Acute care- Neuro Flashcards
(43 cards)
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
Common site of extradural haemorrhage
Temporal region- thin skull at pterion which overlies the middle meningeal artery
Most common cause of extradural haemorrhage
Trauma, most typically ‘low-impact’ (e.g. a blow to the head or a fall)
Mx of extradural haemorrhage
No neurological deficit: cautious clinical + radiological observation
Definitive Tx: craniotomy + evacuation of haematoma.
Presentation of extradural haemorrhage
Initially loses, briefly regains + then loses consciousness again after a low-impact head injury.
Brief regain in consciousness = ‘lucid interval’ + is lost eventually due to the expanding haematoma + brain herniation.
As haematoma expands the uncus of the temporal lobe herniates around the tentorium cerebelli + patient develops a fixed + dilated pupil due to the compression of the parasympathetic fibers of CN 3
Cause of acute subdural haemorrhage
High impact trauma
Cause of chronic subdural haemorrhage
Rupture of bridging veins, slow bleed, seen in elderly + alcoholics
Ix for subdural haemorrhage
CT head
Acute: HYPERdense crescent
Chronic: HYPOdense crescent
