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
