Till few years back, hemiplegia,
coma and convulsions were the only neurological emergencies.
Lately, family doctors are being repeatedly reminded that the
following neurological conditions should also be considered
as medical emergencies:
- Acute Guillain Barre¢ poly-neuritis
-
Acute attacks of multiple sclerosis
-
Attack of Myasthenia Gravis crisis
- Devic’s Disease (neuro-myelitis
optica)
-
Acute transverse myelitis
-
Acute onset of spinal cord compression
In the first five conditions, IV immunotherapy
or massive doses of steroids are administered and in the last
condition, acute surgical decompression may be considered.
I am now adding Bell’s palsy, a very
common condition seen by family physicians. Although, there
are conflicting opinions, it is high time that Bell’s
palsy is considered as a neurological emergency. It is not necessary
to admit patients in the hospital like all the other conditions
mentioned above.
Large doses of steroids (1 mg/kg body weight
daily) and 800 mg of Acyclovir 5 times a day should be given
to all patients without delay for a period of 5-7 days.
If the patient is coming after a week and the
EMG shows diminished action potential, then such patients are
not going to recover. The patient and his relatives should be
informed about the incomplete recovery. Thus they would be mentally
prepared to accept the patient’s slightly deformed face. |
