Neurological emergencies Flashcards
Give 5 common neurological emergency presentations.
- Coma
- Seizures
- Status epilepticus
- Headache
- Acute neuromuscular weakness
- Intra cranial infections
Define the following:
Seizure, Convulsion, Ictal period, Post-ictal period
Seizure - excessive abnormal neuron activity associated with alterations in sensory,
motor, autonomic, and/or cognitive function.
Convulsion - refers specifically to the motor manifestations of a seizure.
Ictal period -is the time during which a seizure or seizure-like activity occurs.
Post-ictal period -is an interval of altered mental status immediately following a seizure,
generally lasting less than 1 hour.
Define status epilepticus.
A single seizure lasting more than 5 minutes in length or two or more
seizures without recovery of consciousness (return to baseline)
between seizures.
What is the goal of management in status epilepticus? (5)
- Resuscitation
- Terminate seizure
- Decrease cerebral metabolic rate
- Diagnose and treat cause
- Treat complications
How do you manage status epilepticus? (6)
- Airway: Risk of aspiration, Recovery position, may need suction, adjuncts ±intubation
- Breathing: Give supplemental O2
- Circulation: Initial tachycardia giving way to hypotension (especially when Benzos or Barbiturates are given). IV infusion important
- Dextrose: Symptomatic hypoglycemia is causing irreversible brain injury until corrected
- Thiamine can be considered for alcoholics and he malnourished
- Diazepam 10mg iv stat, can be repeated in 15minutes if no response
- Lorazepam 1-2mg/midazolam 10mg can be considered if available
- If no response give phenorbarbitone 20mg/kg IV over 20min.
- Other medications that can be used instead of phenobarbitone are sodium valproate 15mg/kg IV over 5min or phenytoin 15mg/kg
over 30min - Consider ICU admission if no response to 2nd line anticonvulsants (phenorbabitone/sodium valproate/ phenytoin)
- Midazolam, propofol and thiopentone infusions can be given in this setting
- Watch for respiratory depression and hypotension when using these drugs
What things are important on the history for seizures? (4)
- Witness accounts
- History of prior seizures
- Presence of acute illness
- Past medical problems
- History of substance use
What things are important on physical examination for seizures? (3)
- Aim at finding possible cause
- Signs of trauma, nuchal rigidity, end organ injury
- Signs of pregnancy
- Subtle signs of seizures (tachycardia, pupil dilation and hippus, nystagmus,
irregular respirations)
Name 5 investigations you would do for seizures.
- Urea and Electrolytes including calcium, phosphorus
- CT of brain
- Toxicology screen
- Pregnancy test if woman is of childbearing age
- Lumbar puncture
Give 4 risk factors for subarachnoid hemorrhage.
- Age, smoking
- Hypertension
- Cocaine use
- Heavy alcohol use,
- Connective tissue disorders
- Sickle cell disease
- First degree relatives with aneurysms
Give 5 symptoms of subarachnoid hemorrhage.
- Cataclysmic thunderclap headache, “the worst headache of my life.”
- The onset of headache may be associated with exertion, the Valsalva maneuver
- The headache peaks in intensity within seconds to minutes.
- Associated signs/symptoms include syncope, nausea and vomiting, neck stiffness, photophobia, and seizures
How do you investigate for a subarachnoid hemorrhage? (2)
CT brain, LP
Define fatigue.
The inability to continue performing a task after multiple repetitions
Define primary weakness.
Inability to perform the task, the first time
Which investigations would you do for acute muscle weakness? (5)
- U&E,
- liver function test
- thyroid function may assist where cause unclear
- CSF - cells, protein, blood, culture if meningitis of GBS suspected
- Nerve conduction tests
- Creatine kinase
- Viral studies
How is acute muscle weakness treated? (4)
- Watch for respiratory failure
- Treatment of electrolyte imbalance, vitamin deficiencies, toxins and
drug withdraw or Correction of organ failure/treatment of systemic
illness may reverse weakness - Myasthenia – pyridostigmine 60mg, some require thymectomy
- Acute polymyositis - Corticosteroids
