Neuro

Question 1

What do unequal pupils indicate in head injury?

Answer 1

HIGH ICP (due to compression of ipsilat CN 3> inactivates PNS > pupil dilatation, loss of light reflex)

Question 2

What are indications for immediate CT head following head injury?

Answer 2

• GCS <13 immediately, <15 after 2 hours
• Fracture (suspected open/depressed skull fracture of basal skull fracture)
• Seizure
• focal neurological deficit
• vomit >1

Question 3

What are signs of a basal skull fracture

Answer 3

Haemotympanum
Panda eyes
CSF leak
Battle sign (mastoid bleed)

Question 4

What are indications for immediate CT spine

Answer 4

GCS <13
Patient intubated
Clinical suspicion + >65/high impact / focal neuro deficit / paraesthesia

Question 5

What are indications for CT head soon <8h from injury

Answer 5

LOC / amnesia +

• age >65
• bleeding / clotting disorders
• collection of events missing
• dangerous mechanism of injury

Question 6

What are signs and sx of raised ICP

Answer 6

headache / vomiting
altered GCS, focal neuro deficit
Cushing’s response (high BP, low HR, cheyne-stokes respiration)

Question 7

What are holding measures for a pt with raised ICP

Answer 7

sit up 40 degrees
if intubated: hyperventilate them (high ventilation causes hypocapnia >vasoconstriction of cerebral arteries > reduces cerebral blood flow and volume)
Osmotic agents eg mannitol
consider steroids if oedema surrounding tumour
fluid restrict

Question 8

What is Cauda Equine Syndrome

Answer 8

Symptoms caused by compression of the cauda equine (below L2)

Question 9

What are red flag symptoms of cauda equine

Answer 9

Bilateraal sciatica
Saddle anaesthesia
Lower limb weakness (+ reduced sexual function)

Question 10

What are white flag sx of cauda equina (too late!)

Answer 10

Urinary retention (complete lack of sensation of fullness)
Urinary/faecal incontinence

Question 11

What aree investigations for CES

Answer 11

clin exam (LL neuro, saddle anaesthesia, DRE)
Bladder scan
MRI

Question 12

What is management for CES

Answer 12

PO dexamethasone (if metastatic, while awaiting MRI results)

Decompressive laminectomy (if <48hours from bladder dysfunction

Question 13

most common causes of SC compression

Answer 13

metastases (oncological emergency)

lung, breast, prostate cancer

Question 14

sx SC scompression

Answer 14

back pain (worse on coughing, lying down)

Question 15

when is SC compression UMN /LMN

Answer 15

Above L1: UMN

Below L1: LMN

Question 16

Ix for SC compression

Answer 16

MRI spine. urgent

FBC, CRP, UE, calcium
Urine for Bence Jones (MM)

Question 17

Mx SC compression

Answer 17

Dexamethasone +-radiotherapy, surgery

Question 18

what should ICP normally be

Answer 18

ICP <15mmHg

Question 19

what is status epilepticus

Answer 19

Seizure lasting >30 mins

Question 20

What can early status epilepticus be classified as, and how would you treat it

Answer 20

Early: 5-30mins&raquo_space;> Lorazepam
EEstablished: 30-60mins&raquo_space; phenytoin
Refractory: >60mins&raquo_space; anaesthetics

Question 21

What ix do you get in status epilepticus

Answer 21

Cap glucose
lab glucose, U&E, Ca, FBC, ECG, LFT
ABG
Put on cardiac monitor and pulse oxymetry
Consider tox screen, anticonvulsant levels, LP, culture blood and urine, EEG, head CT.

Question 22

How do you manage Status epilepticus

Answer 22

A>E
(secure airway, adjuncts as necessary, remove false teeth if poorly fitting)

O2 + suction

IV bolus lorazepam 4mg (10mg buccal midaz / 10mg PR diazepam if no IV access)

Give second dose Lorazepam if no improvement after 10-20mins

Consider thiamine if alcoholic, glucose if abnormal, tx acidosis, call up ITU

Start PHENYTOIN INFUSION

If seizure continues after 60 mins >General anaesthetic

Question 23

symptoms of meningitis

Answer 23

• Severe headache
• Nausea and vomiting
• Photophobia
• Neck stiffness or backache
• Irritability
• Drowsiness
• High-pitched crying or fits (common in children)
• Reduced consciousness
• Fever

Question 24

What is Kernig’s sign

Answer 24

with hips flexed, there is pain/resistance on passive KKKKKKnee extension

Question 25

What is Brudzinski’s Sign

Answer 25

Flexed neck causes involuntary flexion of the hips

Question 26

What Ix should you get for suspected meningitis

Answer 26

Blood cultures
Bloods - glucose (may be deranged in bacterial men), U&E, FBC, VBG (for lactate), LFTs, coag (exclude DIC), CRP, HIV
CT before LP if suspecting raised ICP
LP + MS&S of aspirate - but if LP cannot be completed within 1 hour, start Abx

Question 27

What is contained in a coagulation screen

Answer 27

PT, APTT, INR, fibrinogen, fibrin degradation products

Question 28

What Abx do you give first line in community

Answer 28

community: IM benzylpenicillin 1.2 g

Question 29

What must you give along with Abx in meningitis

Answer 29

IV dexamethasonne

Question 30

Brown Sequard syndrome

Answer 30

hemisection of spinal cord

• ipsilateral hemiparaplegia
• contralateral hemianaestthesia