Neurological Emergencies

Question 1

What are neurological emergencies?

Answer 1

Life-threatening conditions that affect the central or peripheral nervous system, requiring immediate diagnosis and treatment to prevent death or permanent disability.

Question 2

True/False: Neurological emergencies include only stroke and seizures.

Answer 2

False. They include a range of conditions like meningitis, encephalitis, GBS, and more.

Question 3

______ is a neurological emergency caused by the sudden interruption of blood supply to the brain.

Answer 3

Stroke

Question 4

Name three common neurological emergencies.

Answer 4

Stroke, status epilepticus, and acute bacterial meningitis.

Question 5

True/False: Guillain-Barré Syndrome can be classified as a neurological emergency

Answer 5

t

Question 6

What are the two main types of stroke?

Answer 6

Ischaemic stroke and haemorrhagic stroke.

Question 7

The initial treatment for ischaemic stroke is ______ within the first 4.5 hours.

Answer 7

Thrombolysis (e.g., alteplase).

Question 8

True/False: Haemorrhagic stroke requires immediate anticoagulation therapy.

Answer 8

False. It requires blood pressure control and neurosurgical intervention if necessary.

Question 9

Define status epilepticus.

Answer 9

A seizure lasting more than 5 minutes or recurrent seizures without recovery in between

Question 10

First-line treatment for status epilepticus includes ______ or ______ administered intravenously.

Answer 10

Lorazepam; diazepam.

Question 11

True/False: Status epilepticus can lead to permanent brain damage if untreated.

Answer 11

t

Question 12

What is the first-line antibiotic treatment for suspected bacterial meningitis in adults?

Answer 12

IV ceftriaxone or cefotaxime, often with dexamethasone.

Question 13

The classic triad of meningitis includes fever, ______, and altered mental status.

Answer 13

Neck stiffness.

Question 14

True or false : A lumbar puncture should always be performed before starting antibiotics in suspected meningitis.

Answer 14

False. Antibiotics should not be delayed if meningitis is strongly suspected.

Question 15

What are signs of raised ICP?

Answer 15

Headache, vomiting, papilledema, and decreased consciousness.

Question 16

______ posturing is a late sign of raised ICP and indicates severe brain injury.

Answer 16

Decerebrate.

Question 17

True/False: Mannitol and hypertonic saline are used to manage raised ICP.

Answer 17

t

Question 18

What is the most common cause of viral encephalitis?

Answer 18

Herpes simplex virus (HSV).

Question 19

Treatment for HSV encephalitis is intravenous ______.

Answer 19

Acyclovir.

Question 20

True/False: Lumbar puncture is contraindicated in all cases of encephalitis.

Answer 20

False. It is contraindicated only if there are signs of raised ICP.

Question 21

What is the first-line treatment for GBS?

Answer 21

IV immunoglobulin (IVIG) or plasma exchange.

Question 22

In GBS, ascending weakness and ______ are common clinical features.

Answer 22

Areflexia.

Question 23

What neurological emergencies can cause acute respiratory failure?

Answer 23

Guillain-Barré Syndrome, myasthenic crisis, and motor neuron disease.

Question 24

True/False: Non-invasive ventilation is always sufficient in cases of neuromuscular respiratory failure.

Answer 24

False. Intubation and mechanical ventilation may be required.

Question 25

What are red flag symptoms in neurological emergencies?

Answer 25

Sudden severe headache, new focal neurological deficits, altered consciousness, and seizures.

Question 26

Sudden-onset "thunderclap" headache is a key symptom of ______ haemorrhage.

Answer 26

Subarachnoid.

Question 27

True/False: Any patient with acute neurological deficits and fever should be assessed for meningitis or encephalitis.

Answer 27

t

Question 28

How is coma defined?

Answer 28

A prolonged state of unconsciousness, typically with a Glasgow Coma Scale (GCS) score of less than 8.

Question 29

List common causes of coma.

Answer 29

Drugs/toxins (e.g., opiates, alcohol). Anoxia (post-cardiac arrest). Head injury. Stroke (e.g., brainstem infarcts). Infections (e.g., meningitis, HSE). Metabolic (e.g., hypoglycemia, DKA).

Question 30

What are the key clinical features of SAH?

Answer 30

Thunderclap headache ("worst headache of my life"). Nausea, vomiting. Meningism. Altered neurology or loss of consciousness. Sentinel headache (in some cases).

Question 31

How does CT sensitivity for detecting SAH vary over time?

Answer 31

Within 6 hours: 98%. Within 24 hours: 90%. At 7 days: 50%.

Question 32

What are the clinical features of GBS?

Answer 32

Ascending weakness. Areflexia. Cranial nerve involvement (e.g., bifacial weakness). Respiratory and autonomic dysfunction.

Question 33

GBS is characterized by _________ dissociation in CSF, with elevated _________ and no cells.

Answer 33

cyto-protein; protein.

Question 34

What are the primary treatment options for GBS?

Answer 34

IV immunoglobulin (IVIG). Plasma exchange.

Question 35

: What are key investigations for neurological emergencies?

Answer 35

Bloods: glucose, U&Es, ABG, toxicology. Imaging: CT, MRI. Lumbar puncture (e.g., for SAH or infection). EEG (e.g., for seizures).

Question 36

Scenario: A 63-year-old woman develops a severe occipital headache, nausea, and vomiting, with right ptosis and diplopia on upward gaze. What is the likely diagnosis?

Answer 36

SAH with third nerve palsy.

Question 37

A 32-year-old woman presents with ascending weakness and areflexia after diarrhea. CSF shows high protein with no cells. What is the diagnosis?

Answer 37

Guillain-Barré Syndrome.

Question 38

A 25-year-old man experiences status epilepticus after nightclub drug use. MRI shows posterior white matter changes. What is the diagnosis?

Answer 38

PRES (Posterior Reversible Encephalopathy Syndrome).

Question 39

What are the red flags in neurological emergencies?

Answer 39

Sudden severe headache. Loss of consciousness. Acute onset weakness. Seizures or status epilepticus. Respiratory or autonomic compromise.

Question 40

Neuromuscular respiratory failure is a critical component of emergencies caused by conditions like _________, _________, and _________.

Answer 40

Myasthenia Gravis (MG); Guillain-Barré Syndrome (GBS); Motor Neuron Disease (MND).

Question 41

True/False: Ptosis is a typical feature of Guillain-Barré Syndrome.

Answer 41

False

Question 42

A 25-year-old woman presents with a 2-week history of double vision, dysarthria, and dysphagia. Examination shows mild dysarthria and ptosis, with no other neurological deficits. What is the likely diagnosis?

Answer 42

Myasthenia Gravis.

Question 43

True/False: Mebeverine and other anticholinergic drugs should be avoided in MG.

Answer 43

true.

Question 44

What are the key investigations for MG?

Answer 44

Bloods for ACh receptor and MuSK antibodies. CT chest for thymoma. Nerve conduction studies (NCS) or EMG (ideally before treatment).

Question 45

What is the management plan for generalized MG?

Answer 45

Pyridostigmine (starting at 30mg QID, increasing as needed). Steroids with bone protection (gradually increased dose). IVIG or plasma exchange in severe cases. Early treatment of infections.

Question 46

A 48-year-old man presents with progressive lower limb weakness over a week, with back pain and tingling in his feet. Examination shows MRC grade 4/5 power in a pyramidal distribution, absent reflexes, and decreased sensation in the feet. What is the likely diagnosis?

Answer 46

Guillain-Barré Syndrome.

Question 47

GBS often shows _________ dissociation in CSF, characterized by elevated _________ and few or no cells.

Answer 47

cyto-protein; protein.

Question 47

What are the signs of autonomic instability in GBS?

Answer 47

Tachycardia or bradycardia. Hypertension or hypotension. Arrhythmias.

Question 48

True/False: MRI is always abnormal in GBS.

Answer 48

False (MRI may be normal).

Question 49

What is the first-line treatment for GBS?

Answer 49

IVIG. Monitor FVC, pulse, and blood pressure. Supportive care for respiratory and autonomic instability.

Question 50

A GBS patient with worsening weakness develops tachycardia (150 bpm), BP 240/130, and an FVC of 1.2L. What should be done?

Answer 50

Transfer to ITU for respiratory and autonomic management.

Question 50

In MND, non-invasive _________ is often preferred over invasive ventilation due to the progressive nature of the disease.

Answer 50

BiPAP.

Question 50

Low _________ with high suspicion for neuromuscular emergencies requires early _________ referral.

Answer 50

FVC; ITU.

Question 51

A 71-year-old woman with bulbar MND presents with worsening shortness of breath. Examination reveals mixed UMN and LMN signs, crackles at the right lung base, and O₂ saturation of 87% on air. What is the likely cause?

Answer 51

Respiratory failure, possibly due to infection and hypoventilation.

Question 52

What are key components of managing respiratory failure in MND?

Answer 52

Oxygen and treatment of infections. Non-invasive ventilation (BiPAP). Avoidance of ITU in advanced cases.

Question 53

What is the key investigation for assessing respiratory weakness in neuromuscular emergencies?

Answer 53

Forced Vital Capacity (FVC).

Question 54

True/False: IVIG and plasma exchange are equally effective in treating GBS and severe MG.

Answer 54

true