What is one use of oral splints or mouth guards?
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To manage dental issues or protect teeth.
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What is one use of oral splints or mouth guards?
To manage dental issues or protect teeth.
What dental issue can be corrected to improve oral health?
Misaligned teeth.
Why should sodium valproate be avoided during pregnancy?
It is teratogenic and can harm fetal development.
When might a referral to an ENT specialist be necessary?
In severe or chronic cases.
What should be considered for women taking contraception and anti-epileptic medication?
The possible interactions between the contraceptive and anti-epileptic medication.
When do most neurologists start antiepileptic medication?
Following a second epileptic seizure.
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.
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.
What is monitored to assess respiratory function?
Forced vital capacity.
What is syncope?
A transient loss of consciousness due to global cerebral hypoperfusion with rapid onset, short duration, and spontaneous complete recovery.
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.
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.
What is a common symptom of stroke related to muscle function?
Weakness.
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 type of blood tests are important in management?
Arterial blood gas (ABG) tests.
What triggers vasovagal syncope?
A sudden drop in blood pressure and heart rate triggered by emotion, pain, stress, or standing for a long time.
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).
What congenital condition is phenytoin associated with?
Cleft palate.
What factors should be assessed regarding weakness in stroke patients?
Distribution, severity, onset, duration, and course of the weakness.
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.
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.
What are common prodromal symptoms of syncope?
Sweating, pallor, dizziness, nausea/vomiting, lightheadedness, visual disturbances, tinnitus, and muffled hearing.
What is the purpose of venous thromboembolism (VTE) prophylaxis?
To prevent blood clots.
What characterizes trigeminal neuralgia?
Severe unilateral pain.
What aspects of memory loss should be evaluated?
Short/long-term memory, insight and concerns, functional levels, cognitive assessment, and risk to self/others.
Is breastfeeding safe for mothers taking antiepileptics?
Generally considered safe, with possible exceptions for barbiturates.
What are the types of dysphasia associated with stroke?
Expressive dysphasia, receptive dysphasia, and dysarthria.
What is a primary headache?
A headache with no underlying cause.
What is the effect of Riluzole on life expectancy?
It prolongs life by about 3 months.
What is cerebral venous thrombosis (CVT)?
CVT is caused by partial or total occlusion of the cerebral veins and sinuses by a thrombus.
What is the most common cause of trigeminal neuralgia?
The vast majority of cases are idiopathic.
What are counter-pressure maneuvers that can help with syncopal episodes?
Leg crossing with tensing muscles or handgrip exercises.
What is carotid sinus syncope?
A type of syncope resulting from hypersensitivity of carotid sinus baroreceptors leading to bradycardia and/or vasodilation upon stimulation.
What are the components of VTE prophylaxis?
TEDS (thromboembolic deterrent stockings) and LMWH (low molecular weight heparin).
What should be assessed regarding dizziness?
The nature and triggers of dizziness.
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.
What should pregnant women taking phenytoin be given in the last month of pregnancy?
Vitamin K, to prevent clotting disorders in the newborn.
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 expressive dysphasia feel like?
"I knew what I wanted to say, but I couldn’t get it out."
What is a secondary headache?
A headache caused by an underlying condition.
What is the most common risk factor for CVT?
Prothrombotic condition.
What can compress the trigeminal roots and potentially cause trigeminal neuralgia?
Tumours or vascular problems.
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.
Who is predominantly affected by carotid sinus syncope?
Older individuals.
What is the focus of management in myasthenia gravis?
Understanding the principles of management of type 2 respiratory failure.
What is the preferred method for nutritional support in motor neuron disease?
Percutaneous gastrostomy tube (PEG) is preferred and associated with prolonged survival.
What are common presentations of sagittal sinus thrombosis?
Seizures and hemiplegia.
What types of analgesia are used for radiculopathy-related back pain?
NSAIDs or opiates.
What significant risk is associated with maternal use of sodium valproate?
Neurodevelopmental delay in children.
What motor symptoms should be evaluated?
Weakness patterns, character of weakness, and incontinence.
What does receptive dysphasia feel like?
"I wasn’t able to understand anyone, they were speaking gibberish."
What is a characteristic feature of migraine attacks?
They may last up to 72 hours.
What should be administered urgently upon suspicion of temporal arteritis?
High-dose glucocorticoids.
Name a genetic risk factor for CVT.
Antiphospholipid syndrome.
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 defines status epilepticus?
A single seizure lasting more than 5 minutes, or two seizures within a 5-minute period without returning to normal.
What is a characteristic feature of tension headaches?
A 'tight band' around the head or a pressure sensation.
What is subarachnoid hemorrhage (SAH)?
The presence of blood within the subarachnoid space.
What are the potential consequences of carotid sinus syncope?
Recurrent falls due to transient loss of consciousness.
What are the types of epilepsy?
Generalized, complex partial, partial, and focal.
What is the typical starting dose of Fludrocortisone for reflex syncope?
100 micrograms daily, titrated based on clinical response and side effects.
What is the prognosis for patients with motor neuron disease?
Poor; 50% of patients die within 3 years.
What is the primary focus of neurology?
The diagnosis and treatment of disorders of the nervous system.
What type of infarctions are sometimes seen in sagittal sinus thrombosis?
Parasagittal biparietal or bifrontal haemorrhagic infarctions.
What sensory symptoms should be assessed?
Pain, numbness, and tingling.
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.
What is the duration of intravenous immunoglobulin (IVIG) treatment?
A 5-day course.
What does dysarthria feel like?
"My speech was really slurred, it sounded like I was drunk."
What are common symptoms of a migraine?
A severe, unilateral, throbbing headache associated with nausea, photophobia, and phonophobia.
What is the treatment for temporal arteritis if there is no visual loss?
High-dose prednisolone.
What are common trigger factors for trigeminal neuralgia pain?
Light touch, combing hair, washing, shaving, smoking, talking, and brushing teeth.
What are some acquired risk factors for CVT?
Pregnancy, oral contraceptive pill use, malignancy.
How do tension headaches typically present in terms of location?
Symptoms tend to be bilateral.
What is the most common cause of traumatic SAH?
Head injury.
What are some side effects of Sodium Valproate?
Anaemia, confusion, gastric irritation, haemorrhage, hyponatraemia, tremor, weight gain.
Why is status epilepticus considered a medical emergency?
Prolonged seizure activity can lead to irreversible brain damage.
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.
How long can prodromal symptoms last before syncope occurs?
Several seconds to minutes.
What is the recommended duration for long-term anticoagulation with warfarin in provoked CVT?
3 - 6 months.
What is temporal arteritis also known as?
Giant cell arteritis.
What are common symptoms of neurological disorders?
Headaches, seizures, weakness, numbness, and changes in coordination.
What is a conservative management strategy for migraines?
Avoidance of triggers such as certain foods or stressors, including poor sleep.
What sign is associated with sagittal sinus thrombosis on venography?
'Empty delta sign'.
What type of disturbance can affect a patient's ability to walk and coordinate movements?
Ataxia.
What is the mechanism of action of Midodrine?
It is an alpha-1 adrenergic agonist that causes vasoconstriction and increases blood pressure.
What advice is given to women of childbearing age regarding sodium valproate treatment?
They should not start treatment without specialist neurological or psychiatric advice.
What are the types of syncope?
Vasovagal and cardiac syncope.
What specific characteristic of weakness is important in myasthenia gravis?
Weakness is fatigable.
What is plasmapheresis and how does it compare to IVIG?
Plasmapheresis has similar efficacy to IVIG but is associated with more side effects.
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 do patients typically do during a migraine attack?
They go to a darkened, quiet room.
Which infections are commonly associated with CVT?
Staphylococcus aureus, meningitis, or subdural empyema.
What treatment is usually given if there is evolving visual loss in temporal arteritis?
IV methylprednisolone.
What is the first-line treatment for status epilepticus?
Benzodiazepines.
What is the driving restriction for patients after a seizure?
Patients generally cannot drive for 6 months following a seizure.
What may trigger tension headaches?
Stress.
What should be done for patients under 50 presenting with features suggestive of cerebral venous thrombosis (CVT)?
They should be urgently investigated for CVT.
What is situational syncope?
A type of reflex syncope triggered by specific situations such as coughing, micturition, or gastrointestinal events.
What characterizes epilepsy?
Recurrent seizures.
What is spontaneous SAH?
SAH that occurs in the absence of trauma.
What type of arteries does temporal arteritis affect?
Medium and large-sized arteries.
What is the recommended duration for long-term anticoagulation with warfarin in unprovoked CVT?
6 - 12 months.
What is a common type of headache?
Migraine.
What is the first-line acute treatment for migraines?
Oral triptan (e.g., sumatriptan) and an NSAID, or oral triptan and paracetamol.
What are common symptoms following a generalized seizure?
Patients may bite their tongue and experience incontinence of urine.
What are some causes of cavernous sinus syndrome?
Local infection (e.g., sinusitis), neoplasia, trauma.
What are the types of meningitis and encephalitis?
Bacterial and viral meningitis, HIV/AIDS related infections, and immune encephalitis.
What is the first-line treatment for trigeminal neuralgia?
Carbamazepine.
What sensory symptoms might a stroke patient experience?
Sensory disturbance, including numbness or tingling.
What should be done if there is no dramatic response to treatment for temporal arteritis?
Reconsider the diagnosis.
What cognitive assessment can be performed during a neurological history taking?
Mini mental state examination.
What can be administered in the prehospital setting for status epilepticus?
PR diazepam or buccal midazolam.
What are some symptoms of cerebral venous thrombosis?
New headache, nausea and vomiting, seizures, papilloedema, focal neurological deficits, changes in mental state, and encephalopathy.
What is a 'classic' migraine attack precipitated by?
An aura.
How long must patients with established epilepsy be seizure-free before driving?
12 months.
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.
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.
What is the preferred imaging modality for diagnosing cerebral venous thrombosis?
MRI with venography.
What percentage of individuals with cerebral palsy have epilepsy?
Around 30%.
What is a key risk of untreated temporal arteritis?
Permanent loss of vision.
What accounts for around 85% of spontaneous SAH cases?
Intracranial aneurysms (saccular 'berry' aneurysms).
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.
What should be considered for young people aged 12-17 years for acute migraine treatment?
A nasal triptan in preference to an oral triptan.
What is the postictal phase after a seizure?
A phase where patients feel drowsy and tired for around 15 minutes or more.
What is epilepsy?
A neurological disorder characterized by recurrent seizures.
What symptoms are associated with cavernous sinus thrombosis?
Periorbital oedema and ophthalmoplegia.
What is Motor Neuron Disease (MND)?
A progressive neurological condition of unknown cause that can present with both upper and lower motor neuron signs.
What are the types of dementia?
Alzheimer's disease (AD), frontotemporal dementia (FTD), and vascular dementia.
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.
What is generally used in hospitals for status epilepticus?
IV lorazepam, which may be repeated once after 5-10 minutes.
How soon should patients with visual symptoms be seen by an ophthalmologist?
The same day.
Why should Sodium Valproate be avoided during pregnancy?
It is teratogenic.
What visual symptoms can occur in stroke patients?
Visual disturbance.
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.
What defines chronic tension-type headache?
Occurs 15 or more days per month.
What neurological deficits may occur due to CVT?
Motor weakness (e.g., hemiparesis), fluent aphasia, sensory/visual field defects.
What are the types of syncope?
Vasovagal, cardiac, and orthostatic syncope.
What prophylactic measure is recommended for women who developed CVT during pregnancy?
Prophylactic anticoagulation during future pregnancies.
When is cardiac pacing indicated for reflex syncope?
Only if there is evidence of severe cardioinhibitory response or recurrent episodes despite optimal medical therapy.
What are the two main types of seizures in epilepsy?
Focal seizures and generalized seizures.
Which cranial nerve damage typically occurs first in cavernous sinus thrombosis?
6th nerve damage.
What sign can be observed on cranial CT or CT venography indicative of CVT?
The 'empty delta sign'.
What distinguishes anterior circulation stroke from posterior circulation stroke?
Clinical presentation differences based on carotid territory versus vertebral and basilar territories.
What are some conditions associated with berry aneurysms?
Hypertension, adult polycystic kidney disease, Ehlers-Danlos syndrome, and coarctation of the aorta.
What is contraindicated in ischaemic heart disease?
Triptans.
What is the typical age of patients affected by temporal arteritis?
Patients are usually over 60 years old.
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.
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.
At what age does Motor Neuron Disease typically present?
It rarely presents before 40 years.
What should be considered if status epilepticus is ongoing?
Start a second-line agent such as levetiracetam, phenytoin, or sodium valproate.
What is a potential consequence of visual damage in temporal arteritis?
It is often irreversible.
What should women thinking about becoming pregnant take to minimize the risk of neural tube defects?
Folic acid 5mg per day.
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 complications arise from occlusion of cerebral veins and sinuses?
Cerebral ischaemia, oedema, haemorrhage, and raised intracranial pressure.
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.
What are first-line treatments for acute tension headaches?
Aspirin, paracetamol, or an NSAID.
What is myasthenia gravis?
An autoimmune disorder that affects neuromuscular transmission.
What is the first-line drug treatment for males with generalized tonic-clonic seizures?
Sodium valproate.
What are the types of brain trauma?
Concussion, mild to severe brain injury, subdural and epidural hemorrhage.
What are temporomandibular joint disorders (TMD)?
A collection of clinical problems involving the masticatory musculature, the temporomandibular joint (TMJ), and associated structures.
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.
What is a focal aware seizure?
A simple partial seizure where patients are aware and post-ictal symptoms are absent.
What does an elevated D-dimer indicate in the context of CVT?
It supports a diagnosis of CVT alongside neuroimaging findings.
What may trigeminal nerve involvement in cavernous sinus thrombosis lead to?
Hyperaesthesia of the upper face and eye pain.
What is a common symptom of SAH?
Sudden-onset headache, often described as 'thunderclap' or 'worst of my life'.
What sensations might patients experience during a temporal lobe seizure?
Déjà vu, jamais vu, and less commonly, auditory, gustatory, or olfactory hallucinations.
What percentage of patients with temporal arteritis experience headaches?
85%.
What are alcohol or glycerol injections used for in trigeminal neuralgia management?
To damage the trigeminal nerve and reduce pain signals.
What is the primary aim of investigation after confirming spontaneous SAH?
To identify a causative pathology that needs urgent treatment.
What is the most common pattern of Motor Neuron Disease?
Amyotrophic lateral sclerosis (50% of patients).
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.
What additional treatment is required for bone protection in temporal arteritis?
Bisphosphonates.
What are some common causes of raised intracranial pressure?
Traumatic head injuries, tumours, meningitis, idiopathic intracranial hypertension, hydrocephalus, hypercapnia, and infection.
What is the risk of congenital defects in newborns born to non-epileptic mothers?
1-2%.
What is a hemiplegic migraine?
A variant of migraine in which motor weakness is a manifestation of aura in at least some attacks.
What is a key characteristic of cluster headaches?
They occur in clusters lasting several weeks, typically once a year.
How can trauma and surgery contribute to CVT?
They can lead to occlusion of the cerebral veins and sinuses.
What is the first-line drug treatment for females with generalized tonic-clonic seizures?
Lamotrigine or levetiracetam.
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.
What is temporal arteritis?
An inflammation of the blood vessels that can cause headaches and vision problems.
What are the first-line prophylactic treatments for migraines?
Propranolol, Amitriptyline, or Topiramate (with caution in women of childbearing age).
What characterizes focal impaired awareness seizures?
Patients are not aware, and post-ictal symptoms like confusion and drowsiness are common.
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.
What is a common examination finding in temporal arteritis?
Thickened, tender temporal artery.
What cranial nerve palsies are associated with lateral sinus thrombosis?
6th and 7th cranial nerve palsies.
What should be done if there is no response within 45 minutes of onset?
Induction of general anaesthesia or phenobarbital may be necessary.
What are the key features of headaches caused by raised intracranial pressure?
Headache, vomiting, reduced levels of consciousness, papilloedema, and Cushing's triad.
What imaging technique is used to identify vascular lesions such as aneurysms or AVMs in SAH?
CT intracranial angiogram.
What is the first-line investigation for suspected SAH?
Non-contrast CT head.
What is the risk of congenital defects if the mother takes antiepileptic medication?
3-4%.
What medication may be given to prevent gastric ulcers in patients with temporal arteritis?
PPI (Proton Pump Inhibitors).
What are the typical signs of Amyotrophic lateral sclerosis?
Typically LMN signs in arms and UMN signs in legs or a mixture of both.
How long do seizures typically last in the temporal lobe?
Around one minute.
Who is more commonly affected by cluster headaches?
Men (3:1 ratio) and smokers.
What is Guillain-Barré Syndrome (GBS)?
An immune-mediated demyelination of the peripheral nervous system.
What should be offered to girls under 10 years who are unlikely to need treatment later?
Sodium valproate as first-line.
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'.
What is cerebral venous thrombosis?
A condition where a blood clot forms in the brain's venous sinuses.
What additional treatment may help reduce migraine frequency and intensity?
Riboflavin (400 mg once a day).
What are the types of focal seizures?
Motor, non-motor, and those with features such as aura.
