Neurology Flashcards

Question

Status Epilepticus Mx Options

Answer 1

Def: seizure \> 5 minutes duration OR 2 or more seizures without full recovery in between **1st line** Midazolam 0.15mg/kg IV/IM **2nd line** Levetiracetam 40mg/kg Valproate 40mg/kg up to 3g Phenytoin 20mg/kg **3rd line** Phenobarbitone 20mg/kg Propofol 2.5mg/kg, infusion @ 1-3mg/kg/hr Thiopentone 2-5mg/kg, infusion @ 1-4mg/kg/hr Ketamine 1-2mg/kg Pyridoxine 100mg IV in children \< 6mo with refractory seizures

Answer 2

Airway - Hypoxia, aspiration Injury - fractures, Avulsions of bone/tendons, tongue laceration, posterior shoulder dislocation Metabolic - hypoglycaemia, hyperthermia, lactic acidosis, rhabdomyolysis CNS - Todd's paresis, Neuronal damage (prolonged)

Answer 3

**Absolute** * GCS \<8 or deteriorating/fluctuating level of consciousness * Signs raised ICP * A bulging fontanelle + raised ICP **Relative** * Septic shock or haemodynamic compromise * Significant respiratory compromise (eg apnoeas in a baby) * New focal neurological signs or seizures * Seizure within previous 30 min +/- normal conscious level has not returned following a seizure * INR \>1.5 or platelets \<50 or child on anticoagulant medication **Complications** * Failure to obtain a specimen/traumatic bloody tap (common) * Post-dural puncture headache (uncommon) 5-15% * Transient/persistent paraesthesia/numbness (very uncommon) * Respiratory arrest from positioning (rare) * Infection introduced by needle causing meningitis, epidural abscess or osteomyelitis (very rare) * Spinal haematoma (very rare) * Brain herniation (extremely rare in the absence of contraindications above)

Answer 4

Speech area Left side of brain - 99% right handed - 70% left handed L hemisphere → dyphasia R hemisphere → neglect, visuo-spatial + cognitive problems Wernicke's area = posterior first temporal gyrus →expressive dysphasia Broca's = posterior third frontal gyrus → receptive dysphasia

Answer 5

Critical * Basilar artery thrombosis * Botulism * Basilar meningitis * Aneurysm Emergent * Vertebral dissection * MG * Wernicke's encephalopathy * Orbital Apex syndrome / Cavernous sinus process Urgent * Brainstem Tumour * Miller-Fischer syndrome * MS * Thyroid myopathy (Grave's) * Ophthalmoplegic migraine * Ischaemic Neuropathy * Orbital Myositis * Orbital Apex Mass

Answer 6

Def = inability to perform conjugate lateral gaze Pathophysiology Damage to the interneuron (level of MLF) between 2 nuclei of CN III and CN VI at the level of the midbrain or pons Mechanism: Demyelination Ischaemia - basilar artery supply Neoplastic Inflammatory

Answer 7

Peripheral * Infective - HSV, HZV, CMV, EBV, AOM * Trauma - base skull * Neurological - MS, GBS, mononeuropathy * Neoplastic - post fossa, parotid * Autoimmune - Sjogren's * HTN + eclamplsia * Melkersson's syndrome Central * CVA * Intra-cranial tumours * MS * HIV * Vasculitides

Answer 8

C4: shoulder shrugs C5: shoulder abduction and external rotation; elbow flexion C6: wrist extension C7: elbow extension and wrist flexion C8: thumb extension and finger flexion T1: finger abduction L2: hip flexion L3: knee extension L4: ankle dorsiflexion L5: big toe extension S1: ankle plantarflexion S4: bladder and rectum motor supply

Answer 9

**Sensory** - Ascending Tracts Anterolateral tract - fibres cross at level of input - sacral > trunk > cervical (lateral to medial) Anterior spinothalamic tract (light touch and pressure pathway) Lateral spinothalamic tract (pain and temperature pathway) Dorsal Columns Touch, pressure, vibrations, proprioception Cross at medulla Sacral fibres medial, cervical fibres lateral **Motor** Lateral Corticospinal tract (80%) Distal limb muscles Fine motor Fibres corss in spinal cord Cervical medial, lumbar lateral Ventral Corticospinal Tract (20%) Axial and proximal limb muscles Postural and gross limb movements Descends ipsilaterally and does not cross until level of synapse with LMN

Answer 10

Common following diving injury, flexion injuries Injury: - bonu impaction into cord - anterior spinal artery injury or thrombosis Symptoms Loss of motor, pain and temperature sensation below lesion Light touch and proprioception preserved Prognosis: poor

Answer 11

Key points CT within 6 hours effectively rules out diagnosis LP may be useful when presentation is delayed - CSF blood is the hallmark feature of SAH, but may be difficult to distinguish from a traumatic tap - CSF xanthochromia is a more specific finding for SAH, however takes >12 hours to manifest - Xanthochromia from a SAH is nearly always accompanied by more than 1000 RBCs in the CSF (usually > 10000) **Traumatic Tap vs SAH** Traumatic tap occurs in 20% of LP’s Traumatic tap and SAH may co-exist None of the following criteria are 100% accurate - Normal CSF CSF pressure - Clearing of blood in tubes 1-3 / marked decrease in RBC count in tubes 1 to 3 - Proportion of white cells to red cells the same as in blood - i.e. RBC:WBC = 500 - 1,000:1 - Clot formation - No xanthochromia

Answer 12

More common: 1. SAH (subarachnoid hemorrhage) 2. RCVS (reversible cerebral vasoconstriction syndrome) 3. Acute hypertensive crisis 4. Cervical artery dissection (carotid or vertebral) 5. CCVT (cerebral venous thrombosis) 6. ICH (intracerebral hemorrhage) 7. Benign Post Coital HA 8. Benign post exertional headache 9. Pituitary apoplexy 10. Ischemic stroke 11. Primary thunderclap headache. Rarer causes: (LaHue 2021) Spontaneous intracranial hypotension. Cerebral vascultiis. Sphenoid sinusitis. Aqueductal stenosis. Colloid cyst of the third ventricle. Giant cell arteritis. Cardiac cephalgia (pain referral related to myocardial ischemia).

Neurology Flashcards

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