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Summary

This on-demand teaching session, delivered by Dr. Taba Khan, will enhance the attendees' knowledge on significant neurological conditions often presenting in clinical exams including Stroke, Epilepsy, Seizures, Parkinson's disease, multiple sclerosis and Guillain-Barre syndrome. You'll learn through exploring various patient case studies, gaining insights into accurate diagnosis and management procedures, from deciphering symptoms to choosing appropriate medication. This session is invaluable for medical professionals who handle patients with neurological conditions and wish to stay updated with the latest medical procedures and treatments.

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Description

Here's our Schedule!

Prepare for an exhilarating journey through essential medical topics with our expert presenters! 🚀

  1. Gastroenterology - Upper GI Bleed*
  2. Urology*
  3. IBD*
  4. Acute Abdomen*
  5. Obstetrics
  6. ECG+ Arrythmias
  7. Neurology
  8. Haematology
  9. Endocrine
  10. Common A to E Scenarios
  11. Hepatology

*(These topics are completed! See our lecture recordings and slide decks. Don't forget to leave some feedback for those too!)

Mark your calendars for these consecutive Wednesdays starting 14th February, 2024 filled with dynamic, interactive sessions! 🗓️ Get ready to dive into the depths of medical knowledge and enhance your understanding with engaging presentations. Each session promises a thrilling exploration of the respective topics, keeping you on the edge of your seat.

Don't miss out on this opportunity to elevate your medical expertise and interact with our passionate presenters. Stay tuned for updates and further details! 🌟

Hosted by FY1 Doctors - Making Learning Awesome (MLA) Edition!

Learning objectives

  1. Identify the different symptoms and characteristics of neurological disorders such as stroke, epilepsy, seizures, Parkinson's disease, cranial nerve palsy, multiple sclerosis, Guillain-Barre Syndrome, and peripheral neuropathy.
  2. Correctly diagnose different types of stroke and differentiate between ischaemic and haemorrhagic strokes based on patient symptoms and clinical examination.
  3. Understand the appropriate acute and chronic management of stroke including the use of anticoagulants, blood pressure control, rehabilitation and further diagnostic investigations.
  4. Assess and diagnose facial droop and weakness, identifying between Bell's Palsy, acute stroke and other conditions, and understand initial management.
  5. Evaluate and manage different types of seizures, including understanding the appropriate use of antiepileptic medications, and managing status epilepticus.
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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

Neurology DrTaba KhanNeurology forclinical exams • Stroke • Epilepsy andseizures • Parkinson's disease • Cranial nerve palsy • Multiple Sclerosis • Guillain-Barre syndrome • Peripheral neuropathyA65-year-oldmalepatientpresentstotheemergencydepartmentwithsudden onsetleftsidedweakness.HehasapastmedicalhistoryofType2diabetesmellitus andhypertension.Physicalexaminationrevealsreducedpowerinleftarmandleg,a leftsidedhomonymoushemianopia,andleftsidedneglect.Thereisno facial weakness.Whichofthefollowingcorrectlydefinesthemostlikelydiagnosis. • A) Total anteriorcerebralinfarct(rightanteriorandmiddle cerebralartery) • B) Total anteriorcerebralinfarct(left anteriorandmiddle cerebralartery) • C) Partial anteriorcerebralinfarct(rightmiddle cerebralartery) • D) Partial anteriorcerebralinfarct(left middle cerebralartery) • E) Lacunarstroke(perforatingarteriesoftheleft internalcapsule)A65-year-oldmalepatientpresentstotheemergencydepartmentwithsudden onsetleftsidedweakness.HehasapastmedicalhistoryofType2diabetesmellitus andhypertension.Physicalexaminationrevealsreducedpowerinleftarmandleg,a leftsidedhomonymoushemianopia,andleftsidedneglect.Thereisno facial weakness.Whichofthefollowingcorrectlydefinesthemostlikelydiagnosis. • A) Total anteriorcerebralinfarct(right anteriorandmiddle cerebralartery) • B) Total anteriorcerebralinfarct(left anteriorandmiddle cerebralartery) • C) Partial anteriorcerebralinfarct(rightmiddle cerebralartery) • D) Partial anteriorcerebralinfarct(left middle cerebralartery) • E) Lacunarstroke(perforatingarteriesoftheleft internalcapsule)Types ofstroke 85%ofstrokesareischaemic 15%ofstrokesarehaemorrhagic • family historyofischaemicstroke, hypertension,smoking,diabetes, highcholesteroland atrial fibrillation. • Haemorrhagicstroke:age,male sex,hypertension,anticoagulation therapy,illicit sympathomimetic Riskfactors drugs(suchascocaineand amphetamines)andvascular malformations(AVMs)Bamford/OxfordClassificationofstrokeA 72-year-oldmalepatientpresentstotheemergencydepartmentwithsudden onsetdifficultyspeakingandaninabilityto raisehisrightarm.Hehasapastmedical historyofhypertension.Hewaslastknown tobefullyfunctional3hoursagowhen hisdaughterspketohimonthephone.Physicalexaminationrevealsareceptive aphasiaandrightarmparalysis.Thebloodpressureis145/95mmHg,butvitalsigns areotherwisewithinnormalrange.CT headrevealsahyper-intenselesionintheleft middlecerebralarteryvascularterritory.Which ofthefollowingisthemost appropriateacutemanagementforthemostlikelydiagnosis? • A) Intravenousalteplase • B) Supportivemanagementandneurosurgicalreferral • C) Aspirin300mg orally • D) Endovascularintervention(clot-retrieval) • E) IntravenouslabetalolA 72-year-oldmalepatientpresentstotheemergencydepartmentwithsudden onsetdifficultyspeakingandaninabilityto raisehisrightarm.Hehasapastmedical historyofhypertension.Hewaslastknown tobefullyfunctional3hoursagowhen hisdaughterspoketohimon thephone.Physicalexaminationrevealsareceptive aphasiaandrightarmparalysis.Thebloodpressureis145/95mmHg,butvitalsigns areotherwisewithinnormalrange.CT headrevealsahyper-intenselesionintheleft middlecerebralarteryvascularterritory.Which ofthefollowingisthemost appropriateacutemanagementforthemostlikelydiagnosis? • A) Intravenousalteplase • B) Supportivemanagementandneurosurgicalreferral • C) Aspirin300mg orally • D) Endovascularintervention(clot-retrieval) • E) Intravenouslabetalol CT scanofa spontaneous subarachnoid Subduralhemorrhage: Acute onChronic haemorrhage. Bleeds CT scanofa heamorrhagicstroke CT scanofanepiduralhemorrhage BleedsSuB-dural ePI-dural SuB=Banana Pi=pie=lemonmirenguepieAcute Management of stroke • ABCDE! • CT Head-normal?Treatas ischaemic • Ifwithin 4.5 hrsandnocontraindications->thrombolysiswithalteplase* • CT Head= Bleed? Discusswith neurosurgery,BP control • CT Headnormal +notwithinwindow-Give300mg Aspirinfor2weeks then75 mg clopidogrel • All will needPT/OT +furtherinvestigations • LargeVesselthrombusonCT = considerthrombectomy *Thrombolysiscontraindications-Recenttrauma,GI/ICH,recent surgery,veryhighBP,low plateletcount,highINR,onanticoagulationChronic stroke Management: HALTSS • Hypertension • Antiplaetlets/Anticoagulation:After2 weeks,75mg clopidogrelOD or anticoagulationwith warfarin/DOACifAF • Lipidloweringtherapy • Tobacco:Smokingcessation • Sugar:screenandmanagediabetes • Surgery: ipsilateralcarotidartery stenosisof70-90% shouldbereferred forcarotidendarterectomy.A 23-year-oldwomandevelopsacuteonsetweaknessinherlefsshortlyafter returningfromholidayinSpain.Overthenextfewdays,shedevelopsworsening weaknessinthelegsandweaknessinbotharms.Whatisthemostimportantinitial investigation? • A) FBC • B) Peakflow • C) VitalCapacity • D) SerumPotassium • E) ABGA 23-year-oldwomandevelopsacuteonsetweaknessinherlegsshortlyafter returningfromholidayinSpain.Overthenextfewdays,shedevelopsworsening weaknessinthelegsandweaknessinbotharms.Whatisthemostimportantinitial investigation? • A) FBC • B) Peakflow • C)Vital Capacity • D) SerumPotassium • E) ABGGuillianBarre Syndrome • Ascendingpolyneuropathy • Associatedwith LRTI/GIinfection, especiallymycoplasma and campylobacter (alsoCMV,EBV) • Mainlymotor butcanhavesensory signs • Riskofrespiratoyfailure • Bessentialrometry(FVC)is • PlasmaexchangeandIVIG • MayneedITUA54-year-oldRussianmancomplainsofalteredsensationinhisfeetfor several months.Hispastmedicalhistoryisnotableforessentialhypertension,gout and pulmonaryTBtreatedinRussia1yearago.Whatisthemostlikelycauseofhis symptoms? • A) Diabeticneuropathy • B) Isoniazidetoxicity • C) Vincristinetoxicity • D) MotorNeuronDisease • E) GuillainBarreSyndromeA54-year-oldRussianmancomplainsofalteredsensationinhisfeetfor several months.Hispastmedicalhistoryisnotableforessentialhypertension,gout and pulmonaryTBtreatedinRussia1yearago.Whatisthemostlikelycauseofhis symptoms? • A) Diabeticneuropathy • B) Isoniazidtoxicity • C) Vincristinetoxicity • D) MotorNeuronDisease • E) GuillainBarreSyndromePeripheral Neuropathy • Sub-divisions:snsory/sensorymotor, motor • Drugs: askabout chemotherapy • Investigations:bloodtests,nerveconductionstudies • ABCDE o Alcohol o B12 andFolate o CKD o Diabetes Romberg's testis used to testfor o Everythingelse(CMT, Vasculitis,leadtxicity) sensory loss Positive: Unstable with eyes closed onlyA45-year-oldmancomplainsofdoublevision.On examinationthedoctornotesthat hisrighteyeisabducteddownwards,andhispupilislargerthanintheothereye.An MRI scanof hisbrainandorbitsfindsatumourpressingonwhichof thefollowing structure? • A) Abducensnerve • B) Optic nerve • C) Occipital cortex • D) Occulomotor nerve • E) OpticchiasmA45-year-oldmancomplainsofdoublevision.On examinationthedoctornotesthat hisrighteyeisabducteddownwards,andhispupilislargerthanintheothereye.An MRI scanof hisbrainandorbitsfindsatumourpressingonwhichof thefollowing structure? 'Surgical' causes like Parasympatheticneurons tumoursand aneurysms affect • A) Abducensnerve Motor Neuronsof 3rdnerve parasympathetic fibres causing a • B) Optic nerve dilated pupil • C) Occipital cortex • D)Occulomotor nerve 'Medical' causes like • E) Opticchiasm Parasympatheticneurons tumoursand vascular disease Motor Neuronsof 3rdnerve affect motorfibres anddon't tendto affect thepupil Ophthalmoplegia • 3rd nerve palsy- surgical vs medical • Internuclear ophthalmoplegia- MS,stroke, tumour • 6th nerve palsy-raised ICP, MS • 4th- Trauma, MS • CN3supplies all extra-ocular muscles except Superior Oblique (CN4) and Lateral Rectus (CN6) – SO4LR6 If theeye cannotmovelaterally: thereis a CN6lesion If theeye cannotmoveinferiorly when facing medially: there isa CN4 lesion If themajority of theeye’s movements areimpaired and theeye rests in a‘down andout’position: thereis aCN3 lesion If there aredramatically abnormal eye movements which do notfit with a single nerve lesion: thereis‘complex ophthalmoplegia’ (Graves/ mitochondrial/myasthenia/brainstem lesion)55-year-oldmanpresentstohisGP withunilateralfacialdroopandweakness.On furtherquestioningyoufindthatitwassuddenonset6hours agoandwasnot associatedwithothersymptoms(includingpainorintercurrentillness).On Examination,thereisevidenceof foreheadsparingon thesideofthefacial weakness.Whatisthesinglemostlikelydiagnosis? • A) Acutestroke • B) Bell's Palsy • C) Cholesteatoma • D) Spaceoccupyinglesion • E) Conversiondisorder55-year-oldmanpresentstohisGP withunilateralfacialdroopandweakness.On furtherquestioningyoufindthatitwassuddenonset6hours agoandwasnot associatedwithothersymptoms(includingpainorintercurrentillness).On Examination,thereisevidenceof foreheadsparingon thesideofthefacial weakness.Whatisthesinglemostlikelydiagnosis? • A) Acutestroke • B) Bell's Palsy • C) Cholesteatoma • D) Spaceoccupyinglesion • E) Conversiondisorder Differentials:https://oscestop.education/clinical-examination/neurological-differential-diagnosis/7thNerve Palsy • UMN vsLMN = UMN foreheadsparing • UMN: Stroke,MS • LMN • Bell's palsy • Ramsey Hunt • Immune (sarcoid, GBS) • Local malignancy (eg: Parotid) • 5,7,8= Cerebellopontineangletumour74-year-oldright-handedwomanpresentsinthegeneralneurology clinicwitha restingtremorinherrighthandandahistoryoffrequentfallsoverthepastyear whichsheattributestopoor balance.Bradykinesiaisnoted (moreon therightside). Restingtremorispresentinherrighthand.Noposturaltremorisnoted.Whatwould bethemostappropriatemedicationwhichcouldhelpwithhersymptoms? • A) Propranolol • B) Levodopa • C) Deepbrainstimulation • D) Apomorphineinjections • E) Ropinirole74-year-oldright-handedwomanpresentsinthegeneralneurology clinicwitha restingtremorinherrighthandandahistoryoffrequentfallsoverthepastyear whichsheattributestopoor balance.Bradykinesiaisnoted(moreon therightside). Restingtremorispresentinherrighthand.Noposturaltremorisnoted.Whatwould bethemostappropriatemedicationwhichcouldhelpwithhersymptoms? • A) Propranolol • B) Levodopa • C) Deepbrainstimulation • D) Apomorphineinjections • E) RopiniroleParkinsonismisa syndrome • bradykinesia, postural instability • Differentials: Parkinsons disease, vascular, drugs, Parkinson's plus • PD is asymmetrical • Differentiate between ET and Parkinsonism: get them to write! • Complications of PD: dementia, depressionParkinson’sTremor Benign Essential Tremor Asymmetrical Symmetrical 4-6 hertz 6-12 hertz Worse atrest Improves atrest Improves withintentionalmovement Worse withintentionalmovement OtherParkinson’s features Noother Parkinson’s features Nochangewithalcohol Improves withalcoholManagementof Parkinson'sDisease • decarboxylaseinhibitors) o Co-beneldopaorMadopa o Co-careldopaorSinemet • COMTinhibitors • Dopamineagonists • Monoamineoxidase-B inhibitors • SCapomorphine • Deepbrain stimulation Amantadineisa glutamateantagonistthatmaybeused to managedyskinesia associatedwithlevodopa.You areassessinga30-year-oldpatientinA&Ewho hasbeenseizingformorethan5 minutes.He hasalong historyoftonic-clonicseizuresforwhichheistakingsodium valproate.Hehasahistoryof alcoholexcess,andhe hasbeenwellinthefewdays priortohisadmission.Which ofthefollowingisthemostlikelycauseof hisseizure? • A) Acutestroke • B) Epilepsy • C) Subduralhaemorrhage • D) MS • E) MeningitisYou areassessinga30-year-oldpatientinA&Ewho hasbeenseizingformorethan5 minutes.He hasalong historyoftonic-clonicseizuresforwhichheistakingsodium valproate.Hehasahistoryof alcoholexcess,andhe hasbeenwellinthefewdays priortohisadmission.Which ofthefollowingisthemostlikelycauseof hisseizure? • A) Acutestroke • B) Epilepsy • C) Subduralhaemorrhage • D) MS • E) MeningitisYou areassessinga30-year-oldpatientinA&Ewho hasbeenseizingformorethan5 minutes.He hasalong historyoftonic-clonicseizuresforwhichheistakingsodium valproate.Hehasahistoryof alcoholexcess,andhe hasbeenwellinthefewdays priortohisadmission.Which ofthefollowingisthemostlikelycauseof hisseizure? CRAP GPS • A) Acutestroke induce me • B) Epilepsy to rage • C) Subduralhaemorrhage Carbamazepine Rifampicin • D) MS Alcohol(chronic) • E) Meningitis Phenytoin Griseofulvin Phenobarbital Sulfonylureas Types ofseizure Triggers: • Focal • Poorsleep ▪ Complex (lose consciousness) ▪ Simple (don't lose • Alcoholanddrugs consciousness) (withdrawal) ▪ generalised)neralised (Focal -> • Stroke • Intracranial haemorrhage • Generalised ▪ Absence • Space-occupying lesions ▪ Tonic-Clonic • Metabolic ▪ Myoclonic ▪ Atonic disturbances(eg. Hyponatraemia) • EEG • MRIbrain • ECG Management • Serumelectrolytes • Bloodglucose • Bloodcultures,urine culturesandlumbarpuncture Rule ofthumb: Men Women able to have Seizure Type Women who cannot children • Lamotragine, levetiracetamandvalproateare have children goodfor allseizuretypes. Generalised tonic- Lamotrigine or clonic Sodium valproate Levetiracetam • Carbamazepine,gabapentinand phenytoinare Lamotrigine or Partial (or focal) Levetiracetam <- betterfor focal(including secondary generalised) Myoclonic Sodium valproate Levetiracetam seizures. • Ethosuximide isthe drug ofchoicefor absence Tonicand atonic Sodium valproate Lamotrigine seizures. <- Absence Ethosuximide • Carbamazepinemay worsenmyoclonic seizuresStatusepilepticus Lasts>5minutes Lorry, Lorry, funny, call ITU Multipleseizures without regainingconsciousness Ato Eapproach: Secure airway Oxygen BMs IVaccess Medical Treatment: 1. Benzodiazepine- repeat 5-10 mins if seizure continues 2. After 2 doses of benzodiazepine- IV levetiracetam, phenytoin or sodium valproate 3. Phenobarbital or generalised anaesthesiaA600-year-oldmanattendsyour clinicwitha3-monthhistoryoflegweakness.On examination,thetoneisnormalandthereisreducedpowerbilaterallyindistallower limbs.The anklereflexisabsentbilaterally,butkneereflexesarepresent.Plantars areupgoing.Whichof thefollowingclinicalsignsismostinkeepingwiththe diagnosis? • A) Pale opticdisc • B) PositiveRomberg'ssign • C) PosturalHypotension • D) Wastingofsmall handmuscles • E) Internuclearophthalmoplegia UMN +LMN signs? Think MND A600-year-oldmanattendsyour clinicwitha 3-monthhistoryoflegweakness.On examination,thetoneisnormalandthereisreducedpowerbilaterallyindistallower limbs.The anklereflexisabsentbilaterally,butkneereflexesarepresent.Plantars areupgoing.Whichof thefollowingclinicalsignsismostinkeepingwiththe diagnosis? • A) Pale opticdisc - opticneuritis, more likely in MS • B) PositiveRomberg'ssign – sensory, wouldn't be affected in MND • C) PosturalHypotension – Autonomicrather than motor • D)Wastingof small handmuscles – LMN sign,in keeping with mixed picture.Also common inMND • E) Internuclearophthalmoplegia – Oculomotor notaffected in MND, morelikely in MS • Spastic paraparesis:MS,cordcompression,stroke • Spastic hemiparesis:Stroke,tumour,MS • Parkinsonism:idiopathicParkinsons,VascularPArkinsons, drugs • Cerebellar:Alcohol,stroke,MS • Medical3rdnervepalsy:Diabetes,hypertension,stroke Summaryof • haemorrhagenervepalsy:Aneurysm,tumour, intracranial 'T op3' • 4thCranialnerve:Trauma Differentials • Bulbar palsy:Stroke,MND,MyastheniaGravis– NOTMS! brainstem)causebulbar byaffecting LMNastheyleave • SACDdUMN+LMNsigns:MND,cervicalspondylopathy, Differentials:https://oscestop.education/clinical-examination/neurological-differential-diagnosis/Fin. ANYQUESTIONS? PLEASELEAVEFEEDBACK EMAIL: TABAKHAN20@GMAIL.COM