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medicine can be fun > Neuro > Flashcards

Neuro Flashcards

1
Q

extradural haematoma epidemiology

A
  • younger patients
  • playing sports
  • blunt force trauma to head
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2
Q

extradural haematoma site of bleed

A

middle meningeal artery at pterion

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3
Q

extradural haematoma presentation

A
  • acute
  • head trauma followed by acute loss of
    consciousness followed by a lucid interval and
    then signs of raised ICP
  • headache
  • dilated unreactive pupil (raised ICP)
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4
Q

5 signs to order a CT head within 1 hour of head injury

A
  • GCS <13 initially
  • open skull fracture
  • seizure
  • neuro deficit
  • more than 1 vomiting episode
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5
Q

4 signs to order a CT head within 8 hours of head injury

A
  • older than 65
  • taking anticoagulants
  • dangerous injury
  • amnesia of events before
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6
Q

extradural haematoma investigations

A
  • urgent non-contrast CT head
  • lemon shaped white blood
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7
Q

extradural haematoma management

A

neurosurgery for burr holes

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8
Q

extradural haematoma management

A

neurosurgery for burr holes

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9
Q

subdural haematoma epidemiology

A
  • elderly
  • falls
  • alcoholics
  • blood thinners
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10
Q

subdural haematoma site of bleed

A

bridging veins

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11
Q

subdural haematoma presentation

A
  • usually more chronic
  • gradual continuous headache
  • confusion, personality changes
  • raised ICP
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12
Q

subdural haematoma investigations

A
  • urgent non-contrast CT head
  • banana shaped, hypodense (grey) blood
    (older)
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13
Q

subdural haematoma management

A
  • small (<10 mm), no neuro signs: observe
  • large or neuro signs:
    a) burr holes if more chronic
    b) decompressive craniectomy if more acute
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14
Q

what is uncal herniation and how does it present

A
  • raised ICP compresses CN III
  • down and out eye
  • dilated fixed pupil
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15
Q

causes of raised ICP

A
  • bleed
  • idiopathic intracranial hypertension
  • tumour
  • hydrocephalus
  • meningitis
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16
Q

idiopathic intracranial hypertension epidemiology

A

young obese female

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17
Q

signs of raised ICP

A
  • headache
  • papilloedema
  • blurry vision
  • vomiting
  • Cushing’s triad
  • uncal herniation
  • reduced consciousness
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18
Q

what is Cushing’s triad

A
  1. bradycardia
  2. wide pulse pressure
  3. irregular breathing
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19
Q

describe the headache in raised ICP

A

bilateral
throbbing
worse in the morning
worse when lying down
worse when coughing

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20
Q

raised ICP investigations

A
  • urgent CT head: midline shift
  • catheter to monitor ICP
  • DO NOT attempt lumbar puncture
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21
Q

what is the risk of lumbar puncture in raised ICP

A

brainstem herniation causing death

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22
Q

raised ICP management

A

i) elevate the head to 30 degrees
ii) IV mannitol
iii) remove CSF
iv) controlled hyperventilation

23
Q

idiopathic intracranial hypertension management

A
  • weight loss
  • carbonic anhydrase inhibitor (acetazolamide)
24
Q

raised ICP due to brain tumour management

A
  • MRI
  • IV dexamethasone
25
Q

brain tumour causes

A

usually mets from lung, kidney, breast

26
Q

how does controlled hyperventilation help raised ICP

A

hyperventilation reduces CO2 which constricts cerebral arteries

27
Q

subarachnoid haemorrhage site of bleed

A

berry aneurysm in circle of Willis

28
Q

risk factors for subarachnoid haemorrhage

A
  • smoking
  • hypertension
  • polycystic kidney disease
  • Marfan’s
29
Q

subarachnoid haemorrhage presentation

A
  • thunderclap headache
  • meningism signs
30
Q

features of a thunderclap headache

A
  • worst headache ever
  • occipital
  • like being hit at the back of the head with a bat
31
Q

subarachnoid headache investigations

A

i) within 12 hours do a non-contrast CT
- if normal within 6 hours then no SAH no LP
- if normal after 6-12 hours then do a LP

ii) lumbar puncture 12 hours after (only if normal CT)
- xanthochromia

32
Q

subarachnoid haemorrhage management

A
  • neurosurgery to coil aneurysm
  • nimodipine to prevent vasospasm
  • review anticoagulation
33
Q

subarachnoid haemorrhage complications

A
  • hyponatraemia (SIADH)
  • torsades des pointes (polymorphic V-tach)
34
Q

what is Wernicke’s encephalopathy and in what patients is it commonly seen

A

B1 deficiency in alcoholics

35
Q

what are the symptoms of Wernicke’s encephalopathy

A

Wernicke’s triad (CAN)
1. confusion
2. ataxia
3. nystagmus

36
Q

how to manage Wernicke’s encephalopathy

A

give Pabrinex (vitamin B1)

37
Q

what is the preferred imaging in Wernicke’s encephalopathy

A

MRI

38
Q

what is a complication of untreated Wernicke’s encephalopathy

A

Korsakoff syndrome
(amnesia, confabulation)

39
Q

what happens to CNS receptors in alcohol withdrawal

A
  • increased firing of NMDA receptors
  • reduced GABA
40
Q

what is the timeline of symptoms for alcohol withdrawal

A
  • 6-12 hrs: anxiety, tremor, sweating, tachycardia
  • 36 hrs: seizures
  • 48-72 hrs: delirium tremens (hallucinations, fever)
41
Q

investigations for alcohol withdrawal

A

Bedside:
- ECG, VBG, alcohol screen (AUDIT C)
Bloods:
- FBC (high MCV), LFTs, U&E, clotting, glucose
Imaging:
- CT head if suspecting head injury

42
Q

first line management of alcohol withdrawal

A

diazepam (benzodiazepines)

43
Q

what is myasthenia gravis

A

autoimmune condition against acetylcholine receptors

44
Q

epidemiology of myasthenia gravis

A

women around 40 yrs

45
Q

what are 3 symptoms of myasthenia gravis

A
  • muscle fatigue after activity (at the end of the day improve with rest)
  • diplopia
  • dysarthria
46
Q

what is Lambert Eaton syndrome

A
  • muscle weakness improves with use
  • associated with small cell lung cancer
47
Q

investigations for myasthenia gravis

A
  • AChR antibodies
  • normal CK
  • CT thorax for thymoma
  • EMG: repeated stimulation decreases amplitude
48
Q

what is a strong association with myasthenia gravis

A
  • thymoma
  • mass in the mediastinum
49
Q

how to manage a myasthenia gravis crisis

A

IV immunoglobulin

50
Q

first line management of myasthenia gravis

A

pyridostigmine (acetylcholine esterase inhibitor)

51
Q

how to calculate GCS score

A

654 MoVE
- Movement:
6 - obeys commands
5 - localises to pain
4 - withdraws from pain
3 - flexes to pain
2 - extends to pain
1 - no movement
- Verbal:
5 - fluent
4 - confused
3 - words
2 - sounds
1 - nothing
- Eyes:
4 - spontaneously
3 - to voice
2 - to pain
1 - nothing

52
Q

at what GCS score do you need to intubate

A

8/15

53
Q

what is the triad for normal pressure hydrocephalus

A
  • dementia
  • urinary incontinence
  • gait instability

medicine can be fun (12 decks)

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