Neuro Flashcards
What do unequal pupils indicate in head injury?
HIGH ICP (due to compression of ipsilat CN 3> inactivates PNS > pupil dilatation, loss of light reflex)
What are indications for immediate CT head following head injury?
- GCS <13 immediately, <15 after 2 hours
- Fracture (suspected open/depressed skull fracture of basal skull fracture)
- Seizure
- focal neurological deficit
- vomit >1
What are signs of a basal skull fracture
Haemotympanum
Panda eyes
CSF leak (otorrhoea or rhinorrhoea)
Battle sign (mastoid bleed)
What are indications for immediate CT spine
- GCS <13
- Patient intubated
- Clinical suspicion AND >65/high impact / focal neuro deficit / paraesthesia
- a definitive diagnosis of a cervical spine injury is urgently needed (for example, if cervical spine manipulation is needed during surgery or anaesthesia)
- blunt polytrauma involving the head and chest, abdomen or pelvis in someone who is alert and stable
What are indications for CT head soon <8h from injury
(Less strict than 1hr criteria)
For people 16 and over who have had some loss of consciousness or amnesia since the injury, do a CT head scan within 8 hours of the head injury, or within the hour in someone presenting more than 8 hours after the injury, if they have any of these risk factors:
- age 65 or over
- any current bleeding or clotting disorders
- dangerous mechanism of injury
- more than 30 minutes’ retrograde amnesia of events immediately before the head injury.
What are signs and sx of raised ICP
headache / vomiting
altered GCS, focal neuro deficit
Cushing’s response (high BP, low HR, cheyne-stokes respiration)
What are holding measures for a pt with raised ICP
- sit up 40 degrees
- if intubated: hyperventilate them (high ventilation causes hypocapnia >vasoconstriction of cerebral arteries > reduces cerebral blood flow and volume)
- Osmotic agents eg mannitol
- consider steroids if oedema surrounding tumour
- fluid restrict
What is Cauda Equine Syndrome
Symptoms caused by compression of the cauda equine (below L2)
What are red flag symptoms of cauda equine
Bilateraal sciatica
Saddle anaesthesia
Lower limb weakness (+ reduced sexual function)
What are white flag sx of cauda equina (too late!)
Urinary retention (complete lack of sensation of fullness) Urinary/faecal incontinence
What aree investigations for CES
clin exam (LL neuro, saddle anaesthesia, DRE)
Bladder scan
MRI
What is management for CES
PO dexamethasone (if metastatic, while awaiting MRI results)
Decompressive laminectomy (if <48hours from bladder dysfunction
most common causes of SC compression
metastases (oncological emergency)
lung, breast, prostate cancer
sx SC scompression
back pain (worse on coughing, lying down)
when is SC compression UMN /LMN
Above L1: UMN
Below L1: LMN
Ix for SC compression
MRI spine. urgent
FBC, CRP, UE, calcium
Urine for Bence Jones (MM)
Mx SC compression
Dexamethasone +-radiotherapy, surgery
what should ICP normally be
ICP <15mmHg
what is status epilepticus
Seizure lasting >30 mins
What can early status epilepticus be classified as, and how would you treat it
Early: 5-30mins»_space;> Lorazepam
EEstablished: 30-60mins»_space; phenytoin
Refractory: >60mins»_space; anaesthetics
What ix do you get in status epilepticus
Cap glucose
lab glucose, U&E, Ca, FBC, ECG, LFT
ABG
Put on cardiac monitor and pulse oxymetry
Consider tox screen, anticonvulsant levels, LP, culture blood and urine, EEG, head CT.
How do you manage Status epilepticus
A>E
(secure airway, adjuncts as necessary, remove false teeth if poorly fitting)
O2 + suction
IV bolus lorazepam 4mg (10mg buccal midaz / 10mg PR diazepam if no IV access)
Give second dose Lorazepam if no improvement after 10-20mins
Consider thiamine if alcoholic, glucose if abnormal, tx acidosis, call up ITU
Start PHENYTOIN INFUSION
If seizure continues after 60 mins >General anaesthetic
symptoms of meningitis
- Severe headache
- Nausea and vomiting
- Photophobia
- Neck stiffness or backache
- Irritability
- Drowsiness
- High-pitched crying or fits (common in children)
- Reduced consciousness
- Fever
What is Kernig’s sign
with hips flexed, there is pain/resistance on passive KKKKKKnee extension
What is Brudzinski’s Sign
Flexed neck causes involuntary flexion of the hips
Sign of meningitis
What Ix should you get for suspected meningitis
Blood cultures
Bloods - glucose (may be deranged in bacterial men), U&E, FBC, VBG (for lactate), LFTs, coag (exclude DIC), CRP, HIV
CT before LP if suspecting raised ICP
LP + MS&S of aspirate - but if LP cannot be completed within 1 hour, start Abx
What is contained in a coagulation screen
PT, APTT, INR, fibrinogen, fibrin degradation products
What Abx do you give first line in community
community: IM benzylpenicillin 1.2 g
What must you give along with Abx in meningitis
IV dexamethasonne
Brown Sequard syndrome
hemisection of spinal cord
- ipsilateral hemiparaplegia
- contralateral hemianaestthesia
