Neurological disorders Flashcards
Neurological symptoms
- headache
- loss of sensation - numbness
- paraesthesia - pins and needles
- weakness, loss of muscle strength
- seizures
- visual disturbances - double vision, loss of sight
- cognitive changes - memory loss, confusion
- difficulty reading/writing
- speech difficulties
- lack of coordination
Epilepsy
disorder of the CNS characterised by recurrent seizures. A seizure is caused by a sudden burst of excess electrical activity in the brain causing a disruption in the message between cortical neurons.
causes of epileptic seizures
- trauma
- infection
- tumours
- stroke
- birth defect to the brain
Tonic-clonic seizures
dramatic events with stiffening, then bilateral jerking and a post-seizure state of confusion and sleepiness.
Absence seizures
generalised seizures that consist of brief blank spells associated with unresponsiveness, which are followed by rapid recovery.
Juvenile myoclonic epilepsy
myoclonic jerks are key feature of this and often precede a Toni-clonic convulsion. These jerks present as sudden and unpredictable movements and represent a generalised seizure.
Focal seizures
symptoms are variable depending on regions and networks of brain affected. May impair consciousness. An aura is a primary focal seizure.
Preconception care
- congenital malformation risk depends on type, number and dose of AED.
Lamotrigine, Levitiracetam and carbamazepine mono therapy at lower doses have the least risk.
Avoid Sodium valproate, phenobarbital and phenytoin - 5mg folic acid
- never recommended to stop or change anti epileptic drugs abruptly
Antenatal care
- early referral to neurology service, particularly if pregnancy unplanned
- continue AEDs and r/v doses regularly
- rapid neurology r/v if worsening symptoms
- ensure SUDEP awareness
- if women at reasonable risk of seizure –> not to sleep alone at night
- showers rather than baths
- growth scans to identify SGA babies
- Anaesthetic referral
Why might seizure frequency increase in pregnancy?
- poor compliance due to fears of teratogenicity
- decreased drug levels because of increased plasma volume and renal clearance
- some medication can alter AED levels (Abx)
- sleep deprivation
Intrapartum care
- adequate analgesia and appropriate care in labour should be provided to minimise risk factors for seizures such as insomnia, stress and dehydration
- AEDs continued in labour
- prolonged seizure is an emergency (IV access, ABCDE approach, medications) Benzodiazepines are drugs of choice.
- Avoid pethidine
- birthing pool contraindicated as risk of drowning during seizure
- should not be left alone in room
Postnatal care
- all babies born to women on enzyme inducing AEDs should be offered 1mg IM vit K
- AEDs reduced to pre pregnancy dose
- minimise sleep deprivation, pain, stress
- depending on type of AED some types of contraception might be affected. However IUD and IUS not affected
- nappy changing on the floor rather than high table
- co sleeping discouraged
- bathing baby in shallow water with supervision available
Tension type headache vs migraine
headache bilateral, migraine unilateral
headache nausea + vomiting absent, migraine present
headache related to stress, noise, fatigue, dehydration ; migraine triggered by emotional stress, diet, medications
migraines have auras
Management of headaches + migraines
- neurological symptoms > 12 hrs should be r/v
- metoclopramide can be useful to stop vomiting and enhance other medications metabolism
- lifestyle advice –> avoid triggers
- consider potential differential diagnoses –> meningitis, dural puncture, cardiovascular attack, imminent eclampsia, diabetic hypoglycaemia
