Flashcards in Neurology 1 Deck (64):
Range of the glasgow coma scale?
3-15 ( 15 most consciousness)
way to asses level of consciousness?
Structural causes of impaired consciousness?
Global failure causes of impaired consciousness?
head injury most common
vascular - stroke - ischaemic/haemorrhagic
tumour - benign/primary/secondary
of brain - encephalitis, meningitis, malaria/other tropical diseases
of body - any other severe infection e/g pneumonia
overuse of sedative meds
what causes seizures/epilepsy?
excess electrical activity
pt has impaired consciousness, how to act?
identify and treat cause
what is epilepsy?
excessive electrical discharges in the brain
types of seizures?
focal/partial seizures - depends on what part of brain affected
generalised seizures - whole brain affected
simple focal seizures are?
shaking on one side
complex partial seizures are?
temporal lobe related
auras - olfactory hallucinations followed by odd behavious - automatisms
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
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
primary causes of epilepsy?
often hereditaty involvement
secondary causes of epilepsy?
-acute/chronic - b/c stroke,tumour, injury, meningitis
-metabolic - electrolyte disturbance, alcohol withdrawl, hypoglycaemia. always check blood sugar
investigations for epilepsy?
brain imaging - MRI
drug tx of epilepsy?
surgical tx of epilepsy?
tumour removal, arteriovenous malformations, poorly controlled primary epilepsy
avoid treating epileptic pt when?
epilepsy poorly controlled
divisions of headaches?
primary headache disorders
secondary headache disorders - associated with mortality/permanent disability
red flags with headaches?
-severity - sudden onset
-raised intracranial pressure - worsening on positional change/strain, present on waking, nausea/vomitting
-meningism, fever, rash
associated with cancer or HIV
types of primary headaches?
what is a tension headaches?
stress related - tight band symmetrical around head
chronic, gradual onset
worse at end of day
treatment of a tension headache?
tricyclic antidepressants for prophylaxis
what is a migraine?
temporary reduction in blood flow then compensatory excess blood flow
8% more common in females
often none or
wine, cheese, chocoalte, OCP, premenstrual, anxiety, exercise, fasting, sleep deprivation
features of a migraine?
pre headache aura for 15 mins - usually visual
headache within one hour
one side throbbing, nausea, vomitting, photophobia
treatment of a migraine?
acute - analgesia, metoclopramide. serotonin antagonists
prevention of migraines?
avoidance of triggers
what is a cluster headache?
dilation of superficial temporal artery
most common in male smokers
medication overuse headache?
opiates/triptans = most risky
what are trigeminal neuralgia headaches?
intense stabbing pain 10/10 severity
precipitated by touch - shaving, washing,talking
paroxysmal = spontaneous
tx with carbamazepine
increased intracranial pressure caused by?
non traumatic bleeds
hydrocephalus = drainage problem - trauma, bleed, tumour, infection, abscess
diagnose raised intracranial pressure with?
what is bacterial meningitis?
contact spread, common in infancts, adolescents, young adults
pneumococcal - babies and elderly
haemophilius - babies and infants
feautures of bacterial meningitis?
diagnose meningitis with?
treatment of bacterial meningitis?
empirical antibiotics if suspected in the community
prophylaxis for contacts
what is enchepalitis?
inflammation of brain parenchyma
by viral infection - herpes simplex, varicella zoster, rabies
symptoms of enchepalitis?
impaired consciousness, personality change, meningism, seizures
lumbar puncture, ECG
abscess caused by?
ostitis media/mastoidosis, sinusitis, infections, trauma
abscess can cause?
raised intracranial pressure
how to diagnose an abscess?
Non traumatic bleed divisions?
SAH - sub arachnoid hemorrhage
ICH - intracerebral hemorrhage
what is a SAH?
blood in the sub arachnoid space
70% rupture - congenital berry aneurysm
15% rupture - anteriovenous malformation
15% = no cause
between 35-65 years
15 per 100 000
sudden severe headache
SAH diagnosed how?
CT scan +/- angiography to see aneurysm
lumbar puncture in necessary
how to prevent re bleed?
surgery - clip
poss. residual disability
what is an intercerebal heamorrhage?
directly into brain tissue
associated with hypertension - charcot bouchard aneurysms
symptoms of intercerebral haemorrhage?
increased intracranial pressure
not always headaches
how to diagnose ICH?
how to tx ICH?
what is giant cell arteritis?
rare under 55 years old
loss of vision
risk of blindness, stroke, death
tests for giant cell arteritis?
ESR, PV, temporal artery biopsy
tx giant cell arteritis?
high dose prednisolone, immediately
what is glaucoma?
common in elderly
constant ache around eye
nausea and vomitting
red congested eye, dilated, non reactive pupil