D: NEUROLOGIC

nervous_system

In the ABCDs, D is for disability or neurological emergencies. Think NEUROLOGIC to consider what could be affecting the brain (NEURO), spinal cord (L) and peripheral nervous system (OGIC):

Neuron seizure: EEG

  • type: tonic-clonic, absense, myoclonic, atonic, non-convulsive status
  • primary vs secondary (hypoxia, hypoglycemia, hyponatremia, meningitis, brain mass/bleed, pre-eclampsia, toxic/withdrawal)
  • treat: manage aiway, give O2, benzo+/-dilantin+/-propofol, check glucose, treat underlying
  • EEG

Encephalitis/meningitis/abscess: LP

  • encephalitis, eg HSV, West Nile: headache, fever, confusion –> LP, MR
  • meningitis: viral vs bacterial: LP, ceftriaxone, vanco +/- acyclovir
  • abscess: hematogenous, sinus/ear: headache, fever, neuro signs –> CTA

Unregulated pressure: LP

  • intracranial hypertension –> papiledema, POCUS increased optic nerve sheath diameter
    • secondary to tumour, blocked VP shunt, venous thrombosis
    • idiopathic: morning headache/nausea, vision changes
  • intracranial hypotension
    • post-LP headache

RBC clot/bleed: CT, MR

  • bleed
    • epidural hematoma: trauma –> acute accumulation of blood –> require neurosurgical evacuation
    • subdural hematoma –> acute, subacute or chronic –> treatment depend on severity
    • subarachnoid bleed –> acute aneurysm rupture, diagnose by CT/LP, treat by neurosurg clip/coil
    • intraparenchymal bleed: hemorrhagic stroke, AVM bleed –> neurosurg consult
  • clot
    • ischemic stroke: ACA, MCA, PCA territories –> CT, consider tPA; MR
    • dural sinus vein thrombosis: range of symptoms (headache, confusion, seizure) in patient at risk of clot (pregnant, Factor V) –> MRV

Onco tumour: CT/CTA

  • primary or metastatic, symptoms depend on size/location
  • diagnose by CT/CTA, treat with steroids +/- radiation +/- debulking

myeLopathy: MR spine

  • spinal cord compression: traumatic, oncologic –> emergency MRI
  • transverse myelitis

Origin (root) compression:

  • sciatic nerve compression

GBS:

  • peripheral neuropathy with ascending muscle weakness and loss of reflexes

Intersection neuromuscular

  • proximal muscle weakness including cranial nerves, eg botulism, myasthenia, organophosphate poisoning

CK: myopathy

  • proximal muscle weakness,
  • etiology: polymyositis, dermatomyositis, muscular dystrophy, Cushing, statins, hypothyroid

neurologic

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