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Neurology > 17 Jan 24 > Flashcards

17 Jan 24 Flashcards

1
Q

Generalized convulsive status epilepticus

A

> 5mins of gen convusive seizure
Or
2 generalized convulsive seizures without interval recovery of consciousness

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2
Q

GCSE RF

A

Nonadherence to AEDs
Structural brain abnormalities (tumor)
Metabolic abnormalities
Infection
Drug withdrawal

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3
Q

GCSE ttt

A

🍔 stabilize circulation, airway and breathing
🍔 BZ (repeat administration until termination of seizure activity
🍔 begin antiepileptics
🍔 EEG monitoring for refractory status epilepticus or failure to regain consciousness.

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4
Q

GCSE patient who is persistently unresponsive

A

Patients with GCSE regain consciousness after 10-20 mins
persistently unresponsive state mayb due to:

🧠 sedation due to persistent effects of BZ. Or
🧠 ongoing seizure activity without physical manifestations (non convulsive status epilepticus )

Ttt: Do EEG (to diff between them 2)
Continue BZ and AED
Propofol/ phenobarbital for refractory cases

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5
Q

GCSE complications

A

Neuronal injury and death.
Hence immediate seizure cessation is warranted.

We dont do MRi as GCSE is emergency
As seizure cessation is priority

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6
Q

Breath holding spell Cyanotic vs pallid

A

Cyanotic:
Triggered by vigorous crying leading to breath holding , cyanosis , LOC with rapid return to baseline.

Pallid BHS :
After minor trauma
No crying
Pain and fear causes slow HR and breat holding , child becomes pale , diaphoretic , limp .
Brief LOC
Sometimes sleepy and confused for a short period after.

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7
Q

Management of BHS

A

Last < 1min
Clinical dx no workup needed
Screen for iron def anemia
Iron therapy shows improvement
Monitoring shows bradycardia before LOC in BHS

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8
Q

Fibromyalgia Ttt

A

TCA

Alternates in refratory cases
Duloxetine
Milnacipran
Pregablin

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9
Q

Ttt of TN

A

Carbamezipine
Oxcarbazepine(better tolerated)

Side effects:
Hyponatremia (due to inc sensitivity to ADH)
Leukopenia
NV

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10
Q

Trigeminal neuralgia workup

A

MRA / MRI of brain with contrast

If not clear
Nerve conduction (trigeminal reflex) testing

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11
Q

Blepharospasm MECH

A

Recurrent forceful contraction of eyelid muscles
Form of focal dystonia
🤡BL and symmetric
If Ass with spasm of lower face and jaw
(Meige syndrome)
💩affected by sensory input
BRIGHT LIGHTS , may trigger muscle contraction
🦬 sensory trick ;
Touching and brushing the skin around eye may terminate the spasm.

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12
Q

Management of blepharospasm

A

🐊Wear dark glasses to block bright lights
🐊Botulism toxin inj

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13
Q

Workup for first time seizure

A

🚨Glucose CBC eectrolytes renal function liver function urine drug screen
🚨CT (acutely) MRI (elective)
🚨LP (if fever , nuchal rigidity)
🚨EEG
🚨if LOC do ECG for arrythmia

For unprovoked seizures do EEG and MRI. Otherwise dont.

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14
Q

Indications to start antiepileptics

A

Abnormal EEG or imaging
Nocturnal seizures
Focal deficits

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15
Q

Paroxysmal sympathetic hyperactivity

A

Sudden episodes of excessive sympathetic activity

Ass with severe TBI

Mech : damage to cortical areas resp for modulating and imhibiting sympathetic centers.

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16
Q

Paroxysmal sympathetic hyperactivity triggers and S/S

A

External stimuli like bathing and repositioning.

S/S:
Tachycardia
Hypertension
Tachypnea
Fever
Diaphoresis

Last for 20-30 mins.

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17
Q

Management of PSH

A

Avoid triggers
Treat fever
Medicines. Opiods GABA a2agonists
Opioids improve symptoms via gen reduction of symp tone.

18
Q

Mechanism of diffuse Axonal injury

A

▶️Head trauma
▶️Accleration- deceleration or rotational shearing forces on axons (at gray white matter junction)

19
Q

Management of DAI

A

Supportive
Manage incr ICP

20
Q

CF of DAI

A

⛱ severe neurologic impairment (GCS<8)
⛱impairment greater than imaging findings
⛱ MRI:
🧠Punctate hemorrhages in white matter
🧠Blurring of gray-white matter junction

21
Q

Why CT is normal in DAI?

A

DAI is on microscopic level hence not apparent on CT.

MRI is more sensitive and shows minute punctate hem in white matter (axons) and blurring of gray white interface (due to edema).

22
Q

Pediatric TBi when to do CT without contrast in age <2

A

High risk features age <2

AMS/fussy
LOC
Severe mech of injury (fall>3m, high impact , MVC)
Non frontal scalp hematoma
Palpable skull fracture

23
Q

TBI CT indication in age >2-18

A

AMS(somnolence, agitation)
LOC
Sever injury( fall>5m, high impact, MVC)
Vomiting , severe headache
Basilar skull fracture signs ( CSF rhinorrhea )

24
Q

Signs of basilar skull fracture

A

CSF rhinorrhea
Periorbital hematoma
CSF otorrhea
Post auricular ecchymosis (battle sign)

25
Q

Indications for CT scan in concussion

A

Amnesia for events >30mins prior to injury
Focal deficits
Signa of skull fracture

26
Q

Concussion CF

A

👹Transient neurologic disturbance
Dizziness
Disorientation
Amnesia
After mild TBI

👹No structural intracranial injury

27
Q

Ttt of concussion

A

🚑 remove from same day physical play
🚑 neurologic evaluation
🚑 rest for >24h
🚑 gradual return to normal activity (1 week) if symptoms do not worsen
🛖 physical : light aerobic exercise , non contact sports , contact sports
🛖 limit screen time , frequent breaks , shortened days.

28
Q

Concussion mechanism

A

Transient disturbance of normal neuronal function due to:

Widespread neuron depolarisation
Dec CBF
Localised lactic acidosis

29
Q

Concussion vs DAI

A

Concussion is transient neuronal functional disturbance

DAI is severe trauma causing tearing of white matter tracts.
Pts are severely obtunded or comatose
Shaken baby
Head impact car collision

30
Q

Epidural hematoma

A

Trauma to sphenoid bone with tearing of middle meningeal artery

31
Q

Epidural hematoma ttt

A

Urgent surgical evacuation

32
Q

Epidural hematoma CF

A

Brief LOC followed by lucid interval

Hematoma expansion causing;
Inc ICP
Uncal herniation

33
Q

Intervention to reduce Cerebral blood flow to dec ICP

A

Head elevation to ⬆️ venous outflow
Sedation to ⬇️ metabokic demand
Hyoerventilation to ⬇️ PaCO2 resulting in vasoconstriction

34
Q

Subfalcine herniation

A

Cingulate gyrus is displaced under falx cerebri
Does not cause pupillary involvement
IL anterior cerebral artery compression leading to CL leg weakness

35
Q

Mechanism of tranexamic acid in fall pt?

A

Prevents intracranial hemorrhage

36
Q

Manangement of TBI

A

▶️Main cerebral perfusion pressure
▶️Prevent Intracranial hemorrhage
▶️Other measures
Prevent seizure (levetitacetam)
Control blood sugar (insulin target 140-160)
Maintain normothermia (antipyretics , surface cooling devices )

37
Q

How to maintain Cerebral perfusion pressure ?

A

CPP= MAP-ICP

Maintain MAP: Isotonic fluids
Vasopressor therapy

Reduce ICP. :
Head elevation
Sedation (propofol , midazolam)
Osmotic therapy (hypertonic saline, mannitol)
Decompressive ttt (craniectomy, CSF removal)

38
Q

How to prevent ICH in TBI

A

Tranexamic acid(antifibrinolytic)
Reversal of anticoagulation

39
Q

Acute traumatic coagulopathy in TBI

A

TBI pts are at risk of sec traumatic coagulopathy

Severe tissue injury leads to uncontrolled coagulation and consumption of coagulation factors ;

Hypocoagulability
Hyperfibeinolysis (breaking down necessary clots.

Ttt: tranexamic acid (within 3hrs reduces mortality)

40
Q

Central herniation

A

🛞Caudal displacement of diencephalon and brainstem
🛞Rupture of paramedian basilar artery branches
🛞BL midposition & fixed pupils (loss of sympathetic & parasympathetic innervation
🛞Decorticate (flexor) ➡️ decerebrate (extensor) posturing

41
Q

Ttt of central herniation

A

🚨Dec ICP
🚨Correct underlying etiology(Hemorrhage evacuation) to prevent tonsillar herniation which compresses medulla and cause cardiac and resp arrest.

Neurology (19 decks)

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