Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

1234A headache that is becoming more regular/more severe is worrying Nausea and vomiting can be seen in primary headaches, but severe or longstanding N/V is worrying for ↑ICP 5Adult PKD, neurofibromatosis type 2, cluster and migraine headaches 67Always ask women about the Combined oral contraceptive pill. It’s a big contra-indication in people with migraines as it is associated with an increased risk of cerebrovascular events such as TIA’s/Strokes/DVT. 8It is important to consider anti-emetic treatment for nausea and vomiting; these commonly occur in migraine, affecting more than half of all migraine sufferers. Gastric stasis often occurs in migraine and contributes to nausea and emesis. Anti-emetics including domperidone, prochlorperazine and metoclopramide reduce nausea and have a pro- kinetic action, restoring gut motility and enhancing medication absorption. Occulogyric crisis = prolonged involuntary upward deviation of the eyes Side effects of beta blockers: - Bradycardia - Erectile dysfunction - Cold extremities - Bronchoconstriction 9a patient may suffer 3 – 4 attacks a day for weeks or months followed by a pain-free period lasting 1-2 years. Attacks last between 15 minutes and 3 hours. Triptans: risk of overuse headache so don’t give more than 2 doses a day Don’t give in IHD as causes vasoconstriction of blood vessels Avoid verapamil with beta blockers and bradycardia Avoid 100% O2 in COPD patients as it causes increased CO2 retention 10111213CN VI has the longest intracranial course. Compression would affect the lateral rectus, impairing abduction Cushing’s reflex consists of: Severe hypertension Bradycardia Irregular breathing 14Neisseria meningitidissepticaemia. Purpura in a febrile child is meningitis until otherwise proven. Meningococcal sepsis may result in Waterhouse-Fredrichsen syndrome. WaterhouseFredrichsen = bleeding into the adrenal glands resulting in Addisonian crisis (acute shock). This is treated with IV hydrocortisone Acute complications of meningitis These include sepsis, septic shock, disseminated intravascular coagulation, coma, cerebral oedema, raised intracranial pressure, subdural effusions, SIADH, seizures, peripheral gangrene and death. Bacterial meningitis 30–50% of survivors of acute bacterial meningitis experience permanent neurological sequelae. Common complications include: Hearing loss (33.6%) Seizures (12.6%) Motor deficit (11.6%) 15Cognitive impairment (9.1%) Hydrocephalus (7.1%) Visual disturbance (6.3%) 15Extra points: what are the complications of an LP Failure of LP Headache Infection Bleeding Cerebral herniation (i.e. Arnold-Chiari malformation) Radiculopathy Back pain SEPSIS 6 Give 3 Take 3 Give: Fluids Oxygen Abx Take: Blood cultures Lactate 16Urine Output 1617Cefotaxime/ceftriaxone are cephalosporins 18Rifampin, Isoniazid, Pyrazinamide, Ethambutol, 19202122Amaurosis fugax is transient loss of vision, often described as a dark curtain falling over the eye. It can be caused by temporal arteritis and embolic diseasese.g. carotid artery stenosis or endocarditis. There are othercauses but these are the important ones. High Dose Oral Prednisolone (60mg) For patientswith visual loss, 500mg – 1g of intravenous methylprednisolone once daily is typically administered for 3 consecutive days in secondary care followed by an oral prednisolone regime. 23Temporal artery biopwy ill demonstrate mononuclear cell infiltration or granulomatous inflammation usually withmultinucleated giant cells. 2425Acetazolamide is a carbonic anhydrase inhibitor: it lowers the intraocular pressure by reducing the amount of ocular fluid and Cerebrospinal fluid produced. 26Encephalitis should be suspected in any patient with sudden onset behavioral change, new seizures and unexplained acute headache with meningism. 27Characteristic sign on the CT “lemon sign”. Blood will not cross the periosteal sutures, biconcave in shape. A large enoughhaematomawill cause midline shift of the brain tissue. **Not to be confused with the spina bifida “lemon sign” seen in children** Head injury or trauma followed by loss of consciousness, a period of alertness, then rapid deterioration back to unconsciousness. Nausea or vomiting. Weakness in part of the body, usually on the opposite side from the side with the enlarged pupil 28Appears as a “banana” shape on the CT Most common presenting symptoms are personality changes and reduced GCS 2930With LPs, you would take 3 vials normally but if SAH was suspected you take 4 to make sure there are no RBCs that could’ve come in from a traumatic tap. 31Schwannoma (acoustic neuroma): Benign tumour of CNVIII – tinnitus, hearing loss, vertigo. Diagnosed using MRI. Bilateral tumours = neurofibromatosis 2 Extras: Occulomotor (III) nerve palsy: Down and out eye, Horner’s and Ptosis Abducens (VI) nerve palsy: loss of abduction of the eye 3233343536A 37B. Idiopathic intracranial hypertension 38B. Extraduralhaematoma 39D 40C Hypermobility is suggestive of Ehlers-Danlos Syndrome which is genetic (AD) 41C 42434445