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Neurology > Seizures, Encephalitis, Migraine, Raised ICP > Flashcards

Seizures, Encephalitis, Migraine, Raised ICP Flashcards

1
Q

What is status Epilepticus?

A

a medical emergency characterized by prolonged or recurrent seizures that occur without full recovery between episodes or seizures lasting longer than 5 minutes.

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2
Q

How is Status Epilepticus Treated?

A

benzodiazepines (e.g., lorazepam, diazepam)
- Lorazepam given IV
- Diazepam given Rectally
- Midazolam is give Buccal
(Midazolam - Mouth)

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3
Q

In Status Epilepticus if two boluses of IV lorazepam have been given (with 5 minute intervals after each dose), second-line options for terminating the seizure would be IV….

A

phenytoin, levetiracetam or sodium valproate.

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4
Q

What is Encephalitis an inflammation of?

A

The brain parenchyma.

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5
Q

What is the most common cause of Encephalitis?

A

Herpes Simplex Virus type 1

Others:
- VZV
- Enteroviruses

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6
Q

What Clinical features does a patient with Encephalitis show?

A

Personality and behavioural changes, which progresses to reduced level of conciousness and even coma.
- Fever
- Meningism
- Seizures (focal and generalised)

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7
Q

What investigations are done in Encephalitis?

A
  • Blood cultures and Viral PCR.
  • Lumbar Puncture (CSF analysis with Viral PCR)
    (viral - elevated lymphocytes)
  • MRI
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8
Q

Which areas of the brain are involved in Encephalitis?
(seen on MRI)

A

Bilateral Medial TEMPORAL LOBE involvement

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9
Q

What is given in suspected HSV and VZV encephalitis?

A

IV Acyclovir, even before investigation results are available.
- Significantly improves outcomes.

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10
Q

What is Limbic Encephalitis?

A

A form of antibody-mediated encephalitis.
- May be assoc. w underlying malignancy or autoimmune.

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11
Q

What is the management of Limbic Encephalitis?

A

Depends on cause
e.g. Treat tumour for malignancy.
or
Immunosuppression in Autoimmune.

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12
Q

What kind of Electrolyte abnormality is commonly associated with HSV encephalitis?

A

Hyponatraemia

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13
Q

What is the most common cause of Episodic Headache?

A

Migraine

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14
Q

What is the most common type of Migraine?

A

Migraine without Aura (80%)
Migraine with Aura (20%)

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15
Q

Are migraines typically unilateral or bilateral?

A

Unilateral throbbing headache.

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16
Q

What is a typical timeframe for Migraines?

A

4-72 hrs

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17
Q

What sensations can make headaches worse in migraine?

A

Photophobia or Phonophobia.

18
Q

What can be done to try and Identify triggers in Migraines?

A

Headache diary

19
Q

What are the Acute medical treatments offered in Migraine?

A
  • NSAID / Paracetamol + Triptan (5HT agonist) e.g. Sumatriptan, Rizatriptan.

If Gastoparesis consider antiemetic.

20
Q

When should prophylaxis be considered in Migraines?

A

When a patient is experiencing more than 3 attacks per month or has very severe attacks.

21
Q

What is the First, second and Third line Tx in Migraine Prophylaxis?

A

1st : Amitriptyline or Propranalol (CI: Asthma)
2nd : Topiromate/Valproate
3rd : Pizotifen.

22
Q

What are some causes of a raised ICP?

A
  • Mass effect e.g. tumour
  • Brain swelling due to e.g. ischaemia or liver failure.
  • Increased central venous pressure e.g. venous sinus thrombosis.
  • Problems with CSF flow: Hydrocephalus, Increased production (choroid plexus papilloma)
23
Q

What is the normal range for ICP?

A

Constantly fluctuating between 7 and 15mmHg

24
Q

What is the compensatory mechanism for expanding masses called?

A

Monroe-Kellie Doctrine.

25
Q

What is the Immediate compensatory mechanism used for an Increased ICP?

A

Decrease in CSF volume by moving it out of Foramen Magnum.
+
Decrease in Blood volume by squeezing sinuses.

Later: Decrease in ECF

26
Q

What is the Cerebral Perfusion Pressure calculated using?

A

CCP = MAP - ICP

27
Q

What are some early signs of a raised ICP?

A
  • Decreased Level of Consciousness.
  • Headache
  • Pupilliary dysfunction +/- Papilloedema.
  • Changes to vision
  • N&V
28
Q

What are some later signs of Raised ICP?

A
  • Coma
  • Fixed, Dilated pupils
  • Hemiplegia
  • Hyperthermia
  • Increase UO
  • Bradycardia > Cushings triad
29
Q

What is Cushings reflex in response to a raised ICP and how does it affect the HR, BP and RR?

A

Cushings reflex begins when an event causes a raised ICP.
- During the raised ICP both sympathetic and Parasympathetic systems are activated.

Causes an Increased BP, Decreased HR and Irregular Breathing.

30
Q

What are some medical management options for raised ICP?

A

Diuretics - hypertonic Saline
Barbiturate coma (Medically induced coma)
Antiepileptics

31
Q

What is Normal Pressure Hydrocephalus?

A

Idiopathic disease of the elderly, possibly due to decreased brain elastance.

32
Q

What is The Typical triad in Normal Pressure Hydrocephalus?

A

Wet, Wobbly and Weird

Hakim’s Triad:
- Dementia: Often manifests as global cognitive impairment, with memory and Attention disturbance.
- Magnetic Gait: Characterised by difficulty lifting feet off the floor, appearing as if they are stuck.
- Incontinence: Primarily urinary.

33
Q

What is the Investigation usually done in Normal Pressure Hydrocephalus?

A

CT/ MRI : typically show dilated lateral ventricles and absent sulci.

LP: Measurement of walking ability and Cognative assessment pre- and Post LP can help ascertain whether patients could benefit from further surgical management.

34
Q

What is the the management of Normal Pressure Hydrocephalus?

A

Therapeutic LP: Removing CSF to alleviate symptoms.

Ventriculoperitoneal shunt: In px responsive to LP, neurosurgery may insert shunt to permanently redirect the excess CSF from the brain to the abdomen.

35
Q

When should Sumatriptan be taken when a patient is having a Migraine with aura?

A

only once the headache itself starts, but not during the Aura Phase.

36
Q

What is a possible side effect of Lamotrigine?

A

Steven-Johnstone syndrome

Drugs which cause SJS:
SCALP
Sulfonamides
Carbamazepine
Allopurinol
Lamotrigine
Penicillins

37
Q

What visual changes occur in IIH?

A

Enlarged blind spot and constriction of the Visual Fields

38
Q

What can be used in Bacterial Meningitis, especially Pneumococcal meningitis, to reduce the risk of long term neurological symptoms?

A

IV Dexamethasone
- should be started within 4 hrs of IV Abx

39
Q

What is a Cluster Headache?

A
  • Recurrent unilateral periorbital pain of sudden onset
  • Associated symptoms: watery and bloodshot eye, lacrimation, rhinorrhoea, miosis, ptosis, lid swelling, and facial flushing
  • Headache duration of 15 minutes to 3 hours, occurring once or twice daily over 4-12 weeks, followed by a pain-free period of several months
40
Q

Who are most Likely to get Cluster Headaches?

A

Men > Women
Aged 20 - 40 yrs.

41
Q

What is the management of Cluster Headaches?

A
  • Avoiding triggers,
  • Prophylaxis with Verapamil,
  • Treat acute attacks with 100% oxygen via a non-rebreathable mask (contraindicated in COPD) and a subcutaneous or nasal Triptan (contraindicated in ischaemic heart disease).
42
Q

What area do Jacksonian Seizures affect in the brain?

A

The Frontal Lobe

Neurology (13 decks)

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