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Neurology > Head injury, syncope + bleeds > Flashcards

Head injury, syncope + bleeds Flashcards

1
Q

Management of delirium

A

Check bloods

Treat conservatively but haloperidol +- lorazepam

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2
Q

S+S SAH

A

Severe, sudden onset occipital headache - sometimes preceded by sentinel headache
Neck stiffness
N+V
Papilloedema, retinal haemorrhages, focal neurology

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3
Q

Causes of SAH

A

Bending
Post coital
Berry aneurysm - polycystic kidneys, Ehlers/ Marfans, trauma, tumour

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4
Q

Assessing severity of SAH

A

Hunt + Hess scale

1: minimal symptoms
2: mod/ severe headache, stiff, no neuro
3: drowsy/ confused
4: stupor, hemiparesis
5: comatose

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5
Q

Investigations for ?SAH

A

CT - within 48hrs
Lumbar puncture if clear - if blood in CSF, CT angiogram
CSF is bloody early, then yellow after 12 hours
Bloods: clotting screen, U+Es

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6
Q

Management for SAH

A 
Refer to neurosurgery - VP shunt, craniotomy, clipping, endovascular coil - only if cause is aneurysm
Treat raised ICP - Mannitol
Correct hypotension (IV nitrates, nimlodipine)
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7
Q

Indications for skull x ray following head injury

A 
Amnesia
Reduced consciousness
N+V
Neuro signs
CSF/ blood from orifices
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8
Q

Characteristics of extradural haematoma

A 
Dura + skull
Acceleration/ deceleration injury
Temporal region + middle meningeal
Raised ICP
Lucid interval
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9
Q

Characteristics of subdural haematoma

A

Frontal/ parietal lobe
Old age + alcohol are risks
Slow onset of symptoms

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10
Q

What is the management for raised ICP?

A

IV mannitol

Oedema may require decompressive craniotomy

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11
Q

What is the Monroe Kellie doctrine?

A

Cranium is incompressible - volume is fixed
Blood, CSF + brain: increase in 1, decreases the others
Cerebral perfusion = mean arterial pressure - ICP
So if ICP increases, perfusion decreases

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12
Q

What is the Cushings response?

A

Reduced cerebral perfusion due to raised ICP - causes brain hypoxia
Body’s response is to raise BP

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13
Q

What is Cushings triad?

A

HTN, bradycardia, abnormal respiration

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14
Q

Causes of seizures

A 
Vascular - haemorrhage, thrombosis
Trauma
Tumours
Toxins
Metabolites - hypoxia, hypoglycaemia, electrolyte disturbances
Infection
Inflammation
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15
Q

What is the san francisco syncope rule?

A 
CHESS
CCF
Haematocrit <30
ECG abnormal
SOB
Systolic BP
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16
Q

What is the Oseil risk score?

A 
Age >65
History of CV disease
Syncope without prodrome
Abnormal ECG findings
Predicts 12 month mortality after syncope
17
Q

What is the commonest cause of syncope?

A

Reflex bradycardia

Peripheral vasodilation from pain, fear, emotion

18
Q

Investigations for syncope

A 
ECG
Neuro exam
BP lying + standing
Bloods + glucose 
EEG, echo
CT/ MRI
19
Q

GCS eye response

A

Open spontaneously: 4
Open to verbal command: 3
Open in response to pain: 2
No response: 1

20
Q

GCS verbal response

A 
Talking: 5
Confused: 4
Inappropriate words: 3
Incomprehensible sound: 2
No response: 1
21
Q

GCS motor response

A 
Obeys commands: 6
Localises pain: 5
Withdraws from pain: 4
Abnormal flexion: 3
Extension: 2
No response: 1
22
Q

Indications for CT head immediately (within 1 hr) post head injury

A

GCS <13
GCS <15 2 hours after the injury?open fracture
Signs of basal skull fracture: panda eyes, CSF leak, Battle’s sign (bruising over mastoid)
Seizure
Focal neuro deficit
>1 episode vomiting

23
Q

Indications for CT head within 8 hrs post head injury

A 
Any LOC or amnesia +:
>65Hx of bleeding/ clotting
Dangerous mechanism of injury
>30mins retrograde amnesia
Pt on warfarin
24
Q

Transient loss of consciousness - how to determine urgency

A

Person has sustained injury
Person not fully recovered consciousness
TLOC secondary due to other condition

25
Q

What are the 3P’s?

A

Posture
Provoking factors
Prodrome
Indicate simple faint/ situational syncope

26
Q

Red flags for syncope needing urgent CV assessment

A 
ECG abnormality
HFT
LOC during exertion
FHx sudden cardiac death
Inherited cardiac condition
SOB - new or unexplained
Heart murmur
27
Q

What artery is most likely to be ruptured in an extradural haemorrhage?

A

Middle meningeal artery

Neurology (7 decks)

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