Neurological Emergencies Flashcards
What are neurological emergencies?
Life-threatening conditions that affect the central or peripheral nervous system, requiring immediate diagnosis and treatment to prevent death or permanent disability.
True/False: Neurological emergencies include only stroke and seizures.
False. They include a range of conditions like meningitis, encephalitis, GBS, and more.
______ is a neurological emergency caused by the sudden interruption of blood supply to the brain.
Stroke
Name three common neurological emergencies.
Stroke, status epilepticus, and acute bacterial meningitis.
True/False: Guillain-Barré Syndrome can be classified as a neurological emergency
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What are the two main types of stroke?
Ischaemic stroke and haemorrhagic stroke.
The initial treatment for ischaemic stroke is ______ within the first 4.5 hours.
Thrombolysis (e.g., alteplase).
True/False: Haemorrhagic stroke requires immediate anticoagulation therapy.
False. It requires blood pressure control and neurosurgical intervention if necessary.
Define status epilepticus.
A seizure lasting more than 5 minutes or recurrent seizures without recovery in between
First-line treatment for status epilepticus includes ______ or ______ administered intravenously.
Lorazepam; diazepam.
True/False: Status epilepticus can lead to permanent brain damage if untreated.
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What is the first-line antibiotic treatment for suspected bacterial meningitis in adults?
IV ceftriaxone or cefotaxime, often with dexamethasone.
The classic triad of meningitis includes fever, ______, and altered mental status.
Neck stiffness.
True or false : A lumbar puncture should always be performed before starting antibiotics in suspected meningitis.
False. Antibiotics should not be delayed if meningitis is strongly suspected.
What are signs of raised ICP?
Headache, vomiting, papilledema, and decreased consciousness.
______ posturing is a late sign of raised ICP and indicates severe brain injury.
Decerebrate.
True/False: Mannitol and hypertonic saline are used to manage raised ICP.
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What is the most common cause of viral encephalitis?
Herpes simplex virus (HSV).
Treatment for HSV encephalitis is intravenous ______.
Acyclovir.
True/False: Lumbar puncture is contraindicated in all cases of encephalitis.
False. It is contraindicated only if there are signs of raised ICP.
What is the first-line treatment for GBS?
IV immunoglobulin (IVIG) or plasma exchange.
In GBS, ascending weakness and ______ are common clinical features.
Areflexia.
What neurological emergencies can cause acute respiratory failure?
Guillain-Barré Syndrome, myasthenic crisis, and motor neuron disease.
True/False: Non-invasive ventilation is always sufficient in cases of neuromuscular respiratory failure.
False. Intubation and mechanical ventilation may be required.
What are red flag symptoms in neurological emergencies?
Sudden severe headache, new focal neurological deficits, altered consciousness, and seizures.
Sudden-onset “thunderclap” headache is a key symptom of ______ haemorrhage.
Subarachnoid.
True/False: Any patient with acute neurological deficits and fever should be assessed for meningitis or encephalitis.
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How is coma defined?
A prolonged state of unconsciousness, typically with a Glasgow Coma Scale (GCS) score of less than 8.
List common causes of coma.
Drugs/toxins (e.g., opiates, alcohol).
Anoxia (post-cardiac arrest).
Head injury.
Stroke (e.g., brainstem infarcts).
Infections (e.g., meningitis, HSE).
Metabolic (e.g., hypoglycemia, DKA).
What are the key clinical features of SAH?
Thunderclap headache (“worst headache of my life”).
Nausea, vomiting.
Meningism.
Altered neurology or loss of consciousness.
Sentinel headache (in some cases).
How does CT sensitivity for detecting SAH vary over time?
Within 6 hours: 98%.
Within 24 hours: 90%.
At 7 days: 50%.
What are the clinical features of GBS?
Ascending weakness.
Areflexia.
Cranial nerve involvement (e.g., bifacial weakness).
Respiratory and autonomic dysfunction.
GBS is characterized by _________ dissociation in CSF, with elevated _________ and no cells.
cyto-protein; protein.
What are the primary treatment options for GBS?
IV immunoglobulin (IVIG).
Plasma exchange.
: What are key investigations for neurological emergencies?
Bloods: glucose, U&Es, ABG, toxicology.
Imaging: CT, MRI.
Lumbar puncture (e.g., for SAH or infection).
EEG (e.g., for seizures).
Scenario: A 63-year-old woman develops a severe occipital headache, nausea, and vomiting, with right ptosis and diplopia on upward gaze. What is the likely diagnosis?
SAH with third nerve palsy.
A 32-year-old woman presents with ascending weakness and areflexia after diarrhea. CSF shows high protein with no cells. What is the diagnosis?
Guillain-Barré Syndrome.
A 25-year-old man experiences status epilepticus after nightclub drug use. MRI shows posterior white matter changes. What is the diagnosis?
PRES (Posterior Reversible Encephalopathy Syndrome).
What are the red flags in neurological emergencies?
Sudden severe headache.
Loss of consciousness.
Acute onset weakness.
Seizures or status epilepticus.
Respiratory or autonomic compromise.
Neuromuscular respiratory failure is a critical component of emergencies caused by conditions like _________, _________, and _________.
Myasthenia Gravis (MG); Guillain-Barré Syndrome (GBS); Motor Neuron Disease (MND).
True/False: Ptosis is a typical feature of Guillain-Barré Syndrome.
False
A 25-year-old woman presents with a 2-week history of double vision, dysarthria, and dysphagia. Examination shows mild dysarthria and ptosis, with no other neurological deficits. What is the likely diagnosis?
Myasthenia Gravis.
True/False: Mebeverine and other anticholinergic drugs should be avoided in MG.
true.
What are the key investigations for MG?
Bloods for ACh receptor and MuSK antibodies.
CT chest for thymoma.
Nerve conduction studies (NCS) or EMG (ideally before treatment).
What is the management plan for generalized MG?
Pyridostigmine (starting at 30mg QID, increasing as needed).
Steroids with bone protection (gradually increased dose).
IVIG or plasma exchange in severe cases.
Early treatment of infections.
A 48-year-old man presents with progressive lower limb weakness over a week, with back pain and tingling in his feet. Examination shows MRC grade 4/5 power in a pyramidal distribution, absent reflexes, and decreased sensation in the feet. What is the likely diagnosis?
Guillain-Barré Syndrome.
GBS often shows _________ dissociation in CSF, characterized by elevated _________ and few or no cells.
cyto-protein; protein.
What are the signs of autonomic instability in GBS?
Tachycardia or bradycardia.
Hypertension or hypotension.
Arrhythmias.
True/False: MRI is always abnormal in GBS.
False (MRI may be normal).
What is the first-line treatment for GBS?
IVIG.
Monitor FVC, pulse, and blood pressure.
Supportive care for respiratory and autonomic instability.
A GBS patient with worsening weakness develops tachycardia (150 bpm), BP 240/130, and an FVC of 1.2L. What should be done?
Transfer to ITU for respiratory and autonomic management.
In MND, non-invasive _________ is often preferred over invasive ventilation due to the progressive nature of the disease.
BiPAP.
Low _________ with high suspicion for neuromuscular emergencies requires early _________ referral.
FVC; ITU.
A 71-year-old woman with bulbar MND presents with worsening shortness of breath. Examination reveals mixed UMN and LMN signs, crackles at the right lung base, and O₂ saturation of 87% on air. What is the likely cause?
Respiratory failure, possibly due to infection and hypoventilation.
What are key components of managing respiratory failure in MND?
Oxygen and treatment of infections.
Non-invasive ventilation (BiPAP).
Avoidance of ITU in advanced cases.
What is the key investigation for assessing respiratory weakness in neuromuscular emergencies?
Forced Vital Capacity (FVC).
True/False: IVIG and plasma exchange are equally effective in treating GBS and severe MG.
true
