Neurological System Flashcards
(108 cards)
1
Q
Cerebral Palsy **
A
= static encephalopathy, non-progressive disorder of
motion and/or posture causing activity limitation. (Withouot treatment activity can decrease)
2° to an insult of the developing brain (< 5 years)
accompanied by distubances of sensation, cognition, communication, perception,
behaviour, seizure disorders
2
Q
neurological findings of CP
A
increase in peripheral tone, but floppy centrally:
» Cerebrum control tone; spinal cord controls axial reflexes
but After injury: cerebrum does not control tone, BUT reflex in the spinal cord is
still functioning
3
Q
Different types of motor impairment in CP
A
- Spastic: increased tone
- Bilateral: diplegia or quadriplegia
- Unilateral: hemiplegia or monoplegia
- Dyskinetic: abnormal movements
- Hypokinetic: dystonia (focal, segmental or generalized) or rigidity
- Hyperkinetic: dystonia, athetosis, chorea
- Ataxic: unsteadiness
- Hypotonic
- Mixed: spasticity with movement disorder
4
Q
Diplegia
A
Diplegia is a type of paralysis that affects both sides of the body, but typically in a symmetrical pattern. It most commonly refers to paralysis or significant weakness of the same region on both sides
5
Q
Hemiplegia
A
Paralysis on one side of the body Right or left side (arm + leg)
6
Q
Quadriplegia
A
Paralysis of all four limbs Both arms and both legs
7
Q
Athetosis
A
- Slow, writhing, unsustained
- Proximal & distal
- Face, neck, distal extremi&es, wrist
- Exacerbated by movement, anxiety
& cold - Disappears during sleep
8
Q
Chorea
A
- Brief, jerky, unpredictable
- More distal
- Hands, fingers, face, head
- At rest & during voluntary
movement
9
Q
Dystonia
A
- Involuntary, sustained, intermittent
- Abnormal postures with rest or with active movement
- Same postures are repeated
- Resolves with sleep; Excerbated by anxiety
- Tone geneally increased
10
Q
Spastic diplegia
A
▪ Cause: almost always congenital in origin; strong
associa&on with prematurity
▪ Brain injury in premature newborns predominantly affect
the pyramidal tracts from the lower limbs
▪ Difficulty with applica&on of diapers
▪ Commando crawl rather than normal four stance
crawling
▪ Ventral suspension = scissoring
▪ Delayed walking: equinovarus posi&on & tip toe walking
▪ Disuse atrophy & dispropor&onate growth lower limbs
❖ Likelihood of seizures minimal
11
Q
Spastic quadriplegia
A
▪ Cause: commonly perinatal abnormalities
▪ Most severe form: motor impairment all four limbs
▪ O/E: brisk deep tendon reflexes, ankle clonus, Babinski’s,
fis&ng & microcephaly
▪ Pseudobulbar palsy: swallowing difficul&es
▪ Speech rarely develops; when it does it is dysarthric
▪ Vision can be affected: op&c atrophy, squints, cor&cal
blindness
▪ Physiotherapy: prevent “windswept deformity”
❖ “ associa&on with seizures
12
Q
Spastic Hemiplegia
A
▪ Cause: congenital or acquired
▪ decreased spontaneous movements on the affected side; arm
tends to be more involved than leg.
▪ Early signs usually very subtle
▪ Delayed sieng balance with tendency to fall towards the
affected side
▪ Abnormal parachute reflex at 7 months
▪ Delayed walking with circumduc&ve gait
❖ 1/3 epilepsy < 2 y/o
13
Q
Dyskinetic disorder
A
▪ Cause: perinatal
▪ At birth: hypotonia with poor head control & marked
head lag
▪ Movement disorder can take up to 2 years to express
itself
▪ Involvement of oropharyngeal muscles: speech typically
affected
▪ Generally UMN signs are not present
▪ decreased risk of contractures
❖ Seizures uncommon
14
Q
Anatomical correlates to the type of movement disorder CP
A
Spastic diplegia = Periventricular leucomalacia. Prem infant with IVH/PVL
Spastic hemiplegia = Middle cerebral artery. TB meningitis
Dyskinetic disorder = Basal ganglia. Globus pallidus Severe kernicterus association.
Ataxia = Cerebellum fallout
TB Meningitis = Caudate, thalamus
15
Q
Prenatal Aetiology of motor deficits CP
A
- Prenatal
* Infec&on: TORCHES
* Toxins from mom
* Maternal chorioamnioni&s
* Maternal DM
* Intracranial cerebral
malforma&ons
* Cerebrovascular incidents
* Chromosomal
abnormali&es
* Intra-uterine growth
retarda&on
16
Q
Perinatal causes of motor deficits CP
A
- Prematurity
- Birth asphyxia
(< 10%) - Birth trauma
- Metabolic:
hypoglycaemia - Kernicteris
- Neonatal
meningi&s
17
Q
Postnatal causes of CP
A
- Infec&ons: meningi&s,
encephali&s - Vascular malforma&on:
AVM - Toxins/drugs
- Trauma
- Post-cardiac arrest
- Stroke
- Non-accidental injury
18
Q
History you want to know with a CP child
A
- Developmental status & milestones
- Behaviour
- Communica&on
- Speech
- Daily ac&vi&es
- Feeding
- Seizures
- Mobility
19
Q
Examination of CP child
A
- General: dysmorphism, anthropometry
- CNS:
- Posture: fisting, opisthotonus
- Movement
- Asymmetry
- Behaviour
- Eye signs: nystagmus, squint
- Bulbar signs: drooling
- Resp: recurrent chest infections (inadequate clearance & aspiration)
- Abd: constipation, fecal impaction, UTI
- MSK: contractures, hip dislocation, scoliosis
20
Q
Findings of UMN lesion
A
Spas&c CP: “ tone
Overac&ve tendon reflexes
Clonus
21
Q
What can neuroimaging tell us
A
- Congenital malforma&ons
- Gray matter damage
- White matter damage
- Ventriculomegaly, atrophy, CSF fluid space abnormali&es
- Miscellanous abnormali&es not included in above
22
Q
Mx of CP child
A
- MDT
- prevent contactures
- Mx for spasticity = Baclofen GABA agonist, Oral diazepam, Botox
- L-dopa for dyskinetic
- Mx for constipation and reflux
- Anti-convulsants for seizures
23
Q
Hemiparesis
A
Always UMN lesion
BUT differentiate between cause of
1. Supratentorial
decreased LOC
Affected speech
Convulsions
increased ICP
- Posterior fossa
CN fallout
Cerebellar signs
Brainstem signs
Ventricle abn - Spinal cord
Sensory level
Sphincter abn
24
Q
Monoparesis define & causes
A
Weakness (not complete paralysis) in just one limb — either one arm or one leg
- UMNL
Higher cortex: tuberculoma
Make sure it is not a hemiparesis! - LMNL
Anterior horn cell: polio
Nerve injury
25
What can a cortical lesion cause
* Monoparesis
* Hemiparesis
* Paraparesis
* Quadroparesis
26
Organisms causes bacterial meningitis
1. <3mo
Group B haemoly/c strep
Gram nega/ve
▪ E.coli
▪ Klebsiella
2. Children
H. influenza
S. pneumoniae
N. meningi/des
27
Clinical presentation of bacterial meningitis in neonates
Hx:
* Poor feeding
* Vomi/ng, Diarrhoea
* Irritability, Restlessness
* High pitched cry
Vitals:
* Apnea, Bradycardia
* Temp instability, Fever
General:
* Jaundice
CNS exam:
* Bulging frontanelle
* Hypotonia
28
Clinical presentation of bacterial meningitis in children
Hx:
* Lethargy
* Vomi/ng
* Convulsions
* Headache, Neck & backache
* Photophobia
Vitals:
* Fever
General:
* Rash
CNS exam:
* Coma
* Bulging frontanel
* Signs of meningism
29
Tests for meningeal irritation
* Neck s/ffness
* Kernig’s sign: child is unable to extend the knees when the thighs are at right
angles to the body
* Brudzinski’s sign: hips flex when the head bends forward; in the siZng
posi/on, child is unable to touch the knees with the nose
30
Contraindications to LP
- Signs of life-threathening increased ICP (signs of impending hernia/on)
- Focal neuro signs
- Critically ill patients at risk of cardio-pulmonary arrest
- Areas of sepsis over potential pucture site
- Bleeding diathesis or decreased platelet count
31
Signs of life-threathening increasing ICP
Foramen magnum:
- Fluctua/ng LOC
- Irregular breathing, apneic spells
- Episodes of decerebrate posturing
Trans-tentorial
- Deteriora/ng LOC
- Ipsilat CN III: dilated pupil
- Contralat weakness progressing to = Bilat dilated pupils
- Resp irregularity
- HTN & bradycardia
32
CSF findings of bacterial meningitis
Appearance = Turbid increased pressure
Cells = 100’s to 1000’s/mm3 cells, mainly polymorphs
Chemistry = incr protein, incr globulin, decr glucose
Gram stain & culture = Group B strep: gram ✚ cocci in chains
E.coli: gram nega/ve bacilli
Klebsiella: gram nega/ve bacilli
H. influenza: gram nega/ve cocco-bacilli
S. pneumoniae: gram ✚ diplococci
N. meningi/des: gram nega/ve diplococci
33
CSF Findings of meningitis compare bacterial, viral, TB
1. Bacterial
- increasedddd opening pressure
- turbid yellow
- incr neutrophils
- increasedddd protein
- decreased glucose
2. Viral
- clear, normal opening pressure
- increased lymphocytes
- normal protein normal glucose
3. TB
- increaseddd opening pressure
- straw colour
- increased lymphocytes
- increasedddd protein
- decreasedddd glucose
34
Rx for meningitis
<3mo = Cefotaxime
>3mo = Ceftriaxone
Post culture adjust AB to sensitive
Mannitol for Increased ICP
Diazepam for seizures/convulsions
35
Prevention for Meningitis
Immunization
- H influenza = Hib vaccine
- S pneumonia = polyvalent vaccine
Chemoprophylaxis
- H influenza = Rifampicin
- N meningitides = Rif, Ciprofloxacin
36
Complications of meningitis
Acute
1. Convulsions
2. Sensori-neural deafness:
common
3. Blindness
4. Subdural collec/on
5. Brain abscess
6. Hydrocephalus
7. Ventriculi/s
Long term
1. Cogni/ve impairment
2. Motor: hemi/quadriparesis
3. Sensory: deafness
4. Epilepsy
37
Factors worsening the prognosis for meningitis
* Age: neonatal
* Neurological condi/on at Dx: deep coma
* Meningi/s type: pneumococcus or shocked meningococcus
38
Clinical presentation for TB meningitis
ALWAYS supect if theres poor weight gain, with TB contact, low-socioeconomic settings
Stage 1
* Low grade fever
* Apathy & irritability
* Cough (daily for > 2 weeks)
* Vomi/ng
* FTT
Stage 2
* Neuro signs: neck stiffness, " ICP, hemiparesis
* 2a: GCS 15, 2b: GCS 11-14
Stage 3
* CN palsies
* Quadriparesis
* Possible brainstem dysfunction
* Coma
39
Rx for TB meningitis
* Isoniazid, Rifampicin, Ethionamide, Pyrazinamide: 6 months (single dose in
the mornings)
* Prednisone: 1st month of Rx
40
Rx for viral meningitis
Acyclovir
41
Seizure mimics
- breath holding attacks
- syncope
- night terrors
- sleep myoclonus
- day dreaming
- pseudo-seizures
42
Types of Focal/Partial seizures
1. Simple partial (retained awareness)
2. Complex partial
3. Secondary generalized
Can also classify as: motor or sensory OR According to where in the brain they arise
* Frontal: motor func0on, higher
intellectual fx
* Parietal: simple sensa0on
* Occipital: vision
* Temporal: emo0on, hearing, smell
43
Types of Generalised seizures
Tonic
Clonic
Tonic-clonic
Absence
Infan0le spasms
44
What is the definition of epilepsy
≥ 2 unprovoked seizures & requires logical approach to Mx
45
Provoked vs Unprovoked seizures
Provoked = Related to acute systemic or CNS event:
o Hypoglycaemia
o Fever
o Acute ischaemic infec0ons
o Toxins
Unprovoked = Occur spontaneously without any known precipitant
46
NB questions to ask with seizures
1. First?
2. How often?
3. Sick recently? trauma?
4. Provoked/Unprovoked? (sign)
5. How long does it last
6. Describe (one side both sides head bob...)
7. Aura? before and after ask about
47
Investigations with seizures
1. Side room investigations
- BP check
- Fundoscopy
- Hgt
2. Special
- U&E for vomiting ro diarrhea hx
- tox screen if substance exposure
- LP indicated if fever and meningitis signs present
3. EEG if >2 seizures present
48
Bad signs = poor prognosis in epilepsy
o Mul0ple seizure types
o Failure to respond to two
appropriate drugs at therapeu0c
doses
o Structural abn/neuro impairment
more likely to be Rx refractory
o Intractable epilepsy < 2 y/o
associated with later ID
49
Sodium Valproate in epilepsy
▪ Broad spectrum
▪ Ac0ve against focal & generalised
seizures and epilepsies
▪ Unlikely to exacerbate seizures
▪ Ac0ve against photosensi0ve
seizures
▪ Unlikely to be the drug of 1st choice
for females approaching childbearing
age
50
Carbamazepine in Epilepsy
▪ Narrow spectrum
▪ Ac0ve against focal & generalised
seizures and epilepsies
▪ Possibly more effec0ve in focal
epilepsies than valproate
▪ May exacerbate generalised seizures
or epilepsies
▪ Not ac0ve against photosensi0ve
seizures
51
Withdraw of therapy
* Con0nue un0l at least a two year seizure free, before slow withdrawal is
a=empted
* ‘Benign epilepsies’: may be withdrawn if seizure free 6-12 months
52
Recurrence risk:
- Lowest in: absence epilepsy, benign focal epilepsy of childhood
- Highest in: symptoma0c seizures or history of Todd’s paresis
53
STATUS EPILEPTICUS define
= seizure lasting > 30 min or multiple consecutive seizures > 30 min
54
Rx STATUS EPILEPTICUS
1. ABC & check glucose
2. Diazepam Lorazepam (faster)
Get IV access; take blood: Hgt, gas, electrolyes, FBC & culture
3. Repeat Benzo
Access failure: Midazolam intra-nasally
4. Antiepileptic: Phenobarbitone 20 mg/kg IV load over 5 min
5. Phenobarbitone repeated
6. Different antiepileptic: Phenytoin
7. Still having seizure activity: refer to PICU for RSI & Thiopentone
55
the different Epileptic Syndromes
1. Benign focal epilepsy of childhood Rolandic epilepsy
2. Benign epilepsy with occipital paroysms
3. Absence epilepsy
4. Infantile spasms, West syndrome, Epilep4c spasms, Salaam or jack-knife attacks
5. Lennox-Gastaut syndromes
56
GUILLAIN-BARRE define & cause
Acute demyelinating polyneuropathy of the ant & post nerve roots induced by immune process, characterized by progressive flaccid paralysis. All ages
Acquired disorder: preceded by URTI (coxsackie, echo, herpes virus)
57
Clinical features of Guillane barre
* Acute onset (hours to 10 days)
* Ascending symmetrical motor paralysis
* Start at the legs > extend to involve the trunk, upper limbs, resp, bulbar
(often CN VII, IX-XII) & facial muscles
* Accompanying muscle pain
* Global hypotonia
* decreased or absent reflexes
* May be present:
- Sensory loss: glove/stocking (parasthesia in the fingers & toes)
- Instability of autonomic function: wide swings in BP, HR, temp, blushing,
urinary incontinence/retention (transient bladder dysfunction)
58
Investigations of Guillaine Barre
LP = incr protein
59
RX GB
* Suppor.ve: monitor resp status
* Physio
* IV gammaglobulin
complications = fatal resp distress
good prognosis though
60
Classification of headaches
Primary
* Migraine
* Tension-type
* Cluster & other trigeminal autonomic cephalagias
* Other
Secondary
*Attributed to:
* Head/neck trauma
* Cranial or cervical vascular disorder
* Non-vascular intracranial disorder
* Substances or its withdrawal
* Infec&on
* Disorder of haemostasis
* Disorder of the cranium, neck, eyes, nose, sinuses, teeth, mouth or
other facial or cranial structures
* Psychiatric disorder
*Cranial neuralgias & central causes of facial pain
*Other headache, cranial neuralgia, central or 1° facial pain
61
Examination of a child presenting with a headache
* Vitals: BP & temp (if pyrexia exclude meningitis)
* Skin features: neuro-cutaenous syndrome
* incr HC: chronically incr ICP
* Exclude non-neurological causes: ENT, sinuses, teeth, TMJ, cervical spine
* Visual acuity: refractive errors
* Neuro: Majority = normal
▪ Clues indicating 2° causes:
1. Depressed/altered LOC
2. Meningism
3. Papilloedema
4. Focal signs: CN palsies & hemiparesis
▪ Only papilloedema & CN VI palsy: benign intracranial HTN
62
Chronic daily headache define
> 15 headache days per months for > 3 months
63
Types of Chronic daily headache
1. Chronic migraine: >8 days a month
2. New daily persistent headache: common in teens, assoc with orthostatic intolerance
3. Hemicarnia continua: unilateral, autonomic fx like ptosis Rx indomethicin
4. Occipital neuralgia: stabbing tenderness hx of trauma to head
5. Migrainous vertigo: it is not associate with anything other than the headache
64
FEVER CONVULSIONS
6mo to 5yrs mostly in presence of infection viral mostly
seizures associated with fever (mainly > 38°C) in the absence of CNS infection,
metabolic abnormalities, or a Hx of afebrile seizures
65
Classification of Fever convulsions
1. simple:
Generalised tonic-clonic, symmetrical, < 15 min
No recurrence within 24 hours or within same febrile illness
2. complex
Focal features, pronounced on one side of the body, transient hemiparesis & speech impairment, 15 min, ≥ 2 within 24 hours or within same, febrile illness
66
Risk factors for febrile seizures
* Onset < 18 months
* Family Hx of febrile seizures: 1st degree relaAves
* Temp < 40°C
* Atypical presentaAon or febrile status epilepAcus
* CP
* Structural brain lesions or abnormal EEG
67
Criteria for hospital admission
1. < 1 y/o
2. GCS < 15 one hour aier seizure
3. ‘Meningism’ or signs of " ICP
4. Unwell
5. Signs of respiratory aspiraAon
6. High parental or carer anxiety
7. Complex febrile seizure
68
Advice to parents with febrile/fever seizures
- reassurance
- antipyretic : strip clothes opening window or fan should be avioded = causes periheral vasoconstriction which increases the core temp
- initiate antipyretic Rx = paracetamol or NSAIDS early to decr PG synthesis restor thermoregulatory ... doesn't prevent seizures
- diazepam if prolonged
69
HYDROCEPHALUS define
= excessive amount of fluid in the all parts of intracranial fluid spaces which is/has been under increased pressure
70
Mechanisms of Hydrocephalus
1. Obstruc2on of CSF pathway: Tumour, cyst, inflammation. bleed, stenosis
2. Extraventricular block: inflammation(meningitis) or tumour
3. Deficient reabsorp2on: blood/infection
4. Oversecre2on of CSF: Choroid plexus papilloma
71
Clinical presentation of inc ICP in infant
– Vomiting
– Irritability
– Bulging fontanelle
– Setting-sun sign
– Acute onset strabismus
– Signs of herniation
72
ICP presentation in older child
- Depressed LOC
- Vomiting
- headache
- Acute onset strabismus
- HPT/brady
- signs of herniation
73
Clinical signs: herniation
* Depressed level of consciousness
* Pupils – unequal, non-reactive
* Absent oculocephalic (Doll’s eye) reflex
* Absent corneal & gag reflex
* Decerebration
* Neurogenic hyperventilation
74
Investigations of Inc ICP
* Transillumination of skull
* If ant frontanelle is still patent: U/S
* CT/MRI
* Measure CSF pressure: to assist in choosing particular shunt
* LP: to rule out meningitis
75
UMN lesion (CREST)
"CREST"
Clonus
Brisk Reflexes, Spread of reflexes
Leg Extensors strong, Arm Flexors
strong; Extensor reflex (Babinski)
Spastic
Tone increased
76
LMN lesion
Hyporeflexia
Atrophy & fasciculations
Flaccid
Normal/decreased tone
77
Causes of UMN lesion
Upper motor neuron lesions prevent signals from traveling from your brain and spinal cord to your muscles
* Lou Gehrig's disease (amyotrophic lateral sclerosis, or ALS)
* Primary lateral sclerosis (PLS)
* Traumatic brain injury
* Spinal cord injury
* Multiple sclerosis
* Stroke
* Huntington's disease
78
Cerebrovascular disorders caused by embolism
Embolism usually presents with a sudden loss of neurological function
79
Signs of venous thrombosis
Seizures,
altered mental state, signs of raised intracranial pressure, and focal neurological deficits
accompany the insult.
Cerebral haemorrhage has a dramatic onset of headache, vomiting, and a progressive
deterioration of neurological function.
80
Causes of stroke in children
The most common cause of stroke in children is heart disease with a right to left shunt that can cause polycythaemia and emboli.
1. Congenital heart disease
2. Acquired heart disease
3. Systemic vascular disease
4. Vasculitis
5. Vasculopathies
6. Vasospastic disorders
7. Haematological disorders
8. Vascular malformations
9. Trauma
81
Encephalopathy
The most
common cause of stroke in children is heart disease with a right to left shunt that can cause polycythaemia
and emboli.
82
Causes of coma
one needs a bilateral hemisphere lesion to produce coma or in the brainstem to produce coma directly.
1. no focal neurological signs or CSF abnormality
Intoxications
Metabolic
Infections
Shock
Epilepsy
Hypertensive encephalopathy
Hyper/hypothermia
Concussion
2. meningeal irritation with blood or white cells in the CSF
Subarachnoid haemorrhage
Bacterial meningitis
Viral encephalitis
3. causes focal neurological signs without CSF changes
Brain haemorrhage
Cerebral infarction
Brain abscess or empyema
Subdural or epidural
haemorrhage
Brain tumour
Miscellaneous
83
The Glasgow coma scale
1. Eye Opening /4
2. Verbal Response /5
- Cries normally (5)
- Consolable crying (4)
- Persistent inappropriate crying (3)
- Grunts or moans (2)
- No response (1)
3. Motor Response /6
<8 = coma
84
Ataxia define
Ataxia is a lack of voluntary coordination of muscle movements, leading to clumsy, unsteady, or uncoordinated motion. It affects gait, balance, speech, and fine motor skills
incoordination of postural control and gait as well as an
incoordination of the skilled movements involved in fine hand movements and speech. The
cerebellum is vital
85
Causes of ataxia
Ataxia is a lack of voluntary coordination of muscle movements, leading to clumsy, unsteady, or uncoordinated motion. It affects gait, balance, speech, and fine motor skills
Hypoglycaemia
Trauma (cerebellar haemorrhage)
Vascular – rare (embolism; thrombosis; AVMs)
Basilar migraine
Pseudo-ataxia
methotrexate
86
Types of ataxia
Truncal ataxia
Volitional ataxia
Chronic non-progressive ataxia
Friedreich’s ataxia
Ataxia telangiectasia (Louis-Bar disease)
87
Acute Flaccid paralysis
A hypotonic state involving limbs with inability to voluntary move,
usually affecting the lower limbs maximally and initially, followed by the upper
limbs.
All patients with AFP must be screened for poliomyelitis
88
Differential diagnosis of AFP
1. Myelopathy (Spinal cord)
2. Anterior horn cell
3. Peripheral nerve
4. Disorders of neuromuscular transmission
5. Muscle
6. Central or systemic cause
89
Causes of Acute Myelopathy
Cord compression (tumour, trauma, infarction, epidural abscess, TB)
Demyelinating disease (ADEM, MS, Devic’s)
Vascular malformation with thrombus or bleeding.
Transvers myelitis.
90
Anterior Horn Cells cause
Poliomyelitis.
Vaccinal poliomyelitis.
Other polio-like viruses (Entero 70 71 Coxsackie Echo West Nile )
91
Peripheral nerve causes of Acute Flaccid paralysis
Guillan-Barre syndrome (GBS).
Neuropathy of infectious disease (neuroborreliosis,HIV,diptheria)
Acute toxic neuropathy (Heavy metals, snake scorpion)
Volatile solvent abuse (glue sniffing)
92
Disorders of neuromuscular transmission causing AFP
Myasthenia gravis crises.
Botulism.
Insecticide/Organophosphate poisoning.
Snake bites.
Tick paralysis.
Scorpion stings.
93
muscarinic effects of Organophosphate poisoning (clinical signs)
Cholinergic overdrive
Mnemonic 1: SLUDGE
1. Salivation
2. Lacrimation
3. Urination
4. Diarrhea
5. GI cramps
6. Emesis
Mnemonic 2: DUMBBELLS
1. Diarrhea
2. Urination
3. Miosis
4. Bradycardia
5. Bronchospasm
6. Emesis
7. Lacrimation
8. Lethargy
9. Salivation
10. Seizures
94
Nicotinic Effects of organophosphate poisoning (Occur at the neuromuscular junction)
1. Muscle weakness
2. Fasciculation (involuntary muscle twitches)
3. Paralysis
4. Muscle twitching
95
Treatment of Organophosphate poisoning
Anticholinergic = atropine
Pralidoxime reactivates cholinesterase = binds organophosphate
96
Muscle disorders causing AFP
Polymyositis
Post viral myositis
Periodic paralysis syndromes (hypo-,hyper-or normokalaemia)
Mitochondrial disease (infantile type)
Toxic myositis (Corticosteroids & blocking agents.)
97
Central and systemic disease causing AFP
Encephalopathy Dehydration Sepsis
Critical illness neuropathy
Hypokalemia Hyponatremia Hypophosphatemia.
Porphyria
98
Hx for AFP
Detailed description of the symptoms, including fever, myalgia,
Distribution, timing and progression of paralysis
Recent illness, TB HIV
Exposure to chemicals, tick or snake bites
Vaccinations
Trauma of the spinal cord
Spinal cord compression
99
Hx for coma patient
* FEVER
* TRAUMA
– accidental/non-accidental
* POISONING
* TOXINS
– Anti-epileptics/psychtropics
– CONTACT DISEASES
– TB/mumps etc
* PREVIOUS ILLNESS
– epilepsy
100
Main fx on CVS exam for COMA patient
– LEVEL OF CONSCIOUSNESS
– MENINGISM
– INCREASED INTRACRANIAL
PRESSURE
– LOCALIZING SIGNS
– BRAINSTEM FUNCTION
101
Acutely raised ICP signs
– Vomiting
– Altered mental state
– Altered vital signs (BP,
Pulse)
– Strabismus
– Setting sun sign
– Signs of herniation
– Full fontanelle/ widened
sutures
– Headache
– Papilloedema
- Left abducens (N VI) palsy:
102
Chronically raised ICP signs
– Vomiting
– Altered mental state
– Strabismus
– Setting sun sign
– Delayed closure of
fontanelle
– Headache
103
How is the signs of ICP opposite to shock
ICP
1. incr BP
2. decr pulse
3. decr resp
Shock
1. decr BP
2. incr pulse
3. incr respirations
104
Decerebration:
sign of brainstem dysfunction
Intrinsic or secondary to inc ICP
105
Causes of Coma
* I infection
* N neoplastic
* T trauma/ toxic
– accidental/non-accidental
* I congenital/convulsions
* M metabolic
* A allergic/collagen vascular disease
* INTIMA blood/vasculature
– Eg. thrombosis/embolism/haemorrhage
106
Bilateral subdural effusions is indicative of?
H influenzae meningitis
107
Pneumococcal Meningitis main features
* Hydrocephalus
* Leuco-encephalopathy
107
