Neuro emergencies.txt

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Author:
kavinashah
ID:
47781
Filename:
Neuro emergencies.txt
Updated:
2010-11-06 20:56:29
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neuro emerge
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neuro emergen
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  1. what is the definition of status epilepticus? and key point
    • key point: any CONTINUING type of seizure
    • 1. failure to regain consciousness between seizures
    • 2. 30 mins of continuous seizure activity without regaining consciousness
    • 3. can be convulsive or non convulsive
  2. what is the immediate management of status epilepticus?
    • A: secure, left lateral position
    • B: high flow O2
    • C: iv access not antecubital fossa
    • D: cot sides up, BM
    • Bloods: FBC U&E glucose alcohol AED level, tox screen
  3. which drugs are used to treat Status?
    • 1. lorazepam 2-4mg iv bolus
    • 2. phenytoin 18mg/kg over 20mins and ECG monitor
  4. once status has been controlled in a pt with pre-existing epilepsy, what needs to be done?
    • their usual oral AED regime should be reinstated
    • if needed via NG tube
  5. what are 2 neurological causes of acute neuromuscular respiratory failure?
    • GBS
    • myasthenia crisis
  6. what is the most useful lung function test in pts with acute respiratory paralysis? how to use this
    • VC
    • 1L cut off
  7. what type of neuropathy is GBS? 4 descriptions
    • acute
    • inflammatory
    • demyelinating
    • poly
  8. what are the main precipitants for GBS?
    • bacteria: campylobacter jejuni, mycoplasma pneumoniae
    • virus: CMV, EBV, HIV
    • Vaccine: swine influenza
  9. what are the main clinical features of GBS? (8 - think systems)
    • cardio: labile BP, cardiac arrhytmia due to ANS dysfunciton
    • resp: resp failure due to weakness
    • abdo: recent diarrhoea (or vaccine)
    • neuro: ascending paralysis, areflexia, cranial nerve involvement
    • mskel: back ache
    • face: facial weakness, bulbar weakness - speech, swallow - nasal regurgitation
    • eyes: ophthalmoplegia in miller fisher variant
  10. if there is GBS symptoms with ophthalmoplegia, what is going on? what else would you expect? which Ab?
    • miller fisher variant
    • no weakness
    • anti ganglioside Ab
  11. what is GBS an autoimmune attack against?
    myelin proteins
  12. what are the causes of death in GBS?
    • 1. severe weakness
    • 2. aspiration
    • 3. respiratory failure
    • 3. autonomic instability - severe sudden hypotension or cardiac arrhythmia
  13. which investigations need to be done in GBS - simple to complex
    • 1. bloods: campylobacter serology, GM1 antibodies
    • 2. LP - CSF: acellular, raised protein
    • 3. neurophysiology - EMG, NCS: demyelination and conduction block
  14. what 2 things need to be monitored in GBS? - think what will kill
    • 1. VC < 1 anaesthetic
    • 2. cardiac rhythm - ECG
  15. What is treatment of GBS?, what should NOT be given?
    • plasma exchange
    • or
    • IV Ig
    • don't give: STEROIDS
  16. what is the age of onset in women and men for MG?
    • women: 10-30
    • men: 50-70
  17. which type of symptoms does MG usually present with? and when worse?
    • ocular symptoms:
    • fatiguable ptosis - often worse end of day
    • diplopia
  18. what are the symptoms of MG?
    • ocular
    • fatiguable bulbar weakness: dysarthria, dysphagia
    • fatiguable proximal weakness
  19. what is the difference between MG and GBS in symptoms?
    MG - no sensory loss or loss of reflexes
  20. which 5 investigations/tests need to be done for MG diagnosis?
    • 1. fatiguability on repetitive muscle testing
    • 2. Tensilon test: edrophonium - temporary improvement in weakness
    • 3. AChR antibodies
    • 4. EMG - single fibre repetitive stimulation
    • 5. CT chest - thymoma
  21. in an acute crisis of MG what needs to be monitored?
    VC - anaesthetic review if <1
  22. what is the treatment of MG?
    • 1. pyridostigmine 30-60mg PO QDS
    • 2. further immunosuppression: prednisolone, azathioprine,
    • 3. plasmapharesis, IvIG
    • 4. surgery thymectomy
  23. give 2 differentials for MG?
    • 1. botulism
    • 2. lambert eaton
  24. what can precipitate a myasthenia crisis?
    • intercurrent illness
    • drugs - abx, BB

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