what are indications for XRAY after head injury?
- history of significant injury/ impaired consciousness/ continuing manifestations
- signs of a skull fracture
- scalp lacerations
- GCS <15
- penetrating head injury
what are indications for CT after head injury?
- signs of fracture + GCS <15
- GCS <12
- neuro signs
- continuing or new symptoms
what is the ICD10 criteria for alcohol dependence?
- cravings
- difficulties in controlling substance use
- physiological withdrawal state
- physiological tolerance
- increased salience
- persistant use despite knowledge of consequences
in what time period does DT occurs?
72-96 hours after stopping alcohol
what does ‘CAGE’ ask about?
- concern
- Annoyed
- Guilt
- eye opener (morning drinking)
what are adverse consequences of chronic alcohol?
wernickes encephalopathy dementia epileptic tits peripheral neuropathy cerebellum degeneration
what is delirum tremens?
serious withdrawal condition
- clouding of consciousness
- agitation
- tremors
- fits
- visual hallucinations
- delusions
- coma
what can be given as an antidote for benzo OD?
flumazenil
how do benzodiazepines work?
act at the GABA receptor and change the structure –> GABA can attach more effectively –> encouragement of chloride into the cell –> hyperpolarisation
when should you give a benzo for seizures?
if it’s lasted longer than 5 minutes
what is a good benzo for seizures?
lorazepam
how does alcohol change the CNS?
acute use: GABA agonist, NMDA antagonist causes more GABA and less glutamate
Chronic: decrease GABA and increased NMDA as the CNS tries fighting the acute effects
withdrawal: due to the increased NMDA and decreased GABA there is hyperexcitability
what is the treatment for alcohol withdrawal?
- pabrinex MUST BE GIVEN BEFORE GLUCOSE
- glucose if needed
- chlordizaepine
what is the wernickes triad?
Ataxia
Nystagmus
opthalmoplegia
what levels have changed in wernickes?
decreased thiamine
increased glutamate
why is there decreased thiamine due to alcohol?
- decreased nutritional intake
- decreased absorption and utilisation
- decreased liver storage
- decreased phosphorylation to thiamine pyrophosphate
why can brain injury occur due to thiamine deficiency?
- transkeletase in the pentose phosphate pathway uses thiamine meaning less myelin sheath
- pyruvate dehydrogenase is thiamine dependant so lactate will build up
- alpha ketogluterate is dependant meaning increased glutamate and free radicals
what is pallega?
vitamin B3 deficiency
what are signs of vitamin b3 deficiency?
redness and swelling of the mouth and tongue
diarrhoea
skin rash
abdo pain
what is the course of dementia vs delirium?
delirium: fluctuating
dementia: progressive
what cognitive defects are seen in delirium vs dementia?
dementia: poor STM and attention
delirium: same
what is the behaviour of hallucinations/ dellusions in dementia/ delirium?
dementia: no hallucinations and often no delusions but if present often paranoid and fixed
delirium: common visual hallucinations and fleeting delusions
what neurotransmitters are involved in delirium?
increased dopamine leading to less ACh release decreased GABA increased serotonin increased cortisol decreased ach
what are the most common causes of delirium?
Hypoxia
Infection- uti, pneumonia, sepsis
D- drugs; benzos, analgesics, anticholinergics
E; endocrine; diabetes and cushings
M; metabolic; hyper/hypocalcemia, hyponatraemia
A alcohol
P psychosis
