Neuro Flashcards
Epilepsy
Cause, rf, types, hx, ix, mx
- Imbalance between glutmatergic and GABAergic neuronal signalling at the synaptic level resulting in reduced threshold for neurotransmission causing focal or generalised seizures
Risk factors
- Structural abnormalities- head injury, lesion, neurodegenerative disease, genetic disease
- Neurochemical imbalance- genetic disorders
- Seizure threshold- electrolyte imbalance, CNS infection
History and examination
- Eyewitness history
- Prodrome, seizure and post-ictal
- A to E
Investigations
- Obs
- BM
- Bloods
- EEG
- ECG
- MRI
- CT
- PET
- Genetic testing
Management
- Education for safety
- Immunisations
- Anti-epileptics
- Ketogenic
- Vagal nerve stimulation
- Surgery
Febrile convulsion
Def, ix, mx, path
Seizure associated with fever, no CNS infection, occurring in 6 month to 6 year old
Tests
- Blood tests and culture
- Spinal tap
- EEG and MRI if prolonged seizure or neuro signs
Management
- Paracetamol
- Recovery position
- Safe place
- prolonged (more than 5 mins) = medazolam oralmucosal solution
Infantile spasms
Def, ix, mx
- West syndrome
- 3-12 months of age
- Violent flexor spasms of the head, trunk and limbs followed by extension of the arms, lasting 1-2 sec, often multiple bursts of 20-30 often on waking or many times a day
- EEG shows hysarrhythmia
- Manage with vigabartrin
Peri-orbital and orbital cellulitis
Def, sx, ix, mx, path
- Infection of the dermis and subcutaneous tissue layers in the skin
- Causative pathogen: Staphylococcus aureus and
Streptococcus pyogenes (gram +ve)
Site:
Peri-orbital (Preseptal) Cellulitis
• Skin and soft tissue in anterior to the orbital septum
Orbital Cellulitis
• Soft tissue posterior to the orbital septum
Sx:
Peri-orbital
- no pain with movement
- normal vision
Orbital:
- pain with movement
- double vision or blurry
- proptosis (bulging)
Ix and mx:
Peri-orbital
- clinical
- antibiotics (oral or IV)
Orbital
- FBC, CRP, lactate, blood cultures, CT, ENT referral
- IV antibiotics, surgery, supportive care
Raised ICP and hydrocephalus
Causes, sx, ix, mx
Causes:
• Hydrocephalus
- Abnormal build-up of CSF, either due to over production or reduced drainage/reabsorption
- Most common cause is aqueductal stenosis
• High blood pressure
• Infections
• Hemorrhagic stroke
• Swelling of the brain
• Brain tumour
Sx:
• Bulging anterior fontanelle
• Sunset eyes – eyes looking downwards
• Poor feeding and vomiting
• Poor tone
• Blurred vision
• Confusion and drowsiness
• High blood pressure
Ix:
- Imaging (CT/MRI) - can reveal enlarged ventricles,
herniation, or mass effect
- Ophthalmoscopy shows papilledema (swelling of
the optic disc)
Mx:
• Head elevation at 30°
• Osmotic agents – mannitol or hypertonic saline.
• Sedation and analegaeia
• Ventriculoperitoneal shunt
• Decompressive craniectomy
DONT PERFORM LUMBAR PUNCTURE
Migraine and tension headaches
Causes, dx, mx, pattern
Causes:
• Infection, especially ENT
• Head trauma
• Emotional factors
• Genetic predisposition
• Dietary intake
• Vision problems
• Raised ICP
• Brain tumours
• Meningitis
• Encephalitis
• Carbon monoxide poisoning
• Sensory stimuli
Dx:
Migraine-
- headache lasting 4-72 hours
- frontal/temporal location
- pulsating
- moderate to severe
- nausea/vomiting
- photo/phonophobia
- aggrevated by routine physical activity
Tension-
- headache lasting 30 minutes to 7 days
- pressing/tightening
- mild to moderate
- no nausea or vomiting
- not aggrevated by routine physical activity
Mx:
- rest
- fluids
- paracetamol
- ibuprofen
Meningitis
Sx, pathogens, ix, mx
ciprofloxacin given to family members and close contacts
Hypoglycaemia
Cause, sx, ix, mx
Causes
Maternal diabetes: ↑glucose during pregnancy leads to compensatory fetal ↑insulin, which remains postpartum while maternal glucose stops.
Premature or SGA: limited glycogen stores.
Infection: ↑glucose use.
Hypothyroidism
Congenital hyperinsulinism: maternal diabetes, pancreatic islet cell hyperplasia.
Signs and symptoms
Lethargy and altered level of consciousness.
Seizures
Vomiting
Respiratory distress.
Cyanosis
Investigations
Check glucose in all at-risk newborns.
Check pre-feed levels in those with hypoglycaemia.
Management
Prevent through adequate feeding soon after birth and then 3-hourly.
If asymptomatic, ensure feeding is adequate. Consider NG tube if there are problems.
If symptomatic or severe (glucose <1 mmol/L), give IV glucose: bolus then infusion.
