p.4
Syncope Types and Causes
What are the types of syncope?
Vasovagal and cardiac syncope.
p.22
Epilepsy Classification and Management
Under what conditions do NICE guidelines suggest starting antiepileptics after the first seizure?
If there is a structural abnormality on brain imaging, neurological deficit, unequivocal EEG activity, or unacceptable seizure risk perceived by the patient or their family.
p.34
Common Neurological Conditions
What medication is primarily used in the management of motor neuron disease?
Riluzole, which prevents stimulation of glutamate receptors and is mainly used in amyotrophic lateral sclerosis.
p.34
Neurological History Taking
What are the typical clinical signs of motor neuron disease?
No cerebellar signs; abdominal reflexes are usually preserved, and sphincter dysfunction, if present, is a late feature.
p.28
Syncope Types and Causes
What should patients be educated about regarding reflex syncope?
Patients should be informed that reflex syncope is generally benign and taught to recognize prodromal symptoms.
p.32
Neuromuscular Disorders
What are the components of VTE prophylaxis?
TEDS (thromboembolic deterrent stockings) and LMWH (low molecular weight heparin).
p.22
Epilepsy Classification and Management
What should be considered for women taking contraception and anti-epileptic medication?
The possible interactions between the contraceptive and anti-epileptic medication.
p.8
Headache Types and Management
What is the most common cause of trigeminal neuralgia?
The vast majority of cases are idiopathic.
p.4
Myasthenia Gravis and Respiratory Failure
What is the focus of management in myasthenia gravis?
Understanding the principles of management of type 2 respiratory failure.
What is subarachnoid hemorrhage (SAH)?
The presence of blood within the subarachnoid space.
p.27
Syncope Types and Causes
What are common prodromal symptoms of syncope?
Sweating, pallor, dizziness, nausea/vomiting, lightheadedness, visual disturbances, tinnitus, and muffled hearing.
p.2
Neurological History Taking
What should be assessed regarding dizziness?
The nature and triggers of dizziness.
p.28
Syncope Types and Causes
What is the typical starting dose of Fludrocortisone for reflex syncope?
100 micrograms daily, titrated based on clinical response and side effects.
p.22
Epilepsy Classification and Management
When do most neurologists start antiepileptic medication?
Following a second epileptic seizure.
What factors should be assessed regarding weakness in stroke patients?
Distribution, severity, onset, duration, and course of the weakness.
p.28
Syncope Types and Causes
What are counter-pressure maneuvers that can help with syncopal episodes?
Leg crossing with tensing muscles or handgrip exercises.
p.7
Headache Types and Management
What is a characteristic feature of tension headaches?
A 'tight band' around the head or a pressure sensation.
p.8
Headache Types and Management
What are common trigger factors for trigeminal neuralgia pain?
Light touch, combing hair, washing, shaving, smoking, talking, and brushing teeth.
p.16
Cerebral Venous Thrombosis
What should be done for patients under 50 presenting with features suggestive of cerebral venous thrombosis (CVT)?
They should be urgently investigated for CVT.
p.13
Temporal Arteritis and Diagnosis
What should be done if there is no dramatic response to treatment for temporal arteritis?
Reconsider the diagnosis.
p.32
Neuromuscular Disorders
What type of blood tests are important in management?
Arterial blood gas (ABG) tests.
p.5
Headache Types and Management
What is a primary headache?
A headache with no underlying cause.
p.14
Cerebral Venous Thrombosis
Name a genetic risk factor for CVT.
Antiphospholipid syndrome.
p.14
Cerebral Venous Thrombosis
Which infections are commonly associated with CVT?
Staphylococcus aureus, meningitis, or subdural empyema.
p.20
Epilepsy Classification and Management
What are common symptoms following a generalized seizure?
Patients may bite their tongue and experience incontinence of urine.
What are some conditions associated with berry aneurysms?
Hypertension, adult polycystic kidney disease, Ehlers-Danlos syndrome, and coarctation of the aorta.
p.33
Neuromuscular Disorders
What is the most common pattern of Motor Neuron Disease?
Amyotrophic lateral sclerosis (50% of patients).
p.22
Epilepsy Classification and Management
Why should sodium valproate be avoided during pregnancy?
It is teratogenic and can harm fetal development.
p.27
Syncope Types and Causes
What triggers vasovagal syncope?
A sudden drop in blood pressure and heart rate triggered by emotion, pain, stress, or standing for a long time.
p.34
Common Neurological Conditions
What is the effect of Riluzole on life expectancy?
It prolongs life by about 3 months.
p.8
Headache Types and Management
What can compress the trigeminal roots and potentially cause trigeminal neuralgia?
Tumours or vascular problems.
p.8
Headache Types and Management
How does the International Headache Society define trigeminal neuralgia?
A unilateral disorder characterized by brief electric shock-like pains, abrupt in onset and termination, limited to one or more divisions of the trigeminal nerve.
What does dysarthria feel like?
"My speech was really slurred, it sounded like I was drunk."
What are common symptoms of neurological disorders?
Headaches, seizures, weakness, numbness, and changes in coordination.
p.4
Common Neurological Conditions
What are the types of meningitis and encephalitis?
Bacterial and viral meningitis, HIV/AIDS related infections, and immune encephalitis.
p.12
Temporal Arteritis and Diagnosis
What is a key risk of untreated temporal arteritis?
Permanent loss of vision.
p.12
Temporal Arteritis and Diagnosis
What is the typical age of patients affected by temporal arteritis?
Patients are usually over 60 years old.
p.18
Common Neurological Conditions
When might a referral to an ENT specialist be necessary?
In severe or chronic cases.
p.2
Neurological History Taking
What symptoms should be explored when assessing a headache?
Pain characteristics, meningism symptoms (rash, fever, neck stiffness, photophobia), giant cell arteritis symptoms (visual problems, jaw claudication, scalp tenderness), and glaucoma symptoms (visual blurring, red eye, halos around lights).
p.14
Cerebral Venous Thrombosis
What is cerebral venous thrombosis (CVT)?
CVT is caused by partial or total occlusion of the cerebral veins and sinuses by a thrombus.
p.28
Syncope Types and Causes
What lifestyle modifications should be encouraged to prevent reflex syncope?
Avoiding dehydration, prolonged standing, and hot environments; rising slowly from lying or sitting positions; ensuring adequate salt intake if no contraindications exist.
p.21
Epilepsy Classification and Management
What defines status epilepticus?
A single seizure lasting more than 5 minutes, or two seizures within a 5-minute period without returning to normal.
p.5
Headache Types and Management
What are common symptoms of a migraine?
A severe, unilateral, throbbing headache associated with nausea, photophobia, and phonophobia.
p.6
Headache Types and Management
What is a conservative management strategy for migraines?
Avoidance of triggers such as certain foods or stressors, including poor sleep.
p.24
Epilepsy Classification and Management
What is the driving restriction for patients after a seizure?
Patients generally cannot drive for 6 months following a seizure.
p.6
Headache Types and Management
What should be considered for young people aged 12-17 years for acute migraine treatment?
A nasal triptan in preference to an oral triptan.
p.14
Cerebral Venous Thrombosis
What neurological deficits may occur due to CVT?
Motor weakness (e.g., hemiparesis), fluent aphasia, sensory/visual field defects.
p.33
Neuromuscular Disorders
At what age does Motor Neuron Disease typically present?
It rarely presents before 40 years.
p.19
Epilepsy Classification and Management
What is a focal aware seizure?
A simple partial seizure where patients are aware and post-ictal symptoms are absent.
p.5
Headache Types and Management
What is a hemiplegic migraine?
A variant of migraine in which motor weakness is a manifestation of aura in at least some attacks.
What imaging technique is used to identify vascular lesions such as aneurysms or AVMs in SAH?
CT intracranial angiogram.
p.19
Epilepsy Classification and Management
What are the types of focal seizures?
Motor, non-motor, and those with features such as aura.
p.17
Neuromuscular Disorders
What investigations are used for diagnosing temporomandibular joint dysfunction?
Comprehensive health history, physical examination, dental X-rays, CT scan or MRI.
p.9
Headache Types and Management
How is invasive ICP monitoring performed?
By placing a catheter into the lateral ventricles of the brain.
p.34
Neurological History Taking
How is motor neuron disease diagnosed?
Diagnosis is clinical; nerve conduction studies show normal motor conduction, and EMG shows reduced action potentials with increased amplitude.
p.2
Neurological History Taking
What aspects of memory loss should be evaluated?
Short/long-term memory, insight and concerns, functional levels, cognitive assessment, and risk to self/others.
p.34
Common Neurological Conditions
What type of respiratory care is commonly used for patients with motor neuron disease?
Non-invasive ventilation (usually BIPAP) is used at night, showing a survival benefit of around 7 months.
What does receptive dysphasia feel like?
"I wasn’t able to understand anyone, they were speaking gibberish."
p.15
Cerebral Venous Thrombosis
What type of infarctions are sometimes seen in sagittal sinus thrombosis?
Parasagittal biparietal or bifrontal haemorrhagic infarctions.
p.4
Neuromuscular Disorders
What are the common neuromuscular conditions?
Guillain Barre syndrome (GBS), chronic inflammatory demyelinating neuropathy (CIDP), motor neuron disease (MND), myasthenia gravis, Lambert Eaton Myasthenic Syndrome, multiple sclerosis, and neuromyelitis optica spectrum disorders.
p.8
Headache Types and Management
What are some red flags suggesting a serious underlying cause of trigeminal neuralgia?
Optic neuritis, family history of multiple sclerosis, pain only in the ophthalmic division, sensory changes, deafness, age of onset before 40 years.
What is spontaneous SAH?
SAH that occurs in the absence of trauma.
p.14
Cerebral Venous Thrombosis
What are some symptoms of cerebral venous thrombosis?
New headache, nausea and vomiting, seizures, papilloedema, focal neurological deficits, changes in mental state, and encephalopathy.
p.1
Epilepsy Classification and Management
What is epilepsy?
A neurological disorder characterized by recurrent seizures.
p.17
Cerebral Venous Thrombosis
What prophylactic measure is recommended for women who developed CVT during pregnancy?
Prophylactic anticoagulation during future pregnancies.
p.21
Epilepsy Classification and Management
What should be considered if status epilepticus is ongoing?
Start a second-line agent such as levetiracetam, phenytoin, or sodium valproate.
p.16
Cerebral Venous Thrombosis
What does an elevated D-dimer indicate in the context of CVT?
It supports a diagnosis of CVT alongside neuroimaging findings.
p.7
Headache Types and Management
What is a key characteristic of cluster headaches?
They occur in clusters lasting several weeks, typically once a year.
p.6
Headache Types and Management
Why is the combined oral contraceptive pill contraindicated for patients with migraine with aura?
Due to an increased risk of stroke (relative risk 8.72).
What should be done if CT shows evidence of SAH?
Referral to neurosurgery should be made as soon as SAH is confirmed.
What is a major complication associated with aneurysmal SAH?
Re-bleeding, which can have a mortality rate of up to 70%.
p.25
Epilepsy Classification and Management
Is breastfeeding safe for mothers taking antiepileptics?
Generally considered safe, with possible exceptions for barbiturates.
What does expressive dysphasia feel like?
"I knew what I wanted to say, but I couldn’t get it out."
p.5
Headache Types and Management
What is a characteristic feature of migraine attacks?
They may last up to 72 hours.
p.2
Neurological History Taking
What sensory symptoms should be assessed?
Pain, numbness, and tingling.
p.27
Syncope Types and Causes
How long can prodromal symptoms last before syncope occurs?
Several seconds to minutes.
p.5
Headache Types and Management
What do patients typically do during a migraine attack?
They go to a darkened, quiet room.
p.6
Headache Types and Management
What is the first-line acute treatment for migraines?
Oral triptan (e.g., sumatriptan) and an NSAID, or oral triptan and paracetamol.
p.28
Syncope Types and Causes
What is the initial dosing for Midodrine?
2.5 mg two to three times daily, titrated up to a maximum of 10 mg three times daily if tolerated.
p.21
Epilepsy Classification and Management
What is generally used in hospitals for status epilepticus?
IV lorazepam, which may be repeated once after 5-10 minutes.
What distinguishes anterior circulation stroke from posterior circulation stroke?
Clinical presentation differences based on carotid territory versus vertebral and basilar territories.
p.5
Headache Types and Management
What are common triggers for migraines?
Tiredness, stress, alcohol, combined oral contraceptive pill, menstruation, bright lights, lack of food or dehydration, cheese, chocolate, citrus fruits, and red wines.
p.8
Headache Types and Management
What are alcohol or glycerol injections used for in trigeminal neuralgia management?
To damage the trigeminal nerve and reduce pain signals.
p.6
Headache Types and Management
What are the first-line prophylactic treatments for migraines?
Propranolol, Amitriptyline, or Topiramate (with caution in women of childbearing age).
p.7
Headache Types and Management
Who is more commonly affected by cluster headaches?
Men (3:1 ratio) and smokers.
p.9
Headache Types and Management
What initial investigations are recommended for raised intracranial pressure?
ABCDE assessment and neuroimaging (CT/MRI).
p.16
Cerebral Venous Thrombosis
What type of therapy is used for acute antithrombotic treatment in CVT?
Low molecular weight heparin or unfractionated heparin.
p.6
Headache Types and Management
Is hormone replacement therapy (HRT) safe for patients with a history of migraine?
Yes, but it may make migraines worse.
p.33
Neuromuscular Disorders
What does Progressive Bulbar Palsy affect?
The tongue, muscles of chewing/swallowing, and facial muscles due to loss of function of brainstem motor nuclei.
p.33
Neuromuscular Disorders
What is the prognosis of Progressive Bulbar Palsy?
It carries the worst prognosis.
p.29
Syncope Types and Causes
What can cause volume depletion leading to syncope?
Haemorrhage and diarrhoea.
p.33
Neuromuscular Disorders
What are the upper motor neuron signs?
Hypertonia, hyperreflexia, minimal atrophy, and Babinski sign.
p.35
Myasthenia Gravis and Respiratory Failure
What is the first-line treatment for myasthenia gravis?
Long-acting acetylcholinesterase inhibitors, specifically pyridostigmine.
p.18
Common Neurological Conditions
What is one use of oral splints or mouth guards?
To manage dental issues or protect teeth.
p.34
Neurological History Taking
What role does MRI play in diagnosing motor neuron disease?
MRI is performed to exclude differential diagnoses such as cervical cord compression and myelopathy.
What are the types of dysphasia associated with stroke?
Expressive dysphasia, receptive dysphasia, and dysarthria.
p.5
Headache Types and Management
What is a secondary headache?
A headache caused by an underlying condition.
p.13
Temporal Arteritis and Diagnosis
What should be administered urgently upon suspicion of temporal arteritis?
High-dose glucocorticoids.
p.25
Epilepsy Classification and Management
What does the November 2013 Drug Safety Update conclude about sodium valproate?
It should not be used during pregnancy and in women of childbearing age unless clearly necessary.
p.15
Cerebral Venous Thrombosis
What are some causes of cavernous sinus syndrome?
Local infection (e.g., sinusitis), neoplasia, trauma.
p.1
Myasthenia Gravis and Respiratory Failure
What is myasthenia gravis?
An autoimmune disorder that affects neuromuscular transmission.
p.15
Cerebral Venous Thrombosis
What cranial nerve palsies are associated with lateral sinus thrombosis?
6th and 7th cranial nerve palsies.
p.1
Cerebral Venous Thrombosis
What is cerebral venous thrombosis?
A condition where a blood clot forms in the brain's venous sinuses.
p.13
Temporal Arteritis and Diagnosis
What can be used if weaning off steroids is problematic?
Steroid-sparing agents like methotrexate or biological agents (e.g., tocilizumab).
What is the recommended time frame for surgical intervention in intracranial aneurysms?
Preferably within 24 hours.
p.12
Temporal Arteritis and Diagnosis
What is the mechanism behind vision alteration in temporal arteritis?
Occlusion of the posterior ciliary artery leading to ischaemia of the anterior optic nerve head.
p.9
Headache Types and Management
What role does IV mannitol play in managing raised intracranial pressure?
It acts as an osmotic diuretic to reduce ICP.
p.23
Epilepsy Classification and Management
What adverse effect is associated with sodium valproate?
Increased appetite and weight gain.
p.23
Epilepsy Classification and Management
What are some adverse effects of lamotrigine?
Blurred vision, rash, dizziness, headache.
p.35
Myasthenia Gravis and Respiratory Failure
What is the purpose of the Tensilon test in myasthenia gravis?
To temporarily reduce muscle weakness using IV edrophonium.
p.2
Neurological History Taking
What should be assessed regarding fits, falls, or loss of consciousness (LOC)?
Warning signs, circumstances before, duration, movements during, and after effects like amnesia or confusion.
p.25
Epilepsy Classification and Management
What should pregnant women taking phenytoin be given in the last month of pregnancy?
Vitamin K, to prevent clotting disorders in the newborn.
p.2
Neurological History Taking
What motor symptoms should be evaluated?
Weakness patterns, character of weakness, and incontinence.
p.1
Neurological History Taking
What is the primary focus of neurology?
The diagnosis and treatment of disorders of the nervous system.
p.21
Epilepsy Classification and Management
Why is status epilepticus considered a medical emergency?
Prolonged seizure activity can lead to irreversible brain damage.
p.32
Neuromuscular Disorders
What is plasmapheresis and how does it compare to IVIG?
Plasmapheresis has similar efficacy to IVIG but is associated with more side effects.
p.4
Common Neurological Conditions
What are the types of dementia?
Alzheimer's disease (AD), frontotemporal dementia (FTD), and vascular dementia.
p.9
Headache Types and Management
What is the primary cause of headaches due to raised intracranial pressure?
Additional volume in the skull, such as haematoma, tumour, or excessive CSF.
What is a common symptom of SAH?
Sudden-onset headache, often described as 'thunderclap' or 'worst of my life'.
p.17
Neuromuscular Disorders
What are some common causes of temporomandibular joint dysfunction?
Trauma to the jaw, stress (causing bruxism), arthritis in the TMJ, and abnormal jaw or tooth alignment.
p.33
Neuromuscular Disorders
What are the typical signs of Amyotrophic lateral sclerosis?
Typically LMN signs in arms and UMN signs in legs or a mixture of both.
p.13
Temporal Arteritis and Diagnosis
What is required when tapering off steroids in temporal arteritis treatment?
A tapering course of steroids.
p.12
Temporal Arteritis and Diagnosis
What does the 'halo sign' indicate in Doppler ultrasonography for temporal arteritis?
It indicates inflammation in the vessel wall.
p.6
Headache Types and Management
What treatment is recommended for women with predictable menstrual migraines?
Frovatriptan or zolmitriptan as a type of 'mini-prophylaxis'.
p.35
Myasthenia Gravis and Respiratory Failure
Which gender is more commonly affected by myasthenia gravis?
Women (2:1 ratio compared to men).
p.9
Headache Types and Management
What are some techniques for removing CSF to manage raised ICP?
Intraventricular drain, repeated lumbar puncture, and ventriculoperitoneal shunt.
p.36
Myasthenia Gravis and Respiratory Failure
What symptoms may occur with hypercapnia?
Bounding radial pulse, asterixis, headache, flushing, and confusion.
p.27
Syncope Types and Causes
What is syncope?
A transient loss of consciousness due to global cerebral hypoperfusion with rapid onset, short duration, and spontaneous complete recovery.
p.4
Headache Types and Management
What are the common types of headaches?
Migraine, tension headache, cluster headache, trigeminal neuralgia, temporomandibular joint pain, headache of raised intracranial pressure, subarachnoid hemorrhage headache, cerebral sinus venous thrombosis, temporal arteritis, and cerebral vasculitis.
p.25
Epilepsy Classification and Management
What significant risk is associated with maternal use of sodium valproate?
Neurodevelopmental delay in children.
p.34
Common Neurological Conditions
What is the prognosis for patients with motor neuron disease?
Poor; 50% of patients die within 3 years.
p.24
Epilepsy Classification and Management
What are some side effects of Sodium Valproate?
Anaemia, confusion, gastric irritation, haemorrhage, hyponatraemia, tremor, weight gain.
p.7
Headache Types and Management
What differentiates tension headaches from migraines?
Tension headaches are typically bilateral and of lower intensity, not associated with aura, nausea/vomiting, or aggravated by routine physical activity.
p.8
Headache Types and Management
What should prompt a referral to neurology in trigeminal neuralgia cases?
Failure to respond to treatment or atypical features, such as being under 50 years old.
p.7
Headache Types and Management
What are first-line treatments for acute tension headaches?
Aspirin, paracetamol, or an NSAID.
What is the primary aim of investigation after confirming spontaneous SAH?
To identify a causative pathology that needs urgent treatment.
p.19
Epilepsy Classification and Management
What characterizes focal impaired awareness seizures?
Patients are not aware, and post-ictal symptoms like confusion and drowsiness are common.
p.31
Neuromuscular Disorders
What is Guillain-Barré Syndrome (GBS)?
An immune-mediated demyelination of the peripheral nervous system.
p.21
Epilepsy Classification and Management
What is the driving restriction for patients after a seizure?
Patients generally cannot drive for 6 months following a seizure.
p.24
Epilepsy Classification and Management
Is there an indication to monitor antiepileptic drug levels?
No indication to monitor.
p.12
Temporal Arteritis and Diagnosis
What are common systemic symptoms associated with temporal arteritis?
Lethargy, depression, low-grade fever, anorexia, night sweats.
p.19
Epilepsy Classification and Management
What occurs during myoclonic seizures?
Sudden jerks of a limb, trunk, or face.
p.31
Neuromuscular Disorders
What are the later symptoms of Guillain-Barré Syndrome?
Symmetrical and ascending weakness of all limbs, paraesthesia, and reduced or absent reflexes.
p.36
Myasthenia Gravis and Respiratory Failure
What are common symptoms of hypoxia and/or hypercapnia?
Dyspnoea, agitation, accessory muscle use, reduced consciousness, and confusion.
p.31
Neuromuscular Disorders
What are common findings in nerve conduction studies for Guillain-Barré Syndrome?
Decreased motor nerve conduction velocity, prolonged distal motor latency, and increased F wave latency.
p.33
Neuromuscular Disorders
Are there any cerebellar signs in Motor Neuron Disease?
No, there are no cerebellar signs.
p.27
Syncope Types and Causes
What is carotid sinus syncope?
A type of syncope resulting from hypersensitivity of carotid sinus baroreceptors leading to bradycardia and/or vasodilation upon stimulation.
p.34
Common Neurological Conditions
What is the preferred method for nutritional support in motor neuron disease?
Percutaneous gastrostomy tube (PEG) is preferred and associated with prolonged survival.
p.27
Syncope Types and Causes
What are the potential consequences of carotid sinus syncope?
Recurrent falls due to transient loss of consciousness.
p.14
Cerebral Venous Thrombosis
What are some acquired risk factors for CVT?
Pregnancy, oral contraceptive pill use, malignancy.
p.28
Syncope Types and Causes
What is the mechanism of action of Midodrine?
It is an alpha-1 adrenergic agonist that causes vasoconstriction and increases blood pressure.
p.27
Syncope Types and Causes
What is situational syncope?
A type of reflex syncope triggered by specific situations such as coughing, micturition, or gastrointestinal events.
p.2
Neurological History Taking
What cognitive assessment can be performed during a neurological history taking?
Mini mental state examination.
p.20
Epilepsy Classification and Management
What is the postictal phase after a seizure?
A phase where patients feel drowsy and tired for around 15 minutes or more.
p.1
Syncope Types and Causes
What are the types of syncope?
Vasovagal, cardiac, and orthostatic syncope.
p.13
Temporal Arteritis and Diagnosis
What is a potential consequence of visual damage in temporal arteritis?
It is often irreversible.
p.15
Cerebral Venous Thrombosis
What may trigeminal nerve involvement in cavernous sinus thrombosis lead to?
Hyperaesthesia of the upper face and eye pain.
p.14
Cerebral Venous Thrombosis
How can trauma and surgery contribute to CVT?
They can lead to occlusion of the cerebral veins and sinuses.
p.9
Headache Types and Management
What constitutes Cushing's triad?
Widening pulse pressure, bradycardia, and irregular breathing.
p.19
Epilepsy Classification and Management
What happens during generalized seizures?
They involve networks on both sides of the brain, and consciousness is lost immediately.
p.31
Neuromuscular Disorders
What is the pathogenesis of Guillain-Barré Syndrome?
Cross-reaction of antibodies with gangliosides in the peripheral nervous system, with anti-GM1 antibodies present in 25% of patients.
p.33
Neuromuscular Disorders
What is Progressive Muscular Atrophy characterized by?
LMN signs only, affecting distal muscles before proximal, and carries the best prognosis.
p.23
Epilepsy Classification and Management
What is the first-line treatment for focal seizures?
Lamotrigine or levetiracetam.
p.31
Neuromuscular Disorders
What is Miller Fisher syndrome?
A variant of Guillain-Barré syndrome associated with ophthalmoplegia, areflexia, and ataxia.
p.36
Myasthenia Gravis and Respiratory Failure
What chronic conditions can result from chronic hypoxia?
Polycythaemia, pulmonary hypertension (PHT), and cor pulmonale.
p.33
Neuromuscular Disorders
Does Motor Neuron Disease affect external ocular muscles?
No, it doesn't affect external ocular muscles.
p.35
Myasthenia Gravis and Respiratory Failure
What is the role of thymectomy in myasthenia gravis?
Considered in patients with thymic hyperplasia or thymoma.
p.4
Epilepsy Classification and Management
What are the types of epilepsy?
Generalized, complex partial, partial, and focal.
p.7
Headache Types and Management
How do tension headaches typically present in terms of location?
Symptoms tend to be bilateral.
p.25
Epilepsy Classification and Management
What advice is given to women of childbearing age regarding sodium valproate treatment?
They should not start treatment without specialist neurological or psychiatric advice.
p.21
Epilepsy Classification and Management
What can be administered in the prehospital setting for status epilepticus?
PR diazepam or buccal midazolam.
p.15
Cerebral Venous Thrombosis
What symptoms are associated with cavernous sinus thrombosis?
Periorbital oedema and ophthalmoplegia.
p.28
Syncope Types and Causes
When is cardiac pacing indicated for reflex syncope?
Only if there is evidence of severe cardioinhibitory response or recurrent episodes despite optimal medical therapy.
p.14
Cerebral Venous Thrombosis
What complications arise from occlusion of cerebral veins and sinuses?
Cerebral ischaemia, oedema, haemorrhage, and raised intracranial pressure.
p.1
Temporal Arteritis and Diagnosis
What is temporal arteritis?
An inflammation of the blood vessels that can cause headaches and vision problems.
What should be done if a CT head is normal within 6 hours of symptom onset?
New guidelines suggest not doing a lumbar puncture and considering an alternative diagnosis.
What are the supportive management strategies for confirmed aneurysmal SAH?
Bed rest, analgesia, venous thromboembolism prophylaxis, and discontinuation of antithrombotics.
p.17
Neuromuscular Disorders
What are some conservative management measures for temporomandibular joint dysfunction?
Resting the jaw, adhering to a soft diet, physiotherapy, avoiding wide yawning and loud singing, and using heat or cold packs.
p.7
Headache Types and Management
What is the acute treatment for cluster headaches recommended by NICE?
100% oxygen or subcutaneous triptan.
p.31
Neuromuscular Disorders
What cranial nerve symptoms can occur in Guillain-Barré Syndrome?
Diplopia and bilateral facial nerve palsy.
p.19
Epilepsy Classification and Management
What is a focal to bilateral seizure?
A seizure that starts on one side of the brain in a specific area before spreading to both lobes.
p.23
Epilepsy Classification and Management
What is a significant interaction concern with sodium valproate?
It is a P450 enzyme inhibitor and interacts with warfarin.
p.29
Syncope Types and Causes
What symptoms are observed during a collapse from cardiac syncope?
Pallor, abrupt onset, and unlikely seizure activity.
What sensory symptoms might a stroke patient experience?
Sensory disturbance, including numbness or tingling.
p.17
Cerebral Venous Thrombosis
What type of contraception should women who previously took the oral contraceptive pill consider after CVT?
Non-oestrogen methods, such as the progesterone-only pill.
p.7
Headache Types and Management
What defines chronic tension-type headache?
Occurs 15 or more days per month.
p.8
Headache Types and Management
What is microvascular decompression in the context of trigeminal neuralgia?
A surgical procedure to remove or relocate blood vessels that are in contact with the trigeminal root.
p.6
Headache Types and Management
What is the second-line treatment if first-line measures are not effective?
Non-oral preparation of metoclopramide or prochlorperazine, and consider adding a non-oral NSAID or triptan.
p.9
Headache Types and Management
What are the key features of headaches caused by raised intracranial pressure?
Headache, vomiting, reduced levels of consciousness, papilloedema, and Cushing's triad.
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Headache Types and Management
What additional treatment may help reduce migraine frequency and intensity?
Riboflavin (400 mg once a day).
What does xanthochromia indicate in the context of SAH?
It helps to distinguish true SAH from a 'traumatic tap' and indicates red blood cell breakdown.
What is vasospasm in the context of SAH?
Delayed cerebral ischaemia typically occurring 7-14 days after onset.
How is hydrocephalus temporarily treated in SAH patients?
With an external ventricular drain or a long-term ventriculoperitoneal shunt.
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Neuromuscular Disorders
What is a characteristic finding in lumbar puncture for Guillain-Barré Syndrome?
Rise in protein with a normal white blood cell count (albuminocytologic dissociation).
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Neuromuscular Disorders
What antibodies are associated with Miller Fisher syndrome?
Anti-GQ1b antibodies are present in 90% of cases.
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Syncope Types and Causes
What investigations are recommended for patients with syncope?
ECG, blood tests for dyselectrolytaemias, and imaging like TTE.
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Temporal Arteritis and Diagnosis
What type of arteries does temporal arteritis affect?
Medium and large-sized arteries.
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Neuromuscular Disorders
What is Motor Neuron Disease (MND)?
A progressive neurological condition of unknown cause that can present with both upper and lower motor neuron signs.
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Epilepsy Classification and Management
What are the two main types of seizures in epilepsy?
Focal seizures and generalized seizures.
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Epilepsy Classification and Management
What sensations might patients experience during a temporal lobe seizure?
Déjà vu, jamais vu, and less commonly, auditory, gustatory, or olfactory hallucinations.
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Epilepsy Classification and Management
What is the first-line drug treatment for females with generalized tonic-clonic seizures?
Lamotrigine or levetiracetam.
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Temporal Arteritis and Diagnosis
What medication may be given to prevent gastric ulcers in patients with temporal arteritis?
PPI (Proton Pump Inhibitors).
What is the role of oral nimodipine in managing aneurysmal SAH?
To prevent vasospasm which can lead to subsequent ischaemic damage after the bleed.
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Cerebral Venous Thrombosis
What are the three key elements of treatment for cerebral venous thrombosis?
Acute antithrombotic therapy, acute symptom management, and long-term management.
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Epilepsy Classification and Management
What are tonic-clonic seizures characterized by?
Stiffening (tonic) and jerking (clonic) of limbs, with common post-ictal confusion.
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Headache Types and Management
What is the investigation of choice for cluster headaches?
MRI with gadolinium contrast.
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Myasthenia Gravis and Respiratory Failure
Which drugs may exacerbate myasthenia gravis?
Procainamide, quinidine, phenytoin, penicillamine, certain antibiotics (gentamicin, macrolides, quinolones, tetracyclines), beta-blockers, and lithium.
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Epilepsy Classification and Management
What investigations are typically done after a patient's first seizure?
An electroencephalogram (EEG) and neuroimaging, usually an MRI.
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Neuromuscular Disorders
What is the most common presentation of ALS?
Asymmetric limb weakness.
What are important predictive factors in SAH?
Age, amount of blood visible on CT head, and conscious level on admission.
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Syncope Types and Causes
What symptoms may occur before a collapse in cardiac syncope?
Lightheadedness, palpitations, chest pain, and shortness of breath.
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Syncope Types and Causes
When do patients with typical features of syncope not require further investigations?
If they have no postural drop and a normal ECG.
What accounts for around 85% of spontaneous SAH cases?
Intracranial aneurysms (saccular 'berry' aneurysms).
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Headache Types and Management
What are typical features of a visual aura?
They are progressive and last 5 - 60 minutes, including transient hemianopic disturbance or a spreading scintillating scotoma.
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Epilepsy Classification and Management
What are typical features of temporal lobe seizures?
May occur with or without impairment of consciousness; often includes an aura with rising epigastric sensation and psychic phenomena.
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Neuromuscular Disorders
What are temporomandibular joint disorders (TMD)?
A collection of clinical problems involving the masticatory musculature, the temporomandibular joint (TMJ), and associated structures.
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Headache Types and Management
What are some common causes of raised intracranial pressure?
Traumatic head injuries, tumours, meningitis, idiopathic intracranial hypertension, hydrocephalus, hypercapnia, and infection.
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Epilepsy Classification and Management
What should be done if there is no response within 45 minutes of onset?
Induction of general anaesthesia or phenobarbital may be necessary.
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Neuromuscular Disorders
What infections can trigger Guillain-Barré Syndrome?
Classically Campylobacter jejuni, but also mycoplasma, EBV, HIV, CMV, and Hepatitis A.
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Headache Types and Management
What are common symptoms of cluster headaches?
Redness, lacrimation, lid swelling, nasal stuffiness, and severe, sharp pain around one eye.
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Cerebral Venous Thrombosis
What is the role of anticonvulsants in the management of CVT?
To treat seizures and provide prophylaxis against seizures in high-risk patients.
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Cerebral Venous Thrombosis
What treatments are often used for infection and inflammation in CVT patients?
Antibiotic treatment for infection and glucocorticoid therapy for inflammatory disorders.
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Syncope Types and Causes
What is cardiac syncope?
A transient loss of consciousness due to inadequate cardiac output leading to cerebral hypoperfusion.
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Myasthenia Gravis and Respiratory Failure
What is the association of thymomas with myasthenia gravis?
Thymomas are found in 15% of cases.
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Myasthenia Gravis and Respiratory Failure
What should be done if PaCO2 increases by >1.5 kPa during management?
Consider non-invasive ventilation (NIV) or a respiratory stimulant such as doxapram.
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Common Neurological Conditions
What are the types of brain trauma?
Concussion, mild to severe brain injury, subdural and epidural hemorrhage.
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Epilepsy Classification and Management
What is a key advantage of levetiracetam in the management of status epilepticus?
It may be quicker to administer and have fewer adverse effects than alternatives.
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Temporal Arteritis and Diagnosis
What is a common examination finding in temporal arteritis?
Thickened, tender temporal artery.
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Neuromuscular Disorders
What are some symptoms of temporomandibular joint dysfunction?
Pain in the jaw, face, and ear; difficulty in opening and closing the mouth; clicking or popping sounds; a sense of the jaw being 'stuck' or 'locked'.
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Neuromuscular Disorders
What gene is responsible for familial cases of Amyotrophic lateral sclerosis?
The gene lies on chromosome 21 and codes for superoxide dismutase.
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Epilepsy Classification and Management
What are the symptoms of frontal lobe seizures?
Head/limb movements, post-ictal weakness, and Jacksonian march posturing.
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Cerebral Venous Thrombosis
How should raised intracranial pressure be managed in CVT patients?
By elevating the bed, administering osmotic therapy, hyperventilating in an intensive care setting, and possibly emergency decompressive surgery.
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Myasthenia Gravis and Respiratory Failure
What is myasthenia gravis?
An autoimmune disorder resulting in the production of antibodies against nicotinic acetylcholine receptors at the neuromuscular junction.
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Syncope Types and Causes
What drugs can induce orthostatic syncope?
Diuretics, alcohol, and vasodilators.
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Headache Types and Management
What is the aim of controlled hyperventilation in managing raised ICP?
To reduce pCO2, leading to vasoconstriction of cerebral arteries and reduced ICP.
p.29
Syncope Types and Causes
What are some causes of cardiac syncope?
Arrhythmias, structural issues like aortic stenosis, and pulmonary embolism.
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Syncope Types and Causes
What is a key diagnostic criterion for postural blood pressure readings?
A symptomatic fall in systolic BP > 20 mmHg or diastolic BP > 10 mmHg.
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Cerebral Venous Thrombosis
What should be done if a D-dimer test is negative but symptoms suggest CVT?
A negative D-dimer cannot exclude CVT if patients have suggestive symptoms.
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Epilepsy Classification and Management
What should be offered to girls under 10 years who are unlikely to need treatment later?
Sodium valproate as first-line.
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Epilepsy Classification and Management
What are common automatisms observed during temporal lobe seizures?
Lip smacking, grabbing, or plucking.
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Epilepsy Classification and Management
How can antiepileptics affect other medications?
They can induce/inhibit the P450 system, resulting in varied metabolism of other medications.
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Syncope Types and Causes
What is orthostatic syncope?
Syncope resulting from a postural decrease in blood pressure.
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Neuromuscular Disorders
What types of medications may be used to manage temporomandibular joint dysfunction?
Analgesics, muscle relaxants, and anti-inflammatory drugs.
p.19
Epilepsy Classification and Management
What defines atonic seizures?
Sudden loss of muscle tone, causing the patient to fall, while consciousness is retained.
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Epilepsy Classification and Management
What are absence seizures?
Brief pauses for less than 10 seconds.
What is a common cause of hyponatraemia in SAH patients?
Syndrome of inappropriate antidiuretic hormone secretion (SIADH).
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Myasthenia Gravis and Respiratory Failure
What are some common symptoms of myasthenia gravis?
Ptosis, diplopia, dysphagia, respiratory muscle weakness, and proximal muscle weakness.
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Myasthenia Gravis and Respiratory Failure
What investigations are used to diagnose type 2 respiratory failure?
Arterial blood gas analysis, pulse oximetry, simple spirometry, and electrocardiogram.
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Syncope Types and Causes
What are primary causes of autonomic failure leading to orthostatic syncope?
Parkinson's disease and Lewy body dementia.
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Syncope Types and Causes
What are examples of secondary autonomic failure?
Diabetic neuropathy, uraemia, and amyloidosis.
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Myasthenia Gravis and Respiratory Failure
What defines type 2 respiratory failure?
PaO2 < 8 kPa and PaCO2 > 6 kPa.
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Neuromuscular Disorders
What are the typical features of MND?
A mixture of lower motor neuron and upper motor neuron signs, wasting of small hand muscles, fasciculations, and absence of sensory signs/symptoms.
p.33
Neuromuscular Disorders
What are the lower motor neuron signs?
Hypotonia, hyporeflexia, marked atrophy, and fasciculations.
p.36
Myasthenia Gravis and Respiratory Failure
What is the initial management for type 2 respiratory failure?
Controlled oxygen therapy aiming for 88-92% oxygen saturation and PaO2 > 8 kPa.
p.36
Myasthenia Gravis and Respiratory Failure
What type of respiratory failure can myasthenia gravis cause?
Type 2 respiratory failure due to alveolar hypoventilation.
p.35
Myasthenia Gravis and Respiratory Failure
What is the key feature of myasthenia gravis?
Muscle fatigability, where muscles become progressively weaker during activity and improve after rest.
p.36
Myasthenia Gravis and Respiratory Failure
What signs may indicate respiratory failure?
Cyanosis, reduced oxygen saturation, and tachycardia.
p.35
Myasthenia Gravis and Respiratory Failure
What is a common management strategy for myasthenic crisis?
Plasmapheresis and intravenous immunoglobulins.
