Flashcards in Neurology 1 Deck (64):
1
Range of the glasgow coma scale?
3-15 ( 15 most consciousness)
2
way to asses level of consciousness?
AVPU
alert
verbal
pain
unresponsive
3
Structural causes of impaired consciousness?
internal
external
4
Global failure causes of impaired consciousness?
metabolism
infection
drugs/alcohol
seizures
5
external causes?
head injury most common
trauma
6
internal causes?
vascular - stroke - ischaemic/haemorrhagic
tumour - benign/primary/secondary
abscess
7
Metabolism causes?
hypoglycaemia
liver/renal failure
hypoxia
hyperaepnia
hypornatraemia
hypercalcaemia
hyperthyroidism
hypotension
8
Infection causes?
of brain - encephalitis, meningitis, malaria/other tropical diseases
of body - any other severe infection e/g pneumonia
9
drug causes?
opiates
alcohol
recreational drugs
overuse of sedative meds
10
what causes seizures/epilepsy?
excess electrical activity
11
pt has impaired consciousness, how to act?
ABCDE
identify and treat cause
12
what is epilepsy?
excessive electrical discharges in the brain
13
types of seizures?
focal/partial seizures - depends on what part of brain affected
generalised seizures - whole brain affected
14
simple focal seizures are?
shaking on one side
15
complex partial seizures are?
temporal lobe related
auras - olfactory hallucinations followed by odd behavious - automatisms
16
generalised seizures are usually?
grand mal/tonic clonic
tonic phase - limbs stiffen
clonic phase - limbs shake
may be incontinence, tongue biting, cyanosis
headache drowsy after
17
what are petit mal seizures?
type of generalised
-absence seizures - children- stare into space for 10 secs
-myoclonic - limbs jerk and collapse
-atonic - limbs collapse
18
primary causes of epilepsy?
often hereditaty involvement
19
secondary causes of epilepsy?
structural damage
-acute/chronic - b/c stroke,tumour, injury, meningitis
-metabolic - electrolyte disturbance, alcohol withdrawl, hypoglycaemia. always check blood sugar
20
investigations for epilepsy?
blood tests
brain imaging - MRI
electroencephalogram EEG
21
drug tx of epilepsy?
phenytoin
carbamazepine
sodium valproate
22
surgical tx of epilepsy?
tumour removal, arteriovenous malformations, poorly controlled primary epilepsy
23
avoid treating epileptic pt when?
epilepsy poorly controlled
24
divisions of headaches?
primary headache disorders
secondary headache disorders - associated with mortality/permanent disability
25
red flags with headaches?
-severity - sudden onset
-raised intracranial pressure - worsening on positional change/strain, present on waking, nausea/vomitting
-focal neurology
-visual changes
-impaired consciousness/confusion
-meningism, fever, rash
associated with cancer or HIV
26
types of primary headaches?
tension
migraines
cluster
medication overuse
trigeminal neuralgia
27
what is a tension headaches?
stress related - tight band symmetrical around head
chronic, gradual onset
worse at end of day
28
treatment of a tension headache?
concentional analgesics
tricyclic antidepressants for prophylaxis
29
what is a migraine?
temporary reduction in blood flow then compensatory excess blood flow
8% more common in females
30
migraine triggers?
often none or
wine, cheese, chocoalte, OCP, premenstrual, anxiety, exercise, fasting, sleep deprivation
31
features of a migraine?
pre headache aura for 15 mins - usually visual
headache within one hour
one side throbbing, nausea, vomitting, photophobia
32
treatment of a migraine?
acute - analgesia, metoclopramide. serotonin antagonists
33
prevention of migraines?
anti epileptics
beta blockers
amitryptiline
avoidance of triggers
34
what is a cluster headache?
dilation of superficial temporal artery
most common in male smokers
rapid onset
episodic -
35
medication overuse headache?
chronic headaches
opiates/triptans = most risky
36
what are trigeminal neuralgia headaches?
intense stabbing pain 10/10 severity
precipitated by touch - shaving, washing,talking
paroxysmal = spontaneous
tx with carbamazepine
37
increased intracranial pressure caused by?
tumours
non traumatic bleeds
hydrocephalus = drainage problem - trauma, bleed, tumour, infection, abscess
38
diagnose raised intracranial pressure with?
CT scan
39
what is bacterial meningitis?
contact spread, common in infancts, adolescents, young adults
pneumococcal - babies and elderly
haemophilius - babies and infants
40
feautures of bacterial meningitis?
impaired consciousness
meningism
+/- rash
drowsy
photophobia
41
diagnose meningitis with?
lumbar punctures
blood cultures
42
treatment of bacterial meningitis?
empirical antibiotics if suspected in the community
hospital
prophylaxis for contacts
43
what is enchepalitis?
inflammation of brain parenchyma
by viral infection - herpes simplex, varicella zoster, rabies
44
symptoms of enchepalitis?
impaired consciousness, personality change, meningism, seizures
45
diagnose enchepalitis?
lumbar puncture, ECG
46
treat encheplalitis?
antivirals, hospital
47
abscess caused by?
staphylococci/streptococci
ostitis media/mastoidosis, sinusitis, infections, trauma
48
abscess can cause?
raised intracranial pressure
49
how to diagnose an abscess?
CT/MRI
biopsy
50
Non traumatic bleed divisions?
SAH - sub arachnoid hemorrhage
ICH - intracerebral hemorrhage
51
what is a SAH?
blood in the sub arachnoid space
70% rupture - congenital berry aneurysm
15% rupture - anteriovenous malformation
15% = no cause
52
SAH incidence?
between 35-65 years
15 per 100 000
53
SAH symptoms?
sudden severe headache
often occipital
vomit/collapse/drowsy
54
SAH diagnosed how?
CT scan +/- angiography to see aneurysm
lumbar puncture in necessary
55
how to prevent re bleed?
surgery - clip
coils
poss. residual disability
56
what is an intercerebal heamorrhage?
directly into brain tissue
associated with hypertension - charcot bouchard aneurysms
57
symptoms of intercerebral haemorrhage?
increased intracranial pressure
focal neurology
not always headaches
58
how to diagnose ICH?
imaging
59
how to tx ICH?
surgery
rehabillitation
60
what is giant cell arteritis?
rare under 55 years old
scalp tenderness
jaw claudication
loss of vision
risk of blindness, stroke, death
61
tests for giant cell arteritis?
ESR, PV, temporal artery biopsy
62
tx giant cell arteritis?
high dose prednisolone, immediately
63
what is glaucoma?
common in elderly
constant ache around eye
reduced vision
nausea and vomitting
red congested eye, dilated, non reactive pupil
64