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4. Senior Block- Special Senses > Neurology > Flashcards

Neurology Flashcards

(55 cards)

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1
Q

At what value is intracranial pressure considered raised?

A

> 20 mmHg

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2
Q

Give 3 physiological things that alter the intracranial pressure

A 
Valsalva 
Sneezing 
Coughing 
Leaning forward 
Lying flat
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3
Q

Give 4 pathological causes of raised intracranial pressure

A 
Idiopathic 
CNS inflammation or infection 
Intracranial haemorrhage 
Hyponatraemia 
Intracranial tumour 
Elevated venous pressure 
Hydrocephalus 
Epilepsy
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4
Q

What is Cushing’s Triad?

A

Hypertension
Bradycardia
Irregular breathing

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5
Q

Why does Cushing’s triad occur in raised intracranial pressure?

A

Decreased cerebral perfusion pressure will result in a compensatory rise in BP to increase the blood to the brain.
The increase in BP activates the parasympathetic system (Vagus Nerve) and causes the heart rate to drop.
Increased pressure on the brainstem causes irregular breathing

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6
Q

What is cerebral herniation?

A

As pressure rises in the cranium brain tissue is pushed out of the cranium which results in damage and ischaemia

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7
Q

What is coning?

A

Compression of the brainstem

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8
Q

What is a subfalcine herniation?

A

Displacement of the cingulate gyrus under the falx cerebri which results in hydrocephalus and hemiparesis

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9
Q

What is Uncal herniation?

A

Uncus of temporal lobe herniates under the tentorium cerebelli which results in a fixed, dilated pupil and contralateral homonymous hemianopia

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10
Q

What is tonsillar herniation?

A

Cerebellar tonsils herniate through the foramen magnum which results in reduced consciousness, decerebrate posturing, apnea, impaired circulation and death

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11
Q

Give 5 clinical features of raised intracranial pressure

A 
Cushing's triad
Decreased consciousness
Headache 
Vomiting
Diplopia 
Papilloedema
Behavioural changes
Infants= bulging fontanelle
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12
Q

What investigations can be done if raised intracranial pressure is suspected?

A

CT
MRI
Ocular sonography
Intraventricular ICP monitoring (high risk patients)

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13
Q

How is raised intracranial pressure managed acutely?

A 
A-E resuscitation
Head elevation 
IV mannitol 
Sedation 
Analgesia 
Antipyretics 
Antiseizure medications
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14
Q

How is raised intracranial pressure managed in the longer term?

A 
Position head up 
Keep patient euvolemic 
Encourage hyperventilation 
Osmotic diuretics (IV Mannitol) 
Treat the cause- brain tumour removal, cerebral shunt, decompressive craniotomy
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15
Q

What is brain death?

A

Irreversible complete loss of function of the entire brain

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16
Q

What is cerebral oedema?

A

Excess fluid within the brain parenchyma as a result of damage to the blood-brain barrier

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17
Q

Give 3 predisposing factors for a subarachnoid hemorrhage

A 
Smoking 
Hypertension 
Alcohol excess 
Family history 
Cocaine use
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18
Q

Give 3 pathological mechanisms for a subarachnoid hemorrhage

A

Traumatic
Ruptured berry aneurysm in circle of Willis
Ruptured AV malformation

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19
Q

Give 3 triggers for a non-traumatic subarachnoid hemorrhage

A

Caffeine
Acute anger
Physical exercise

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20
Q

What are the consequences of a subarachnoid hemorrhage?

A

Secondary ischaemic stroke due to raised ICP and release of clotting factors and vasoactive substances

Raised ICP –> Cushing’s triad

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21
Q

Give 3 clinical features of a subarachnoid hemorrhage

A

Severe headache in the week prior
Sudden, severely painful headache (Thunderclap)
Meningism- stiff neck, photophobia, N+V
Impaired consciousness
Fever
Mass effects- CN palsy, psychiatric symptoms, seizures

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22
Q

How is a potential subarachnoid hemorrhage investigated?

A

Non enhanced CT head
LP (raised RBCs, WBCs and protein)

To find the cause:
CT angiography
Digital subtraction angiography (DSA)

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23
Q

How is a subarachnoid hemorrhage managed acutely?

Study These Flashcards
A 
Bed rest
Analgesia
IV fluids 
Reverse anticoagulation 
Control BP 
Prevent vasospasm (Nimodipine) 
Seizure prophylaxis
24
Q

Give 2 definitive treatments for subarachnoid hemorrhage

Study These Flashcards
A

Endovascular coiling

Surgical clipping

25
Give 3 potential complications of a subarachnoid hemorrhage
``` Vasospasm Rebleeding Hydrocephalus Seizures SIADH ```
26
What is the definition of status epilepticus?
Continuous seizure for >5 minutes or >2 seizures with consciousness not being fully regained in the interictal period.
27
Give 3 causes of status epilepticus
``` Withdrawal from antiepileptics Hyponatraemia TCA use Tumours Stroke CNS infection ```
28
How is status epilepticus managed?
Recovery position plus A-E IV access- U+Es, FBC, glucose, toxicology, antiepileptic levels, ABG O2 therapy if needed Monitor O2 stats 1st line= IV Lorazepam 2nd line= IV Diazepam If no IV access, use PR diazepam or buccal lorazepam
29
Give 3 complications of status epilepticus
``` Death Cerebral oedema Rhambdomyolysis Hyperthermia Cerebral CV failure Intracerebral haemorrhage ```
30
What is cauda equina?
Terminal spinal nerve root compression in lumbosacral region
31
Give 3 causes of cauda equina
``` Spinal tumours Slipped disc Trauma Spinal stenosis Spinal epidural haematoma Epidural abscess ```
32
Give 4 features of cauda equina
``` Back pain Saddle anaesthesia Impotence Sensory motor loss Neurogenic bladder dysfunction Muscle atrophy of lower limbs Decreased rectal tone ```
33
How is cauda equina investigated?
MRI Spine | CT Myelography
34
How is cauda equina managed?
Urgent surgical decompression within 48 hours
35
What is the difference between an open and closed head injury?
``` Closed= dura mata intact Open= dura mata injured ```
36
What is the difference between a primary and secondary head injury?
``` Primary= acute physical injury Secondary= pathology induced by inflammation after the primary injury ```
37
What is a acceleration-deceleration trauma?
Seen in high impact injuries Shearing, strain and compression of the cerebral contents ``` Coup= injury on side of injury Countercoup= injury on opposite side of injury ```
38
Give 4 clinical features seen in a head injury
``` Headache Amnesia Confusion Dizziness Nausea and vomiting Focal deficit Cushing's triad Seizures Post concussion syndrome ```
39
Give 3 signs of a basilar skull fracture?
``` CSF rhinorrhoea Halo sign Hemotympanum Subcutaneous haematoma behind the ear CSF otorrhoea CN palsy ```
40
What investigations should be done in someone presenting with a head injury?
Cranial CT GCS Score CT angiography Survey x-ray
41
How is a head injury managed?
``` Fluids Pain relief BP management Intubate if GCS <8 Monitor temperature, blood glucose, CPP and ICP Prevent seizures and secondary infections and secondary bleeding Superficial debridement Closure of dura Removal of haematomas ```
42
Where does an extradural haematoma collect?
Extradural space- between the dura and the skull
43
What is the typical history of an extradural haematoma? What complications will it result in?
Low impact trauma will cause a bleed and the patient will lose consciousness. Lucid interval and then decline in consciousness. Mass effect on the brain causes uncal herniation and a fixed dilated pupil due to a CNIII palsy.
44
Is an extradural haematoma made up of venous or arterial blood?
Arterial
45
How does an extradural haemorrhage present on a CT scan?
Bright biconvex collection | Lemon shaped
46
How is an extradural haematoma managed?
Craniotomy + evacuation of haematoma
47
What is an acute subdural haemorrhage and how does it present?
Fresh collection of blood under the layer of the dura mater. Caused by high speed collisions, acceleration-deceleration injuries or AV malformations. Can present anywhere between asymptomatic and comatosed.
48
What does an acute subdural haemorrhage look like on a CT scan?
Bright crescent-shaped collection | Banana
49
How is an acute subdural haemorrhage treated?
Decompressive craniotomy
50
Give 3 patient groups who are more likely to have a chronic subdural haemorrhage
Elderly Infants Alcoholics Patients on anticoagulation
51
How does a chronic subdural haemorrhage present?
``` Presents several weeks after a head injury Loss of consciousness Confusion Weakness Cortical dysfunction ```
52
What does a chronic subdural haemorrhage look like on a CT scan?
Dark crescent-shaped collection, not limited by suture lines
53
How is a chronic subdural haematoma managed?
Burr-Hole drainage
54
What is an intracerebral haemorrhage?
Collection of blood within the brain substance. Caused by hypertension, aneurysm, AV malformation or a brain tumour.
55
What does an intracerebral haemorrhage look like on a CT scan?
Bright hyperdensity within the brain substance

4. Senior Block- Special Senses (4 decks)

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