Neurological Emergancies Flashcards Preview

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Flashcards in Neurological Emergancies Deck (32):

What are the signs and symptoms of meningitis?

- generalised headache, gradual onset
- vomiting, neck stiffness, fever, photophobia, altered consciousness
- Kernig's sign - difficult to bend knee
- non-blanching rash


What the main risk factors for menginitis?

- extremes of age
- diabetes
- immunosuppression
- splenectomy
- alcoholism
- contagious infection
- defects in dura mater
- IV drug abuse
- malignancy


What are the most common causative organisms for bacterial meningitis?

- S.pneumoniae
- N. meningitides
- If pregnant or over 60 its more likely to be L. monocytogenes
- recently had surgery = S.aureus


What is the essential treatment if bacterial meningitis is suspected?

- start benzylpenicllins in case its meningococcus


What are the diagnostic tests for meningitis?

- CT indicated if impaired conciousness or focal neurological deficit
- LP to diagnose
- blood tests to look for DIC


What the CSF findings for bacterial meningitis?

- marked elevation of WBCs, mainly polymorphs
- usually elevated protein
- reduced glucose by 50%


What are the CSF findings for viral meningitis?

- WBC elevated, usually lymphocytes
- protein elevated
- normal glucose


What are the CSF findings for TB meningitis?

- elevated WBCs, mixed,
- usually very high protein
- reduced glucose


Malignant CSF findings

WBCs elevated
- often elevated protein
- reduced glucose


How does TB meningitis present?

- insidious onset, however acute presentation can occur if it is complicated by hydrocephalus or vasculitis
- often presents with mild heachace, lesions of CN 6, 3 and 4
- papilloemea, and optic nerve damage


How is TB meningitis treated?

- rifampicin
- isoniazid
- pyrazinamide
- ethambutol
+ steroid over two months


How is viral meningitis treated?

- antipyretics and support until full recovery occurs


What is the treated of the following causes of bacterial meningitis?
- unknown
- meningococcus
- pneumococcus
- s.aureas

- unknown = cefotaximine
- meningococcus = cefotaximine/benzylpenicillin, if allergic chloramphenicol can be used, also give dexamethasone
- pneumococcus = cefotaximine
- s.aureas = rifampicin


What is encephalitis?
What are the symptoms?

- inflammation of the brain parenchyma
- symptoms include headache, fever, focal neurological deficit (dysphagia, weakness), seizures, and encephalopathy


What is the typical cause of encephalitis?

- typically viral in cause, usually HSV and other human herpesvirus
, but can also be due to bacteria such as listeria. Additionally autoimmune is increasing in prevelance


How should HSV encephalitis be treated?

- if suspected acyclovir should commence before investigation


What are the investigations for encephalitis?

- MRI, EEG, LP to culture virus


In all episodes of acute and sub-acute flaccid weakness it is important to...

- monitor respiration in all causes using FVC


What are the causes of acute and subacute neuromuscular failure?

- Nerve lesions include Guillain Barre
- Muscle disease such as inflammatory dermatomyositis and metabolic disorders such as acid maltase
- NMJ pathology includes myasthenia graves and botulism


What are the features of Guillain Barre?

most common cause of acute NMJ weakness, leading to inflammatory polyradiculopathy
- it normally is preceded by respiratory tract infection, generating antibodies that then cross-react with the myelin sheath of neurones


What are the symptoms of GBS?

- parastheisa but little sensory loss, back pain is common
- distal upper and proximal lower limb weakness, facial and bulbar involvement
- respiratory muscles may be involved


What are the investigations for GBS?

- LP, CSF will show elevated protein, and nerve conduction studies


Prognosis in GBS is poor if it is caused by ........ . Why?

- axonal loss, and the time to nadir is short-
Treatment - plasma exchange and IV Ig to accelerate recovery


What is MG?

- an autoimmune condition characterised by the presence of AChR antibodies that block the post-synaptic receptor at the NMJ
- this will present with fatiguable weakness of muscle function with no autonomic features


What are the investigations for MG?

- the ice test (placing ice over brow will decrease ptosis), the tenilson test (give a short active acetyl- cholinesterase inhibitor will increase function) and repetitive stimulate EMG
- blood test should shoe AChR antibodies and/or MuSK antibodies
- CXR and CR thorax can show thymoma


What is the treatment for MG?

Treatment is both symptomatic and immunosuppressive
- long acting acetyl-cholinesterase inhibitors such as pyridostigmine and steroids such as methotrexate and prednisolone
- thymectomy may be indicated
- in acute cases, plasma exahcnage and IV Ig


What is status epilepticus?

- continuous seizures for 30 minutes or serial seizures over 30 minutes without regaining conciseness


What are the causes of status epilepticus?

- non-compliance to anti-epileptics
- alcohol
- drug overdose
- metabolic disorders
- hypoxia
- tumour
- trauma


How is status epilepticus traeted?

- manage ABCDE
- cause of precipitating factor should be addressed, this include 50ml of 20% IV glucose if BM is kit
- 1-2mg lorazepam
- if not effective then phenytoin and fosphentoin can be used
- if the patient remains in status they need to be paralysed using thiopentone/propofol and supported in ITU


How should status epileptics be investigated?

urgent biochemistry, haematology, BMs,
- AED, calcium and Mg levels measured
- blood gases taken
CT scanning, LP, EEG monitoring


What are the causes of coma?

Neurological - infection, neoplasm
Systemic - metabolic, endocrine, infection
Extrinsic - drugs, toxins


What is the difference in signs and symptoms between cord compression and cauda equina compression?

- cord compression - weakness is asymmetrical and reflexes are absent
- cauda equina - weakness is equal and bilateral and reflexes are brisk