Neurological Emergencies Flashcards
What is status epilepticus?
Seizures lasting > 30 min or repeated seizures without intervening consciousness
What are differentials of status epilepticus?
- Epilepsy
- Structural brain lesion
- Eclampsia
What is the first line treatment for status epilepticus?
IV lorazepam (~4mg)
What do you do if there is no response to IV lorazepam in status epilepticus after 10-20 min?
Give a second dose
For which medication and when can you use the rectal route in status epilepticus?
Diazepam - if IV access is difficult
What is the first line treatment for status epilepticus if IV access is unavailable e.g. in the community?
Buccal midazolam 10mg
What is second line treatment for status epilepticus if second dose of IV lorazepam or buccal midazolam doesn’t work and fits continue?
IV Phenytoin infusion (1-2g) (100mg/6-8h is maintenance dose) - requires BP and ECG monitoring
When can you not use phenytoin?
If bradycardic or heart block (can decrease BP)
How do you treat status epilepticus if phenytoin doesn’t work?
ICU - paralysis and anaesthesia e.g. with propofol is required
How do you treat status epilepticus if vasculitis/cerebral oedema (tumour) is possible?
IV Dexamethasone 10mg
What would a first, worst thunderclap headache indicate?
Subarachnoid haemorrhage
What are the two differentials of a unilateral headache and eye pain?
- Cluster headache
- Acute glaucoma
What would a headache which is cough-initiated or worse in the morning or bending forward indicate?
- Raised ICP
- Venous thrombosis
What are the differentials of papilloedema?
1) Tumour
2) Venous sinus occlusion
3) Malignant hypertension
4) Idiopathic intracranial hypertension
5) Prolonged CNS infection e.g. TB meningitis
What is the most common cause of a subarachnoid haemorrhage?
Berry aneurysm rupture
