Category Archives: Neurology

The daily educational pearl – features of ischaemic CVA on CT

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CT findings that suggest the presence of an ischaemic CVA

– loss of grey/white matter differentiation

– effacement of cortical sulci

– local mass effect

– parenchymal hypodensity

– obscuration of lentiform nucleus

– hyperdense cerebral artery (middle most commonly) – associated with higher risk of haemorrhagic transformation and contraindication to thrombolysis

 

 

 

The daily educational pearl – status epilepticus

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Status epilepticus = continuous or intermittent seizures for more than 5 minutes without recovery of consciousness (after 20 min – very high risk of irreversible neurologic damage)

Non-convulsive status epilepticus = abnormal mental state or confusion, with no overt seizure activity or subtle motor signs (twitching, blinking, eye deviation); usually diagnosed on EEG

Epilepsia partialis continua = focal tonico-clonic seizure with NORMAL alertness; can be mistaken for pseudoseizures

 

Complications of status epilepticus

– irreversible cerebral injury (mainly secondary to hypoxia)

– hyperthermia + DIC

– hypoglycaemia

– rhabdomyolysis + ARF

– profound lactic acidosis

– cardiac dysrhythmias, pulmonary oedema

– injuries – head / spine / limbs / other

 

The daily educational pearl – altered mental state after a witnessed seizure

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Your next patient was witnessed to have a tonico-clonic seizure 30 min ago. He remains GCS 6. Why might that be?

Causes of persisting altered mental state following a seizure

– status epilepticus

– iatrogenic (i.e. given benzodiazepines prehospital or in ED)

– normal postictal state

– persisting cause (of seizure + AMS): hypoNa / hypoglycaemia / toxins / SAH / intracerebral haemorrhage / meningitis / encephalitis

– complications of the ictal state – hypoxic brain injury / severe metabolic acidosis