Neurology Flashcards
1
Q
American Spinal Injury Association impairment scale
A
complete (Grade A)
- complete sensory and motor deficit below lesion level
- in acute
- > reflexes are absent
- > no plantar response
- > tone is flaccid
- males may have priapism
- urinary and retention may occur
incomplete
- Grade B
- > sensory incomplete
- > loss of motor but not sensory below lesion level
- Grade C and D
- > both motor incomplete
- > vary by how many muscle groups remain >3+
2
Q
Central cord syndrome
A
- lesion encroaching on medial corticospinal tract/anterior horn gray matter
- > medially placed fibres disproportionately affected
- > greater weakness in arms than legs
- arching reflex fibres are disrupted
- > loss of reflexes below level
- disruption of crossing spinothalamic fibres
- > loss of pain/temp for adjacent dermatomes
- > retained above and below
- proprioception and vibration sense often spared
- urinary retention may occur
3
Q
Anterior cord syndrome
A
- injury to anterior spinal artery by retropulsed disc/bone fragment
- > loss of anterior two thirds of spinal cord tracts
- corticospinal
- > weakness and reflex changes
- spinothalamic
- > bilateral pain and temp loss
- autonomic tract
- > urinary incontinence
- gracile/cuneate tracts spared
- > retained touch, vibration, proprioception
4
Q
Spinal injury assessment
A
ABCD
-priority may be given to other life threatening injuries
Spinal precautions
- NSAID
- > neurological deficit
- > spinal pain
- > altered GSC
- > intoxication
- > distracting injury (extremity fracture)
- precautions
- > rigid cervical collar
- > log roll
- > spinal board
- > can use straps and blocks
- removing precautions
- > non of above criteria
- > full range of neck movement
Imaging
- not required for people with no NSAID criteria
- axial CT first line
- > superior to xray
- > poor with soft tissue injury
- MRI
- > when suspected soft tissue injury
- flexion extension Xray
- > when CT clear
- > suspicion of ligament damage and dynamic instability
5
Q
chronic complications of c spine injury
A
C-Spine PINBOARDS
- cardiac
- > arrhythmias
- > MI
- spasticity
- pneumonia
- immobility
- > DVT
- > pressure ulcers
- neuropathic pain
- bowel and bladder dysfunction
- osteoporosis
- autonomic dysreflexia
- resp failure
- > dyspnea
- > reduced exercise tolerance
- depression
- sexual dysfunction
6
Q
Clinical assessment of SAH
A
ABCDEFG
- AB = need for cardiorespiratory support
- C= heart rate and rhythm
- D= GCS, pupils (terson’s syndrome is vitreous haemorrhage with subarachnoid)
Hx
Presentation
- thunderclap “worst of life” headache
- onset with sex, emotions, exercise
- nausea and vom
- decreased level of consciousness
- meningismus
- neurological deficits
- seizure activity
- photophobia
Past medical sentinel bleed risk factors -previous bleed -family hx -smoking -heavy alcohol -hypertension -polycystic kidney disease -connective tissue disease -simpathomimetic drugs -anti-coags/anti-platelets
Exam:
Full neurological
- GCS
- focal deficits
- meningismus
- CNIV/CNVI palsy
Dilated pupil
- Torsens (=worse prognosis)
- papilloedema
7
Q
investigations SAH
A
Bedside:
-ECG (prolonged QT, ST segment abnorm)
Bloods:
- FBC (leukocytosis, platelets)
- Coags (associated coagulopathy)
- Trops (associated with higher mortality. seen inabsence of coronary artery disease)
- EUCs (hyponatraemia)
Imaging:
- CT brain (good sensitivity and specificity, decreases overtime)
- LP if CT normal: RBC count, clearing of blood from tubes 1-4, xanthochromia
8
Q
investigations TBI
A
Bedside:
- glucose
- opthalmoscope (papiloedema)
Bloods:
- FBC (anaemia, platelets)
- Coags
- EUC (renal function for investigations)
- LFTS (baseline, coag)
Imaging:
-CT non con
LP contraindicated with suspected ICP
9
Q
grading scale SAH
A
Hunt and Hess (looks at symptoms and motor deficit)
- grades 1-5
- asymptomatic and slight nuchal rigidity
- to deep coma, decerebrate
World Federation of Neurological Surgeons
- grades 1-5
- GCS 15 with no motor deficit
- to GCS 3-6 with or without motor deficit
10
Q
investigations meningitis
A
Bloods:
FBC (DIC and infection) -anaemia -leukocytosis -thrombocytopaenia CRP -when CSF gram stain neg., normal CRP almost excludes bacterial from viral cause VBG, or EUC and CMP -acidosis -hypokalaemia -hypoglycaemia -hypocalcaemia Coags with TT, fibrinogen, fibrin degradation products and D dimer (DIC) Blood culture consider serum procalcitonin (bacterial vs viral. more sensitive than specific)
Lumbar puncture
- opening pressure raised
- gram stain
- culture
- raised protein
- decreased glucose (CSF:serum glucose <0.6)
- pleocytosis (polymorph)
- lactate raised (distinguish aseptic from bacterial)
- latex agglutination (neisseria capsular polysaccharide antigen)
- PCR (more accurate for viral and bacterial infection)
Imaging
- CT brain when concerns for raised ICP
- underlying pathologies
- oedema and hydrocephalus common in meningitis
11
Q
prognosis SAH
A
- 50% mortality
- cognitive impairment 20%
- epilepsy increased risk
- risk of recurrence
12
Q
aetiology SAH
A
Aetiologies = A Past Vascular Defect
-Aneursymal (vast majority. mostly saccular, can be mycotic or fusiform)
-Perimesencephalic (most common non anneursymal)
-Vascular malformations
-Drugs (simpathomimetics)
also Tumors and Trauma
13
Q
pathophys SAH (saccular)
A
- formation of aneursym due to loss of internal elastic lamina and thinning of smooth muscle
- most aneursyms do not rupture
- association with site (more common in anterior circ but most likely to rupture in posterior circulation) and size
- Aneurysm develop over days. Initial size determined by structural forces. Will either rupture or harden. Larger aneursyms that have not ruptured are more likely (due to Laplace’s law) to continue growing, and rupture later. Supports finding that aneursyms that rupture late are larger than those that rupture early.
- Size greater than 1cm is increased risk
- Acute trigger usually (but not always) precedes rupture
14
Q
risk factors SAH
A
Risk factors for development of aneurysm:
- Family Hx
- Polycystic kidney disease
- Erhlers danlos
- Coarctation of aorta (HTN)
- Smoking
- HTN
- Post menopause estrogen decline
Risk factors for rupture/SAH
- Size
- posterior circ
- prior haemorrhage
- ETOH
- Simpathomimetic drugs
- Antithrombotic therapy
15
Q
ddx meningitis
A
encephalitis (confusion, mental state), meningitis, SAH
Infective meningitis
- infective
- > bacterial
- > viral
- > fungal
- aseptic
- bacterial parameningeal infection
- > epidural, subdural empyema
- > intracerebral abscess
Aseptic meningitis
- non infective
- > neoplasia (primary, secondary, haematological)
- inflammatory
- > SLE
- drug induced
- > NSAIDs
- > antibiotics
- > lamotragine
