neuro vol 2 Flashcards
discuss extra dural haematoma
an acute haemorrhage between the dura mater and the inner surface of the skull.
most commonly affects males in 20s-30s- being struck in the temple
caused by skull trauma in the temporoparietal region, typically following a fall, assault or sporting injury.
symptoms = headache, nausea/vomiting, confusion and reduced level of consciousness.
signs= confusion, cranial nerve deficits, motor or sensory deficits
disease cause of extra dural haematoma + Ix appearances + Rx of disease
associated with skull fracture in 75% of cases.
Middle meningeal artery damaged from trauma on pterion
loss of consciousness–> then lucid phase where feel fine. –> then drop off a cliff
Cushing’s syndrome is present- HTN, bradycardia,
Ix:
as with any head trauma with loss of consiousness - CT non contrast.
looks like a lemon- stays within suture lines.
ECG, FBC + coag etc.
Rx:
reversal of anticoagulation
anticonvulsants to prevent seizures
trauma/ burr hole craniectomy
generally a good prognosis but better if treated early.
discuss head trauma and management of this including coma
manage ABC
if GCS less than 8 then contact anesthetics and intubate.
once stabilised get CT <1 hr if:
gcs <13 or 15 2 hrs later
focal neuro deficit
suspected skull # (panda eyes etc)
csf leak
vom >1 x
seziure
ct < 8 hr if
LOC/ amnesia
over 65, coagulopathy, high impact fall >1m or 5 stairs.. retrograde amnesia >30 mins.
don’t consider alcohol incapacitation if blood conc less than 44mmol/L.
many people will live for a long time even if consciousness loss is greater than 1 month.
discuss multiple sclerosis diagnostic criteria
Mcdonald diagnostic criteria:
defined by at least 2 separate episodes of / clinical evidence of 2 lesions OR clinical evidence of 1 lesion + reasonable history of another.
Or two or more attacks + evidence of 1 lesion
Or one attack + evidence of 2 or more lesions
peripheral nerves are not affected
can be relapsing remitting or progressive, or combination. (preg is protective against relapses)
one episode does not count
onset after puberty or before 65
risk factors for MS + epidemiology
Older age
EBV contracted at later age
Smoking
Vit D deficiency
Family Hx
Northern latitude
epidemiology:
3x more common in women
20-40 years old.
distance from the equator during pre adult years.
some genetic factors- HLA-DRB1
some environmental factors
pathophysiology of MS
an autoimmune reaction against myelin and oligodendrocites.
normally macrophages don’t cross blood brain barrier- but in MS they express a4b1 which enables adherence and movement through.
myelin is broken down- conduction slowing/ block
more commonly seen in:
Optic nerves
Periventricular region
Corpus callosum
Brainstem and cerebellar connections
Cervical spinal cord => posterior and corticospinal tracts
Ventricles/ fluid filled spaces => called Dawson’s finger
investigations and management of MS
Ix; full history
neuro exam- inc RAPD/ pupillary reflexes
MRI is imaging of choice brain + spine
LP for CSF evaluation (normal in 20-30%)
Mx;
acute flare- rule out any co cominant infection
high dose methylprednisolone with oral taper
chronic Rx:
interferon beta e.g glatiramer- supress T cell actions leading to reduce flares.
classification of headaches and the red flags for these
primary- occurring without physiological cause - usually not serious.
2’- s a consequence of some other pathology- usually serious
Red flags:
new onset in over 50
hx cancer or immuno def
thunderclap features or sudden onset
history of aneurysm.
Raised ICP features (inc on lying down, worse in morning)
GCS/ any neuro signs
meningism
fever
discuss migraines
an episodic neuro disorder- strong genetic components. 4-72 hour duration usually.
S- unilateral
O- slow onset
C- pulse/ throbbing
R- back of head retro orbital
A- photophobia, phonophobia N + V
T- hours- days
E- fatigue, hangover, travel
S- severe 8-9/10
Mx- avoid triggers + healthy lifestyle
high dose NSAIDS 1st, then - tryptans.
high flow o2 in emergency dept.
Generally a clinical diagnosis but can rule out other things. painful dilation of arteries in the brain.
should not take the combines oral contraceptive pill if have migraines with aura.
discuss cluster headaches
S- unilateral centered around one eye
O- fast and repeated - 1 hour
C- intense stabbing pain
R- no
A- red eye, lacrimation, blocked nose.
T- 1 hour duration but up to 8 a day. can last weeks with months gaps.
E- alcohol
S- really very bad.
100% 02 15L. sub cut sumatriptan, pred at start of cluster to stop.
vermapil to prevent.
trigeminal neuralgia
S- unilateral V2-3 distribution
O- sudden
C- stabbing
R- V2-3 dist
A- N/A
T- many times a day for weeks / months then stops
E- touching face (wash, shave)
S- short but painful.
Ix:
MRI usually identifies vascular loop touching V5
more common in women than men. rare in under 40s.
Rx; carbamazepine + referral to neuro if not working.
tension headache
most common type of primary headache
occurs repetitively.
aetiology not fully understood- stress, muscle tension, vitamin (D, B12),
last 30 mins to 7 days, 6 hours average.
bilateral with band like quality across forehead.
does not worsen with activity, photophobia usually not present. no N+V. can usually go about most duties.
need 10 episodes for diagnosis- clinical so imaging not needed.
chronic if >15 a month for >3 month.
infrequent if <12 days a year
frequent if between.
NSAIDs mainstay of treatment. ibuprofen + aceaminophen.
can use amytriptaline
Physio!
usually a good prognosis 50% remission, 15% progression to chronic.
discuss syncope inc S+S
temporary loss of consciousness due to blood flow disruption (vasovagal)
excessive vagal nerve stimulation –> parasympathetic symptoms –> Vasodilation + BP drop –> floor.
S+S= hot/ clammy
sweats
dizzy
blur vision
headache
convulsions
aetiology of syncope
primary- dehydration, excessive warm standing, vasovagal response to blood, surprise, pain etc.
2’ - hypoglycaemia
anaemia
infection
anaphylaxis
arrhythmias
valvular heart disease
obstructive cardiomyopathy.
Ix + Rx of syncope
Ix: ECG (look for arrythmia or long QT syndrome)
24 hour ECG
Echo
Bloods, electrolites, BM, viral screens (e.g COVID)
Mx: Rx underlying cause
avoid dehydration, standing for long periods, sit when experancing prodromal features.
