Neurological Emergencies Flashcards

A head-injured patient develops a fixed, dilated pupil on one side and a decreasing GCS. This finding most likely indicates:

Answer: Uncal herniation compressing cranial nerve III

A unilateral fixed dilated pupil in a deteriorating head-injured patient indicates uncal herniation compressing the ipsilateral oculomotor nerve (CN III), a neurosurgical emergency.

In the UAE pre-hospital setting, which drug is typically used as first-line treatment for a paediatric patient in status epilepticus without IV access?

Answer: Intranasal or buccal midazolam

Intranasal or buccal midazolam is the preferred first-line agent when IV access is unavailable in paediatric status epilepticus due to ease of administration and rapid onset.

The current thrombolysis (tPA) time window from symptom onset for eligible ischaemic stroke patients is generally:

Answer: Up to 3–4.5 hours

The established tPA treatment window for ischaemic stroke is 3–4.5 hours from symptom onset in eligible patients, making rapid pre-hospital identification critical.

The AVPU scale rates a patient as 'V'. What does this indicate?

Answer: Patient responds only to Voice

In the AVPU scale, 'V' indicates the patient responds to verbal stimuli but is not spontaneously alert, corresponding roughly to a GCS of 9-13.

A patient describes the worst headache of their life, with sudden onset ('thunderclap' headache). Which condition must be immediately suspected?

Answer: Subarachnoid haemorrhage (SAH)

A sudden-onset 'thunderclap' headache described as the worst of the patient's life is the classic presentation of subarachnoid haemorrhage until proven otherwise.

Which clinical feature helps differentiate Bell's palsy from a stroke-related facial palsy?

Answer: Ability to wrinkle the forehead on the affected side in stroke

In a central (stroke-related) facial palsy, the upper face is spared (forehead wrinkling is preserved) because bilateral cortical input protects upper facial muscles; Bell's palsy affects all facial muscles including the forehead.

A patient with suspected central vertigo (rather than benign peripheral vertigo) would most likely present with which additional finding?

Answer: Diplopia, dysarthria, or limb ataxia

Central vertigo (e.g., posterior fossa stroke or tumour) is distinguished by associated brainstem signs such as diplopia, dysarthria, dysphagia, or limb ataxia, which are absent in peripheral (inner ear) vertigo.