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MedEd Lectures > Acute neurology > Flashcards

Acute neurology Flashcards

1
Q

What are common symptoms before epileptic seizures

A
  1. Epileptic aura

2. triggers such as flashing lights

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2
Q

What are common symptoms during epileptic seizures

A
  1. stiffness
  2. jerking
  3. incontinence
  4. tongue biting
  5. sweating
  6. frothing at the mouth
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3
Q

What are the characteristics of simple partial seizures

A
  1. Focal (one hemisphere or lobe) seizures without LOC
  2. awareness unimpaired (can remember what is happening)
  3. No post ictal confusion
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4
Q

What are common symptoms post-ictal

A
  1. ache
  2. Todd’s paralysis: unilateral paralysis which is self-limiting
  3. post-ictal drowsiness
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5
Q

What are characteristics of complex partial seizures

A
  1. focal seizure with LOC
  2. usually cannot remember what is happening to them
  3. post ictal confusion
  4. Deja-viu, depersonalisaion, altered emotion, epigastric fullness
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6
Q

A 25-year-old man was hit on the side of the head with the ball, whilst playing cricket. He recovered enough to finish off the game. He then presented to A&E 8 hours later with a severe headache and vomiting. On Examination he pupil are looking down and out, and soon after this he rapidly loses consciousness

Subarachnoid Haemorrhage
Extradural Haemorrhage
Stokes-Adam’s Attack
Postural Hypotension
Hypoglycaemia
A

Extradural Haemorrhage

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7
Q

A 52 year old fund manager with a history of previous heart attacks, feels some palpitations and collapses. A witness said that he went very pale as he collapsed but then became flushed and regained consciousness after 30 seconds.

Subarachnoid Haemorrhage
Extradural Haemorrhage
Stokes-Adam’s Attack
Postural Hypotension
Hypoglycaemia
A

Stokes-Adam’s Attack

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8
Q

A previously well 14 year old girl collapses after being in a crowd for 2 hours at a pop concert.

Cardiac Arrhythmia
Aortic Stenosis
Vasovagal Syncope
Postural Hypotension
Situational Syncope
A

Vasovagal Syncope

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9
Q

A 75-year-old man is found on his bedroom floor by his wife and is now conscious. He got out of bed in the middle of the night to go to the toilet and felt dizzy and fell to the ground. He is on treatment for hypertension and has no other medical problems.

Cardiac Arrhythmia
Aortic Stenosis
Vasovagal Syncope
Postural Hypotension
Situational Syncope
A

Postural Hypotension

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10
Q

A 56 year old lady collapses whilst running for the bus. O/E there is a thrusting apex beat and an ejection systolic murmur. This is best heard on expiration and radiates to the carotids.

Cardiac Arrhythmia
Aortic Stenosis
Vasovagal Syncope
Postural Hypotension
Situational Syncope
A

Aortic Stenosis

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11
Q

A 20 year old man, who was picked up by the police, is behaving irrationally & is confused & irritable. He is pale & sweaty & smells of alcohol. He keeps asking for biscuits.

Subarachnoid Haemorrhage
Extradural Haemorrhage
Stokes-Adam’s Attack
Postural Hypotension
Hypoglycaemia
A

Hypoglycaemia

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12
Q

44 y/o gentleman. On examination he appears drowsy, only opening his eyes in response to speech, he seems confused and disorientated, and when assessing his movements he is able to obey commands. Calculate his GCS

6
8
9
10
13
A

13

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13
Q

A 65 year old man with a history of an MI 2 years ago. He lost consciousness and presents to you 36 hours later with reduced power in his left arm and leg.

Stroke
Subdural Haematoma
Encephalitis
SOL
Epilepsy
A

Stroke

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14
Q

A 21-year-old man is walking down the street to visit his friends while suddenly he falls to the ground unconscious. His body goes stiff and then he begins to jerk his arms. He becomes incontinent of urine.

Stroke
Subdural Haematoma
Encephalitis
SOL
Epilepsy
A

Epilepsy

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15
Q

COL in COLLAPSE

A

Carotid si

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16
Q

COL in COLLAPSE

A

Carotid sinus syncope
Orthostatic (postural) hypotension
refLex - vasovagal syncope

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17
Q

Loss of consciousness: causes (beat - heart)

A 
Syncope = loss of consciousness due to a drop in blood pressure 
BP = HR X SV X TPR

HR = bradycardia + arrhythmia (i.e. AF, VT, long QT, complete heart block)

SV inc outflow obstruction =
tamponade, cardiomyopthay
Left = HOCM, aortic stenosis
Right = PE

TPR inc neuropathy =
vagal overactivity
peripheral autonomic neuropathy (DM, Parkinson’s)

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18
Q

What is orthostatic hypotension

A

LOC when lying to standing

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19
Q

What is (refLex) vasovagal syncope

A

reflex bradycardia

+/- vasodilation provoked by emotion, pain, fear, standing too long

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20
Q

APS in COLLAPSE

A

Arrhythmia/Stoke’s Adam’s attack
Panic attack
Situational synocpe

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21
Q

How does a collapse due to arrhythmia/Stoke’s Adam’s attack manifest

A

Collapse with no warning
recovery in seconds
patient flushes
pulse returns

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22
Q

What is Stokes Adam attack

A

a sudden reduction in CO

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23
Q

What is postural hypotension

A

When systolic BP >20mmHg or diastolic BP >20 mmHg after standing for 3 minutes vs lying down

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24
Q

What are the risk factors for postural hypotension

A
  1. Elderly
  2. Hypovolaemia
  3. Drugs: Nitrates, diuretics, antihypertensives, antipschychotics
  4. peripheral neuropathy
  5. Endocrine (addison’s, hypopituitarism - reduced ACTH)
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25
Q

How do you confirm postural hypotension

A

tilt test

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26
Q

What are the main causes of aortic stenosis

A
  1. congenital bicuspid valve

2. calcification of normal tri-leaflet valves

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27
Q

How does aortic stenosis present

A
  1. Chest pain
  2. dyspnoea
  3. syncope
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28
Q

What are the clinical signs of aortic stenosis

A
  1. Harsh ejection systolic murmur, heard loudest at the right upper sternal edge at end expiration, which radiates up towards the carotids
  2. narrow pulse pressure + slow rising pulse
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29
Q

What are the risk factors for hypoglycaemia

A
  1. mainly diabetic on NEW insulin/oral hypoglycaemic + exercise
  2. Alcohol, liver failure = reduced glucose production
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30
Q

What are the symptoms of hypoglycaemia

A
  1. sweating
  2. weakness
  3. reduced GCS
  4. palpitations and anxiety
  5. asking for biscuits
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31
Q

What are the first line investigations for blackouts

A 
1. Bedside: cardio, neuro examination, lying and standing BP 
Bloods: FBC, U+E, glucose, ABG 
Imaging:
- ECG, cardiac monitor, 24hrs ECG 
- Echocardiogram 
- EEG, CT/MRI
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32
Q

What is a TIA

A

are acute episodes of focal loss or cerebral function lasting <24 hours
due to in adequate blood supply

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33
Q

What is the difference between a stroke and TIA

A

duration of symptoms
TIA <24 hours
Stroke >24 hours

34
Q

Blockage to anterior cerebral artery affects which parts of the brain

A

frontal lobe, parietal lobe

35
Q

What are the symptoms of stroke via the anterior cerebral artery

A

Affects the frontal and parietal lobe
1. personality changes
2. Disturbance of judgement /loss of social behaviour
3. Contralateral hemiparesis (weakness) leg>arm
4.

36
Q

What are the symptoms of stroke via the anterior cerebral artery

A

Affects the frontal and parietal lobe

  1. personality changes
  2. Disturbance of judgement /loss of social behaviour
  3. Contralateral hemiparesis (weakness) leg>arm
  4. mild sensory deficit
37
Q

blockage to the middle cerebral artery affects to which part of the brain

A 
frontal, parietal, temporal 
subcortical structures (e.g. basal ganglia) 
internal capsule
38
Q

What are the symptoms of stroke via the middle cerebral arteries

A
  1. Contralateral hemiplegia (paralysis)
    arms>legs
  2. aphasia
  3. hemisensory deficits
39
Q

Blockage to the posterior cerebral artery affects which parts of the brain

A

occipital and lower temporal

40
Q

A 65-year-old hypertensive man has complained of losing vision twice in one eye, which lasted for a few hours and then went back to normal. He says it’s like ‘a black sheet falling over the front of my eye’.

Right-sided Stroke
Transient Ischaemic Attack
Meningitis
Encephalitis
Left-side Stroke
A

Transient Ischaemic Attack

41
Q

An 80-year-old woman who is a smoker was brought into A&E from a residential home where her carers noticed that she had difficulty swallowing and that she also had difficulty moving her left arm and leg for the past few days.

Right-sided Stroke
Transient Ischaemic Attack
Meningitis
Encephalitis
Left-side Stroke
A

Right-sided Stroke

42
Q

A 30-year-old woman experienced a strange feeling in her stomach, followed by stiffness & jerking in the left arm. Afterwards, she felt drowsy but remembers everything.

Myoclonic Seizure
Complex Partial Seizure
Simple Partial Seizure
Tonic-Clonic Seizure
Absence Seizure
A

Complex Partial Seizure

43
Q

A 30-year-old woman experienced a strange feeling in her stomach, followed by stiffness & jerking in the left arm. Afterwards, she felt drowsy but remembers everything.

Myoclonic Seizure
Complex Partial Seizure
Simple Partial Seizure
Tonic-Clonic Seizure
Absence Seizure
A

Tonic-Clonic Seizure

44
Q

What are the investigations for a TIA

A
  1. CT head to exclude a haemorrhagic aetiology
    esp if pt has
    - depressed consciousness (GCS<13)
    - suspected haemorrhage (drugs etc) or raised ICP
45
Q

What is the treatment for TIA

A

thrombolysis with tPA within 4.5 hours

Thrombolysis is done with Altplase at 10% bolus, 90% infusion at dose 0.9 mg/kg

46
Q

What drug is used in thrombolysis in a TIA

A

Alteplase

47
Q

How is alteplase administered

A

10% bolus

90% infusion at a dose of 0.9 mg/kg

48
Q

TIA: What if a patient presents after 4.5 hours after the onset of symptoms

A

manage with aspirin

49
Q

All people presenting with acute ischaemic stroke should be given …

A

aspirin

50
Q

Name Convulsive (generalised seizures)

A
  1. tonic
  2. clonic
  3. tonic-clonic
  4. myoclonic
51
Q

Seizures: describe tonic

A

limb stiffening

52
Q

Seizures: tonic characteristics

A

limb stiffening

53
Q

Seizures: clonic characteristics

A

limb jerking

54
Q

Seizures: tonic-clonic characteristics

A
  1. LOC followed by stiff body with flexed elbows and extended legs followed by violent shaking with eyes rolling (grand mal)
  2. incontinence
  3. post-ictal confusion & drowsiness
55
Q

Seizures: myoclonic characteristics

A

sudden isolated jerk of limb, face or trunk

56
Q

what are the non-convulsive seizures

A
  1. absence

2. atonic (akinetic)

57
Q

Seizures: absence characteristics

A

<10 seconds of vacancy, sometime myoclonic jerks (petit mal), presents in childhood
no post ictal

58
Q

Seizures: atonic (akinetic) characteristics

A

sudden loss of muscle tone

‘drop attacks’ w/out LOC

59
Q

What is status epilepticus

A

continuous seizure or serial (>2) discrete seizures between which there is incomplete recovery of consciousness of at least 30 minutes duration
MEDICAL EMERGENCY

60
Q

What do you do when approached with someone with status epilepticus

A 
MEDICAL EMERGENCY 
1. ABC approach 
2. Oxygen 100%
3. Slow IV bolus Lorazopam 2-4mg
Lorazepam again in 10 minutes if no response 
4. Continuing seizure
61
Q

What do you do when approached with someone with status epilepticus

A

MEDICAL EMERGENCY
1. ABC approach
2. Oxygen 100%
3. Slow IV bolus Lorazopam 2-4mg
Lorazepam again in 10 minutes if no response
4. Continuing seizure IV infusion phenytoin/diazepam

62
Q

What condition can present with seizures and LOC

A
  1. stroke
  2. epilepsy
  3. Infection (encephalitis, meningitis)
  4. Metabolic
63
Q

What is encephalitis

A

inflammation of the brain parenchyma

64
Q

What are the causes of encephalitis

A

Viral:

  1. HSV (herpes simplex virus)
  2. CMV (cytomegalovirus)
  3. EBV (epstein barr virus)
  4. VZV (varicella zoster virus)

Non-viral:

  1. any bacterial meningitis
  2. TB
65
Q

What are the symptoms of encephalitis

A
  1. bizarre encephalopathic behaviour
66
Q

What are the symptoms of encephalitis

A
  1. bizarre encephalopathic behaviour
  2. reduced GCS/coma
  3. fever
  4. focal signs
  5. sizures
67
Q

When would encephalitis be a medical emergency

A

If the CT scan showed cerebral oedema + compressive symtpoms

68
Q

What is the most common cause of meningitis

A

meningococcus pneumococcus

69
Q

What are the symptoms of meningitis

A
  1. headache
  2. meningism
  3. reduced GCS/coma
  4. focal signs seizures
  5. fever
  6. rash
70
Q

What signs are positive in meningitis

A

1, Kernig’s sign

2. Brudzinski’s sign

71
Q

What is a cause of hyponatraemia

A

thiazide diuretics (hypo/eu/hypervolaemic)

72
Q

What are the symptoms of hyponatraemia

A
  1. headaches
  2. vomiting
  3. drowsiness
  4. seizures
73
Q

What is hyponatraemia

A

low sodium

<135

74
Q

What are they symptoms of hypocalcaemia

A 
4CATS 
Convulsions
Arrhythmia 
tetany 
spasms
75
Q

What are the clinical signs of hypocalcaemia

A

positive

chvostek’s and trousseu’s sign

76
Q

A 50-year-old man presents with an instantaneous onset of a severe headache, followed by drowsiness & vomiting. Shortly after presentation he loses consciousness

Subarachnoid Haemorrhage
Extradural Haemorrhage
Anaemia
Postural Hypotension
Hypoglycaemia
A

Subarachnoid Haemorrhage

77
Q

An 80 year old man fainted with a 2 week history of abdominal pain and coughing up a black coffee-ground like substance. He has been feeling irritable, tired and sleepy.

Subarachnoid Haemorrhage
Extradural Haemorrhage
Anaemia
Postural Hypotension
Hypoglycaemia
A

Anaemia

78
Q

A 10-year-old girl is not doing well at school, her teacher says she doesn’t concentrate and shows no interest. Her parents also noticed the girl has moments (around 10secs) when she just stares blankly, blinking and then returns to normal. It happens up to several times an hour.

Myoclonic Seizure
Complex Partial Seziure
Simple Partial Seizure
Tonic-Clonic Seizure
Absence Seizure
A

Absence Seizure

79
Q

A 87-year-old lady had a seizure at home. Her husband says she has been drowsy for the last couple of days. She is otherwise in good health but she has recently started antihpertensive drugs. On examination, her skin turgor is reduced.

Hypercalcaemia
Hypocalcaemia
Hyperglycaemia
Hypoglycaemia
Hyponatraemia
A

Hyponatraemia

80
Q

A 66-year-old was getting increasing confused over the last couple of days. She was admitted after a seizure. She appears distressed and is pyrexial with mild meningism but no rash. A CT head scan shows changes in the left temporal lobe and cerebral oedema.

Right-sided Stroke
Transient Ischaemic Attack
Meningitis
Encephalitis
Left-side Stroke
A

Encephalitis

81
Q

A 71 year old man with long standing hypertension lives on his own. He is found by his son with marked right upper limb weakness and difficulties with speech. He is now incontinent of urine and has some personality changes.

Right-sided Stroke
Transient Ischaemic Attack
Meningitis
Encephalitis
Left-side Stroke
A

Left-side Stroke

MedEd Lectures (15 decks)

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