Neuro - Altered Conscious Level and Neurological Disturbance Flashcards

Question

GCS Detailed

Answer 1

``` Motor 1-6: No response to pain Extensor response to pain Flexor response to pain Withdrawing to pain Localising to pain Obeying commands ``` ``` Verbal 1-5: None Incomprehensive sounds Inappropriate speech Confused (disoriented) Oriented (time/place/person) ``` ``` Eyes 1-4: None In response to pain In response to voice Spontaneous ```

Answer 2

3: Globally no response 8 or less: Coma, Severe injury, Consider airway 9-12: Moderate injury 13-15: Minor injury

Answer 3

Rapidly developing clinical signs of focal or global disturbance of cerebral function, with symptoms lasting 24 hrs or more, with no apparent cause other than that of a vascular origin.

Answer 4

Transient ischaemic attacks are acute episodes of focal loss of cerebral function lasting less than 24 hrs, which are attributed to an inadequate blood supply.

Answer 5

``` Contralateral Signs – motor and sensory NO fasciculations NO muscle wasting Spasticity Weakness – Extensors-Arms; Flexors-Legs Hyperreflexia Upgoing Plantar response Pronator Drift ```

Answer 6

Frontal and parietal lobes Disturbance of judgement Loss of social behaviour Contralateral hemiparesis leg > arm Mild sensory deficit

Answer 7

Frontal, Parietal, Temporal Lobe, Subcortical Structures (e.g. Basal Ganglia) Internal Capsule Contralateral hemiplegia arm/face/thorax > leg Aphasia (Broca & Wernicke’s areas) Hemisensory deficits

Answer 8

Occipital and Lower Temporal Lobe Visual Defects: Homonymou hemianopia Visual agnosia Prosopagnosia

Answer 9

(Common in SBAs is a description of) Focal neurological deficit unilaterally, e.g. Amaurosis Fugax (Transient and painless loss of vision in one eye due to the passage of an embolus into the central retinal artery).

Answer 10

CT Head to exclude a haemorrhagic aetiology immediately. - -> Depressed consciousness (GCS < 13) - -> Suspected haemorrhage (drugs etc) or Raised ICP Consider thrombolysis with tPA if within the 4.5 hour window and there are no contraindications. --> Thrombolysis is done with Alteplase (tPA) at 10% bolus, 90% infusion at a dose of 0.9mg/kg Presentation after the 4.5 hr window is managed with aspirin. All people presenting with acute ischaemic stroke should be given aspirin.

Answer 11

Seizure - A paradoxical discharge of cerebral neurons --> External manifestations Epilepsy - A recurring tendency to have seizures. Before: epileptic aura (marks onset), triggers (flashing lights) During: stiffness, jerking, incontinence, side tongue-biting, sweating, palpitations, mouth frothing, pallor, cyanosis After: muscle ache, post-ictal confusion/drowsiness Seizures may be partial (focal) or generalised (involving both hemispheres)

Answer 12

Simple Partial [Focal motor/sensory/autonomic/psychic] Awareness unimpaired No post-ictal confusion Complex Partial [Deja-vu, depersonalisation, altered emotion, epigastric fullness; can start as simple partial (=aura)] Most commonly arise form the temporal lobe Awareness/consciousness is impaired Post-ictal confusion common

Answer 13

``` Behaviour Motor – posturing, peddling Dysphasia/speech arrest Motor arrest, subtle behaviour disturbances Jacksonian March ```

Answer 14

``` Complex Emotional disturbance Hallucinates (smell/taste) Depersonalisation Automatisms ```

Answer 15

Sensory disturbance – tingling, numbness | Motor symptoms – abnormal movement/rhythmic muscle contractions

Answer 16

Visual phenomena - spots, lines, flashes

Answer 17

Convulsive vs Non-Convulsive Convulsive: Tonic - limb stiffening Clonic - limb jerking Tonic-Clonic - LOC followed by a stiff body with flexed elbows and extended legs followed by violent shaking with eyes rolling (grand mal), incontinence, post-ictal and drowsiness Myoclonic - sudden isolated jerk of limb, face or trunk; disobedient limb --> thrown to the ground Non-Convulsive: Absence - 10s or fewer of vacancy, sometimes myoclonic jerks (petit mal), presents in childhood - no post ictal. Atonic (Akinetic) - Sudden loss of muscle tone, 'Drop Attacks'. No LOC

Answer 18

Continuous seizure or serial (at least 2) discrete seizures between which there is incomplete recovery of consciousness of at least 30 min duration. --> Medical Emergency Rx: ABC - open and maintain airway, recovery position Oxygen 100% Stop seizures --> Slow IV Bolus Lorazepam (1) 204mg --> Lorazepam (2) if no response in 10 mins Continuing seizures --> IV Phenytoin/Diazepam

Answer 19

Brain parenchyma inflammation - may be focal symptoms Causes Viral - HSV, CMV, EBV, VZV Non-viral - Any bacterial meningitis, TB, cryptocossus, etc Bizarre Encephalopathic behaviour Decreased GCS/Coma Focal signs Seizures CT - cerebral oedema - compressive symptoms (Medical Emergency

Answer 20

Meningeal Inflammation Causes: Meningococcus Pneumococcus ``` Headache Meningism Decreased GCS/Coma Focal signs Seizures Fever Rash Kernig's sign + Brudzinski + ```

Answer 21

Encephalitis: Compressive symptoms/focal YES Seizures YES Altered Mental State YES Meningitis: Meningism YES Seizures < encephalitis Altered mental state < encephalitis

Answer 22

Hyponatraemia (<135) Headaches, comiting, drowsiness, seizures Thiazide Diuretics (Hypo/Eu/Hypervolaemic) Hypocalcaemia e.g. complicatoin of thyroid surgery (loss of parathyroids) 4 CATS - Consulvsions, Arrhythmia, Tetany, Spasms Chvostek's and Trousseau's signs (Face and hand)

Neuro - Altered Conscious Level and Neurological Disturbance Flashcards

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