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YR6 Images + Instruments > Acute care- Neuro > Flashcards

Acute care- Neuro Flashcards

1
Q

Suspected bacterial meningitis Mx

A
  1. IV access: take bloods + BCs
  2. LP
  3. Cefotaxime/ Ceftriaxone IV (+ Amoxicillin if >50y)
  4. Dexamethasone IV
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2
Q

Mx of patients with suspected bacterial meningitis + signs of raised ICP

A

Critical care input
Secure airway + high flow O2
IV access + Abx + Dex
Neuroimaging

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3
Q

Blood tests in suspected bacterial meningitis

A

FBC
Renal function
Glucose
Lactate
Clotting profile
CRP

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4
Q

CSF tests in suspected bacterial meningitis

A

Glucose, protein, MC+S
Lactate
Meningococcal + Pneumococcal PCR
enteroviral, herpes simplex + varicella-zoster PCR
Consider Ix for TB meningitis

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5
Q

PPx of bacterial meningitis in those who had contact in 7 days before onset

A

Ciprofloxacin PO once only

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6
Q

Mx of suspected bacterial meningitis in the community

A

Benzylpenicillin sodium IM

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7
Q

Mx of suspected viral meningitis

A

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

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8
Q

Most common cause of viral meningitis

A

Enteroviruses e.g. Cocksackie

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9
Q

LP in viral meningitis

A

High cell count: Lymphocytes
Normal glucose
Normalish protein

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10
Q

Most common cause of viral encephalitis

A

HSV1
Lateral temporal lobe changes

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11
Q

Mx of encephalitis

A

Aciclovir IV

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12
Q

SAH Ix

A

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

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13
Q

SAH Mx

A

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

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14
Q

Most common cause of SAH

A

Head injury (traumatic SAH)
Intracranial “Berry” aneurysm (most common cause of spontaneous SAH)

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15
Q

List 3 conditions associated with berry aneurysms

A

HTN
PKD
EDS

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16
Q

5 complications of SAH

A

Rebleeding
Hydrocephalus
Vasospasm
Hyponatraemia (SIADH)
Seizures

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17
Q

Ix for extradural haemorrhage

A

Non contrast CT head: biconvex, limited by suture lines

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18
Q

Common site of extradural haemorrhage

A

Temporal region- thin skull at pterion which overlies the middle meningeal artery

19
Q

Most common cause of extradural haemorrhage

A

Trauma, most typically ‘low-impact’ (e.g. a blow to the head or a fall)

20
Q

Mx of extradural haemorrhage

A

No neurological deficit: cautious clinical + radiological observation
Definitive Tx: craniotomy + evacuation of haematoma.

21
Q

Presentation of extradural haemorrhage

A

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

22
Q

Cause of acute subdural haemorrhage

A

High impact trauma

23
Q

Cause of chronic subdural haemorrhage

A

Rupture of bridging veins, slow bleed, seen in elderly + alcoholics

24
Q

Ix for subdural haemorrhage

A

CT head
Acute: HYPERdense crescent
Chronic: HYPOdense crescent

25
Q

Mx of acute subdural haemorrhage

A

Small/ incidental: Conservative
Monitor ICP
Definitive: Decompressive craniotomy

26
Q

Mx of chronic subdural haemorrhage

A

Small/ incidental: conservative
Confusion/ neurological signs: BURR hole decompression

27
Q

Ischaemic stroke Mx

A
  1. CT r/o haemorrhage
    <4.5h from onset: Alteplase
    >4.5h from onset: Aspirin
  2. Rankin <3, NIHSS >5
    Y + <6h + proximal anterior circulation: Thrombectomy
    N: N/A
  3. Aspirin 300mg 14 days
28
Q

Secondary prevention after ischaemic stroke

A

No AF: Clopidogrel 75mg
AF: Apixaban

29
Q

TIA Mx

A

Aspirin 300mg IMMEDIATELY unless CI

30
Q

CI to Aspirin in TIA

A

Bleeding disorder
Already taking Aspirin
Taking an anticoagulant

31
Q

Describe the time frame within which patients with TIA should be assessed

A

If >1 TIA/ suspected cardioembolic source/ severe carotid stenosis: discuss URGENT admission
If TIA in last 7 days: within 24h
If TIA >7 days previously: within 7 days
No driving until seen by specialist

32
Q

Ix following suspected TIA

A

Diffusion weighted MRI: determine territory of ischaemia/ haemorrhage/ ddx
Urgent carotid doppler

33
Q

Secondary prevention following TIA

A

Clopidogrel 75mg
Atorvastatin

34
Q

Indication for carotid endarterectomy

A

If stroke/ TIA in carotid territory
+ NOT severely disabled
+ carotid stenosis >70%

35
Q

Driving recommendations following TIA/ Stroke

A

Stroke/ TIA: 1 month off driving

Multiple TIAs over short period: 3 months off driving + inform DVLA

36
Q

Raised ICP Mx

A

Head elevation to 30º

IV mannitol may be used as an osmotic diuretic

Controlled hyperventilation (to reduce pCO2 → vasoconstriction of the cerebral arteries → reduced ICP). Caution needed as may reduce blood flow to already ischaemic parts of the brain

Removal of CSF:
drain from intraventricular monitor
repeated LP (e.g. IIH)
ventriculoperitoneal shunt (for hydrocephalus)

37
Q

Raised ICP Ix

A

Fundoscopy
CT/ MRI
Invasive ICP monitoring: catheter placed into lateral ventricles of brain to monitor pressure

38
Q

5 Indications for CT head within 1h of head injury

A

GCS <13 on initial assessment or GCS <15 at 2h
Focal neurological deficit
Suspected open/ depressed skull fracture/ signs of basal skull fracture
Post-traumatic seizure
Vomiting more than one

39
Q

Indications for CT head within 8h of head injury

A

Any loss of consciousness/ amnesia AND any of
>,65y
Coagulopathy
High impact injury e.g. fall >1m/ >5 stairs
Retrograde amnesia >30 mins

40
Q

Indications for CT cervical spine within 1h

A

GCS <13 on initial assessment
Patient has been intubated
Definitive dx of C-spine injury is needed urgently e.g. before surgery
Patient is having other body areas scanned
Clinical suspicion of C-spine injury AND any of: >,65y, high impact injury, FND, paraesthesia in limbs

41
Q

Myasthenic crisis Mx

A

Plasmapheresis, IVIG

42
Q

GCA Mx

A

No visual loss: PREDNISOLONE PO 60mg
VIsual loss: METHYLPREDNISOLONE IV

43
Q

GCA Ix

A

ESR + CRP
Temporal artery USS (if low probability)
Temporal artery biopsy

YR6 Images + Instruments (21 decks)

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