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4. Senior Block- Special Senses > Neurology > Flashcards

Neurology Flashcards

1
Q

At what value is intracranial pressure considered raised?

A

> 20 mmHg

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2
Q

Give 3 physiological things that alter the intracranial pressure

A 
Valsalva 
Sneezing 
Coughing 
Leaning forward 
Lying flat
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3
Q

Give 4 pathological causes of raised intracranial pressure

A 
Idiopathic 
CNS inflammation or infection 
Intracranial haemorrhage 
Hyponatraemia 
Intracranial tumour 
Elevated venous pressure 
Hydrocephalus 
Epilepsy
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4
Q

What is Cushing’s Triad?

A

Hypertension
Bradycardia
Irregular breathing

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5
Q

Why does Cushing’s triad occur in raised intracranial pressure?

A

Decreased cerebral perfusion pressure will result in a compensatory rise in BP to increase the blood to the brain.
The increase in BP activates the parasympathetic system (Vagus Nerve) and causes the heart rate to drop.
Increased pressure on the brainstem causes irregular breathing

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6
Q

What is cerebral herniation?

A

As pressure rises in the cranium brain tissue is pushed out of the cranium which results in damage and ischaemia

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7
Q

What is coning?

A

Compression of the brainstem

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8
Q

What is a subfalcine herniation?

A

Displacement of the cingulate gyrus under the falx cerebri which results in hydrocephalus and hemiparesis

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9
Q

What is Uncal herniation?

A

Uncus of temporal lobe herniates under the tentorium cerebelli which results in a fixed, dilated pupil and contralateral homonymous hemianopia

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10
Q

What is tonsillar herniation?

A

Cerebellar tonsils herniate through the foramen magnum which results in reduced consciousness, decerebrate posturing, apnea, impaired circulation and death

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11
Q

Give 5 clinical features of raised intracranial pressure

A 
Cushing's triad
Decreased consciousness
Headache 
Vomiting
Diplopia 
Papilloedema
Behavioural changes
Infants= bulging fontanelle
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12
Q

What investigations can be done if raised intracranial pressure is suspected?

A

CT
MRI
Ocular sonography
Intraventricular ICP monitoring (high risk patients)

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13
Q

How is raised intracranial pressure managed acutely?

A 
A-E resuscitation
Head elevation 
IV mannitol 
Sedation 
Analgesia 
Antipyretics 
Antiseizure medications
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14
Q

How is raised intracranial pressure managed in the longer term?

A 
Position head up 
Keep patient euvolemic 
Encourage hyperventilation 
Osmotic diuretics (IV Mannitol) 
Treat the cause- brain tumour removal, cerebral shunt, decompressive craniotomy
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15
Q

What is brain death?

A

Irreversible complete loss of function of the entire brain

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16
Q

What is cerebral oedema?

A

Excess fluid within the brain parenchyma as a result of damage to the blood-brain barrier

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17
Q

Give 3 predisposing factors for a subarachnoid hemorrhage

A 
Smoking 
Hypertension 
Alcohol excess 
Family history 
Cocaine use
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18
Q

Give 3 pathological mechanisms for a subarachnoid hemorrhage

A

Traumatic
Ruptured berry aneurysm in circle of Willis
Ruptured AV malformation

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19
Q

Give 3 triggers for a non-traumatic subarachnoid hemorrhage

A

Caffeine
Acute anger
Physical exercise

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20
Q

What are the consequences of a subarachnoid hemorrhage?

A

Secondary ischaemic stroke due to raised ICP and release of clotting factors and vasoactive substances

Raised ICP –> Cushing’s triad

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21
Q

Give 3 clinical features of a subarachnoid hemorrhage

A

Severe headache in the week prior
Sudden, severely painful headache (Thunderclap)
Meningism- stiff neck, photophobia, N+V
Impaired consciousness
Fever
Mass effects- CN palsy, psychiatric symptoms, seizures

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22
Q

How is a potential subarachnoid hemorrhage investigated?

A

Non enhanced CT head
LP (raised RBCs, WBCs and protein)

To find the cause:
CT angiography
Digital subtraction angiography (DSA)

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23
Q

How is a subarachnoid hemorrhage managed acutely?

A 
Bed rest
Analgesia
IV fluids 
Reverse anticoagulation 
Control BP 
Prevent vasospasm (Nimodipine) 
Seizure prophylaxis
24
Q

Give 2 definitive treatments for subarachnoid hemorrhage

A

Endovascular coiling

Surgical clipping

25
Q

Give 3 potential complications of a subarachnoid hemorrhage

A 
Vasospasm 
Rebleeding 
Hydrocephalus 
Seizures 
SIADH
26
Q

What is the definition of status epilepticus?

A

Continuous seizure for >5 minutes or >2 seizures with consciousness not being fully regained in the interictal period.

27
Q

Give 3 causes of status epilepticus

A 
Withdrawal from antiepileptics
Hyponatraemia 
TCA use 
Tumours 
Stroke 
CNS infection
28
Q

How is status epilepticus managed?

A

Recovery position plus A-E
IV access- U+Es, FBC, glucose, toxicology, antiepileptic levels, ABG
O2 therapy if needed
Monitor O2 stats

1st line= IV Lorazepam
2nd line= IV Diazepam
If no IV access, use PR diazepam or buccal lorazepam

29
Q

Give 3 complications of status epilepticus

A 
Death 
Cerebral oedema 
Rhambdomyolysis 
Hyperthermia 
Cerebral CV failure 
Intracerebral haemorrhage
30
Q

What is cauda equina?

A

Terminal spinal nerve root compression in lumbosacral region

31
Q

Give 3 causes of cauda equina

A 
Spinal tumours 
Slipped disc 
Trauma 
Spinal stenosis 
Spinal epidural haematoma
Epidural abscess
32
Q

Give 4 features of cauda equina

A 
Back pain 
Saddle anaesthesia
Impotence
Sensory motor loss 
Neurogenic bladder dysfunction 
Muscle atrophy of lower limbs 
Decreased rectal tone
33
Q

How is cauda equina investigated?

A

MRI Spine

CT Myelography

34
Q

How is cauda equina managed?

A

Urgent surgical decompression within 48 hours

35
Q

What is the difference between an open and closed head injury?

A 
Closed= dura mata intact 
Open= dura mata injured
36
Q

What is the difference between a primary and secondary head injury?

A 
Primary= acute physical injury 
Secondary= pathology induced by inflammation after the primary injury
37
Q

What is a acceleration-deceleration trauma?

A

Seen in high impact injuries
Shearing, strain and compression of the cerebral contents

Coup= injury on side of injury 
Countercoup= injury on opposite side of injury
38
Q

Give 4 clinical features seen in a head injury

A 
Headache 
Amnesia
Confusion 
Dizziness 
Nausea and vomiting 
Focal deficit 
Cushing's triad
Seizures
Post concussion syndrome
39
Q

Give 3 signs of a basilar skull fracture?

A 
CSF rhinorrhoea 
Halo sign 
Hemotympanum 
Subcutaneous haematoma behind the ear 
CSF otorrhoea 
CN palsy
40
Q

What investigations should be done in someone presenting with a head injury?

A

Cranial CT
GCS Score
CT angiography
Survey x-ray

41
Q

How is a head injury managed?

A 
Fluids 
Pain relief
BP management 
Intubate if GCS <8 
Monitor temperature, blood glucose, CPP and ICP
Prevent seizures and secondary infections and secondary bleeding 
Superficial debridement
Closure of dura 
Removal of haematomas
42
Q

Where does an extradural haematoma collect?

A

Extradural space- between the dura and the skull

43
Q

What is the typical history of an extradural haematoma? What complications will it result in?

A

Low impact trauma will cause a bleed and the patient will lose consciousness. Lucid interval and then decline in consciousness.

Mass effect on the brain causes uncal herniation and a fixed dilated pupil due to a CNIII palsy.

44
Q

Is an extradural haematoma made up of venous or arterial blood?

A

Arterial

45
Q

How does an extradural haemorrhage present on a CT scan?

A

Bright biconvex collection

Lemon shaped

46
Q

How is an extradural haematoma managed?

A

Craniotomy + evacuation of haematoma

47
Q

What is an acute subdural haemorrhage and how does it present?

A

Fresh collection of blood under the layer of the dura mater.

Caused by high speed collisions, acceleration-deceleration injuries or AV malformations. Can present anywhere between asymptomatic and comatosed.

48
Q

What does an acute subdural haemorrhage look like on a CT scan?

A

Bright crescent-shaped collection

Banana

49
Q

How is an acute subdural haemorrhage treated?

A

Decompressive craniotomy

50
Q

Give 3 patient groups who are more likely to have a chronic subdural haemorrhage

A

Elderly
Infants
Alcoholics
Patients on anticoagulation

51
Q

How does a chronic subdural haemorrhage present?

A 
Presents several weeks after a head injury 
Loss of consciousness 
Confusion 
Weakness 
Cortical dysfunction
52
Q

What does a chronic subdural haemorrhage look like on a CT scan?

A

Dark crescent-shaped collection, not limited by suture lines

53
Q

How is a chronic subdural haematoma managed?

A

Burr-Hole drainage

54
Q

What is an intracerebral haemorrhage?

A

Collection of blood within the brain substance. Caused by hypertension, aneurysm, AV malformation or a brain tumour.

55
Q

What does an intracerebral haemorrhage look like on a CT scan?

A

Bright hyperdensity within the brain substance

4. Senior Block- Special Senses (4 decks)

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