A 34-year-old female presents with vomiting preceded by an occipital headache of acute onset. On examination she was conscious and alert with photophobia but no neck stiffness. CT brain is reported as normal.
What is the most appropriate further management?
Correct Answer C: If the CSF examination revealed xanthochromia, or there was still a high level of clinical suspicion, then cerebral angiography would be the next step.
Subarachnoid haemorrhage: Causes:
Investigations:
Complications:
Management:
*The way nimodipine works in subarachnoid haemorrhage is not fully understood. It has been previously postulated that it reduces cerebral vasospasm (hence maintaining cerebral perfusion) but this has not been demonstrated in studies.
In patients with Guillain-Barre syndrome, respiratory function should be monitored with:
Correct Answer E: FVC is used to monitor respiratory function in Guillain-Barre syndrome.
Guillain-Barre syndrome:
Guillain-Barre syndrome describes an immune mediated demyelination of the peripheral nervous system often triggered by an infection (classically Campylobacter jejuni).
Prognosis:
A 73-year-old female with a history of recurrent falls at home and alcohol excess is brought to the Emergency Department due to episodes of confusion over the past 5 days. Between these episodes she is apparently her normal self. On examination her GCS is 14/15 and she has nystagmus on left lateral gaze.
What is the most likely diagnosis?
Correct Answer A: Fluctuating consciousness = subdural haemorrhage.
The combination of falls, alcohol excess, fluctuating episodes of confusion and focal neurology points towards a diagnosis of subdural haemorrhage. The phrase 'fluctuating conscious level' is common in questions and should always bring to mind subdural haemorrhage.
Subdural haemorrhage: Basics:
Features:
Treatment:
A 47-year-old man with a known history of schizophrenia is admitted to the Emergency Department due to confusion. A bottle of procyclidine tablets are found in his pocket. On examination the temperature is 38.1ºC with a blood pressure of 155/100 mmHg. Neurological examination reveals a GCS of 13/15 but assessment of his peripheral nervous system is difficult due to generalized increased muscle tone.
Correct Answer A: Neuroleptic malignant syndrome is a rare but dangerous condition seen in patients taking antipsychotic medication. It carries a mortality of up to 10% and can also occur with atypical antipsychotics.
A raised creatine kinase is present in most cases. A leukocytosis may also be seen.
You review a 25-year-old man who is complaining of leg weakness. Other than a bout of diarrhoea three weeks ago he has been feeling fit and well and has no significant medical history. On examination you note reduced power in his legs, normal sensation and reduced knee and ankle reflexes. His:
Correct Answer B: Guillain-Barre syndrome describes an immune mediated demyelination of the peripheral nervous system often triggered by an infection (classically Campylobacter jejuni). The characteristic features of Guillain-Barre syndrome is progressive weakness of all four limbs. The weakness is classically ascending i.e. the lower extremities are affected first, however it tends to affect proximal muscles earlier than the distal ones. Sensory symptoms tend to be mild (e.g. distal paraesthesia) with very few sensory signs. Some patients experience back pain in the initial stages of the illness.
Other features:
Less common findings:
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