Neurological Emergencies and Management

Question 1

Headache types?

Answer 1

Primary head aches - spontaneous
Secondary headaches - i.e head trauma.
Migraine - unilateral and frontal
Tension - every day
Medication overuse - 3 months
Cluster - excruciating oine sided headaches
Subarachnoid - sudden onset very severe

Question 2

Headache - red flags?

Answer 2

Severe sudden onset (thunderclap)
Located at top of head
Crescendo (intense then fades)
Change in vision
New Ataxia (disorder affects balance and speech)
Posture related
Meningeal irritation/evidence of rash

Question 3

Headache management

Answer 3

Correct all ABCD Issues
Assess and record AVPU - oxygen if below 94%
Assess for evidence of rash, neck stiffness/photophobia, loss of function, flushed face.

Pre alert to nearest ED IF new red flag symptoms.

ASK is this the worst headache?
Is this a new headache?
Is it different from your usual headaches?

Question 4

Altered level of consciousness red flags conditions?

Answer 4

Stroke/TIA
Head Injury
Epilepsy
Hypoglycemia
Hyperglycemia
Subarachnoid haemorrhage
Overdose
Sepsis
Adrenal Sufficiency

Question 5

What is transient loss of consciousness?

Answer 5

Spontaneous loss of consciousness with complete recovery i.e. full recovery of consciousness without any residual neurological deficit ie blackout or collapse.

Question 6

Acute Cauda Equina

Answer 6

affects the spinal nerves arising from the lower portion of spine.
Nerve roots become compressed.
Causes: herniated discs, spinal stenosis, tumours, infections, spinal injuries.
Delayed treatment can lead to permanent nerve damage resulting in long term consequences like incontinence and paralysis.

Question 7

CES Red Flags

Answer 7

Severe lower back pain/leg weakness
Loss of bladder/bowel dysfunction
Saddle numbness
New onset of sexual dysfunction
Motor/sensory weakness or loss of reflexes in lower limbs.

Question 8

CVA/TIA

Answer 8

Stoke - ischaemic (blockage)
Haemorrhagic (bleed on the brain)
TIA - temporary interruption to cerebral blood flow.
Symptoms self resolve within 24 hours.

Question 9

Stroke Causes?

Answer 9

AF
Hypertension
Diabetes
Heroin abuse
Straining
Alcohol abuse
Gender
Race
History
Smoking

Question 10

Stroke red flag symptoms

Answer 10

Sudden onset of numbness or weakness in the dace
New confusion
New visual disturbance.
New onset trouble walking
Sudden onset severe headache
Sudden onset of dizziness, nausea and vomiting
Reduced level of consciousness
Acute onset neurological deficit
Acute onset neck pain or neck stiffness
Locked in syndrome (full body paralysis below the neck)

Question 11

Generalised cause of seizures?

Answer 11

Absence - brief interruption, blank staring
Tonic - rigid, falls, but no jerking
Atonic - sudden loss of muscle tone
Tonic clonic - ridgid falls jerks

Question 12

Status epilepticus?

Answer 12

Bilateral tonic clonic seizure that has not stopped after 5 minutes or a series of such seizures without recovery in between, which lasts for 5 minutes or more.

Question 13

Non epiletiform epilepsy causes?

Answer 13

Febrile convulsions - rapid rise in temp.
Hypoxia - A and B are essential.
Stroke
Tumour
Drug O/D
Electrolyte balance

Question 14

Psychogenic non epileptic seizures

Answer 14

involuntary psychological responses to distress and are commonly associated with emotional trauma.
Those who recieved a diagnosis of PNES may know their condition by another name.

Question 15

Eclampsia?

Answer 15

Tonic clonic convulsion associated with pregnancy
Pre existing pre eclampsia.
Convulsions self limiting but severe and repetitive.

Question 16

Types of lobes

Answer 16

Occipital (back) - visual distubances
Parietal lobe (up) - numbness or tingling
Frontal lobe ( front) - wave going through your head
Temporal lobe (bottom) - rising feeling in the stomach or deja vu.