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Basic Overview of Neurology
Basic Overview of Neurology
Dr Estelle McFadden
MBChB, MRCP, MRCGP
GPwSI, Bradford
Headaches
www.mipca.org.uk
Why is this important?
• Psychogenic
Red Flags
• If history inadequate
– Presume cardiovascular till proven otherwise
• ECG, cardiac enzymes, cardiac monitor, ECHO, tilt table,
carotid sinus massage
• If cardiac symptoms present before, during or
after arrange cardiac tests especially while
symptomatic
• Altered consciousness, behavioural change
– Exclude epilepsy
– Exclude cardiac/cardiovascular causes
– The Blackouts Checklist (refs)
• Vomiting
Vertigo and the neck
• Compression of vertebral arteries
expect multiple neurological symptoms;
tinnitus & hearing loss
– very rare cause of recurrent vertigo
• Carotid sinus hypersensitivity
– Relatively common, but causes falls NOT vertigo
• Cervicogenic vertigo
proprioceptive dysfunction
desensitization to neck stimuli
vestibular failure
Not common
Nystagmus
• Curative manoeuvres
– Epley
– Barrel
Epley manoeuvre and Barrel
manoeuvre
3 4
5 6
The best policy: A team approach
2 Unilateral ≥ 60 mins
weakness
Risk of stroke following TIA
• Antiplatelet
– Aspirin 75mg – 300mg plus dipyridamole MR
200mg bd for 2 years following event then
aspirin alone
– Clopidogrel alone if aspirin intolerance or
sensitivity
• Anticoagulation
– Anticoagulant if arrhythmia unless
contraindication (high risk of falls, recent GI
bleed)
Secondary prevention
• Hypertension
– Risk of stroke halves with every 10mmHg fall
in diastolic blood pressure even in
normotensive patients
• Cholesterol
– Equal benefit of simvastatin 40mg across all
those who had had a stroke or TIA down to
baseline 3.5mmol/l total cholesterol
Lifestyle advice
• Smoking cessation
• Alcohol intake
– Binge drinking associated with increase in
blood pressure
• Exercise
• Obesity