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Neurology
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Important features in the history
- If you would like to have a go at adding some “top tips” to this page for this specialty (and have your name displayed proudly with bradfordvts), please email me – rameshmehay@googlemail.com
Important features in the Examination
Vertigo: The HINTS examination
The HINTS exam- this exam helps to differentiate between peripheral and central cause of vertigo, such as vestibular neuritis vs stroke. It should be done on patients who present within hours or days of on going vertigo and nystagmus.
- Reassuring HINTS exam is – Unidirectional nystagmus, No vertical skew, and abnormal head impulse test. likely vestibular neuritis.
- Worrying HINTS test is – Bidirectional or vertical nystagmus, vertical skew or normal head impulse test. Need imaging to rule out posterior or cerebellar stroke.
Red Flags
Other Top Tips
- EPILEPSY:
- 1st seizure in young people: medication is often only started after a 2nd seizure. In contrast, new-onset epilepsy in older people (>65y) is often treated after just a single seizure. Why? More likely to be an underlying cause – for example, scarring from a stroke. Risk of harm from seizures may be greater – for example, seizure causes fall >> fracture. Also, more likely to live alone – increased risk of sudden unexpected death in epilepsy (SUDEP).
- All older people with a seizure need to be seen urgently at the hospital for a full workup. Immediately if you think there may have been a stroke that triggered this. 2ww if you are concerned there may be an underlying tumour. Neurology outpatients within 2 weeks for all with new onset of seizures.
- Decision to treat is made by the hospital but GPs asked to up-titrate medication. Bear in mind that as a general rule of thumb: the initial dose and rate of titration of antiepileptic medication in older people should be about half of that in younger patients – helps with tolerability.
