Neurovascular conditions

How many people in the UK have dementia?

850,000 - 1 in 14 over the age of 65

How many people does Parkinson’s disease affect in the UK?

1 in 500

How is Parkinson’s disease treated?

Medication and physiotherapy

What gender is more at risk of developing Parkinson’s disease?

Men

What is multiple sclerosis?

A condition affecting the brain and spinal cord, stopping nerve impulses travelling correctly

How many people in the UK does multiple sclerosis affect?

130,000

How is MS managed?

Medication

Which gender does MS affect most?

Women

What is ataxia?

A group of disorders affecting balance, speech and co-ordination

How many people does ataxia affect?

1 in 50,000

What is paralysis?

Complete loss of muscle function

What is monoplegia?

Paralysis of one limb

What is hemiplegia?

Paralysis of one side of the body

What is quadriplegia?

Paralysis of all 4 limbs

What is paraplegia?

Paralysis of both lower limbs

What is a cerebrovascular event (CVE)?

A CVE is an umbrella term for stroke and TIAs

How many people in the UK are living with the effects of a CVE?

Almost 1 million

What are CVE risk factors?

• age

• Sex

• Ethnicity

• Family history

• Hypertension

• Smoking

• AFib

• Alcohol

• Physical activity

• Obesity

What is a stroke?

When the blood supply to the brain is interrupted

What is the arterial circle called that provides a pathway for blood flow to the brain called?

The circle of Willis

What are the two different origins of a stroke?

• haemorrhagic - bleed

• Ischaemic - blockage of arteries (caused by atherosclerosis or an embolus from the heart)

What is a TIA?

• signs and symptoms of a stroke but they will resolve within 24 hours (usually within minutes/ hours)

• A “mini stroke”

• Treat as a stroke

What are common signs and symptoms of a CVE?

• Numbness

• Weakness/ paralysis

• Slurred speech

• Blurred vision

• Confusion/ inability to communicate

• Severe headaches

• FAST +ve

How would you assess a patient with a suspected CVE using FAST?

• F - face - Ask pt to smile/ show their teeth

• A - arms - ask the pt to put their arms out in front of them for 5 seconds with their eyes closed

• S - speech - Ask pt to say a tongue twister like ‘purple hippopotamus’

• T - time - BE QUICK TO TRANSFER TO A HASU

How would you manage a patient who is suspected of having a CVE?

• DRCABCDE

• O2 if indicated

• Patient positioning - where is comfortable

• Reassurance for pt, friends and family

• Nil by mouth

What is a convulsion?

Involuntary muscle contraction and relaxation of muscles

What are the two types of convulsions and what are the differences between them?

• Generalised - affects a large part of the cerebral cortex

• Partial - affects a localised part of the cerebral cortex

What characterises a tonic-clonic seizure?

Tonic - ridgidity

Clonic - Jerking movements

What is the post-ictal phase?

The recovery period following a seizure

Can a patient be conscious when having a partial convulsion?

Yes

What is status epilepticus?

• continuous convulsions lasting 5 minutes or longer

OR

• A series of convulsions (3 or more in an hour) close together without a recovery period in between

What are causes of convulsions not caused by epilepsy? (Acute causes)

• Hypoxia

• Hypoglycaemia

• Alcohol

• Arrhythmias

• Recreational drugs

• Kidney Failure

• Infections

• Tumour

• Stroke

• And more

How likely is it that you will show up to a patient in the post-ictal phase?

80% of cases

How would you treat someone who is having a seizure?

• AVPU

• Protect pt from injury

• DON’T use an OP

• Breathing may be hard to assess - consider o2

• Check BGL

What 3 seizures in a patient need to be conveyed to hospital?

• first

• Worst

• Longest

What is meningococcal disease?

A bacterial infection of the meninges or infection of the bloodstream

How many patients a year are affected by meningitis?

1200

What are the two types of meningococcal disease?

• meningitis

• Septicaemia

What are symptoms of meningitis?

• fever and vomiting

• Severe headache

• Non-blanching rash

• Stiff neck

• Sensitivity to bright lights

• Very sleepy - difficult to wake

• Confusion/ delirium

• Seizures

What are symptoms of septicaemia?

• Fever/ vomiting

• Limb/joint muscle pain

• Cold hands/feet

• Shivering

• Pale/ mottled skin

• Breathing fast/ breathlessness

• Non-blanching rash

• Very sleepy/ difficult to stay awake

• Confusion/ delirium

How would you assess a patient with meningococcal disease?

• DRCABCDE

• E- expose - examine for a haemorrhagic, non-blanching rash Very sleepy

How would you know if a patient is time-critical for meningococcal disease?

• major ABCDE problems

• Non-blanching rash

• Suspicion of meningococcal disease

Continue assessment en route

What level GCS score does a patient need to have to be comatose?

8