neurology Flashcards
meningitits causes
most common is viral
bacterial
- neonates: listeria, group B strep
- children: H. influenzae, meningococcal, pneumococcal
meningitis general presentation
- fever
- lethargy
- confusion
- seizures
- difficult feeding
- bulging fontanelles
- nausea, vomiting, abdominal pain
meningitis septic presentation
- fever
- tachypnoea
- cold peripheries
- tachycardia hypotension
- change in skin colour (pale)
- rash (may/may not be a non-blanching purpuric rash)
meningitis meningeal presentation
- tend to be the last symptoms to present
- photophobia
- neck stiffness
- Kernig’s sign (resistance to knee extension when hip is flexed)
meningitis diagnosis
- urine analysis (mid-stream sample of urine)
- FBC, CRP, glucose, culture, meningococcal PCR
- meningococcal PCR should always be sent off and can be used as an alternative for blood cultures
- lumbar puncture (unless meningococcal septicaemia)
meningitis management
- IM benzylpenicillin
- if under 3 months: cefotaxime and amoxicillin
- if > 3 months: 1 dose cefotaxime, daily doses of ceftriaxone (possibly with dexamethasone)
infective encephalitis causes
- herpes simplex is most common
- mumps
- varicella zoster
- parovirus B19
infectvie encephalitis presentation
as per meningitis but with odd behaviour and viral prodrome
infective encephalitis diagnosis
- as per meningitis
- MRI: bilateral temporal lobe focus (HSV encephalitis)
infective encephalitis management
IV acyclovir
what are febrile convulsions
- infantile seizures that develop as a consequence of a febrile illness
defined by presence of the following features:
- occurs after 1 month of age
- no previous neonatal or unprovoked seizures
- not meeting criteria for other acute diagnoses
- associated with a febrile illness that isn’t CNS in nature
simple febrile convulsion presentation
- generalised tonic-clonic seizure that lasts under 5 minutes
- complex recovery of consciousness within 1 hour
complex febrile convulsion presentation
- focal onset
- lasts > 10 minutes
- recurrent seizures in the one febrile illness (multiple in 24 hours)
febrile convulsion red flags
- under 2 years
- complex seizures
- drowsiness or altered loss of consciousness > 1 hour
- presence of neurological deficit > 1 hour
- history of irritability, lethargy, being off food
- signs of meningism: bulging fontanelles, neck stiffness, photophobia, focal neurological signs
febrile convulsion management
- stay calm
- don’t restrain child
- protect child from any harm
- check in their mouth
- once seizure has stopped, check airway is open and put them in recovery position
- following a seizure a child may be sleepy for about an hour
- rectal or buccal midazolam (should be given if seizure lasts > 5 minutes)
