Acute neurological issues

Question 1

meningitis type symptoms

Answer 1

headache
nucal rigidity
photophobia
fever
altered consciousness
neurological sings
purpuric rash

Question 2

septicemia type symptoms

Answer 2

cold hands
fever
mottled skin
low BP
confused

Question 3

emergency management of meningitis

Answer 3

emergency hospital transfer
stabilise ABC
monitor NEWS and GCS
readmission antibiotics
manage sepsis
antibiotic treatment, empirical then targeted

Question 4

which comes first scan or LP

Answer 4

scan

Question 5

when would a scan be performed

Answer 5

focal neurological signs
presence of papilloedema
uncontrolled seizures or septic shock
GCS 12 or less

Question 6

risk factors for acute bacterial meningitis

Answer 6

infants
teens
young adults
elderly
pregnant
immunosuppressed
smoker
alcoholism
IV drug use
foreign travel
CSF shunt
splenectomy
crowding

Question 7

status epilepticus

Answer 7

Convulsive status epilepticus is a life-threatening neurological condition defined as five or more minutes of continuous seizure activity or repetitive seizures without regaining consciousness between episodes.

Question 8

classification of status epilepticus

Answer 8

convulsive and non-convulsive

Question 9

convulsive

Answer 9

complete loss of awareness with stiff rigid limbs
and/or incontinence and tongue biting
period of recovery/confusion
often focal onset

Question 10

non-convulsive

Answer 10

loss of consciousness or confusion
without any involuntary movements
seizure activity seen on EEG

Question 11

causes of status epilepticus

Answer 11

epilepsy
metabolic problem
infection
recreational drug abuse/overdose
low blood sugar
underlying tumour
stroke
trauma

Question 12

management of convulsive status epilepticus

Answer 12

emergency hospital admission
buccal midazolam in community
benzodiazepines e.g. lorazepam
stop seizure if prolonged
prevent further seizures
identify cause of seizure
protocol for treatment (phenytoin, levetiracetam)
potential ventilation and ICCU care

Question 13

thunderclap headache

Answer 13

sudden onset of unusual severity reaching maximal intensity in under 1 minute

Question 14

causes of sudden onset headaches

Answer 14

pituitary bleed
subarachnoid/ intercerebral haemorrhage
meningitis/ infections
cerebral bleed and/or tumour
arterial dissection
spontaneous CSf leak
cerebral venous sinus thrombosis
phaeochromocytoma
RCVS
idiopathic

Question 15

primary vs secondary headaches

Answer 15

18% headaches are secondary

Question 16

headache red flag features

Answer 16

sudden onset
severe to wake at night
associated vomiting
worse in morning/coughing/stooping
visual obscurations

Question 17

what is in the image

Answer 17

giant cell arteritis

Question 18

giant cell arteritis

Answer 18

systemic inflammatory granulomatous large essel vasculitis
disease of elderly
more women affected
unknown cause

Question 19

clinical presentation of giant cell arteritis

Answer 19

sudden
non specific: aching, malaise, weight loss, fever, loss appetite
headache in 2/3 temporal
proximal pain
jaw claudication
blurred vision then sudden visual loss
ache not weakness
co existent polymyalgia rheumatica

Question 20

examination findings in giant cell arteritis

Answer 20

swollen superficial temporal artery
check pulses
check options nerve and vision for anterior ischaemic optic neuropathy or retinal vessel occlusion

Question 21

investigations for giant cell arteritis

Answer 21

ESR usually over 50mm/h
CRP
temporal artery biospy
colour duplex ultrasonography

Question 22

risk of untreated giant cell arteritis

Answer 22

blindness
irreversible
stroke/ large vessel involvement
multi infarct dementia

Question 23

treatment of giant cell arteritis

Answer 23

treat with steroids at high dose
monitor ESR
titrate dose
watch for relapse

Question 24

management of giant cell arteritis

Answer 24

prevent further visual loss and systemic squealae of schema
steroids high dose
or low dose aspirin, methotrexate, toclizumab

Question 25

acute spinal cord compression causes

Answer 25

trauma/fracture/dislocation
tumour, metastatic: breast lung renal carcinoma, prostate thyroid and myeloma and lymphoma
epidural abscess and infection
disc/ spinal stenosis
arthropathy

Question 26

traumatic causes of acute spinal cord compression

Answer 26

via vertebral fracture or facet joint dislocation

Question 27

infective causes of acute spinal cord compression

Answer 27

infections resulting in abscess formation can cause compression
chronic infections typically seen with TB and fungal infections

Question 28

disc prolapses causes of acute spinal cord compression

Answer 28

rare cause
lumbar disc herniation typically causes compression of caudal equine inferior to spinal cord

Question 29

most common cause of acute spinal cord compression

Answer 29

metastatic spinal cord compression

Question 30

greater risk of spinal cord compression

Answer 30

any pathology that can predispose to narrowed cord canal
so inflammatory conditions or degenerative conditions contributing to a spinal stenosis

Question 31

red flags for spinal cord compression

Answer 31

elderly, major trauma
steroids
osteoporosis
infection (fever, chills, weight loss, bacterial infection, immunosuppression, iv drug use)
pain keeping up at night
cancer history
rheumatoid arthritits

Question 32

examination of patient with spinal cord compression will guide to site of lesion

Answer 32

look for UMN pattern weakness
reflexes increased
sensory level
planters upgoing
clonus at ankle
sphincter loss/ urinary retention
nb spinal shock at onset if acute

Question 33

management of acute spinal cord compression

Answer 33

urgent MRI
contract neurosurgery or spinal team on call, high dose steroids/ transfer
treatment depends on cause: surgery, antibiotics, steroids, radiotherapy
risk of delayed treatment

Question 34

MRI pre and post operative of spinal cord compression

Answer 34