Neurological emergencies Flashcards
5 key questions to answer in a neurological emrgency
Are there features of meningism?
Are there signs of raised ICP?
Are there any localising neurological signs?
Is the patient fitting?
Is there evidence of severe or progressive neuromuscular weakness?
What are the clinical features of meningism?
Headache, photophobia, neck stiffness, Kernig’s +Brudzinski’s
What is Kernig’s sign?
Inability to fully extend knee when hip flexed
What is Brudzinski’s sign?
Passive flexion of the neck causes flexion of thighs and knees
What are 4 features of raised ICP?
Headache
N + V
Papilloedema
6th nerve palsy
Pathophysiology of pailloedema?
ICP causes interruption of axonal flow in retinal ganglion axons as they pass across the optic disc. This causes axonal swelling and leakage of fluid into the extracellular space of the optic disc
How does raised ICP cause sixth nerve palsy? How does this maniffest?
Abducens has long intracranial course
Palsy paralyses the lateral rectus, so the eye on the affected side cannot move laterally beyond the midline
The pt will have horizontal diplopia most marked on extreme lateral gaze
Occipital lobe lesion presents with….
Hemianopia
Hemiparesis localises lesion to…
frontal lobe/internal capsule
Dysphasia localises to…
dominant frontal or temporal lobe
Unilateral sensory neglect localises to…
non-dominant parietal lobe
Cerebellar lesion presents with…
ataxia
Brain stem lesions present with ….
cranial nerve palsies
Spinal cord lesions present with….
sensory level and bilateral pyramidal signs
What are the two best prognostic indicators in neuromuscular weakness?
RR and FVC
