Neurology

Simple Febrile Seizure:

◦ Isolated
◦ GTCS
◦ <15 minutes
◦ Do not recur in 24 Hrs
◦ Do not recur in same illness
◦ Complete Recovery in 1 hr

Complex Febrile Seizure:

◦ Not isolated
◦ ParCal or Focal in onset
◦ > 15 minutes
◦ Recurrence in 24 Hours
◦ Recurrence in same illness
◦ Incomplete Recovery in 1 hour

Indica6ons for Referral:

◦ Age <18 months
◦ Signs of Meningismus
◦ Complex or Prolonged
◦ No clear focus of infecCon
◦ Systemically Unwell
◦ Parental Anxiety
◦ Current or Recent AnCbioCc use
◦ First Febrile Convulsion

PRES (Posterior Reversible Encephalopathy Syndrome)

Synonymous to hypertensive encephalopathy
◦ Pre-eclampsia
◦ Kidney Failure
◦ Hypomagnesemia
◦ HTN
◦ Tacrolimus/CisplaCn
◦ Autoimmune condiCon
◦ Cocaine/Amphetamine

Asep6c Meningi6s
◦ SLE
◦ Behcets
◦ NSAIDS
◦ TMP-SMX
◦ Brucellosis

SVT (Dipyridamole & Carbamazepine increases the effect of adenosine (up

regulates adenosine receptors)

Nimodipine in SAH
Lowers BP
Prevent Secondary Vasospasm

Normal Post Void Residue < 50 ml

Post dural Headache:

< 24 hours = NSAIDs & Caffeine
> 24 hours = Blood Patch

Altered Mental Status (Confusion) + Ataxia + Nystagmus (Ophthalmoplegia) =

Wernicke’s

Confusion, Ataxia & Incon6nence = NPH

Papilloedema + Chronic Headaches + Blindness = Pseudotumor Cerebri

Ver6go, Diplopia, Dysmetria = Cerebellar stroke

Myasthenia Gravis
Ptosis, 3rd Nerve palsy, Diplopia
Thymoma (15%)
Edrophonium test
Ice pack on eyes

Drugs: Magnesium, Amino-glycosides, Quinolones/Quinines, Macrolides, StaCns,

Beta Blockers, Iodinated radiological contrasts

Pobs Puffy Tumour: OsteomyeliCs of frontal bone with abscess formaCon

Cyclobenzaprine Muscle relaxant

Most common type of headache: Tension Headache

Pain worsens as day progresses.

Albumino-cytological dissociaCon: GBS & MS

GBS Nerve ConducCon Studies
MFS Ophthalmoplegia, ataxia and areflexia (Elevated CSF Protein): Self LimiCng

SAH
99% posiCve CT if done within 6 hours
> 6 hours LP as CT is unreliable
Red blood cell count decline from tube 1 to tube 4 is diagnosCc
Xanthochromia

CORTICAL VS SUBCORTICAL
• Gray maber (neuronal cell bodies) of the brain forms a rim over the cerebral
hemispheres, forming the cerebral cortex.
• White maber (neuronal axons coated in myelin) is located below the cortex
and makes up the "subcorCcal" regions of the brain.
• Strokes affecCng the cerebral cortex (i.e. corCcal strokes) classically present
with deficits such as neglect, aphasia, and hemianopia.
• SubcorCcal strokes affect the small vessels deep in the brain, and typically
present with purely motor hemiparesis affecCng the face, arm, and leg.
• Nearly 30% of all ischemic strokes are subcorCcal in nature, and includes
lacunar infarcts which have the best prognosis.

Cluster headache is a neurological disorder characterized by recurrent, severe

headaches on one side of the head, typically around the eye. (PTOSIS MIOSIS)

Migraine:
Metochlopramide
StemeCl
Sumatriptan 3mg S/C
Dihydroergotamine

Hyperemesis Gravidarum
PUQE Score
HELP Score
AnChistamine, phenothiazine, doxyamine/pyridoxine
Ondansetron
Pabrinex

Nicardipine IV
3 - 5 mg/hour for 15 minutes
increase 0.5 - 1 mg/hour every 15 minutes
Max 15 mg/hr
Reduce Gradually taper

OpCc NeuriCs 15 - 30% MS

MRI Brain: Periventricular White Plaques

3rd Nerve Palsy

Down & Out
No pupils = Ischaemia
Pupils = Low GCS (HerniaCon), Normal GCS (Aneurysm)

Herpes Simplex 1 EncephaliCs Temporal Haemorrhage

Headache CT IndicaCons
◦ New Headache + Neuro deficit
◦ Sudden onset severe headache
◦ HIV +ve
◦ Age > 50 years

Type 2 DM with BL Stocking-glove distribuCon

Pregabalin & DuloxeCne

Spinal Epidural Abscess (IVDU, Midline Tenderness, ESR raised)

MRI +/- Gadolinium (Sn/Sp >90%)
Skip Lesions in 15% Cases

Pure Motor Stroke (Internal Capsule, Thalamus, one sided stroke)

Idiopathic Intracranial HTN

Young Obese
Prevent Blindness (OpCc Disc Swelling)
Headaches worse in Morning/Lying flat/Sneezing/Coughing
Beber when Standing
6th Nerve palsy (loss of peripheral Vision)
Associated with Hypercoagulable State
TherapeuCc Lumbar punctures

Internuclear Ophthalmoplegia
MLF
MulCple Sclerosis
(Lack of coordinaCon between 3rd & 6th Nerve)

Headache worst in the morning and gets beber as day progresses = ?Mass Lesion
Dystonic ReacCon
AnCpsychoCcs
Strychnine
HCN
Lithium
Tetanus
(Risus Sardonicus)

GBS (Acute demyelinaCng neuropathy)

Paresthesia + Motor Weakness
Autonomic Symptoms 2/3 paCents
ECG Monitoring in GBS

GBS
C Jejuni/URTI
Rapidly Progressive
Symmetric Ascending
DTR absent
IVIG/Plasmapheresis

MFS
2/3 Ataxia, Areflexia, Ophthalmoplegia
Lower Cranial Nerves/Facial Nerve
No Limb Involvement

MG
Worsens as day progresses
FaCgue
Ptosis, Diplopia
Post SynapCc (Ab against Ach Receptor)
Thymoma

Lambert Eaton
PresynapCc (Ab against Ca+2 Channel)
DTR reduced
SCC Lung

BidirecConal VerCgo = Cerebellar Stroke

ABCD2 in TIA
< 4 Aspirin
> 4 Aspirin + Clopidogrel (Loading + Maintenance)
PRES Parieto-occipital lobes
HTN Encephalopathy
Kidney Disease