Acute neurological issues Flashcards
meningitis type symptoms
headache
nucal rigidity
photophobia
fever
altered consciousness
neurological sings
purpuric rash
septicemia type symptoms
cold hands
fever
mottled skin
low BP
confused
emergency management of meningitis
emergency hospital transfer
stabilise ABC
monitor NEWS and GCS
readmission antibiotics
manage sepsis
antibiotic treatment, empirical then targeted
which comes first scan or LP
scan
when would a scan be performed
focal neurological signs
presence of papilloedema
uncontrolled seizures or septic shock
GCS 12 or less
risk factors for acute bacterial meningitis
infants
teens
young adults
elderly
pregnant
immunosuppressed
smoker
alcoholism
IV drug use
foreign travel
CSF shunt
splenectomy
crowding
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.
classification of status epilepticus
convulsive and non-convulsive
convulsive
complete loss of awareness with stiff rigid limbs
and/or incontinence and tongue biting
period of recovery/confusion
often focal onset
non-convulsive
loss of consciousness or confusion
without any involuntary movements
seizure activity seen on EEG
causes of status epilepticus
epilepsy
metabolic problem
infection
recreational drug abuse/overdose
low blood sugar
underlying tumour
stroke
trauma
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
thunderclap headache
sudden onset of unusual severity reaching maximal intensity in under 1 minute
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
primary vs secondary headaches
18% headaches are secondary
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
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
