10. Emergency in neurology

Question 1

Which situations are considered neurological emergencies?

Answer 1

1. Nervous system lesion causing respiratory failure
2. Nervous system disease leading to life threatening
3. Nervous system dysfunction caused by disease/states originating outside the NS (metabolic, hypoxia, intox. etc)
4. Stroke/TIA
5. Status epilepticus
6. Traumatic brain injury
7. Wernicke encephalopathy
8. Compressive spinal emergency: spinal cord compression + conus medullaris syndrome + cauda equina syndrome

Question 2

Definition of neurologic emergency

Answer 2

All cases with disorders of conciousness, respiratory and/or circulatory failure, and/or epileptic activity

Question 3

Respiratory failure in neurology

Answer 3

May be caused by damage to
- CNS –> increased ICP
- PNS –> myasthenia, guillan-barre
- Neural structures, including muscles

Resp. failure from any cause may also lead to secondary damage of CNS which are sensitive to hypxoa (cortex, basal ganglia)

Question 5

Cause of persistent vegetative state

Answer 5

Damage to cerebral cortex
- Global cerebral ischemia due to circulatory arrest, severe hypoglycemia, hepatic failure etc.
- Extensive white matter damage (trauma)
- Bilateral damage to thalamus

Question 6

Management of patients with disorders of conciousness

Answer 6

ABC, GCS, brainstem reflexes, motor system examination

Question 7

Causes of increased ICP

Answer 7

Can be caused by:
- focal space ccupying lesions (tumor, asbcess, hemorrhage)
- Disorders of CSF circulation (occlusive hydrocephalus)
- Cerebral edema (vasogenic, cytotoxic, interstitial)