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what is the definition of status epilepticus? and key point
- key point: any CONTINUING type of seizure
- 1. failure to regain consciousness between seizures
- 2. 30 mins of continuous seizure activity without regaining consciousness
- 3. can be convulsive or non convulsive
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what is the immediate management of status epilepticus?
- A: secure, left lateral position
- B: high flow O2
- C: iv access not antecubital fossa
- D: cot sides up, BM
- Bloods: FBC U&E glucose alcohol AED level, tox screen
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which drugs are used to treat Status?
- 1. lorazepam 2-4mg iv bolus
- 2. phenytoin 18mg/kg over 20mins and ECG monitor
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once status has been controlled in a pt with pre-existing epilepsy, what needs to be done?
- their usual oral AED regime should be reinstated
- if needed via NG tube
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what are 2 neurological causes of acute neuromuscular respiratory failure?
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what is the most useful lung function test in pts with acute respiratory paralysis? how to use this
-
what type of neuropathy is GBS? 4 descriptions
- acute
- inflammatory
- demyelinating
- poly
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what are the main precipitants for GBS?
- bacteria: campylobacter jejuni, mycoplasma pneumoniae
- virus: CMV, EBV, HIV
- Vaccine: swine influenza
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what are the main clinical features of GBS? (8 - think systems)
- cardio: labile BP, cardiac arrhytmia due to ANS dysfunciton
- resp: resp failure due to weakness
- abdo: recent diarrhoea (or vaccine)
- neuro: ascending paralysis, areflexia, cranial nerve involvement
- mskel: back ache
- face: facial weakness, bulbar weakness - speech, swallow - nasal regurgitation
- eyes: ophthalmoplegia in miller fisher variant
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if there is GBS symptoms with ophthalmoplegia, what is going on? what else would you expect? which Ab?
- miller fisher variant
- no weakness
- anti ganglioside Ab
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what is GBS an autoimmune attack against?
myelin proteins
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what are the causes of death in GBS?
- 1. severe weakness
- 2. aspiration
- 3. respiratory failure
- 3. autonomic instability - severe sudden hypotension or cardiac arrhythmia
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which investigations need to be done in GBS - simple to complex
- 1. bloods: campylobacter serology, GM1 antibodies
- 2. LP - CSF: acellular, raised protein
- 3. neurophysiology - EMG, NCS: demyelination and conduction block
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what 2 things need to be monitored in GBS? - think what will kill
- 1. VC < 1 anaesthetic
- 2. cardiac rhythm - ECG
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What is treatment of GBS?, what should NOT be given?
- plasma exchange
- or
- IV Ig
- don't give: STEROIDS
-
what is the age of onset in women and men for MG?
-
which type of symptoms does MG usually present with? and when worse?
- ocular symptoms:
- fatiguable ptosis - often worse end of day
- diplopia
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what are the symptoms of MG?
- ocular
- fatiguable bulbar weakness: dysarthria, dysphagia
- fatiguable proximal weakness
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what is the difference between MG and GBS in symptoms?
MG - no sensory loss or loss of reflexes
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which 5 investigations/tests need to be done for MG diagnosis?
- 1. fatiguability on repetitive muscle testing
- 2. Tensilon test: edrophonium - temporary improvement in weakness
- 3. AChR antibodies
- 4. EMG - single fibre repetitive stimulation
- 5. CT chest - thymoma
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in an acute crisis of MG what needs to be monitored?
VC - anaesthetic review if <1
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what is the treatment of MG?
- 1. pyridostigmine 30-60mg PO QDS
- 2. further immunosuppression: prednisolone, azathioprine,
- 3. plasmapharesis, IvIG
- 4. surgery thymectomy
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give 2 differentials for MG?
- 1. botulism
- 2. lambert eaton
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what can precipitate a myasthenia crisis?
- intercurrent illness
- drugs - abx, BB
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