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Yr3/4 and Yr 5Neuro > neurological emergencies > Flashcards

neurological emergencies Flashcards

1
Q

can alcohol withdrawal cause a seizure

A

yes

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2
Q

rescue therapy for seizure

A

buccal midazolam - rohipnole ( date rape)

rectal diazepam

IV lorazepam ( diazepam )

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3
Q

status epilepticus defintion

A

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

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4
Q

causes of status elipticus

A

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

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5
Q

Ix for status epilepticus

A

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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6
Q

provoked seizures causes

A

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

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7
Q

brugada syndrome in seizures -features

is herediatary

A

porlonged PR
RBBB
st segment raised

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8
Q

tx for brugada

A

apceamke or defib

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9
Q

mx of long QT

A

BB

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10
Q

drug induced long QT

A

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

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11
Q

1st seziure driving

A

6 months - 1 years of no drive

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12
Q

HGV 1st

A

10yr

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13
Q

establish epilepsy driving

A

need to be seizure free for 12months

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14
Q

withdrawal of tx

A

time to wean and 6 months

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15
Q

SUDEP

A

sudden unexplained death in epilepsy

this risk is reduced with anti-convulsants

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16
Q

ix for subarachnoid heamorrhage

A

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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17
Q

coital headache - thunderclap headache

features

A

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

distinguidh grom subarachnoid bleed - spondylotic pain

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18
Q

mx of coital headache

A

angiography
reassurance - prophylacitc NSAID

19
Q

temporal arteritis fx

A

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

20
Q

dx temproal arteritis

A

plasma viscosity - infalmmatory nmarker

temproal artery biopsy

21
Q

horner syndrome fx

A

miosis
ptosis
enopthalmos
unliateral loss of sweating on forehead

22
Q

hemiplegic migraine - emergency

fx and ix

A

aura - hemisensosry loss or weakness with same sided headache

familial

all need MRI and MRA( angiography) (OPD)

OPA - neurology to discuss

23
Q

cluster headache - migrainous neuralgia fx

A

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

24
Q

cluster headache tx

A

treatment is sumatriptan and lithium

25
Q

raised ICP

A

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

26
Q

UMN

A

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

27
Q

LMN

A

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

28
Q

ASIA score

A

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.

29
Q

anterior cord syndrome

A

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

preservation of proprioception

30
Q

posterior cord syndrome what test

A

B12 and folate

31
Q

b12 defiiciency

A

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

32
Q

central cord syndrome

A

pain and temp loss both sides
spastic paraparesis

33
Q

glove and stocking distribution

A

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

34
Q

distal symmetric polyneuropathy

A

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

35
Q

mononeuropathy

A

damage to nerve outside brain or spinal cord

36
Q

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

A

vasculitis
diabetes
polyarteriits
sle amylodiisos
direct tumour inovlement
RA
paraneoplastic syndrome

37
Q

hot cross bun sign

A

MSA - cerebella changes

ED early sign
atonic features
autonomic distrubance
postural hypotension

38
Q

cerebella dysfunction causes

A

vasc
SOL
alcohol

etc

39
Q

poker face

A

parkinsonian face hypomimia , no blinking

40
Q

dyskinesia

A

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

41
Q

dystonic tremour - one particualr msucle in parkinsons how to treat

A

botulinum toxin

42
Q

chorea patient

A

look like they are fidgeting

43
Q

lambert eaton vs myasthenia

A

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

44
Q

what can cause seizures

A

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.

Yr3/4 and Yr 5Neuro (9 decks)

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