Neurology Notes 1

Vasovagal and cardiac syncope.

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.

Riluzole, which prevents stimulation of glutamate receptors and is mainly used in amyotrophic lateral sclerosis.

No cerebellar signs; abdominal reflexes are usually preserved, and sphincter dysfunction, if present, is a late feature.

Patients should be informed that reflex syncope is generally benign and taught to recognize prodromal symptoms.

TEDS (thromboembolic deterrent stockings) and LMWH (low molecular weight heparin).

The possible interactions between the contraceptive and anti-epileptic medication.

Cleft palate.

The vast majority of cases are idiopathic.

Understanding the principles of management of type 2 respiratory failure.

The presence of blood within the subarachnoid space.

High-dose prednisolone.

Forced vital capacity.

Sweating, pallor, dizziness, nausea/vomiting, lightheadedness, visual disturbances, tinnitus, and muffled hearing.

The nature and triggers of dizziness.

NSAIDs or opiates.

100 micrograms daily, titrated based on clinical response and side effects.

Head injury.

Following a second epileptic seizure.

Distribution, severity, onset, duration, and course of the weakness.

Leg crossing with tensing muscles or handgrip exercises.

Older individuals.

A 'tight band' around the head or a pressure sensation.

Light touch, combing hair, washing, shaving, smoking, talking, and brushing teeth.

Ataxia.

They should be urgently investigated for CVT.

Reconsider the diagnosis.

Misaligned teeth.

Arterial blood gas (ABG) tests.

A headache with no underlying cause.

Prothrombotic condition.

Antiphospholipid syndrome.

A 5-day course.

Giant cell arteritis.

Staphylococcus aureus, meningitis, or subdural empyema.

Patients may bite their tongue and experience incontinence of urine.

MRI with venography.

The same day.

Hypertension, adult polycystic kidney disease, Ehlers-Danlos syndrome, and coarctation of the aorta.

Sodium valproate.

Amyotrophic lateral sclerosis (50% of patients).

It is teratogenic and can harm fetal development.

A sudden drop in blood pressure and heart rate triggered by emotion, pain, stress, or standing for a long time.

It prolongs life by about 3 months.

Tumours or vascular problems.

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.

"My speech was really slurred, it sounded like I was drunk."

Headaches, seizures, weakness, numbness, and changes in coordination.

Benzodiazepines.

Bacterial and viral meningitis, HIV/AIDS related infections, and immune encephalitis.

Permanent loss of vision.

Visual disturbance.

Patients are usually over 60 years old.

In severe or chronic cases.

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).

CVT is caused by partial or total occlusion of the cerebral veins and sinuses by a thrombus.

Avoiding dehydration, prolonged standing, and hot environments; rising slowly from lying or sitting positions; ensuring adequate salt intake if no contraindications exist.

A single seizure lasting more than 5 minutes, or two seizures within a 5-minute period without returning to normal.

A severe, unilateral, throbbing headache associated with nausea, photophobia, and phonophobia.

Avoidance of triggers such as certain foods or stressors, including poor sleep.

Patients generally cannot drive for 6 months following a seizure.

Carbamazepine.

A nasal triptan in preference to an oral triptan.

Motor weakness (e.g., hemiparesis), fluent aphasia, sensory/visual field defects.

It rarely presents before 40 years.

A simple partial seizure where patients are aware and post-ictal symptoms are absent.

A variant of migraine in which motor weakness is a manifestation of aura in at least some attacks.

CT intracranial angiogram.

Motor, non-motor, and those with features such as aura.

Comprehensive health history, physical examination, dental X-rays, CT scan or MRI.

UMN signs only.

By placing a catheter into the lateral ventricles of the brain.

Diagnosis is clinical; nerve conduction studies show normal motor conduction, and EMG shows reduced action potentials with increased amplitude.

Short/long-term memory, insight and concerns, functional levels, cognitive assessment, and risk to self/others.

Non-invasive ventilation (usually BIPAP) is used at night, showing a survival benefit of around 7 months.

"I wasn’t able to understand anyone, they were speaking gibberish."

Parasagittal biparietal or bifrontal haemorrhagic infarctions.

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.

Optic neuritis, family history of multiple sclerosis, pain only in the ophthalmic division, sensory changes, deafness, age of onset before 40 years.

SAH that occurs in the absence of trauma.

New headache, nausea and vomiting, seizures, papilloedema, focal neurological deficits, changes in mental state, and encephalopathy.

A neurological disorder characterized by recurrent seizures.

Prophylactic anticoagulation during future pregnancies.

Start a second-line agent such as levetiracetam, phenytoin, or sodium valproate.

It supports a diagnosis of CVT alongside neuroimaging findings.

They occur in clusters lasting several weeks, typically once a year.

Non-contrast CT head.

Temporal artery biopsy.

Due to an increased risk of stroke (relative risk 8.72).

Levetiracetam.

Referral to neurosurgery should be made as soon as SAH is confirmed.

Re-bleeding, which can have a mortality rate of up to 70%.

Weakness.

Generally considered safe, with possible exceptions for barbiturates.

"I knew what I wanted to say, but I couldn’t get it out."

They may last up to 72 hours.

Pain, numbness, and tingling.

Several seconds to minutes.

They go to a darkened, quiet room.

Oral triptan (e.g., sumatriptan) and an NSAID, or oral triptan and paracetamol.

2.5 mg two to three times daily, titrated up to a maximum of 10 mg three times daily if tolerated.

IV lorazepam, which may be repeated once after 5-10 minutes.

Clinical presentation differences based on carotid territory versus vertebral and basilar territories.

Tiredness, stress, alcohol, combined oral contraceptive pill, menstruation, bright lights, lack of food or dehydration, cheese, chocolate, citrus fruits, and red wines.

To damage the trigeminal nerve and reduce pain signals.

Propranolol, Amitriptyline, or Topiramate (with caution in women of childbearing age).

Men (3:1 ratio) and smokers.

Aim for monotherapy.

ABCDE assessment and neuroimaging (CT/MRI).

Low molecular weight heparin or unfractionated heparin.

Yes, but it may make migraines worse.

The tongue, muscles of chewing/swallowing, and facial muscles due to loss of function of brainstem motor nuclei.

It carries the worst prognosis.

Haemorrhage and diarrhoea.

Hypertonia, hyperreflexia, minimal atrophy, and Babinski sign.

Long-acting acetylcholinesterase inhibitors, specifically pyridostigmine.

To manage dental issues or protect teeth.

MRI is performed to exclude differential diagnoses such as cervical cord compression and myelopathy.

Expressive dysphasia, receptive dysphasia, and dysarthria.

A headache caused by an underlying condition.

High-dose glucocorticoids.

It should not be used during pregnancy and in women of childbearing age unless clearly necessary.

3 - 6 months.

IV methylprednisolone.

Local infection (e.g., sinusitis), neoplasia, trauma.

Around 30%.

It is teratogenic.

Triptans.

An autoimmune disorder that affects neuromuscular transmission.

Bisphosphonates.

6th and 7th cranial nerve palsies.

A condition where a blood clot forms in the brain's venous sinuses.

Alcohol.

Steroid-sparing agents like methotrexate or biological agents (e.g., tocilizumab).

Preferably within 24 hours.

Occlusion of the posterior ciliary artery leading to ischaemia of the anterior optic nerve head.

Head elevation to 30º.

It acts as an osmotic diuretic to reduce ICP.

Increased appetite and weight gain.

Blurred vision, rash, dizziness, headache.

To temporarily reduce muscle weakness using IV edrophonium.

Warning signs, circumstances before, duration, movements during, and after effects like amnesia or confusion.

Severe unilateral pain.

Vitamin K, to prevent clotting disorders in the newborn.

Weakness patterns, character of weakness, and incontinence.

The diagnosis and treatment of disorders of the nervous system.

Prolonged seizure activity can lead to irreversible brain damage.

Plasmapheresis has similar efficacy to IVIG but is associated with more side effects.

6 - 12 months.

12 months.

Alzheimer's disease (AD), frontotemporal dementia (FTD), and vascular dementia.

6th nerve damage.

Additional volume in the skull, such as haematoma, tumour, or excessive CSF.

Sudden-onset headache, often described as 'thunderclap' or 'worst of my life'.

Trauma to the jaw, stress (causing bruxism), arthritis in the TMJ, and abnormal jaw or tooth alignment.

Typically LMN signs in arms and UMN signs in legs or a mixture of both.

A tapering course of steroids.

It indicates inflammation in the vessel wall.

Frovatriptan or zolmitriptan as a type of 'mini-prophylaxis'.

Sodium valproate.

Lamotrigine.

Verapamil.

Women (2:1 ratio compared to men).

Intraventricular drain, repeated lumbar puncture, and ventriculoperitoneal shunt.

Bounding radial pulse, asterixis, headache, flushing, and confusion.

A transient loss of consciousness due to global cerebral hypoperfusion with rapid onset, short duration, and spontaneous complete recovery.

To prevent blood clots.

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.

Neurodevelopmental delay in children.

Poor; 50% of patients die within 3 years.

Anaemia, confusion, gastric irritation, haemorrhage, hyponatraemia, tremor, weight gain.

Weakness is fatigable.

Migraine.

Tension headaches are typically bilateral and of lower intensity, not associated with aura, nausea/vomiting, or aggravated by routine physical activity.

Failure to respond to treatment or atypical features, such as being under 50 years old.

The 'empty delta sign'.

Aspirin, paracetamol, or an NSAID.

To identify a causative pathology that needs urgent treatment.

Patients are not aware, and post-ictal symptoms like confusion and drowsiness are common.

An immune-mediated demyelination of the peripheral nervous system.

Patients generally cannot drive for 6 months following a seizure.

No indication to monitor.

Lethargy, depression, low-grade fever, anorexia, night sweats.

Sudden jerks of a limb, trunk, or face.

Symmetrical and ascending weakness of all limbs, paraesthesia, and reduced or absent reflexes.

85 - 90%.

Dyspnoea, agitation, accessory muscle use, reduced consciousness, and confusion.

Decreased motor nerve conduction velocity, prolonged distal motor latency, and increased F wave latency.

No, there are no cerebellar signs.

A type of syncope resulting from hypersensitivity of carotid sinus baroreceptors leading to bradycardia and/or vasodilation upon stimulation.

Percutaneous gastrostomy tube (PEG) is preferred and associated with prolonged survival.

Recurrent falls due to transient loss of consciousness.

Pregnancy, oral contraceptive pill use, malignancy.

It is an alpha-1 adrenergic agonist that causes vasoconstriction and increases blood pressure.

A type of reflex syncope triggered by specific situations such as coughing, micturition, or gastrointestinal events.

Mini mental state examination.

A phase where patients feel drowsy and tired for around 15 minutes or more.

Vasovagal, cardiac, and orthostatic syncope.

It is often irreversible.

Hyperaesthesia of the upper face and eye pain.

They can lead to occlusion of the cerebral veins and sinuses.

3-4%.

Widening pulse pressure, bradycardia, and irregular breathing.

They involve networks on both sides of the brain, and consciousness is lost immediately.

Cross-reaction of antibodies with gangliosides in the peripheral nervous system, with anti-GM1 antibodies present in 25% of patients.

LMN signs only, affecting distal muscles before proximal, and carries the best prognosis.

Floaters and flashes.

Lamotrigine or levetiracetam.

A variant of Guillain-Barré syndrome associated with ophthalmoplegia, areflexia, and ataxia.

Polycythaemia, pulmonary hypertension (PHT), and cor pulmonale.

No, it doesn't affect external ocular muscles.

Considered in patients with thymic hyperplasia or thymoma.

Seizures and hemiplegia.

Generalized, complex partial, partial, and focal.

Symptoms tend to be bilateral.

They should not start treatment without specialist neurological or psychiatric advice.

Recurrent seizures.

PR diazepam or buccal midazolam.

Periorbital oedema and ophthalmoplegia.

Only if there is evidence of severe cardioinhibitory response or recurrent episodes despite optimal medical therapy.

Cerebral ischaemia, oedema, haemorrhage, and raised intracranial pressure.

85%.

An inflammation of the blood vessels that can cause headaches and vision problems.

Around one minute.

New guidelines suggest not doing a lumbar puncture and considering an alternative diagnosis.

Bed rest, analgesia, venous thromboembolism prophylaxis, and discontinuation of antithrombotics.

Resting the jaw, adhering to a soft diet, physiotherapy, avoiding wide yawning and loud singing, and using heat or cold packs.

Back and leg pain.

100% oxygen or subcutaneous triptan.

Diplopia and bilateral facial nerve palsy.

A seizure that starts on one side of the brain in a specific area before spreading to both lobes.

It is a P450 enzyme inhibitor and interacts with warfarin.

Pallor, abrupt onset, and unlikely seizure activity.

'Empty delta sign'.

Stress.

Sensory disturbance, including numbness or tingling.

Non-oestrogen methods, such as the progesterone-only pill.

Occurs 15 or more days per month.

A surgical procedure to remove or relocate blood vessels that are in contact with the trigeminal root.

Non-oral preparation of metoclopramide or prochlorperazine, and consider adding a non-oral NSAID or triptan.

1-2%.

Headache, vomiting, reduced levels of consciousness, papilloedema, and Cushing's triad.

Riboflavin (400 mg once a day).

Sodium valproate.

It helps to distinguish true SAH from a 'traumatic tap' and indicates red blood cell breakdown.

Paraesthesia.

The dose of Lamotrigine.

Delayed cerebral ischaemia typically occurring 7-14 days after onset.

With an external ventricular drain or a long-term ventriculoperitoneal shunt.

Rise in protein with a normal white blood cell count (albuminocytologic dissociation).

Anti-GQ1b antibodies are present in 90% of cases.

ECG, blood tests for dyselectrolytaemias, and imaging like TTE.

Medium and large-sized arteries.

An aura.

A progressive neurological condition of unknown cause that can present with both upper and lower motor neuron signs.

Focal seizures and generalized seizures.

Folic acid 5mg per day.

Déjà vu, jamais vu, and less commonly, auditory, gustatory, or olfactory hallucinations.

Lamotrigine or levetiracetam.

PPI (Proton Pump Inhibitors).

To prevent vasospasm which can lead to subsequent ischaemic damage after the bleed.

Acute antithrombotic therapy, acute symptom management, and long-term management.

Stiffening (tonic) and jerking (clonic) of limbs, with common post-ictal confusion.

MRI with gadolinium contrast.

Procainamide, quinidine, phenytoin, penicillamine, certain antibiotics (gentamicin, macrolides, quinolones, tetracyclines), beta-blockers, and lithium.

An electroencephalogram (EEG) and neuroimaging, usually an MRI.

Asymmetric limb weakness.

Age, amount of blood visible on CT head, and conscious level on admission.

Lightheadedness, palpitations, chest pain, and shortness of breath.

If they have no postural drop and a normal ECG.

Intracranial aneurysms (saccular 'berry' aneurysms).

They are progressive and last 5 - 60 minutes, including transient hemianopic disturbance or a spreading scintillating scotoma.

May occur with or without impairment of consciousness; often includes an aura with rising epigastric sensation and psychic phenomena.

A collection of clinical problems involving the masticatory musculature, the temporomandibular joint (TMJ), and associated structures.

Traumatic head injuries, tumours, meningitis, idiopathic intracranial hypertension, hydrocephalus, hypercapnia, and infection.

Induction of general anaesthesia or phenobarbital may be necessary.

Hypercoagulable states.

Classically Campylobacter jejuni, but also mycoplasma, EBV, HIV, CMV, and Hepatitis A.

Redness, lacrimation, lid swelling, nasal stuffiness, and severe, sharp pain around one eye.

Low-dose aspirin.

20 mmHg.

To treat seizures and provide prophylaxis against seizures in high-risk patients.

Antibiotic treatment for infection and glucocorticoid therapy for inflammatory disorders.

A transient loss of consciousness due to inadequate cardiac output leading to cerebral hypoperfusion.

Thymomas are found in 15% of cases.

Consider non-invasive ventilation (NIV) or a respiratory stimulant such as doxapram.

Concussion, mild to severe brain injury, subdural and epidural hemorrhage.

It may be quicker to administer and have fewer adverse effects than alternatives.

Thickened, tender temporal artery.

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'.

The gene lies on chromosome 21 and codes for superoxide dismutase.

Head/limb movements, post-ictal weakness, and Jacksonian march posturing.

Carbamazepine.

By elevating the bed, administering osmotic therapy, hyperventilating in an intensive care setting, and possibly emergency decompressive surgery.

An autoimmune disorder resulting in the production of antibodies against nicotinic acetylcholine receptors at the neuromuscular junction.

Diuretics, alcohol, and vasodilators.

To reduce pCO2, leading to vasoconstriction of cerebral arteries and reduced ICP.

Arrhythmias, structural issues like aortic stenosis, and pulmonary embolism.

A symptomatic fall in systolic BP > 20 mmHg or diastolic BP > 10 mmHg.

A negative D-dimer cannot exclude CVT if patients have suggestive symptoms.

Sodium valproate as first-line.

Lip smacking, grabbing, or plucking.

They can induce/inhibit the P450 system, resulting in varied metabolism of other medications.

Syncope resulting from a postural decrease in blood pressure.

Analgesics, muscle relaxants, and anti-inflammatory drugs.

Sudden loss of muscle tone, causing the patient to fall, while consciousness is retained.

Brief pauses for less than 10 seconds.

Syndrome of inappropriate antidiuretic hormone secretion (SIADH).

Ptosis, diplopia, dysphagia, respiratory muscle weakness, and proximal muscle weakness.

Arterial blood gas analysis, pulse oximetry, simple spirometry, and electrocardiogram.

Parkinson's disease and Lewy body dementia.

Diabetic neuropathy, uraemia, and amyloidosis.

PaO2 < 8 kPa and PaCO2 > 6 kPa.

A mixture of lower motor neuron and upper motor neuron signs, wasting of small hand muscles, fasciculations, and absence of sensory signs/symptoms.

Hypotonia, hyporeflexia, marked atrophy, and fasciculations.

Controlled oxygen therapy aiming for 88-92% oxygen saturation and PaO2 > 8 kPa.

Type 2 respiratory failure due to alveolar hypoventilation.

Ethosuximide.

Muscle fatigability, where muscles become progressively weaker during activity and improve after rest.

Cyanosis, reduced oxygen saturation, and tachycardia.

Plasmapheresis and intravenous immunoglobulins.