Category Archives: Neurology

Huntington’s disease

(BMJ module; information from Dr David Crawford, consultant in neuropsychiatric genetics at St Mary’s, Manchester. Module chosen as I have a patient with Huntington’s who is developing increasing problems.) Huntington’s causes a combination of progressive motor, cognitive, and psychiatric symptoms. … Continue reading

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Headaches – red flags and orange flags

Red flags Probability of underlying tumour >1%. Investigate urgently. Focal neurology Significant alterations in consciousness Memory loss or confusion Co-ordination problems Seizures Known cancer Orange flags Probability of underlying tumour: 0.1 – 1%. Monitor carefully and have low threshold for … Continue reading

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Triptans

These divide into two groups: Sumatriptan, Rizatriptan, Zolmitriptan, Eletriptan and Almotriptan have a higher speed of onset. Naratriptan & Frovatriptan have a lower side-effect profile, and also possibly less chance of headache recurrence. Interestingly, someone who hasn’t responded to one … Continue reading

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Metastatic spinal cord compression

Presentation Pain The most common first symptom – 95% of patients will present initially with pain. May be present for up to two months before signs appear. May be localised in/around spinal column, or may be radicular (unilateral or bilateral) … Continue reading

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Bell’s Palsy

Comes on over a period of 12 – 36 hours. Prodromes can happen – facial numbness, altered taste, or pain around the ear. Initially progressive, but progression should have halted by 3/52 and if it continues to progress after that … Continue reading

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Migraine treatment

According to latest NICE guidelines, it’s now worth trying combination treatment (triptan + NSAID or paracetamol) as first-line, as found to be effective. For prophylaxis, as per NICE: First-line: Propranolol or topiramate Second-line: Gabapentin (up to 1200 mg/day) or acupuncture … Continue reading

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Normal pressure hydrocephalus

Presents with a triad of gait disorder, urinary urge incontinence, and increasing memory loss progressing to dementia. Gradual onset and worsening of symptoms. The gait disorder typically starts with subtle general imbalance/unsteadiness and progresses to wide-based short slow shuffling movements, … Continue reading

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