key concepts

• Confusion, ataxia, nystagmus/ophthalmoplegia→ give Pabrinex (IV B/C vitamins)
• Lumbar puncture is the key diagnostic test in suspected Guillain-Barre syndrome
• Patient presenting with acute stroke should be sent urgently to the local stroke centre and treatment should be delayed until an ischaemic stroke is confirmed.Once an ischaemic stroke is confirmed the patient should be given aspirin 300 mg daily for 2 weeks then clopidogrel 75 mg daily long-term. A statin should also be offered if the patient is not already on statin therapy.
• Multiple sclerosis diagnosis requires demyelinating lesions that are separated in space and time
• On CT imaging, acute haematomas appear bright (hyperdense) whereas chronic haematomas appear dark (hypodense). 
• Drugs for neuropathic pain are typically used as monotherapy, i.e. if not working then drugs should be switched, not added
• Reduction in consciousness and vomiting more than once are sinister signs in headache: urgent CT head is indicated
• Tetracyclines increase the risk of idiopathic intracranial hypertension
• Lateral medullary syndrome - PICA lesion - cerebellar signs, contralateral sensory loss & ipsilateral Horner's
• Urinary incontinence + gait abnormality + dementia = normal pressure hydrocephalus
• Baclofen and gabapentin are first-line for spasticity in multiple sclerosis
• A young boy is noted to have occasional periods where he stares blankly in class - absence seizure
• Levodopa should be offered for patients with newly diagnosed Parkinson's who have motor symptoms affecting their quality of life
• Worsening lower limb weakness following gastroenteritis - think Guillain-Barre
• Subdural haemorrhage results from bleeding of damaged bridging veins between the cortex and venous sinuses
• All TIA patients should have an urgent carotid doppler unless they are not a candidate for carotid endarterectomy
• Confusion, gait ataxia, nystagmus + ophthalmoplegia are features of Wernicke's encephalopathy
• Patients cannot drive for 6 months following a first unprovoked or isolated seizure if brain imaging and EEG normal
• Clopidogrel is the preferred antiplatelet for secondary prevention following stroke
• Confusion, ataxia, nystagmus/ophthalmoplegia→ give Pabrinex (IV B/C vitamins)
• Carotid endarterectomy is considered in a patient who has had a TIA with carotid artery stenosis exceeding 70% on the side contralateral to the symptoms
• Dopamine receptor agonists e.g. Ropiniroleare associated with the highest chance of inhibition disorders out of the antiparkinsonian medications
• Temporal lobe seizures typically feature epigastric aura and automatisms
• Syncopal episodes are associated with a rapid recovery and short post-ictal period. Seizures are associated with a far greater post-ictal period
• Propranolol is preferable to topiramate in women of childbearing age (i.e. the majority of women with migraine)
• Parkinsons disease should only be diagnosed, and management initiated, by a specialist with expertise in movement disorders
• Epilepsy medication for males:

  • generalised seizure: sodium valproate
  • focal seizure: lamotrigine or levetiracetam
• The Barthel index is a scale that measures disability or dependence in activities of daily living in stroke patients
• Symmetrical tremor is rarely caused by idiopathic Parkinson's disease
• Confusion, ataxia, nystagmus/ophthalmoplegia→ give Pabrinex (IV B/C vitamins)
• Management of myasthenic crisis - intravenous immunoglobulin, plasmapheresis
• Progressive peripheral polyneuropathy with hyporeflexia suggests Guillain-Barre syndrome
• Parkinsonism with associated autonomic disturbance (atonic bladder, postural hypotension) points towards Multiple System Atrophy
• Carotid endarterectomy is considered in a patient who has had a TIA with carotid artery stenosis exceeding 70% on the side contralateral to the symptoms
• Contralateral hemiparesis and sensory loss with the upper extremity being more affected than the lower, contralateral homonymous hemianopia and aphasia - middle cerebral artery
• A man loses consciousness, falls to the ground and starts to stiffen and straighten his limbs alternatively. During the seizure he bites his tongue - tonic-clonic seizure
• Myoclonic seizures: sodium valproate is first-line for males
• Fluctuating consciousness = subdural haemorrhage
• Cluster headache - acute treatment: subcutaneous sumatriptan + 100% O2
• The classical history of vestibular schwannoma includes a combination of vertigo, hearing loss, tinnitus and an absent corneal reflex