neuro ILAs Flashcards
what are some causes of unilateral vision loss?
vascular - a. fugax / AION (GCA / non-arteritic) - occlusion of central retinal vein or artery inflammatory - optic neuritis acute angle closure glaucoma vitreous haemorrhage retinal detachment vitreous haemorrhage
what are the 4 core presenting symptoms of PD?
think of BIRT bradykinesia instability (postural) rigidity / tone tremor
what would you suspect if a patient had PD-esque symptoms BUT early bladder/bowel Sx and extreme thirst
MSA
what is the pathophysiology of parkinson’s?
neuronal cell loss in the pars compacta of the substantia nigra
leads to decreased striatal dopamine levels
lewy bodies are associated with the remaining cells
(remember the SN acts like an accelerator on the basal ganglia - so damage = slowing down)..
what are the primary differentials of PD - and give a feature that would point you towards each one…
- Vascular parkinsonism - ‘lower half PD’ / minimal response to l-dopa
- Lewy body dementia - EARLY DEMENTIA / rigidity
PARKINSONS PLUS: - PSP - early falls, hummingbird sign on MRI
- MSA - early autonomic symptoms / nystagmus
(MSA-P/C/A) - Corticobasal degeneration - no response to Ldopa
what would be your investigations of PD:
- trial of dopaminergic agent
- CT/MRI to exclude other causes
- functional imaging eg. PET scan
- genetic testing - parkin gene
- serum copper -
what is the management of PD:
MAO-b inhibitors (selegiline / rasigiline)
Dopamine agonist (pramipexole)
L-dopa (when Sx are disabling eg. in flare- as it will wear off.. give with beneldopa to get it into the brain, and with a COMTi eg. entacapone
can give b blocker eg. propranol for tremor
if drug induced tremor - can give procyclidine as an Anti-Ach
deep brain stimulation
what are the potential complications of PD
infections
bed sores
falls
malnutrition
outline the clinical management of a head injury
ABCDE + resuscitation if required
assess for other injuries such as C spine
Mannitol
Mx seixures (rectal diazepam)
intubate if GCS<8 / severely agitated
neurosurgery (ICP monitoring / burrholes / craniotomy)
if suspicion of ICH and on anticoagulants - reverse
what does a mini-neuro exam entail in a head injury?
GCS
painful stimulus
withdrawal- spinal reflex
should you suture a scalp laceration before or after CT?
before
is GCS accurate 20 mins post head injjury?
no - innacurate w/in 1hr of event
list some complications of head injuries
chronic subdural haematoma
CS leakage
vertebral artery dissection
how would you monitor someone with a head injury? split in to ventilated and non-vent after the core ones
- vital signs
- mini-neuro exam
non-vent:
- gcs
- lateralising signs
-pupils
Vent:
ICP monitoring
safeguarding in acute head injury - what can be done if an ill pt was trying to abscond?
DOLS can be authorised by cons / SpR for <=7 days
