taking warfarin

Dangerous mechanism of injury

> 30 mins of retrograde amnesia of events prior to injury

Front 3

Migraine Prophylaxis

Back 3

1) Propanolol or topiramate.

2) 10 sessions of acupuncture over 5-8 weeks

3) Gabapentin

4) Riboflavin

5) Menstrual migraine - frovatriptan or zolmitriptan - mini-prophylaxis

Front 4

Migraine Treatment

Back 4

1) Oral triptan and NSAID or Oral triptan and paracetamol

2) Aged 12-17 years - nasal triptan

3) Non-oral preparation of metoclopramide or prochlorperazine + non-oral NSAID/triptan

Front 5

Migraine without aura

Back 5

A) At least 5 attacks fulfilling B-D

B) Headache attacks lasting 4-72 hours

C) >= 2 of: unilateral, pulsating, moderate/severe pain intensity, aggravated by movement.

D) >= 1 of: nausea +/- vomiting, photophobia and phonophobia.

E) Not attributed to anything else.

Front 6

Parkinson's Disease

Back 6

Degeneration of dopaminergic neurons in basal ganglia

Mean age 65 years, 2x men

Resting tremor - 3-5 hz, worsens with tiredness, pill-rolling

Bradykinesia - difficulty initiating, short shuffling steps, poverty of movement

Rigidity - cog-wheel, lead-pipe

Mask-like, flexed, micrographia, drooling, depression, dementia, reduced smell, sleep disorder

Front 7

Essential tremor

Back 7

Autosomal dominant

Bilateral

Worse with arms outstretched

Improved by alcohol and rest

Most common cause of titubation - head tremor

Mx - propanolol, primidone

Front 8

MS Features

Back 8

Visual - optic neuritis (most common), optic atrophy, worsening of vision following rise in temp, internuclear opthalmoplegia.

Sensory - pin/needles, numbness, trigeminal neuralgia, parasthesia in limbs on neck extension.

Motor - spastic weakness.

Cerebellar - ataxia.

Urinary incontinence, erectile dysfunction, intellectual deterioration

Front 9

Neuropathic pain

Back 9

1) Amitriptyline, duloxetine, gabapentin, pregabalin

2) If first doesn't work try the others

3) Tramadol for breakthrough pain

4) Capsaicin cream if localised

Front 10

Restless Leg Syndrome

Back 10

Spontaneous, continuous lower leg movements.

May be associated paraesthesia.

2-10 % population, M=F, FHx.

Uncontrollable urge to move legs - symptoms worse at night, crawling or throbbing sensation.

Causes - FHx, low ferritin, uraemia, DM, pregnancy.

Mx - stretching, iron replacement, dopamine agonists, benzodiazepines, gabapentin.

Front 11

Dopamine Receptor Agonists

Back 11

Bromocriptine, ropinerole, cabergoline, apomorphine.

If ergot derived - cabergoline, bromocriptine - pulmonary, retroperitoneal and cardiac fibrosis - ECHO, ESR, creatinine and CXR prior to starting treatment.

Impulse control disorders and daytime somnelence.

Postural hypotension, hallucinations, nasal congestion.

Front 12

Levodopa

Back 12

Combined with decarboxylase inhibitor to prevent peripheral metabolism of levodopa to dopamine.

Reduced effectiveness with time - 2 years.

Dyskinesia, on-off effect, dry mouth, anorexia, psychosis, postural hypotension, drowsiness.

Front 13

Monamine Oxidase B Inhibitors

Back 13

Selegiline

Inhibits the breakdown of dopamine secreted by dopaminergic neurons

Front 14

Amantadine

Back 14

Probably increases dopamine secretion and inhibits its uptake at dopaminergic receptors.

Ataxia, slurred speech, confusion, dizziness, livedo reticularis.

Front 15

COMT Inhibitors

Back 15

Entacapone, tolcapone.

COMT is an enzyme involved in the breakdown of dopamine - used as an adjunct to levodopa.

Front 16

Antimuscarinics

Back 16

Block cholinergic receptors.

Used in drug-induced PD.

Help tremor and rigidity.

Front 17

Epilepsy Mx

Back 17

Started after 2nd seizure, unless neurological defect, structural brain abnormality, EEG shows unequivocal epileptic activity, high risk.

Front 18

Generalised tonic-clonic Seizures

Back 18

1) Sodium Valproate

2) Carbamazepine or lamotrigene (young/pregnant girls)

Front 19

Partial Seizures

Back 19

1) Carbamazepine

2) Lamotrigene, Sodium valproate

Front 20

Absence Seizures

Back 20

Sodium valproate

Ethosuximide

Front 21

Myoclonic Seizures

Back 21

1) Sodium Valproate

2) Clonazapam, Lamotrigine

Front 22

Triptans Adverse Effects and CI

Back 22

Adverse effects - tingling, heat, tightness, heaviness, pressure.

CI - Hx of or singificant risk factors for IHD/cardiovascular disease.

Front 23

Epilepsy Classification

Back 23

1) Generalised - tonic-clonic, absence, myoclonic (brief, rapid muscle jerks).

2) Partial - simple (preserved consciousness, memory + awareness), complex (loss of consciousness or awareness or memory), temporal lobe.

Front 24

MND

Back 24

Amyotrophic lateral sclerosis, progressive muscular atrophy, bulbar palsy.

Fasciculation, no sensory signs, upper limb - LMN lesion, lower limb - UMN, wasting of small hand muscles and tibialis anterior.

Doesn't effect external occular muscles.

No cerebellar dysfunction.

Abdominal reflexes preserved.

Front 25

GCS

Back 25

M6: Obeys commands, localises to pain, withdraws from pain, flexion to pain, extension to pain, nothing.

V5: Normal speech, confused, words, sound, nothing.

E4: Spontaneous, voice, pain, nothing.

Front 26

Migraine

Back 26

Last up to 72 hours - usually unilateral headache.

Third have associated aura.

3x women - 18 %.

Triggers - tiredness, stress, alcohol, COCP, dehydration, lack of food, cheese, chocolate, wine, citrus fruits, menstruation, bright lights.

Front 27

Phenytoin Side-effects

Back 27

Acute - dizziness, diplopia, nystagmus, slurred speech, ataxia, confusion, seizures.

Chronic - gingical hyperplasia, hirsutism, coarsening of facial features, tiredness, megaloblastic anaemia, osteomalacia, lymphadenopathy, dyskinesia.

Idiosyncratic - fever, rashes, hepatitis, dupuytrens contracture, aplastic anaemia, lupus.

Teratogenic - cleft palate, congenital heart disease.

Front 28

Sodium Valproate Adverse Effects

Back 28

Nausea, weight gain, increased appetite, alopecia, ataxia, tremor, pancreatitis, hepatitis, teratogenic, thrombocytopenia, hyponatraemia.

Inhibits P450 system.

Front 29

Stopping Antiepileptics

Back 29

Seizure free for > 2 years - do over 2-3 months

Front 30

Diabetic Gastroparesis

Back 30

Erratic BM control, bloating, vomiting.

Mx - Metoclopramide, domperidone, erythromycin.

Front 31

Causes Motor Peripheral Neuropathy

Back 31

Guillain-Barre Syndrome

Porphyria

Lead poisoning

Charcot-Marie-Tooth

Chronic Inflammatory Demyelinating Polyneuropathy

Diphtheria

Front 32

Causes Sensory Peripheral Neuropathy

Back 32

DM

Alcohol

Vitamin B12 Deficiency

Uraemia

Leprosy

Amyloidosis

Front 33

Pre-hospital Management of Seizures

Back 33

Rectal diazepam.

Neonates - 1.25-2.5mg

1 month - 2 years - 5mg

2 years - 12 years - 5-10mg

12-18 years - 10mg

Adult - 10-20mg (max 30mg)

Elderly - 10mg (max 15mg)

Front 34

Wilson's Disease

Back 34

Excessive copper deposition in the tissues.

Onset 10-25 years. Children present with liver disease, adults with neurological symptoms.

Hepatitis, cirrhosis, basal ganglia degeneration, speech disturbance, chorea, dementia, kayser-Fleischer rings, renal tubular acidosis, blue nails, haemolysis.

Diagnosis - reduced serum caeruloplasmin, raised 24 hr urinary copper.

Mx - penicillamine - copper chelation.

Front 35

ABCD2

Back 35

A - Age >= 60 years

B - Blood pressure >= 140/90

C - Clinical features - unilateral weakness = 2, speech disturbance + no weakness = 1

D - Diabetes

D - Duration - > 60 mins = 2, 10-50 mins =1

Front 36

Rosier Score

Back 36

> 0 = stroke likely.

Loss of consciousness/syncope = -1

Seizure activity = -1

Asymmetrical facial weakness = 1

Asymmetrical arm weakness = 1

Asymmetrical leg weakness = 1

Speech disturbance = 1

Visual field disturbance = 1

Front 37

Good prognostic factors for MS

Back 37

Female

Young at diagnosis

Sensory symptoms

Remitting-relapsing course

Long time between first two relapses

Front 38

Pizotifen Side-effects

Back 38

Weight gain

Drowsiness

Front 39

Lhermitte's Sign

Back 39

Paraesthesiae in limbs on neck flexion

Seen in MS, subacute combined degeneration of the cord and cervical stenosis

Front 40

Uhthoff's Phenomenon

Back 40

Worsening of vision following a rise in body temperature

Seen in MS.

Front 41

Cluster Headache Management

Back 41

Treatment - Subcutaneous sumatriptan and 100 % oxygen.

Prophylaxis - prednisolone, verapamil.

Front 42

Medication overuse headache

Back 42

1 in 50.

Present for >= 15 days of a month, developed or worsened whilst taking analgesia, opiods and triptans are most risky.

Mx - triptans and simple analgesia - stop abruptly, opioids - withdraw gradually.

Front 43

Drugs that worsen seizure control with epilepsy

Back 43

Alcohol, cocaine, amphetamines

Ciprofloxacin, levofloxacin

Aminophylline, theophylline

Buproprion

Methylphenidate

Mefenmic acid

Front 44

Oculogyric Crisis

Back 44

Dystonic reaction to certain drugs or medical conditions.

Restlessness, agitation.

Involuntary upward deviation of the eyes.

Causes - metoclopramide, phenothiazines, haloperidol, postencephalitic Parkinsons disease

Mx - procyclidine

Front 45

Idiopathic Intracranial Hypertension

Back 45

Features - headache, papilloedema, blurred vision, enlarged blind spot, 6th nerve palsy.

Risk factors - female, fat, pregnancy, COCP, steroids, tetracycline, vitamin A.

Mx - weight loss, acetazolamide, topiramte, lumbar puncture, surgery.

Front 46

MS Management

Back 46

Acute - IV methylprednisolone.

Disease modifying - beta-interferon.

Spasticity - baclofen, gabapentin, diazepam, dantrolene, tizanidine.

Bladder dysfunction - if no residual volume - anticholinergics.

Front 47

Normal Pressure Hydrocephalus

Back 47

Urinary incontinence + gait abnormality + dementia.

Reversible.

Reduced CSF absorption at the arachnoid villi.

Also occurs with head injury, subarachnoid haemorrhage and meningitis.

Enlarged 4th ventricle.

Shunting.