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Neurology

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bethdrysdale's version from 2017-11-11 11:16

Section 1

Question Answer
SAH symptoms vs subdural Hsudden "thunderclap" occipital headache = SAH. an elderly alcoholic man presents with a persistent headache after falling over the previous day. On examination he has a fluctuating level of consciousness = SDH
Psychogenic non-epileptic seizure presentationa 20-year-old woman who is known to have a borderline personality disorder is admitted with an ongoing seizure. During the seizure she appears to itch her nose
Simple partial seizure presentationa 20-year-old woman is referred to the epilepsy clinic with repeated episodes of her right hand jerking uncontrollably. She is fully conscious throughout
Lacunar infarcts vs POCs location Involves perforating arteries around the internal capsule, thalamus and basal ganglia = LACs. Involves vertebrobasilar arteries = POCs
Complex partial seizure presentationa 30-year-old woman has been told by her husband she often wakes at night, makes a grunting sound and starts lip smacking. She is non-responsive during the episode. After a minute she falls asleep again
Meniere's vs Acoustic neuromamenieres = episodes of vertigo, tinnitus and hearing loss. AN = ongoing vertigo, tinnitus and hearing loss, absent corneal reflex
Lewy body dementia presentationprogressive cognitive impairment parkinsonism visual hallucinations. Neuroleptics should be avoided.
Phaeochromocytoma presentationPhaeochromocytoma is a rare catecholamine secreting tumour. hypertension (around 90% of cases, may be sustained) headaches palpitations sweating anxiety. Surgery is the definitive management.
Wilsons Disease presentationliver disease, neuropsychiatric features
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Section 2

Question Answer
Carbamazepine adverse effects Stevens-Johnson syndrome. P450 enzyme inducer, dizziness and ataxia, drowsiness, agranulocytosis, SIADH (syndrome of inappropriate antidiuretic hormone secretion). carbamazepine is used first-line for patients with partial seizures
Sodium Valproate adverse effectssodium valproate is used first-line for patients with generalised seizures and absence seizures. increased appetite and weight gain alopecia: regrowth may be curly P450 enzyme inhibitor ataxia tremor hepatitis pancreatitis thrombocytopaenia
Lamotrigine adverse effectsStevens-Johnson syndrome. Used second-line for a variety of generalised and partial seizures.
Nimodipineprevention of vasospasm after subarachnoid haemorrhage
Triptans (eg sumatriptan)specific 5-HT1 agonists used in the acute treatment of migraine. They are generally used first-line in combination therapy with an NSAID or paracetamol. adverse effects = tingling, heat, tightness (e.g. throat and chest), heaviness, pressure
Benzodiazepines for acute seizuresmost commonly first-line medication for terminating acute seizures
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