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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
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
which drugs are used to treat Status?
- 1. lorazepam 2-4mg iv bolus
- 2. phenytoin 18mg/kg over 20mins and ECG monitor
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
what are 2 neurological causes of acute neuromuscular respiratory failure?
what is the most useful lung function test in pts with acute respiratory paralysis? how to use this
what type of neuropathy is GBS? 4 descriptions
what are the main precipitants for GBS?
- bacteria: campylobacter jejuni, mycoplasma pneumoniae
- virus: CMV, EBV, HIV
- Vaccine: swine influenza
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
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
what is GBS an autoimmune attack against?
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
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
what 2 things need to be monitored in GBS? - think what will kill
- 1. VC < 1 anaesthetic
- 2. cardiac rhythm - ECG
What is treatment of GBS?, what should NOT be given?
- plasma exchange
- IV Ig
- don't give: STEROIDS
what is the age of onset in women and men for MG?
which type of symptoms does MG usually present with? and when worse?
- ocular symptoms:
- fatiguable ptosis - often worse end of day
what are the symptoms of MG?
- fatiguable bulbar weakness: dysarthria, dysphagia
- fatiguable proximal weakness
what is the difference between MG and GBS in symptoms?
MG - no sensory loss or loss of reflexes
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
in an acute crisis of MG what needs to be monitored?
VC - anaesthetic review if <1
what is the treatment of MG?
- 1. pyridostigmine 30-60mg PO QDS
- 2. further immunosuppression: prednisolone, azathioprine,
- 3. plasmapharesis, IvIG
- 4. surgery thymectomy
give 2 differentials for MG?
- 1. botulism
- 2. lambert eaton
what can precipitate a myasthenia crisis?
- intercurrent illness
- drugs - abx, BB