neurological emergencies Flashcards by HARRY RICHARDSON

can alcohol withdrawal cause a seizure

yes

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rescue therapy for seizure

buccal midazolam - rohipnole ( date rape)

rectal diazepam

IV lorazepam ( diazepam )

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status epilepticus defintion

over 5 mins of continuous seizure
or over 3 discrete seizures between which there is an incomplete recovery of consciousness

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causes of status elipticus

structual brain injury
AED non compliance
withdrawal seizures
metabolic abnormalities
overdose of medication

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Ix for status epilepticus

IV acces
glcuse abd urea creatienn LFT electrolytes crp fbc and clotting and anticovulsant drug levels

CXR for aspriation
CT head if no previosu history
PMH and drug use

LP IF CNS infection or inflamation

refractory urgent CT head regardless

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provoked seizures causes

( predominately H) stroke
subdural , subarachnoid
HIE
brain abscess
meningitis or encephaltiis
neoplasma
vascular malforamation

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brugada syndrome in seizures -features

is herediatary

porlonged PR
RBBB
st segment raised

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tx for brugada

apceamke or defib

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mx of long QT

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drug induced long QT

antiarrhythmis
certain nosedating antihistamines
macrolide abx
certain psychotropic medications
certain gastric motility agents such as domperidone

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1st seziure driving

6 months - 1 years of no drive

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HGV 1st

10yr

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establish epilepsy driving

need to be seizure free for 12months

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withdrawal of tx

time to wean and 6 months

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SUDEP

sudden unexplained death in epilepsy

this risk is reduced with anti-convulsants

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ix for subarachnoid heamorrhage

Investigation
non-contrast CT head is the first-line investigation of choice
acute blood (hyperdense/bright on CT) is typically distributed in the basal cisterns, sulci and in severe cases the ventricular system.

if CT head is done within 6 hours of symptom onset and is normal
new guidelines suggest not doing a lumbar puncture!!!!!1

consider an alternative diagnosis
if CT head is done more than 6 hours after symptom onset and is normal
do a lumber puncture (LP)
timing wise the LP should be performed at least 12 hours following the onset of symptoms to allow the development of xanthochromia (the result of red blood cell breakdown).

xanthochromia helps to distinguish true SAH from a €˜traumatic tap’ (blood introduced by the LP procedure).
as well as xanthochromia, CSF findings consistent with subarachnoid haemorrhage include a normal or raised opening pressure

if the CT shows evidence of a SAH
referral to neurosurgery

After spontaneous SAH is confirmed, do find cause
CT intracranial angiogram (to identify a vascular lesion e.g. aneurysm or AVM)
+/- digital subtraction angiogram (catheter angiogram)

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coital headache - thunderclap headache

features

usually nake
during intercourse in orgasm
sudden severe occipital pain
self limiting

distinguidh grom subarachnoid bleed - spondylotic pain

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mx of coital headache

angiography
reassurance - prophylacitc NSAID

temporal arteritis fx

pain chewing in jaw or tongue
scalp pain or tender over temproal artery
headache one sided
fever or flu like sx
anameia
fatigue
loss of appetite and WL
swears
aches in joints and or muscles
vision loss

dx temproal arteritis

plasma viscosity - infalmmatory nmarker

temproal artery biopsy

horner syndrome fx

miosis
ptosis
enopthalmos
unliateral loss of sweating on forehead

hemiplegic migraine - emergency

fx and ix

aura - hemisensosry loss or weakness with same sided headache

familial

all need MRI and MRA( angiography) (OPD)

OPA - neurology to discuss

cluster headache - migrainous neuralgia fx

middle aged male
wakes at 2am
frontal and unilateral throbbing in eye nose water and runs
hroner syndrome
trigger

cluster headache tx

treatment is sumatriptan and lithium

raised ICP

mornings occipital eases later in day worse lying down visual blurrin and related to posture change

UMN

tone increased clonus brisk reflex plantar ext - same as baby pyramidal pattern weak - toned upper arm and weakened leg dissue atrophy

LMN

tone decreased fasiculations diminished absent reflexs plantar flexor or mute global weakness wasting

ASIA score

the American Spinal Injury Association Impairment Scale is a standardized neurological examination used by the rehabilitation team to assess the sensory and motor levels which were affected by the spinal cord injury.

anterior cord syndrome

loss of motor and loss of pain and temperature a supplied by anterior spinal artery preservation of proprioception

posterior cord syndrome what test

B12 and folate

b12 defiiciency

glossisits vibration sense lost paitent sways with eyes closed - romberg pernicious anamia

central cord syndrome

pain and temp loss both sides spastic paraparesis

glove and stocking distribution

diabetic neuropathy wasting of hand muscles - lower sensory etensoru ahllucis brevis wasting

distal symmetric polyneuropathy

diabetes b12 or folate drugs such as chemotherpa posotions cancer alcohol excess CKD injries infections such as shingles or HIV guillian barre connective tissue certian inflammtory condtions usch as sarcodiosis charcot marie tooth idiopathic

mononeuropathy

damage to nerve outside brain or spinal cord

mononeuritis multiplex - one nerve involved but many at once - just need to map out - could be ulnar axiallary and sacral

vasculitis diabetes polyarteriits sle amylodiisos direct tumour inovlement RA paraneoplastic syndrome

hot cross bun sign

MSA - cerebella changes ED early sign atonic features autonomic distrubance postural hypotension

cerebella dysfunction causes

vasc SOL alcohol etc

poker face

parkinsonian face hypomimia , no blinking

dyskinesia

involuntary, erratic, writhing movements of the face, arms, legs or trunk. can be seen in parkinsosn if overtreated with L dopa or if theve had a neural transplant

dystonic tremour - one particualr msucle in parkinsons how to treat

botulinum toxin

chorea patient

look like they are fidgeting

lambert eaton vs myasthenia

as they do more work they get better and stronger throghout the day myasthenia just get weaker need CT if get nothing on CT need to do a PET to go hunting for small cell lung cancer - so could reverse affect

what can cause seizures

fever, low blood glucose Abnormal levels of sodium or glucose in the blood. Brain infection, including meningitis and encephalitis. Brain injury that occurs to a baby during labor or childbirth. Brain problems that occur before birth (congenital brain defects) Brain tumor (rare) Drug abuse. Electric shock. Epilepsy.