Neurology 1 Flashcards
Range of the glasgow coma scale?
3-15 ( 15 most consciousness)
way to asses level of consciousness?
AVPU alert verbal pain unresponsive
Structural causes of impaired consciousness?
internal
external
Global failure causes of impaired consciousness?
metabolism
infection
drugs/alcohol
seizures
external causes?
head injury most common
trauma
internal causes?
vascular - stroke - ischaemic/haemorrhagic
tumour - benign/primary/secondary
abscess
Metabolism causes?
hypoglycaemia liver/renal failure hypoxia hyperaepnia hypornatraemia hypercalcaemia hyperthyroidism hypotension
Infection causes?
of brain - encephalitis, meningitis, malaria/other tropical diseases
of body - any other severe infection e/g pneumonia
drug causes?
opiates
alcohol
recreational drugs
overuse of sedative meds
what causes seizures/epilepsy?
excess electrical activity
pt has impaired consciousness, how to act?
ABCDE
identify and treat cause
what is epilepsy?
excessive electrical discharges in the brain
types of seizures?
focal/partial seizures - depends on what part of brain affected
generalised seizures - whole brain affected
simple focal seizures are?
shaking on one side
complex partial seizures are?
temporal lobe related
auras - olfactory hallucinations followed by odd behavious - automatisms
generalised seizures are usually?
grand mal/tonic clonic tonic phase - limbs stiffen clonic phase - limbs shake may be incontinence, tongue biting, cyanosis headache drowsy after
what are petit mal seizures?
type of generalised
- absence seizures - children- stare into space for 10 secs
- myoclonic - limbs jerk and collapse
- atonic - limbs collapse
primary causes of epilepsy?
often hereditaty involvement
secondary causes of epilepsy?
structural damage
- acute/chronic - b/c stroke,tumour, injury, meningitis
- metabolic - electrolyte disturbance, alcohol withdrawl, hypoglycaemia. always check blood sugar
investigations for epilepsy?
blood tests
brain imaging - MRI
electroencephalogram EEG
drug tx of epilepsy?
phenytoin
carbamazepine
sodium valproate
surgical tx of epilepsy?
tumour removal, arteriovenous malformations, poorly controlled primary epilepsy
avoid treating epileptic pt when?
epilepsy poorly controlled
divisions of headaches?
primary headache disorders
secondary headache disorders - associated with mortality/permanent disability
red flags with headaches?
-severity - sudden onset
-raised intracranial pressure - worsening on positional change/strain, present on waking, nausea/vomitting
-focal neurology
-visual changes
-impaired consciousness/confusion
-meningism, fever, rash
associated with cancer or HIV
types of primary headaches?
tension migraines cluster medication overuse trigeminal neuralgia
what is a tension headaches?
stress related - tight band symmetrical around head
chronic, gradual onset
worse at end of day
treatment of a tension headache?
concentional analgesics
tricyclic antidepressants for prophylaxis
what is a migraine?
temporary reduction in blood flow then compensatory excess blood flow
8% more common in females
migraine triggers?
often none or
wine, cheese, chocoalte, OCP, premenstrual, anxiety, exercise, fasting, sleep deprivation
features of a migraine?
pre headache aura for 15 mins - usually visual
headache within one hour
one side throbbing, nausea, vomitting, photophobia
treatment of a migraine?
acute - analgesia, metoclopramide. serotonin antagonists
prevention of migraines?
anti epileptics
beta blockers
amitryptiline
avoidance of triggers
what is a cluster headache?
dilation of superficial temporal artery
most common in male smokers
rapid onset
episodic -
medication overuse headache?
chronic headaches
opiates/triptans = most risky
what are trigeminal neuralgia headaches?
intense stabbing pain 10/10 severity
precipitated by touch - shaving, washing,talking
paroxysmal = spontaneous
tx with carbamazepine
increased intracranial pressure caused by?
tumours
non traumatic bleeds
hydrocephalus = drainage problem - trauma, bleed, tumour, infection, abscess
diagnose raised intracranial pressure with?
CT scan
what is bacterial meningitis?
contact spread, common in infancts, adolescents, young adults
pneumococcal - babies and elderly
haemophilius - babies and infants
feautures of bacterial meningitis?
impaired consciousness meningism \+/- rash drowsy photophobia
diagnose meningitis with?
lumbar punctures
blood cultures
treatment of bacterial meningitis?
empirical antibiotics if suspected in the community
hospital
prophylaxis for contacts
what is enchepalitis?
inflammation of brain parenchyma
by viral infection - herpes simplex, varicella zoster, rabies
symptoms of enchepalitis?
impaired consciousness, personality change, meningism, seizures
diagnose enchepalitis?
lumbar puncture, ECG
treat encheplalitis?
antivirals, hospital
abscess caused by?
staphylococci/streptococci
ostitis media/mastoidosis, sinusitis, infections, trauma
abscess can cause?
raised intracranial pressure
how to diagnose an abscess?
CT/MRI
biopsy
Non traumatic bleed divisions?
SAH - sub arachnoid hemorrhage
ICH - intracerebral hemorrhage
what is a SAH?
blood in the sub arachnoid space
70% rupture - congenital berry aneurysm
15% rupture - anteriovenous malformation
15% = no cause
SAH incidence?
between 35-65 years
15 per 100 000
SAH symptoms?
sudden severe headache
often occipital
vomit/collapse/drowsy
SAH diagnosed how?
CT scan +/- angiography to see aneurysm
lumbar puncture in necessary
how to prevent re bleed?
surgery - clip
coils
poss. residual disability
what is an intercerebal heamorrhage?
directly into brain tissue
associated with hypertension - charcot bouchard aneurysms
symptoms of intercerebral haemorrhage?
increased intracranial pressure
focal neurology
not always headaches
how to diagnose ICH?
imaging
how to tx ICH?
surgery
rehabillitation
what is giant cell arteritis?
rare under 55 years old scalp tenderness jaw claudication loss of vision risk of blindness, stroke, death
tests for giant cell arteritis?
ESR, PV, temporal artery biopsy
tx giant cell arteritis?
high dose prednisolone, immediately
what is glaucoma?
common in elderly constant ache around eye reduced vision nausea and vomitting red congested eye, dilated, non reactive pupil
tx gluacoma?
urgent opthamology ref
