neurological emergencies Flashcards
can alcohol withdrawal cause a seizure
yes
rescue therapy for seizure
buccal midazolam - rohipnole ( date rape)
rectal diazepam
IV lorazepam ( diazepam )
status epilepticus defintion
over 5 mins of continuous seizure
or over 3 discrete seizures between which there is an incomplete recovery of consciousness
causes of status elipticus
structual brain injury
AED non compliance
withdrawal seizures
metabolic abnormalities
overdose of medication
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
provoked seizures causes
( predominately H) stroke
subdural , subarachnoid
HIE
brain abscess
meningitis or encephaltiis
neoplasma
vascular malforamation
brugada syndrome in seizures -features
is herediatary
porlonged PR
RBBB
st segment raised
tx for brugada
apceamke or defib
mx of long QT
BB
drug induced long QT
antiarrhythmis
certain nosedating antihistamines
macrolide abx
certain psychotropic medications
certain gastric motility agents such as domperidone
1st seziure driving
6 months - 1 years of no drive
HGV 1st
10yr
establish epilepsy driving
need to be seizure free for 12months
withdrawal of tx
time to wean and 6 months
SUDEP
sudden unexplained death in epilepsy
this risk is reduced with anti-convulsants
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)
coital headache - thunderclap headache
features
usually nake
during intercourse in orgasm
sudden severe occipital pain
self limiting
distinguidh grom subarachnoid bleed - spondylotic pain
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.
