NERVOUS SYSTEM Flashcards
**Stroke
Score system
Time for thrombolysis window
Treatment post ischaemic
screen if occured <55
- 85% ischaemic and haemorrhagic 15%
SYX: Dysphasia, weakness, Facial sparing, homonymus hemianopia, focal signs, amaurois fugax
Brainstem syndrome = pontine haemorrhage or basilar artery = locked in
Rosier score > 0 likely
IVX: Blood glucose, bloods, PNS assessemnt, CNS assessment
Assess Neglect
- Admission to Stroke Unit
- Urgent CT/MRi (haemorrhagic bright instantly)
Criteria:
- <4hr in thrombolysis window
- GCS <13
- Risk bleeding
- Severe headache or raised ICP - alteplase if ischaemia within 4.5hrs of symptoms
CT head after 24 hrs
Aspirin 2 weeks
- Decompression hemicraniotomy if young and MCA infarction - Antiplatlet Aspirn 300mg then Clopidogrel 300mg PO then 75mg
Warfarin if AF - <180 bp ischamic and <140 haemorrhagic - NBM swallow assessment
ICP stockings
- -> Surgery if haemorragic with Nimodipine before
- -> SALT+ OT
- -> cant drive for 1 month
LT: thrombophillia and autoimmune screen if <55
- Statin
**Meningitis
Gp treatment
hospital treatment
meningism
Bacterial: 80% cases under 16 SEVERE
Neonate – 3mo = Group B Strep (g+ve) E.Coli (g+ve), Listeria (g+ve)
3m – 6 yr = N.Meningitidis (g–ve), S.Pneumoniae (g+ve), H.Influenzae (g-ve - <4yrs + unvaccinated)
>6yrs = N.Meningitidis (g-ve), S.Pneumoniae
Viral: more common but less severe
Infants: poor feeding, URTI, fever
Meningism: Photophobia, Neck Stiffness, Headache
Brundski and Kernigs signs
Raised ICP = late sign - high pitched cry, headache worse on coughing
IVX: Bloods, ABG, cultures
Lumbar puncture: CSF to identify organism
bacterial: low glucose
Viral: same glucose - PCR
TX: BUFALO If sepsis
GP –> IM BENZYLPENICILLIN
HOSPTAL –> IV Cefotoxamine under 3
over 3 cefTRIaxone
Anaphylaxis PO Ciprofloxacin in household and vaccination
Meningococcal septicaemia: sepsis, non blanching purpuric rash, shock
**Acute Confusional State
Delerium
- Find cause
- Treat
- Reduce confusional factors
**Subarrachnoid haemorrhage
prodromal syx?
Condition associated with?
name of severity scale?
Time for LP
Drugs given before neurosurgery
- Rupture of Saccular Berry Aneurysm
CF: Distinct headache days/weeks before then
THUNDERCLAP sudden and severe, radiating behind occiput + neck stiffness, N+V, impaired consciousness
Hunt and Hess scale assesses severity
Condition associated with = autosomal dominant polycystic kidney disease.
IVX: urgent CT scan, LP >12 hr after onset shows yellow colour
Management: Analgesia, Antiemetic, Refer to Neurosurgery
- Nimodopine to reduce vasospasm + ionotropes to maintain cerebral perfusion
Status Epilepticus cause and Hx
TREATMENT:
Causes: Life threatening causes: Stroke (23%), Epilepsy (21%), Alcohol, Infection, hypoxia, cardiac disease, hypoglycaemia, metabolic (↓Ca, ↓/↑Na), trauma, meningitis etc. ↑ICP & CVA, drug OD, HTN, pre-eclamps
Hx: before, during, after
IVX: bloods, glucose, ecg, urine (drug screen), LP if suspect meningiits
TREATMENT:
- 5 Mins Lorazepam IV 4mg max
+ pabrinex and glucose if ? alcohol withdrawal/ impaired nutrition
- 20 mins = PHENYTOIN 20mg/kg! and contact anaesthetics
-
Cranial nerve lesions
OOOTTAFVGVAH
olfactory 1 = loss of smell optic 2 = decreased acuity occulomotor 3 = ptosis trochlear4 = defective downward gaze Trigeminal 5 = trigeminal neuralgia and loss of corneal reflex or facial sensation Abducens 6= defective abduction Facial 7 = loss of corneal reflex and taste, stroke with forehead sparing + bells palsy Vestibulocochlear 8 = hearing loss Glossoppharangeal 9 = Loss of gag reflex Vagus 10 = Uvula Deviates Spinal Accessory 11 = Weakness turing head to side Hypoglossal 12 = tongue deviates to side
Peripheral nerve lesions
Klumpkes palsy: C8-T1, lower trunk of brachial plexus damaged during shoulder dystocia- sudden upward jerk of hand- claw hand.
Erbs Palsy: C5-6, damage to upper trunk of brachial plexus during birth - waiters tip
Subdural haematoma
- Bleeding from bridging veins confined between brain and dura (subdural space)
Extradural Haemoatoma
- Bleeding from middle meningeal artery due to temporal bone fracture (lense shaped) post high impact injury – elderly
Multiple sclerosis
Chronic, T-cell-mediated autoimmune attack of myelin
a) Relapsing and remitting (80%) = poor healing (remyelination) causes periods of good health on remission, followed by sudden relapse
b) Secondary proressive and c) primary progressive
Trggers: infection, F>M
CF: syx worse after hot shower, optic neuritis, paraesthesia, badder symptoms, headache, fatigue
IVx: bloods, crp, consultant neurologist
Management:
- stop smoking, exercise, vitamin D
- METHYLPREDNISOLONE 1g OD
- DMARDS: alemtuzumab
Parkisons disease
Triad?
Management
- Degeneration of dopaminergic pathways in pars compacta of substantia nigra
CF: BRADYKINESIA, Muscular rigidity “cog-wheel”, resting tremor, postural instability
IVX: structural MRI/PEt
Management
1. Levodopa = dyskinesias side effects
2 Dopaine angonist - Ropinirole
Dementia
4 types of dementia
4 as
Treatment for each
Frontal lobe
Vascular
Alzheimers
Frontal Lobe
Lewey Body
Diagnosis: Reduce language ability – aphasia Reduced motor ability – apraxia Reduced recognition – agnosia Reduced memory- Amnesia
Test with: MOCA, MMSE
IVX: vitamin defieicnecy, TFT, imaging of brain
Alzheimers: Anticholinesterase drugs e.g. donepezil
NMDA receptor antagonists – memantine
Vascular: Aspirin or warfarin therapy, Controlling BP, Anticholinesterases and memantine
Lewy body: rivastigmine
Frontal: Antidepressants and antipsychotics
Epilepsy
General – discharge arises from both hemispheres
Focal – seizure arise from one area of one hemisphere
Myoclonic – BRIEF shock like movement of one, or several parts of body
Tonic – stiff, sustained contractions
Clonic – RHYTHMIC jerking of one limb, side or whole body
Tonic-clonic – BOTH also post-ictal confusion + drowsy
Atonic – myoclonic jerks → sudden loss of muscle tone (sudden fall to floor) – no LoC
Absence: abrupt psychomotor arrest (5-15 s), upward deviation eyelid, perioral myoclonus (twitching of mouth)
IVX: ECG and EEG after 2nd seizure
Management:
Absence, tonic-clonic: NA Valproate, lamotragne
Myoclonic: Na Valproate
Focal: Carbamazepne or Lamotragine
2 years seziure free ween off AED
Annual review + inform DVLA
Sinusitis headache
CF:
Treatment:
- Acute
- Chronic
- Causes = Viral, smoknig, medication
CF: Often occurs post-URTI or asthma exacerbation
Facial pain + tenderness – frontal pressure, worse when bending forward
Rhinorrhoea – thick + purulent
Nasal obstruction causing mouth breathing
Post nasal drip causing chronic cough
Fever
Acute Bactieral Rhino-sinusitis: Diagnosis >4 sx of pururlent discharge, locla pain, fever >38, ESR increasing
IVX: bloods, CT paranasal sinuses if chronic
Acute: Analgesia, nasal saline irrigation, decongestants and Doxycycline
Chronic: intranasal corticosteroids, ENT referral
Migraine
INTENSE headache
Triggers: alcohol, chocolate, cheese, orgasms
+ N+V, photophobia
Management Acute: NSAIDS and PO Triptan Chronic: BB propanolol - Amitryptiline - Valproate
