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Final Year - Neuro > Neurological Emergencies > Flashcards

Neurological Emergencies Flashcards

1
Q

Acute onset neuro conditions

A

Stroke

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2
Q

Subacute onset neuro conditions

A

Infection
Malignancy

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3
Q

Chronic onset neuro conditions

A

Neurodegenerative

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4
Q

How to think about neuro pathology location

A

Brain
Brainstem
Spinal cord

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5
Q

What are you worried when looking on a CT if someone has a haemmorhagic stroke?

A

Raised ICP - herniation - coning - death

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6
Q

Management of haemmorhagic stroke

A

Craniectomy - remove skull to relieve pressure so the patient doesn’t die
Conscious level? Midline shift?

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7
Q

How does something point towards encephalitis instead of meningitis?

A

seizures
agitation
confusion

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8
Q

Which cause of encephalitis should you not miss? How would you manage?

A

HSV encephalitis mx - Aciclovir

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9
Q

If someone has encephalitis, how do you manage?

A

Treat - IV aciclovir
Abx

CT - to exclude raised ICP
LP

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10
Q

Where does HSV encephalitis affect?

A

Medial temporal lobes- hippocampal
Often asymmetrical
Short term memory difficulties

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11
Q

Long term effect of HSV enchpalitis

A

Propensity for seizures in the future
Amnesia

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12
Q

Alcoholic with ataxia, confusion, forgetful

A

Wernicke’s - thiamine deficiency

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13
Q

Wernicke’s features

A

Ophthalmoplegia
Ataxia
Confusion

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14
Q

Below the level of L1 - what’s the syndrome

A

Cauda equina due to bleed, tumour, compression due to lumbar disc disease

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15
Q

Features of cauda equina syndrome

A

Lower back pain
Shpincter distrubance
Saddle anaesthesia - numbnress betweet legs
Pain down leg and limbing gait

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16
Q

Sphincter distrubance - where is the pathology

A

Spinal cord

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17
Q
A

Lermitte’s phenomenon - on flexion of spine - associated with cervical lesions

18
Q

32 year old woman with acute onset of tingling in hands and feet. Heaviness in right leg and numb over left trunk. Several falls, bladder retention, electrical shock down spine on neck flexion.

A

MRI of brain and cervical spine

If lesion on spine alone - transverse myelitis
If brain and spine - MS

19
Q

Demyelination

A

Sub acute - over a few days
Age - middle aged

20
Q
A

Aquaporin 4 related disorders

21
Q

71 year old man with severe back pain, tingling in feet more than fingers, palpitations, weakness of legs and falls, progression over hours/days, mild bilateral facial weakness. Where is the pathology.

A

Peripheral nerves.

Autonomic dysfunction with palpitations, arrhythmias, gut abnormalities etc

22
Q

Peripheral nerve pathology causes

A

GBS
Peripheral neuropathies

23
Q

GBS signs

A

Weakness
Back pain
Sensory disturbance (pain)
Numbness
Flaccid tone, sinking into the bed, floppy

24
Q
A

Sensory signs but no symptoms - not really a problem

25
Q

What causes people to die with GBS?

A

Bulbar weakness - respiratory muscle weakness

26
Q

How do you measure lung function in someone with

A

Sats are an unreliable way of determining respiratory function in neuromuscular disorders
FVC - ensure good seal around tube, sit them up, best of three

27
Q

How do you investigate someone with GBS

A

Full cardiac (do ECG), respiratory, gastro exam (exclude ileus)

Protein raised in LP of GBS
If WCC raised in LP, suggests a virus mimicking GBS

28
Q

Management of GBS

A

IV Immunoglobulin

29
Q

48 year old person with eye lid drooping, double vision, difficulty coming hair, heavy legs on climbing stairs, swallowing difficulty, SOBOE. Where is the lesion and what could the pathology be.

A

Could be peripheral nerve motor neuropathies or NMJ problem

30
Q

Myasthenia gravis

A

Decrement on repetitive testing on EMG

31
Q

Myasthenia gravis mx ???

A

IVIG
Pyrostigmine to increase acetylcholine in NMJ

32
Q

Mild pain on eye movement, 17 year old with eye problem

A

Inflammatory condition in eye

33
Q

Eye symptoms worse after taking shower/drinking hot tea

A

Ootof’s phenomenon

34
Q

Over 50, headaches, tender scalp, jaw claudication, malaise, aching limbs

A

ESR - very high
CRP
Fibrinogen

35
Q

Management of giant cell arteritis

A

Temporal artery biopsy
Oral pred 60mg

36
Q
A
37
Q

Acute ptosis with eye looking up and out - mx

A

3rd nerve palsy

38
Q

What are you looking out for in third nerve palsy

A

Pupil involvement = dilated pupil - posterior communicating artery aneurysm

pupil sparing - microvascular third nerve palsies

39
Q

What is Horner’s syndrome

A
40
Q

52 year old with violent headaches and vomiting, passive and abulic, depressed, fatigue

A

Raised intracranial pressure causes -

41
Q

Abulia

A

flattened affect
loss of motivation
without mood changes (not depression)

42
Q
A

Final Year - Neuro (13 decks)

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