Neuro assessment and Managemet

Question 1

What are some primary causes of a headache?

Answer 1

Migraine
Tension type headache
Cluster headache
Primary thunderclap headache
New daily persistent headache

Question 2

What are some possible causes for a secondary headache?

Answer 2

Subarachnoid haemorrhage or temporal arteritis

Question 3

Define a subarachnoid haemorrhage

Answer 3

A type of stroke caused by bleeding into the subarachnoid space, the area between the brain and the skull. This bleeding is often due to a ruptured blood vessel, most commonly a brain aneurysm

Question 4

Define temporal arteritis

Answer 4

An inflammatory condition that affects large and medium-sized blood vessels, primarily those in the head and neck, particularly the temples

Question 5

What is one key aspect of the history?

Answer 5

Rapidity of onset. An isolated headache with an abrupt onset may represent a potentially serious cause such as cerebral vein thrombosis.

Question 6

Define cerebral vein thrombosis:

Answer 6

A rare stroke-like condition caused by a blood clot in the brain’s venous sinuses, obstructing blood flow and leading to potential complications like stroke, bleeding, and increased pressure. Increased risk to young adults and women.

Question 7

What other symptoms indicate a migraine?

Answer 7

Recurrent headaches
Aura
Nausea
Vomiting
Photophobia

Question 8

What can be a helpful question to ask patients of a headache?

Answer 8

What they do when they have a headache:
Such as abandoning tasks and seeking bed in the dark (indicates a migraine)
Or pacing around the room in an agitated state suggests a cluster headache

Question 9

Define syncope:

Answer 9

Loss of consciousness due to inadequate cerebral perfusion and is the most common cause of transient loss of consciousness

Question 10

What does syncope with no warning or trigger suggest?

Answer 10

Cardiac cause

Question 11

What can recurrent dizziness indicate?

Answer 11

Postural hypotension
Cerebrovascular disease
Hyperventilation

Question 12

Define what vertigo is:

Answer 12

a sensation of movement, often a spinning or whirling sensation, when the body is actually stationary, or the environment is stationary

Question 13

Why is drug history important to ask a patient?

Answer 13

Can increase neurological symptoms

Question 14

Define meningism:

Answer 14

Inflammation or irritation of the meninges

Question 15

How do you assess neck stiffness for meningitis?

Answer 15

• place your hand on either side of the patients head supporting the occiput
• Flex the patients head gently until their chin touches their chest
• Ask the patient to hold that position for 10 seconds. If neck stiffness is preset, the neck cannot be passively flex and you may feel a spasm in the neck muscles
• Flexion of the hips and knees in response to neck flexion is called Brudzinskis sign

Question 16

What is kernigs sign?

Answer 16

For testing meningitis
+ Flex one of the patients legs to 90 degrees at both the hip and the knee with your left hand placed over the medial hamstring
+ Extend the knee while the hip is maintained in flexion. Look at the other leg for signs of any reflex flexion
+ Kernings sign is positive when the extension is resisted by spasm in the hamstrings

Question 17

Define dysarthria

Answer 17

Refers to slurred or strangulated speech caused by articulation problems due to a motor deficit

Question 18

Define dysphonia

Answer 18

Describes the loss of volume caused by laryngeal disorders

Question 19

Define dysphasia

Answer 19

Disturbance of language resulting in abnormalities of speech production and/ or understanding.

Question 20

What can frontal lobe damage cause?

Answer 20

= personality and behaviour changes
= loss of emotional responsiveness or emotional liability
= cognitive impairments
= dysphasia
= urinary incontinence
= focal motor seizures

Question 21

What does temporal lobe damage cause?

Answer 21

= memory impairment
= focal seizures with psychic symptoms
= receptive dysphasia (dominant hemisphere)

Question 22

What are some features of parietal lobe dysfunction?

Answer 22

= cortical sensory impairments
= dyslexia, dysgraphia
= focal sensory seizures

Question 23

What are some features of occipital lobe damage?

Answer 23

= visual field defects
= disturbances of visual perception
= visual hallucinations

Question 24

What does the olfactory nerve convey?

Answer 24

Sense of smell

Question 25

What does the trigeminal nerve convey?

Answer 25

The sensation from the face, mouth and part of the dura and provides motor supply to the muscles of mastication

Question 26

What does the facial nerve supply?

Answer 26

Supplies the muscles of facial expression and carries parasympathetic fibres to the lacrimal, submandibular and sublingual salivary glands

Question 27

What does the glossopharyngeal nerve do?

Answer 27

Carries sensation from the pharynx and tonsils and sensation and taste from the posterior one third of the tongue. It also supplies the carotid chemoreceptors.

Question 28

What does the vagus nerve carry?

Answer 28

Carries important sensory information but also innervates upper pharyngeal and laryngeal muscles

Question 29

Describe lower motor neurone lesions:

Answer 29

Motor fibres together with input from other systems involved in the control of movement, including extrapyramidal, cerebellar

Question 30

What are the symptoms of meningitis?

Answer 30

A high fever Headache A stiff neck A rash that does not fade when a glass is rolled over it Seizures Drowsiness or unconsciousness

Question 31

What is the management of meningitis

Answer 31

Where the patient meets the indications - Benzylpenicillin sodium Oxygen if the patients Sats are below 94% Fluids if required (blood pressure) - do not delay on scene for fluid replacement, cannulate en route

Question 32

Define Cauda Equina syndrome (CES):

Answer 32

Caused by the compression of the nerves in the spinal canal below the end of the spinal cord.

Question 33

What patients can Cauda Equina syndrome occur with?

Answer 33

Patients with trauma, a herniated disc, chronic or acute low back pain, tumours or infection

Question 34

What are the red flags for Cauda Equina Syndrome?

Answer 34

- Loss of bladder and/ or bowel dysfunction causing incontinence. - Urinary retention - New onset of sexual dysfunction - Neurological deficit in the lower limb (motor, sensory loss, reflex changes, bilaterial sciatica

Question 35

Define bilateral sciatica:

Answer 35

sciatica pain experienced in both legs

Question 36

Define what sciatica pain is:

Answer 36

- A sharp, burning, or shooting pain that may be accompanied by numbness, tingling, or weakness. - Sciatica is a type of pain that travels along the sciatic nerve