Neuro problems Flashcards
What is Idiopathic intracranial hypertension (IIH)
a disease of unknown aetiology, which is associated with increased intracranial pressure without hydrocephalus or mass lesion, with normal cerebrospinal fluid composition.
Idiopathic intracranial hypertension (IIH) predominantly affects which target group
Obese women of child bearing age
What is the common presenting symptom of IIH
Headache and transient visual obscuration.
The headache can occur daily and is typically a throbbing, retrobulbar headache that can worsen with eye movements & coughing
straining Diplopia in 38% +/- loss of vision (31%) with diplopia
IIH ratio in males to females
IIH has a female to male ratio of 8:1.
The incidence of IIH in women of childbearing age is
about 0.9/100 000
which increases to 19.3/100 000 in obese women.
Other symptoms of IIH
- nausea
- vomiting
- photophobia
- visual blurring
- visual loss
- double vision
- tinnitus
- vertigo
- rarely, spontaneous CSF otorrhoea or rhinorrhoea.
This condition may aggravate pre-existent migraine
What is the Lumbar pressure to diagnose IIH
Greater than 250 mmh2o
How we manage IIH
- MDT
- Growth scan are recommended for obs indications
- The frequency of visual field testing depends on the symptoms
- If the patient visual symptoms are stable: Visual field testing be done every 2 to 3 months
IIH
When we take anasthesia input?
in later half of pregnancy (36 weeks)
What mode of delivery is allowed in IIH
Vaginal delivery can be allowed (50%)
Which anasthesia is safest in IIH
Spinal
Avoid general and epidural
Why can’t we give epidural anastgesia to patients with IIH
it carries a potential risk of increasing ICP because of large volume of drugs in the epidural space .
IIH
Those patient who already have lumboperitoneal shunt ..What measures we can take for them
- Particular attention to be given to women with lumboperitoneal shunt who need regional anesthesia.
*There is potential risk of shunt damage - Prior imaging is recommended because there is a risk of shunt enlargement
Why we don’t prefer general anesthesia in IIH
Raises ICP when we use rapid sequence induction
How we manage patients of IIH medically
It is ideal for women with IIH to limit their weight gain to 20 lb during the pregnancy.
Analgesics:
- paracetamol is safe
- Opioid can be use but can cause physical dependence in neonate
- NSAID should be avoided in late pregnancy
Diuretics:
* Acetazolamide
* Loop diuretics (only for short time)
* Steroids only in acute condition
IIH
What is the mechanism of action of acetazolamide
Carbonic anhydrase inhibitor
Inhibits carbonic anhydrase enzyme in the CNS which delays abnormal and excessive discharge of CSF from choroid plexus .
Why thiazide diuretics are contraindicated in IIH
Fetal Growth Restriction
IIH
Treatment in case of acute deterioration of optic nerve function
optic nerve sheath fenestration use lesi stent and divert the CSF flow.
If there is worsening of visual function despite medical treatment then we will go towards lumboperitoneal shunting to divert the CSF FLOW
Lumbar puncture in treating of IIH
Another treatment which can be done everyday in acute cases is lumber puncture.
Can be done multiple times.
Give relief in symptoms but for a temporary period again when CSF pressure will high there will be headache and vision problems and again we have to repeat the procedure
IIH
For breast feeding women what treatment you will prescribe?
- Acetazolamide can be continued during breastfeeding
- Paracetamol and short-term use of NSAIDs are safe to use.
- Ibuprofen is the drug of choice if long-term use is contemplated.
Define epilepsy
Recurrent unprovoked seizures resulting from excessive neuronal discharge
Define SUDEP
Sudden unexpected witnessed or unwitnessed, non traumatic and non drowning death in a patient with epilepsy with or without evidence of a seizure and excluding documented status epilepticus in which postmortem doesn’t reveal a toxicology or anatomic cause of death.
What is the prevalence of epilepsy in.child bearing age?
0.5-1%
WHAT is the most common cause of SUDEP?
Generalized tonic colonic seizures
Or Grand mal seizures
