Neurology
Seizures, raised ICP and the paediatric neuro exam.
Use as a study guide only. These notes are part of a free open-access medical education (FOAMed) project and may contain errors or outdated information. Always verify against current guidelines (e.g. eTG, RACGP, local health district policies) and reputable sources before applying anything to patient care. See the full disclaimer.
From the wards
Clinical pearls & learnings
Tips and tricks collected over the years — a living list that grows with every rotation. Use as a study guide only and check current guidelines before acting on anything.
Raised intracranial pressure
Raised intracranial pressure
- Head of bed to 30°, head midline, call for help early
- Ventilate to a normal PaCO₂ (~35–45 mmHg) — avoid hypercapnia and routine aggressive hyperventilation (causes cerebral ischaemia); brief hyperventilation is a rescue measure only, for impending herniation
- Hyperosmolar therapy: hypertonic saline (3%) or mannitol
- Urgent CT head and neurosurgical involvement
- Treat fever, seizures and hypoglycaemia aggressively
Work down this list while calling for neurosurgical help.
Look for Cushing's triad — hypertension, bradycardia and irregular breathing — as a late, ominous sign.
Cerebral palsy
Early signs of cerebral palsy
- Hand dominance established before 6 months of age is abnormal and should raise suspicion.
- Reduced muscle tone and reduced (or rapidly deteriorating) motor control.