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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

tx gluacoma?

urgent opthamology ref