Neurological assessment and management

Question 1

What are the layers of the skull

Answer 1

Dura matter
Arachnoid matter
Pia Matter
Brain

Question 2

What are some common stroke mimics?

Answer 2

Seizures
Migraines
Fainting
Infections
Functional Neurological Disorder (FND)

Question 3

What is Functional Neurological Disorder?

Answer 3

“Functional Stroke” Caused by a disorder that effects the nervous system rather than the brain resulting in the signals between brain and body being interrupted.

Question 4

What is a TIA

Answer 4

Transient Ischemic Attack

Question 5

What is the timeframe for it to be classed as a TIA and not a full stroke?

Answer 5

24 hours

Question 6

What can you use to assess risk if you suspect a patient has had a TIA?

Answer 6

ABCD2

Question 7

What is ABCD2?

Answer 7

A scoring system used to assess the risk of TIA to occur in the next 2 days, 7 days, or 90 days.

Question 8

What are seizures?

Answer 8

Seizures occur when there is a rapid and intense episode of electrical activity.

Question 9

What are convulsions?

Answer 9

A convulsion is an involuntary contraction and relaxation of the muscles producing rigidity and violent shaking of the body and limbs. Often associated with altered / reduced consciousness

Question 10

What are focal seizures?

Answer 10

When one localised area of the brain is initially involved - can spread to other areas.

Question 11

What are generalised seizures?

Answer 11

Affects both sides of the brain

Question 12

What is the tonic phase of a tonic clonic seizure?

Answer 12

LOC
Stiffness of muscles
Crying out (air pushing out of vocal cords)
May bite there tung

Question 13

What is the clonic phase of a tonic clonic seizure?

Answer 13

Rhythmic jerking of limbs
Loss of control of bladder/bowels
Breathing affected - cyanosis may occur.

Question 14

How long do tonic clonic seizures last?

Answer 14

1-3 mins - longer than 5 mins in status epilepticus.

Question 15

What is the responsiveness level of focal aware seizures?

Answer 15

Fully aware of surroundings during the seizure but may not be able to move or respond.

Question 16

What are focal impaired awareness seizures?

Answer 16

Where awareness is affected at some point during the seizure.

Question 17

What are motor seizures?

Answer 17

Muscle activity localised jerking, loss of tone, or repeated movement.

Question 18

What are non motor seizures?

Answer 18

No muscle activity btt may affect emotions, thinking and sensations.

Question 19

What are typical absences seizures?

Answer 19

Usually last 10 secs but come in clusters.
Appear to be day dreaming, may be slight jerking.
Usually unnoticed
May not fall
Will not be aware of what is happening.

Question 20

What are atypical absences seizures?

Answer 20

Usually last about 30 secs
Similar to typical but last longer and have a slower start and finish.
May be able to move around but appear clumsy as muscles become limp.
Can occur in any age group but often occurs in people with learning difficulties or brain conditions.

Question 21

What are myoclonic seizures?

Answer 21

Can be focal or generalised.
Mild twitches or can be more forceful.
Does not usually affect level of consciousness.
Usually last for less than a second but can be in clusters.

Question 22

What are tonic seizures?

Answer 22

Can be focal or generalised.
Muscle stiffness
May fall
Neck extension
Eyes open and roll upwards
Arms and legs stretch and contract
May cry out and stop breathing briefly
Usually last 3 secs - 2 mins

Question 23

What are atonic seizures?

Answer 23

Muscles become limp
Will fall to floor if standing
Usually lasts less than a couple of seconds.

Question 24

What is the treatment of seizures?

Answer 24

Protect against injury
Do not move patient unless for safety of patient.
Protect dignity
They usually self resolve.

Question 25

If BTCS (bilateral tonic clonic seizure) has not stopped after 5 mins to a series of seizures without recovery. Then it is classed as what?

Answer 25

Convulsive Status Epilepticus and give diazepam.

Question 26

What is recovery for Focal seizures?

Answer 26

Very quick with little to no after effects, may feel tired or headaches.

Question 27

What is recovery for tonic clonic seizures?

Answer 27

Headache, sore, tired, very unwell, may be confused and have memory issues. Can last hours to days.

Question 28

What is the recovery for absent seizures?

Answer 28

Usually recover quickly and may present as if nothing has happened although may feel unwell or tired.

Question 29

What is the recovery for myoclonic seizures?

Answer 29

Usually immediate recovery

Question 30

What is the recovery for tonic seizures?

Answer 30

Sleepy, tired and may be confused for some time afterwards.

Question 31

What is the recovery for atonic seizures?

Answer 31

Normally no after effects and muscle tone returns but may be injured from fall.

Question 32

What are Acute Symptomatic Seizures?

Answer 32

Non epileptic seizures

Question 33

What are acute symptomatic seizures caused by?

Answer 33

TBI Brain Tumour Stroke TB Neurocysticercosis Alcohol withdrawal Renal failure Hepatic failure Hypoglycaemia

Question 34

What does PNES stand for?

Answer 34

Psychogenic Non Epileptic Seizures

Question 35

When does PNES occur?

Answer 35

Usually when trauma occurs and the brain gets overwhelmed and causes seizure. NOT EPILEPTIC

Question 36

How is meningitis usually transmitted?

Answer 36

Coughing Sneezing Kissing

Question 37

How many cases of bacterial meningitis are fatal?

Answer 37

1 in 10 cases

Question 38

What is encephalitis?

Answer 38

Uncommon but very serious condition. It is an inflammation of the brain. Most common in very young and very old.

Question 39

What are the non serious symptoms of encephalitis?

Answer 39

Similar to flu Fever Headache N&V Aching muscles and joints

Question 40

What are the serious symptoms of encephalitis?

Answer 40

Confusion Drowsiness Seizures Agitation Difficulty speaking Weakness or loss of movement Hallucinations Loss of feeling in certain parts of body LOC

Question 41

What is the difference between vertigo and dizziness?

Answer 41

Dizziness everything is spinning around Vertigo is spinning up and down ( on a boat ) Vertigo is a symptom of a condition

Question 42

What are the two types of vertigo?

Answer 42

Peripheral Central

Question 43

Want is vertigo usually caused by?

Answer 43

The way that balance works in the inner ear, but can have other causes as well within the brain

Question 44

What is peripheral vertigo?

Answer 44

Benign Paroxysmal Positional Vertigo (BPPV) Head injury Labryinthitis Caused by balance mechanisms in the inner ear.

Question 45

What is Gullain Barre syndrome?

Answer 45

Rare condition Immune system attaks the peripheral nervous system Can affect all ages – most common in adult males Most recover fully Symptoms develop usually over hours or days Usually reaches most severe within 4 weeks Early symptoms tend to be in feet and hands

Question 46

What is bells palsy?

Answer 46

Temporary weakness or lack of movement usually affecting one side of the face (other symptoms include, drooling, drooping eyelid, loss of taste, dry mouth and dry or watering eye) Treated with steroids, eye drops to stop drying out, tape to close eye during sleep Recovery usually around 6 months

Question 47

What is supra nuclear palsy (rare)

Answer 47

Neurological condition that can cause problems with balance, movement, vision, speech and swallowing caused by build up of protein (tau) damaging brain cells Other symptoms include falls, changes in behaviour muscle stiffness, inability to control eye movement, memory problems Increasing damage to brain cells over time Approx 4000 people with PSP in UK (PSP Association figures) Usually develop in people over the age of 60

Question 48

What is the most common cause of vertigo?

Answer 48

BPPV ( Benign Paroxysmal Positional Vertigo )