Neurological Emergencies

Question 1

Acute onset neuro conditions

Answer 1

Stroke

Question 2

Subacute onset neuro conditions

Answer 2

Infection
Malignancy

Question 3

Chronic onset neuro conditions

Answer 3

Neurodegenerative

Question 4

How to think about neuro pathology location

Answer 4

Brain
Brainstem
Spinal cord

Question 5

What are you worried when looking on a CT if someone has a haemmorhagic stroke?

Answer 5

Raised ICP - herniation - coning - death

Question 6

Management of haemmorhagic stroke

Answer 6

Craniectomy - remove skull to relieve pressure so the patient doesn’t die
Conscious level? Midline shift?

Question 7

How does something point towards encephalitis instead of meningitis?

Answer 7

seizures
agitation
confusion

Question 8

Which cause of encephalitis should you not miss? How would you manage?

Answer 8

HSV encephalitis mx - Aciclovir

Question 9

If someone has encephalitis, how do you manage?

Answer 9

Treat - IV aciclovir
Abx

CT - to exclude raised ICP
LP

Question 10

Where does HSV encephalitis affect?

Answer 10

Medial temporal lobes- hippocampal
Often asymmetrical
Short term memory difficulties

Question 11

Long term effect of HSV enchpalitis

Answer 11

Propensity for seizures in the future
Amnesia

Question 12

Alcoholic with ataxia, confusion, forgetful

Answer 12

Wernicke’s - thiamine deficiency

Question 13

Wernicke’s features

Answer 13

Ophthalmoplegia
Ataxia
Confusion

Question 14

Below the level of L1 - what’s the syndrome

Answer 14

Cauda equina due to bleed, tumour, compression due to lumbar disc disease

Question 15

Features of cauda equina syndrome

Answer 15

Lower back pain
Shpincter distrubance
Saddle anaesthesia - numbnress betweet legs
Pain down leg and limbing gait

Question 16

Sphincter distrubance - where is the pathology

Answer 16

Spinal cord

Answer 17

Lermitte’s phenomenon - on flexion of spine - associated with cervical lesions

Question 18

32 year old woman with acute onset of tingling in hands and feet. Heaviness in right leg and numb over left trunk. Several falls, bladder retention, electrical shock down spine on neck flexion.

Answer 18

MRI of brain and cervical spine

If lesion on spine alone - transverse myelitis
If brain and spine - MS

Question 19

Demyelination

Answer 19

Sub acute - over a few days
Age - middle aged

Answer 20

Aquaporin 4 related disorders

Question 21

71 year old man with severe back pain, tingling in feet more than fingers, palpitations, weakness of legs and falls, progression over hours/days, mild bilateral facial weakness. Where is the pathology.

Answer 21

Peripheral nerves.

Autonomic dysfunction with palpitations, arrhythmias, gut abnormalities etc

Question 22

Peripheral nerve pathology causes

Answer 22

GBS
Peripheral neuropathies

Question 23

GBS signs

Answer 23

Weakness
Back pain
Sensory disturbance (pain)
Numbness
Flaccid tone, sinking into the bed, floppy

Answer 24

Sensory signs but no symptoms - not really a problem

Question 25

What causes people to die with GBS?

Answer 25

Bulbar weakness - respiratory muscle weakness

Question 26

How do you measure lung function in someone with

Answer 26

Sats are an unreliable way of determining respiratory function in neuromuscular disorders FVC - ensure good seal around tube, sit them up, best of three

Question 27

How do you investigate someone with GBS

Answer 27

Full cardiac (do ECG), respiratory, gastro exam (exclude ileus) Protein raised in LP of GBS If WCC raised in LP, suggests a virus mimicking GBS

Question 28

Management of GBS

Answer 28

IV Immunoglobulin

Question 29

48 year old person with eye lid drooping, double vision, difficulty coming hair, heavy legs on climbing stairs, swallowing difficulty, SOBOE. Where is the lesion and what could the pathology be.

Answer 29

Could be peripheral nerve motor neuropathies or NMJ problem

Question 30

Myasthenia gravis

Answer 30

Decrement on repetitive testing on EMG

Question 31

Myasthenia gravis mx ???

Answer 31

IVIG Pyrostigmine to increase acetylcholine in NMJ

Question 32

Mild pain on eye movement, 17 year old with eye problem

Answer 32

Inflammatory condition in eye

Question 33

Eye symptoms worse after taking shower/drinking hot tea

Answer 33

Ootof's phenomenon

Question 34

Over 50, headaches, tender scalp, jaw claudication, malaise, aching limbs

Answer 34

ESR - very high CRP Fibrinogen

Question 35

Management of giant cell arteritis

Answer 35

Temporal artery biopsy Oral pred 60mg

Question 37

Acute ptosis with eye looking up and out - mx

Answer 37

3rd nerve palsy

Question 38

What are you looking out for in third nerve palsy

Answer 38

Pupil involvement = dilated pupil - posterior communicating artery aneurysm pupil sparing - microvascular third nerve palsies

Question 39

What is Horner's syndrome

Question 40

52 year old with violent headaches and vomiting, passive and abulic, depressed, fatigue

Answer 40

Raised intracranial pressure causes -

Question 41

Abulia

Answer 41

flattened affect loss of motivation without mood changes (not depression)