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Neurology and special senses (Y4) > 5- Neurology (Emergencies: Acute bulbar palsy, temporal arteritis, head trauma, status epilepticus) > Flashcards

5- Neurology (Emergencies: Acute bulbar palsy, temporal arteritis, head trauma, status epilepticus) Flashcards

1
Q

Acute bulbar palsy
Background

A
  • Set of sign an symptoms linked to the impaired function of lower cranial nerves
  • Damage to either:
    o The LMN (neurones that connect the CNS (brain and spinal cord) to the muscles they innervate
    o To the lower cranial nerves (9,10,11,12)
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2
Q

which cranial nerves are affected in acute bulbar palsy

A

Cranial nerves affected are those that arise straight from the brainstem
- CN IX (9) - glossopharyngeal
- CN X (10)- vagus
- CN XI (11)- accessory
- CN XII (12)- hypoglossal

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3
Q

how is acute bulbar palsy related to pseudobulbar palsy

A

Due to damage of UMN
- Similar presentation
- Atypical expression of emotion e.g. unusual outbursts of laughing or crying- lability
- Spastic and pointed tongue
- Exaggerated jaw jerk
- Can be classified as progressive (escalation of symptoms over time)or non progressive (rare)

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4
Q

causes of acute bulbar palsy

A

Causes

  • Brainstem stroke
  • Brainstem tumour
  • Degenerative disease
    o Motor neurone disease
  • Autoimmune conditions
    o Guillain-Barre syndrome
  • Infection
    o Diphtheria
    o Poliomyelitis
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5
Q

Presentation of acute bulbar palsy

A

Wide variety of symptoms dependent on which CN is damaged

  • Glossopharyngeal – reduced salivation, dysphagia and absent gag reflex

Other signs and symptoms associated with other CNS

  • Chewing
  • Nasal regurgitation
  • Slurred speech
  • Difficulty in handling secretions
  • Aspiration of secretions
  • Dysphonia
  • Dysarthria
  • Nasal speech which lacks modulation
  • Difficult with all consonants
  • Atrophic (wasting tongue)
  • Drooling
  • Weakness or jac and facial muscles
  • Absent jaw jerk
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6
Q

Investigations for acute bulbar palsy

A
  • Lumbar puncture to rule out MS
  • MRI to diagnose stroke or tumour
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7
Q

management of acute bulbar palsy

A
  • No treatment
  • Intubation if airway obstruction
  • Supportive treatment
    o E.g. medication for drooling
    o Feeding tubes
    o SALT
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8
Q

summary of acute bulbar palsy

A
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9
Q

basilar skull fracture background

A

Skull base (Basilar) fractures
Background
- Traumatic head injury
- Fracture in base of skull e.g. around the foramen magnum (hole in the base of the skull where brains stem exits)

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10
Q

define basilar fracture

A

Defined as a fracture of one or more bones at the base of the skill (temporal occipital sphenoid frontal or ethmoid bones)

  • Complex structure that forms the floor of the cranial cavity and separates the brain from the head and neck
  • Composed of the temporal, occipital, sphenoid, frontal and ethmoid bones
  • These bones have numerous foramina’s, that allow cranial nerves and blood vessels to pass from one region to another
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11
Q

basilar fractues are classified based on

A
  • Based on location of fracture
    o Anterior fossa
    o Middle fossa
    o Posterior fossa
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12
Q

Causes/ risk factors of basilar skull fracture

A
  • Facial fractures often occur
  • High force injury e.g. motor vehicle
  • Penetrating injuries
  • Falls
  • Assaults
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13
Q

2 main presentations of basilar skull fracture

A

battle sign
panda eyes

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14
Q

battle sign

A

Bruising mastoid process (behind ears)

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15
Q

panda eyes

A

o Bruising around eyes
o Blood behind the ear drum

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16
Q

other presentation of basilar skull fracture

A
  • battle sign
  • panda eyes
  • CSF leakage from nose or ears
  • menigitis
  • injury to cranial nerve e.g. facial or oculomotor
17
Q

presentation of basilar skull fracture based on location

A
18
Q

which type of basilar fracture can cause injury to the internal carotid

A

temporal bone fracture

19
Q

Investigations basilar skull fracture

A
  • Physical exam
  • Glasgow coma scale (severe if <7)
  • Neuro exam
  • CT
20
Q

Management basilar skull fracture

A

Admit to hospital
- Most heal by themselves
- Non-displaced fractures usually heal without intervention
- Surgery to manage
o CSF leak
o To relieve pressure on CN
o Repair blood vessels

21
Q

temporal arteritis background

A

also known asGiant cell arteritis
- Vasculitis of large and medium sized arteries of head
- Superficial temporal artery commonly involved.

22
Q

Risk factors temporal arteritis

A
  • F>M
  • > 50 years (most common >75 yrs)
  • Polymyalgia rheumatica
  • White
23
Q

Presentation temporal arteritis

A
  • Unilateral headache typically around temple and forehead
  • Scalp tenderness when brushing hair
  • Jaw claudication
  • Blurred or double vision
  • Associated: fever, muscle aches, fatigue, weight loss, lossof appetite, peripheral oedema
24
Q

investigations for temporal arteritis

A
  • Clinical presentation
    - Raised ESR
  • Temporal artery biopsy
    –> Multinucleated giant cells found

Additional tests
- FBC- normocytic anaemia and thrombocytosis
- LFT may show raised ALP
- CRP raised
- Duplex US may show hypoechoic halo sign

25
Q

management of temporal arteritis

A

Initial
- Steroids -> to reduce risk of permanent slight loss
- 40-60mg per day
- Aspirin
- PPI – for steroid
- Referral to vascular surgeons, rheumatology, ophthalmology

Ongoing management
- Continue high dose steroids into symptom resolve and then wean

26
Q

complication of temporal arteritis

A

Complications
- Risk of irreversible loss of vision due to involvement of blood vessels supplying CN II (optic)
- Cerebrovascular accident (stroke)
- Relapse
- Aortitis – AA or aortic dissection
- Steroid related effects

27
Q

Status epilepticus
Background

A
  • Medical emergency- time is brain
  • Seizure lasting more than 5 minutes or more than 2+ seizures without full recovery within 30 mins (new definition)
28
Q

Management of status epileptics in the hospital:

A

Take an ABCDE approach:

  • Secure the airway
  • Give high-concentration oxygen
  • Assess cardiac and respiratory function
  • Check blood glucose levels (D- DON’T FORGET GLUCOSE)
  • Gain intravenous access (insert a cannula)
  • IV lorazepam 4mg, repeated after 10 minutes if the seizure continues
  • If seizures persist: IV phenytoin or phenobarbital or valproate or levetiracetam ,
  • If still no recovery call ITU – rapid sequence induction with Thiopental
29
Q

status epilepticus medical options in the community:

A
  • Buccal midazolam
  • Rectal diazepam
30
Q

summary status epilepticus case with A-E, management and investigations

A

Neurology and special senses (Y4) (52 decks)

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