Emergency Medicine - Neurology Flashcards
Differential diagnosis (new onset AMS in ED)
DOG MIST
Drugs + drug withdrawal/alcohol
Oxygen
Glucose - hypoglycemia
Meds + Metabolic (electrolyte, liver failure, endocrine) (meingitis/encephalitis)
Infection, ischaemia
Seizure, shock
Trauma (concussion, bleed)
Constipation (elderly)
Initial management
- ALWAYS check glucose
- Thaimine
- naloxone
- oxygen
- ?sedation if agitated
- Vitals
- Investigations
Differential of primary and secondary headache
Primary
-cluster, tension, migrane, medicaiton overuse/withdrawal
Secondary
- Meningitis/encephalitis
- SAH
- subdural haemorahge
- Abscess
- Malignancy
- Hypertensive headache
- Idiopathic Intracranial hypertension
- Cerebral venous thrombosis (pregnant)
Red flag symptom questions - Headache
–sudden onset, worst ever, vomiting, pain on cough or bending, stiff neck, photophobia, pain immediately on waking, fever, weight loss, temporal tenderness
Stroke - brain territories corresponding to symptoms
ACA - feet, legs
MCA - arms, face, speech
Lacunar - pure motor, pure sensory, ataxic hemiparesis, dysarthria
Posterior - Visual disturbance (homonymeous hemainopia)
Basilar/Vertebral - Syncope
Cerebellum - coordination, ataxia
Types of seizures
Partial (part of brain)
Simple - single limb
complex - more then single limb
secondarily generalized - starts out as one limb then become generalized
Generalized (all of brain)
- absence - blankness
- myoclonic - muscle jerks
- tonic - stiff
- clonic - jerking
- tonic-clonic - stiff, then jerk
- atonic - collapse
Epilepsy - no underlying cause
Causes of seizures
VITAMIN
Vascular - strokes
Infections – meningitis, encephalitis, fever
Trauma – head injury
Autoimmune – alzihemers
Metabolic/MEDS - hypoxia, hypoglycaemia, hypocalcaemia, hyponatraemia, hypomagnesia
Medications (tramadol, tricylic, salicylate, isonazid, lithium)
Iatrogenic – Drugs (cocaine, mdma), Alcohol, benzo withdrawal
Neoplasm
DDx seizure
Syncope Epilepsy hypoglycaemia Hyponatraemia Pre-eclampsia Intracranial hemorrhage malignancy underlying cause psychogenic alcohol/benzo withdrawal
Meningitis
- 3 most common bacterial cause
- DDx
- Treatment
- contraindications of LP
- Prophylaxis
Most common causes - n.meningitits, streptococcus pnuemonia, h.influenza (listeria)
DDx - brain abscess, tumor, bleed, spinal epidural abscess
Contraindications of LP - elevated ICP (look for papilooedema), or suspicious for mass or abscess, siezure
Treatment
- Ceftriaxone, vanc
- Dexamethasone
- Acylovir - viral
Prophylaxis - close contacts, in contact w secretions
Reversible causes of Delirium/dementia to test
- thyroid
- creatinine, U+E
- B12
- LFTs
- Neurosyphillis
- Depression
Types of dementia
Alzhimers - memory first, diffuse atrophy, plaques and tangles
Picks disease (fronto-temporal degeneration) - retain memory, lose filter
Lewy Body - Parkinsons (visual hallucinations)
Vascular - strokes, stepwise decline
CJD - prions, cow/mutation
Normal pressure hydrocephalus - Wet, weird, wobbly.
CT - hydrocephalus, LP improves.
VP shunt
Cerebellar symptoms
DANISH V Dysdiadochokinesis ataxia nystagmus Intention tremor Slurred speech Hypotonia Vertigo
** Central causes of vertigo and symptoms
Peripheral causes
Central - MS, CVA, tumor, abscess, migraines, seizures
-No tinnitus, no hearing loss, focal neuro symptoms, cerebellar symptoms
MRI
Peripheral
BPPV
Labyrinths/vestibular neruitis - post viral. Tx - steroids, antiemetics
Minners - hearing loss, tinnitus, vertigo. Tx - Salt restriction, thiazide diurertics, Antiemetics
Motor - neuron disease
MS - demyleniating, AI, random neuro symptoms (Dx MRI, Tx steroids) (UMN)
Symptoms Urinary retention - bethanecol Urinary incontinence - Amitriptyline Spams - Baclofen Neuropahtic - Gabapentin
GB - demylinating, ascending paralysis, hyporeflexia (Dx LP, Tx - IVIg or plasmaphoresis) (LMN)
MG - antibodies against ACH receptor, fatigue (Dx antibodies, EMG, CT scan - thymoma. Tx cholinesterase inhibitors, SE - increases secretions)
EL - Para neoplastic syndrome, antibodies calcium channels, improvement w use. (Dx EMG, CT - Small cell lung cancer)
ALS - Upper/lower motor neuron lesions. (Dx emg, Tx supportive)
Parkinsons
-Loss of dopaminergic nuerons in the substantia nigra
TRAP Tremor (resting) Rigidity (cogwheel) Akinesia/bradykinesia Postural instability (shuffling gait)
Dx- clinical
Tx- Levo dopa, carbidopa
Tremors
resting essential intention chorea Huningtons
Resting - Parkinson
Essential - worse with use. Tx - BB
Intention - cerebellar dysfunction (stroke, alcohol). Tremor worsening w movement, worse closer to target
Chorea - Huntingtons
-autosomal dominant
pyschosis, depression.
