Altered level of consciousness Flashcards

Question

Causes of fits, faints, funny turns

Answer 1

``` Infants and toddlers - Apnoea and acute life threatening event - Febrile convulsion - Breathing hold spells - Reflex anoxic spells - Infantile spasm - Hypoglycaemia and metabolic conditions School aged children - Seizure/Epilepsy - Syncope - Hyperventilation - Cardiac arrhythmia - Hypoglycaemia ```

Answer 2

Possible drug ingestion Prodromal illness or so tact with serious illness Possibility of non accidentally injury Hx of convulsion and details about them Child neurodevelopmental Hx normal prior.

Answer 3

Vital signs - bradycardia in raised ICP - tachyarrythmia - drug ingestion - Deep, sighing (Kussmaul) - DKA Ketones on breath Focus of infection - check rashes, neck stiffness, pneumonia and UTI Check pupils - symmetrical and constrict? Check for abnormal posture eg decorticate or decerebrate Assess LOC with GSC or AVPU Blood pressure

Answer 4

Blood glucose - hypo-hyperglucaemia FBC - infection or blood loss Blood culture - infective U and E - urea if dehydrated. Na high or low Blood gases - Metabolic or Resp acidosis CXR - infection or cardia failure, trauma eg rib fracture CT or MRI - focal pathology - tumour, haemorrhage, abscess LP - infection (meningitis, encephalitis) or bleeding (SAH) Metabolic screen - ammonia in urea cycle defect or Reye's syndrome. need to exclude raise ICP LFT - hepatic encephalopathy URine - toxicology screen for poisoning or overdose. Ketones and culture.

Answer 5

``` Viral - Mumps virus - Coxsackie virus - Echovirus - Herpes simplex - Poliomyelitis Bacterial - Neisseria meningitis - Streptococcus pneumoniae - Haemophilus influenza epidemic type B - Group B streptococcus - newborn - Escherichia coli and listeria - newborn ```

Answer 6

``` Viral Preceded by pharyngitis or GI upset Develops fever, headache, neck stiffness Bacteria Drowsy and may be vacant Irritability is common High pitched cry Convulsion Examination Ill child with stiff neck and positive Kernig's sign (pain on extending leg). Bulging fontanelle. Petechiae or purpuric rash. DDX - tonsillitis and otitis media and mimic neck stiffness ```

Answer 7

Confirmed by LP showing leucocytosis, high protein count, low glucose and may show organism. Appears cloudy.

Answer 8

Herpes simplex virus | Mycoplasma pneumoniae

Answer 9

Onset is mor insidious then meningitis Personality may change Confused or clumsy before coma LP - lymphocytesis, culture and PCR for virus

Answer 10

``` Acyclovir Erythromycin Cefotaxime Used until organism is known EEG and MRI show temporal lobe involvement. ```

Answer 11

Hypoglycaemia - due to reduced carbohydrate intake or excess insulin in children with DM or inborn error of metabolism or adrenal insufficiency Hyperglycaemia - uncontrolled diabetes can lead to DKA and coma. Onset is gradual. Severe uraemia from renal failure High ammonia from inborn errors of metabolism such as urea cycle Sever hypernatraemia or hypo atresia Severe dehydration

Answer 12

Preceded by viral illness eg influenza or chickenpox Commoner in winter Triggered by aspirin during viral illness Symptoms - initial phase of vomiting, and lethargy followed by a non inflammatory encephalopathy illness with personality changes, irritability and then coma with ICP Fatty changes n liver may lead to acute hepatic failure Tx - mainly supportive aggressive intensive care Tx to trest ICP.

Answer 13

CT brain scan and skeletal survey Retinal haemorrhages Urine toxicology screen Drugs that affect CNS - opiate analgesics, alcohol and antidepressents

Answer 14

Birth asphyxia Near miss cot death Post cardiac arrest

Answer 15

Capillary refill greater then 2 sec Cool, mottled peripheries Thready pulse

Answer 16

Fever | Hx of changes in personality or ability

Answer 17

Symptoms Headache, vomiting and visual disturbances Depressed consciousness Photophobia Tinnitus retrobulbar pain Papilloedema decreased visual acuity Extra ocular movement problems Diplopia relative afferent pupillary defect Signs Cushing’s triad: Hypertension, bradycardia, Irregular breathing Signs of Herniation Subfalcine = common: Headache, contralateral leg weakness Transtentorial - central: Small but reactive pupil, drowsiness Transtentorial - temporal uncle: CN III - ipsilateral dilated pupil Tonsillar: Obtundation, decerebrate posture Cardiorespiratory arrest.

Answer 18

Subdural haematoma Extramural haematoma Diffuse axonal injury Non accidentally injury

Answer 19

Vasculitis disorder HTN Thrombotic disorder malformation

Answer 20

``` Hypoglycaemia DKA Inborn errors of metabolism Renal failure - uraemia Liver failure - hepatic encephalopathy Reye's syndrome ```

Answer 21

Status epileptic us | Hx of epilepsy

Answer 22

Primarily in babies and toddlers Resolves by 18m Symptoms - crying due to pain or temper. Cries once or twice and then takes a deep breath become deeply cyanosis and limbs extend. May loose consciousness and have convulsive Jerks. After becoming limp resumes breathing and after a few seconds become alert. 1 min in total. Dx clinically due to Hx and no postictal. Tx educating the parent and reassureiing them to treat the child as normal.

Answer 23

White breath holding attacks Peak at in 6m to 2 yr Occur after a bump on the head or other minor injury which trigger a excessive vagal reflex results in bradycardia, and circulatory impairment. May or may not cry, turns pale and collapses. Transient apnoea and lumpiness followed by recovery after 30-60mins May have eye rolling and incontinence and sometime clonic stiffening of the limbs but no tongue bitting. Afterwards may be tired and emotional DDX for epilepsy by Hx and absence of postictal drowsiness. Tx Educate that they are benign and disappear before school. In episodes : put child in recovery position and await recovery. Reassurance.

Answer 24

Form of generalised myoclonus epilepsy Onset in infancy, peaking between 4-8m Symptoms - sudden tonic flexor spasm of the head and trunk causing the child to bend forward Relaxation after a few seconds and episode may occur in cluster up to 10 to 20 times, Common on awakening, or just before sleep. Sometime extensor spasm Dx EEG - Chaotic hips arrhythmia pattern Ass with tuberous sclerosis so examine with a Wood's light MX Vigabatrin may be beneficial Ass with severe learning disability.

Answer 25

Cause - Hypotension and decrease cerebral perfusion Particularly - Teenage girl reacting to painful or emotional stimuli or prolonged standing. Symptoms - blurred vision, light headedness, sweating and nausea precede loss of consciousness. Regain consciousness after lying flat. In childhood it is rarely a symptom of cardiac arrhythmia a or poor cardiac output in childhood. Mx - cardiovascular examination - standing and lying BP - ECG if cause is doubted - Tilt table test in unusually severe cases.

Answer 26

If clear Hx of palpitations or FmHx of cardiac tachyarrythmia said or sudden death. Cause - Hypertrophic cardiomyopathy - autosomal dominant condition. Due to episodes ventricular tachycardia with syncope. - Wolff- Parkinson White syndrome - SVT - recently rhythms and Characteristics ECG wth short PR, Delta wave upstroke to R wave, markedly increase QT interval on ECG Need 24hr ECG recording.

Answer 27

causes - excitement in teenagers leads to hyperventilation and LOC particularly in teenage girls - Hypervention - drop in CO2 - triggering apnoea Dx based on Hx of breathing excessive and deep and tetany may occur. Tx - rebreathe into a paper bag to allow CO2 - if recurrent episode then psychological therapy is needed.

Answer 28

``` Cause LOC with seizures of ALOC Suspect underlying metabolic problem if following as present - developmental delay - Dysmorphism - Hepatosplenomegaly - Micro or macrocephaly ```