Acute care- Neuro Flashcards
Suspected bacterial meningitis Mx
- IV access: take bloods + BCs
- LP
- Cefotaxime/ Ceftriaxone IV (+ Amoxicillin if >50y)
- Dexamethasone IV
Mx of patients with suspected bacterial meningitis + signs of raised ICP
Critical care input
Secure airway + high flow O2
IV access + Abx + Dex
Neuroimaging
Blood tests in suspected bacterial meningitis
FBC
Renal function
Glucose
Lactate
Clotting profile
CRP
CSF tests in suspected bacterial meningitis
Glucose, protein, MC+S
Lactate
Meningococcal + Pneumococcal PCR
enteroviral, herpes simplex + varicella-zoster PCR
Consider Ix for TB meningitis
PPx of bacterial meningitis in those who had contact in 7 days before onset
Ciprofloxacin PO once only
Mx of suspected bacterial meningitis in the community
Benzylpenicillin sodium IM
Mx of suspected viral meningitis
Ceftriaxone + Aciclovir IV whilst awaiting LP results (in case bacterial)
Generally self-limiting, with Sx improving over 7 - 14 days
Aciclovir if suspected secondary to HSV
Most common cause of viral meningitis
Enteroviruses e.g. Cocksackie
LP in viral meningitis
High cell count: Lymphocytes
Normal glucose
Normalish protein
Most common cause of viral encephalitis
HSV1
Lateral temporal lobe changes
Mx of encephalitis
Aciclovir IV
SAH Ix
Non contrast CT head, refer to neurosurgery
If within 6h + normal: consider ddx
If >6h + normal: LP for xanthochromia (at least 12h after)
CT intracranial angiogram: identifies vascular lesion
SAH Mx
A-E + connect to cardiac monitor
Paracetamol + Cyclizine
Neuro obs every 30 mins
NIMODIPINE: prevents vasospasm
Intervention within 24h: IR coil or craniotomy + clipping
DVT ppx: compression stockings
Stop + reverse anticoagulation
Most common cause of SAH
Head injury (traumatic SAH)
Intracranial “Berry” aneurysm (most common cause of spontaneous SAH)
List 3 conditions associated with berry aneurysms
HTN
PKD
EDS
5 complications of SAH
Rebleeding
Hydrocephalus
Vasospasm
Hyponatraemia (SIADH)
Seizures
Ix for extradural haemorrhage
Non contrast CT head: biconvex, limited by suture lines