Acute neurological issues Flashcards by Lara Everett

meningitis type symptoms

headache
nucal rigidity
photophobia
fever
altered consciousness
neurological sings
purpuric rash

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septicemia type symptoms

cold hands
fever
mottled skin
low BP
confused

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emergency management of meningitis

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

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which comes first scan or LP

scan

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when would a scan be performed

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

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risk factors for acute bacterial meningitis

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

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status epilepticus

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.

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classification of status epilepticus

convulsive and non-convulsive

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convulsive

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

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non-convulsive

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

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causes of status epilepticus

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

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management of convulsive status epilepticus

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

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thunderclap headache

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

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causes of sudden onset headaches

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

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primary vs secondary headaches

18% headaches are secondary

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headache red flag features

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

what is in the image

giant cell arteritis

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

clinical presentation of giant cell arteritis

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

examination findings in giant cell arteritis

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

investigations for giant cell arteritis

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

risk of untreated giant cell arteritis

blindness
irreversible
stroke/ large vessel involvement
multi infarct dementia

treatment of giant cell arteritis

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

management of giant cell arteritis

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

acute spinal cord compression causes

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

traumatic causes of acute spinal cord compression

via vertebral fracture or facet joint dislocation

infective causes of acute spinal cord compression

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

disc prolapses causes of acute spinal cord compression

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

most common cause of acute spinal cord compression

metastatic spinal cord compression

greater risk of spinal cord compression

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

red flags for spinal cord compression

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

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

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

management of acute spinal cord compression

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

MRI pre and post operative of spinal cord compression