Week 12 - Neurology Flashcards
impaired consciousness: what are the indexes used to measure this?
- GCS: Glasgow Coma Scale
- AVPU: Alert, verbal, pain, unresponsive
impaired consciousness: general causes?
- structural damage: external or internal
- global failure: metabolism, infection, drugs & toxins, seizure
impaired consciousness: structural damage: external & internal - examples?
external: head injury
internal:
- vascular, “stroke”. can be ischaemic stroke or haemorrhage stroke
- tumour: benign/primary/secondary
- abscess: organisms enter blood brain barrier and cause infection
impared consciousness: global brain failure - metabolic causes?
- hypoglycaemia
- liver failure (hepatic encephalopathy)
- renal failure (uremic encephalopathy)
- hypoxia
- hypercapnia
- hyponatraemia
- hypercalcaemia
- hypothyroidism
- hypotension
impaired consciousness: global brain failure - examples of infections?
- encephalitis
- meningitis
- malaria & other tropical illness
- other severe infections like pneumonia, GI, urine infections
impaired consciousness: global brain failure - causative drugs and toxins?
- alcohol
- opiates
- other recreational drugs
- any prescribed sedating medication: benzodiazepines, tranquilisers, antidepressants, opiates, anti-epileptics
impaired consciousness: global brain failure - how do seizures/epilepsy contribute?
- excess electrical activity
impaired consciousness: what is the clinical approach?
- ABCDE
- identify and treat cause
describe the ABCDE approach to impaired consciousness
- take note of airway obstruction
- usually put in recovery position
- administer oxygen
- AVPU / GCS
- check blood sugar
impaired consciousness: methods to identify causes?
upon examination:
- trauma
- rash
- seizure activity
- focal weakness
- signs of co-existent illness: SEWS (temperature, BP, pulse, respiratory rate, oxygenation)
- blood sugar
- other clues i.e. jaundice, needle tracks, breath
- collateral history
impaired consciousness: how to treat?
- treat cause: usually hospitalization
- but first consider treating: hypoglycaemia, hypoxia, severe infection, benzodiazapine overdose
epilepsy: what is it characterized as?
excessive electrical discharges in the brain
epilepsy: what are the clinical features of the 2 different types?
- focal (partial) seizures: depends on part of brain affected
- generalized seizures: whole brain affected
epilepsy - focal/partial seizures: describe:
- simple partial seizures
- complex partial seizures
- shaking on one side (maintained consciousness)
- temporal lobe affected: aura, resulting in olfactory (rarely visual) hallucinations
- odd behaviour: automatisms such as lip smacking, odd posture, staring
epilepsy - generalized seizures: list the forms of generalized seizures
- grand mal/tonic-clonic (usual)
- petit mal
- myoclonic
- atonic
epilepsy - generalized seizures: describe the characteristics of a grand mal/tonic-clonic seizure?
- loss of consciousness
- limbs stiffen: tonic phase
- limbs shake: clonic phase
- incontinence
- tongue biting
- cyanosis
- headache, drowsiness afterwards
epilepsy - generalized seizures: describe the characteristics of a petit mal seizure?
- absent-mindedness in children
- staring into space, lasts about 10 seconds
- instantly responsive after seizure
epilepsy - generalized seizures: describe the characteristics of a myoclonic seizure?
- limbs jerking
- collapse
pilepsy - generalized seizures: describe the characteristics of an atonic seizure?
- limbs collapse
epilepsy: primary causes?
often hereditary element
epilepsy: secondary causes?
- structural damage
- acute or chronic: stroke, tumour, post head injury/surgery, arteiovenous malformation, meningitis - metabolic damage
- electrolyte disturbance, alcohol withdrawal, hypoglycaemia
- always check blood sugar
epilepsy: methods of investigation?
- blood tests
- brain imaging: ideally MRI
- electroencephalogram - EEG
epilepsy - treatment?
- drugs (usually)
- phenytoin, carbamazepine, sodium valproate, lamotrigine, etc - surgery
- tumours, arteriovenous malformations
- poor controlled primary epilepsy
epilepsy - dental aspects?
- recognize how well controlled, avoid tx if poorly controlled
- management of seizure
- take note of drug side effects
headache: different types?
- primary headache disorders: unpleasant
- secondary headache disorders: associated with mortality or permanent disability
headache: red flags?
- severity
- sudden onset
- features of raised intracranial pressure
- focal neurology
- visual changes
- impaired consciousness/confusion
- meningism, fever, rash
- associated history i.e. cancer/HIV
features of raised intracranial pressure?
- worsening headache on positional change/strain
- headache present on waking
- nausea and vomiting
list the primary headache disorders
- tension headache
- migraine
- cluster headache
- medication overuse headache
- trigeminal neuralgia
headache - tension headache: describe its characteristics?
- stress related
- “tight band” feeling
- pain is bilateral/symmetrical
- chronic, gradual onset
- gets worse towards end of the day
headache - tension headache: treatment?
- conventional analgesia
- tricyclic antidepressants for prophylaxis
headache - migraine:
- what is it?
- what are its triggers?
- temporary reduction in blood flow then compensatory excess blood flow
- often has no triggers, but could be wine, cheese, chocolate, OCP, premenstrual, anxiety, exercise, sleep deprivation, fasting
headache - migraine: what are its classic features?
- pre-headache aura ~ 15minutes.
- visual: flashing lights, wavy lines, dots, spots, distorted vision - headache within 1 hour
- one sided, throbbing
- nausea, vomiting
- photophobia
headache - migraine: treatment?
acute:
- conventional analgesia (paracetamol, aspirin, ibuprofen)
- metoclopramide
- serotonin agonists: sumatriptan
headache - migraine: prevention?
- anti-epileptics, amitryptyline, beta blockers
2. avoidance of triggers
headache - cluster headache: caused by?
characterized by?
more common in?
- dilatation of superficial temporal artery
- severe pain around eye: watery, blood shot, lid swelling, runny nose
- more common in males, smokers
headache - medication overuse headache:
- users of what are most at risk? can also occur with use of what drug?
- management?
- users of opiates and triptans
- paracetamol
- medication withdrawal to manage
headache - trigeminal neuralgia:
- how is the pain described?
- precipitated by?
- management?
- intense stabbing pain, of 10/10 severity. felt along trigeminal nerve distribution
- touch (shaving, washing, talking). can also be paroxysmal (spontaneous)
- carbamazepine, after ruling out other causes
headache - secondary headache disorders: what are the causes?
- head injury
- infections
- non-traumatic bleeds
- giant cell arteritis
- glaucoma
headache - raised intracranial pressure:
- causes?
- tumour
- bleeds: head injury/non-traumatic
- hydrocephalus: drainage problem (trauma/bleed, tumour, infection, idiopathic)
- abscess
headache - raised intracranial pressure: how is it diagnosed?
diagnosis made from CT scan
headache - bacterial meningitis:
- list the causative agents and who they affect?
- meningococcus: infants, adolescents, young adults (contact spread)
- pneumococcus: babies & the elderly)
- haemophilus: babies & infants
headache - bacterial meningitis: associated features?
- impaired consciousness
- meningism
- meningococcal rash
- drowsiness
- photophobia
headache - bacterial meningitis: how is diagnosis carried out?
- lumbar puncture
- blood cultures
headache - bacterial meningitis: treatment?
- empirical antibiotics (if suspected in community)
- urgent hospitalization
- prophylaxis
headache - encephalitis:
- inflammation of?
- what type of infection?
- inflammation of brain parenchyma
- viral infection: herpes simplex, varicella zoster, rabies
headache - encephalitis:
- impaired consciousness
- change in personality
- meningism
- seizures
headache - encephalitis:
- diagnostic methods? management?
- lumbar puncture
- electroencephalogram
- antivirals and hospitalization
headache - cerebral abscess: usually caused by which bacteria?
symptoms?
- staphylococci or streptococci
- raised ICP
headache - cerebral abscess: diagnostic methods? management?
- CT/MRI (better)
- biopsy/ surgery sample
- drainage and antibiotics
headache - cerebral bleed: lost two types of non-traumatic cerebral bleeds
- sub-arachnoid haemorrhage (SAH)
2. intracerebral haemorrhage (ICH)
headache - cerebral bleed (subarachnoid haemorrhage): what are the main causes?
- congenital berry aneurysm
- arteriovenous malformation
- no cause (15%)
headache - cerebral bleed (subarachnoid haemorrhage): clinical features?
- sudden, severe headache “thunderclap”
- often occipital
- may be vomiting, collapse, drowsiness
headache - cerebral bleed (subarachnoid haemorrhage): diagnostic methods & management?
- CT scan, angiography. may require lumbar puncture if negative
mx: - prevent re-bleeding
- best outcome in those with little neurological damage: surgical clipping or coiling
headache - cerebral bleed (intracerebral haemorrhage): bleeding into?
usually associated with?
other symptoms?
- directly into brain tissue
- usually associated with hypertension: charcot-bouchard aneurysm
- raised ICP, focal neurology
headache - cerebral bleed (intracerebral haemorrhage): how to diagnose?
management?
- imaging
- may be fatal, mx with surgery or rehabilitation
headache - giant cell arteritis: clinical features? importance?
- scalp tenderness
- jaw claudication
- loss of vision
- there is risk of blindness, stroke and death
headache - giant cell arteritis: possible investigations?
treatment?
- blood tests + temporal artery biopsy
- high dose prednisolone
headache - glaucoma: clinical features?
- constant ache around one eye
- reduced vision
- nausea & vomiting
- red, congested eye, with dilated, non-reactive pupil
