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Emed > #10: Neuro > Flashcards

#10: Neuro Flashcards

1
Q

episode of abnormal neurologic function caused by inapprop discharge of neurons/imbalance of excitatory and inhibitory NTs

A

Seizure

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2
Q

What are the diff categories of seizures (4)?

A

Categories of seizures

  1. epilepsy
  2. generalized seizures
  3. Partial seizures
  4. Status epilepticus
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3
Q
  1. epilepsy
  2. EtOH withdrawal
  3. toxins/drugs
  4. TBI
  5. HYPOglycemia
  6. brain tumors
  7. infxns

these are causes of ____

A
  1. epilepsy
  2. EtOH withdrawal
  3. toxins/drugs
  4. TBI
  5. HYPOglycemia
  6. brain tumors
  7. infxns

causes of seizures

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4
Q

1 What 2 age groups are is epilepsy more common in?

A

epilepsy - more common in young kids and elderly

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5
Q

2 Generalized Seizures

  • how do generalized seizures differ from partial seizures
  • what are the 2 types
A 
#2 Generalized Seizures types 
- generalized = LOC .......partial = NO LOC
  1. Tonic-Clonic (convulsive)
  2. Absence (non-convulsive)
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6
Q

2 Generalized Seizures types

  1. which type is a/w post seizure AMS, biting tongue and hypoxic state while seizing
  2. which type is a/w brief loss of responsiveness and minor motor movements (blink/stare)
  3. which type is NOT a/w loss of postural tone
A

2 Generalized Seizures types

  1. Tonic clonic = a/w post seizure AMS, biting tongue and hypoxic state while seizing
  2. Absence = a/w brief loss of responsiveness and minor motor movements (blink/stare)
  3. Absence = NOT a/w loss of postural tone (falling)
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7
Q 
#3 Partial Seizures 
- what are the 2 types
A

3 Partial Seizures types

  1. Simple partial
  2. complex partial
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8
Q

3 Partial Seizures

  1. which type a/w isolated motor sxs and jacksonian march
  2. which type a/w aura followed by impaired responsiveness
A

3 Partial Seizures

  1. simple partial = a/w isolated motor sxs and jacksonian march
  2. complex partial = a/w aura followed by impaired responsiveness
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9
Q

What type of seizure is a/w unresponsiveness, small jerky movements of body or nystagmus

A

Status epilepticus

  • unresponsiveness, small jerky movements of body or nystagmus
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10
Q

4 Status epilepticus

  1. what is the criteria for it (1 of 2 things must be met)
  2. what does non-convulsive SE mean
A

4 Status epilepticus

  1. criteria (1 of 2 things must be met)
    - sz activity > 10 mins -OR- 2+ sz in < 30 min
  2. what does non-convulsive SE = seizure that doesnt occur in motor strip–> no motor sxs
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11
Q

What is more important for diagnosing a seizure: history or PE

A

Hx > PE for Dx a seizure

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12
Q

What are 2 signs that a person might have faked a seizure

A

faked seizure

  1. awake right after seizure
  2. no urinary incontinence
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13
Q

What test used to Dx seizures (although NOT done in ER)

A

EEG = main test for dx seizures

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14
Q

To find the cause of a seizure, what tests ARE done in the ER? (3 plus what type of cause should you look for)

A

tests done in the ER to Dx seizures

  1. Glucose testing (HYPOglycemia mimics it)
  2. EtOH/drug screen
  3. MRI/CT (look for brain abn)
    - plus look for infectious causes
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15
Q

Seizure Tx

  • what 3 drugs are 1st line for most sz types and whay class of drugs are they
A

Seizure Tx : 1st line drugs for most sz types

  1. Phenytoin
  2. Valproic Acid
  3. Carbamazepine
    - class = anti convulsants
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16
Q

Seizure Tx

  • What 2 drugs are spp for tx of generalized absence/non-convulsive seizures
A

Seizure Tx: generalized absence/non-convulsive seizures

  1. Ethosuximide
  2. Valproic acid
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17
Q

what should be occurring simultaneously while assessing someone w/ a seizure

A

seizures = assessment + management occur simultaneously

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18
Q

Tx of Status Epilepticus

  1. what should you do 1st (2 things)
  2. what should you give if pt has low blood sugar
  3. what should you give if pt is known alcoholic
  4. what is the main drug given for SE
  5. 2nd line drug for it
  6. 3rd line
A

Tx of Status Epilepticus

  1. 1st secure airway and give O2
  2. low blood sugar –> give glucose
  3. known alcoholic –> give Thiamine + Mg
  4. main drug given for SE = Lorezepam
  5. 2nd line = phenytoin
  6. 3rd line = phenobarbital/Gen Anesthesia
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19
Q

Rapidly evolving, symmetric, demyelinating neuropathy, that usually affects motor > sensory function

A

Guillain Barre Syndrome

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20
Q

Guillain Barre Syndrome

  1. what type response occurs and what is the resp d/t
  2. what organism is one proven cause of it
A

Guillain Barre Syndrome

  1. autoimmune response d/t infxn or inoculation
  2. Campylobacter jejuni = 1 proven cause of it
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21
Q

Guillain Barre Syndrome

  1. what 2 Sxs REQUIRED for Dx
  2. other than normal admission labs what other testing needs done on these pts (3)
A

Guillain Barre Syndrome

  1. Sxs needed for Dx
    - progressive muscle weakness (ASCENDING)
    - Areflexia (NO REFLEXES)
  2. Testing
    - serial PFTs
    - LP
    - EMG/NCV testing
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22
Q

Guillain Barre Syndrome: LP

- what results are consistent w/GBS

A

Guillain Barre Syndrome: LP

  • elevated protein but only few cells in CSF
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23
Q

Guillain Barre Syndrome: Tx

- what 2 things are mainstays

A

Guillain Barre Syndrome: Tx

IVIG or plasmapharesis

24
Q

Guillain Barre Syndrome Tx

  1. what type of monitoring should pts be on
  2. what types of pain meds are good for GBS
  3. why PT needed
A

Guillain Barre Syndrome Tx

  1. cardiac monitoring
  2. pain meds = gabapentin, opiates
  3. PT needed to prevent contractures
25
Q

Pt comes stating few wks ago had a cold, which resolved. Then 3 days ago pt noticed feeling faitgued and tingling in foot. Then tingling spread up leg and it got harder to walk and now cant stand or feel my legs. On exam pt has no achilles or patellar reflexes

Dx + Tx?

A 
Dx = GBS 
Tx = IVIG or plasmapharesis
26
Q

What types of territories do strokes follow + why

A

strokes follow vascular territories

- b/c stroke = block/rupture in blood vessel

27
Q

Location of Strokes

  1. Which is MC and why
  2. which a/w leg > arm weakness
  3. which a/w visual cortex defects + decr light touch/pinprick sensation
  4. which a/w aphasia, homonymous hemianopsia, arm > leg weakness
  5. which a/w CN deficits on 1 side of face + limb weakness on other side
  • which one often missed/why
A

Location of Strokes

  1. MC = MCA b/c doesnt need to travel around circle of willis
  2. ACA = leg > arm weakness
  3. PCA = visual cortex defects + decr light touch/pinprick sensation
  4. MCA = aphasia, homonymous hemianopsia, arm > leg weakness
  5. Vertebrobasilar = CN deficits on 1 side of face + limb weakness on other side
    `
    - PCA often missed b/c no motor Sxs
28
Q

What is the most important question to ask pt w/ suspected stoke

A

Most imp question for stroke pts

- when did the Sxs start

29
Q

Trauma to the neck is a/w what location for stroke + why

A

Neck trauma = a/w vertebrobasilar stroke

- vertebrobasilar region perfuses brainstem

30
Q

Pt presents w/ drooling, R sided facial droop, flattened nasolabial fold, decr grip strength on R side, arm drift, sensory loss to light touch and neglect

Dx? (spp)

A

Stoke on L side of brain

Sxs on R side

31
Q

How to differentiate stroke from bell’s palsy

A

stroke = pts can lift/wrinkle both eyebrows

bell palsy pts cant

32
Q

What are the 2 main categories of strokes

  • which is more common
  • which has higher mortality
  • can you typically distinguish b/t the 2 by Sxs?
A

Categories of strokes

  1. Ischemic = MC
  2. Hemorrhagic = higher mortality

CANT (usu) distinguish b/t them by Sxs

33
Q

Categories of strokes

  1. which occurs when blood vessel clots –> cant deliver O2 to part of brain
  2. which occurs when blood vessel bursts –> cant deliver O2 to part of brain
A

Categories of strokes

  1. Ischemic = blood vessel clots –> cant deliver O2 to part of brain
  2. Hemorrhagic = blood vessel bursts –> cant deliver O2 to part of brain
34
Q

Hemorrhagic Strokes

- what are the 2 types

A

Hemorrhagic Strokes: 2 types

  1. ICH (Intracranial hemorrhage)
  2. SAH (Subarachnoid hemorrhage)
35
Q

Hemorrhagic strokes

  1. which is d/t an aneurysm or AVM
  2. which occurs d/t incr BP –> weakening arterioles –> bleeding
A

Hemorrhagic strokes

  1. SAH = d/t an aneurysm or AVM
  2. ICH = d/t incr BP –> weakening arterioles –> bleeding
36
Q

what is the most important initial test for stroke

A

non contrast head CT

37
Q

Pt presents w/ abrupt onset of the worst HA of their life occurring in the back of the head and decr consciousness. She has associated photophobia, N/V and nuchal rigidity

What type of stroke is this

A

Dx = SAH

38
Q

What is a sentinal bleed

- what type of stroke is it a/w

A

sentinal bleed = recent severe HA that resolved

- a/w SAH

39
Q

Hemorrhagic Strokes

  1. how do they appear on CT
  2. what is difference b/t ICH and SAH on CT
A

Hemorrhagic Strokes

  1. on CT = bright white
  2. difference b/t ICH and SAH on CT:
    - ICH = in a vascular distribution
    - SAH = NOT in common vascular distribution
40
Q

Hemorrhagic strokes and LP

  1. if pt had neg CT w/in 6 hrs of HA onset is an LP required?
  2. Which type a/w xanthochromia on LP
A
  1. NO, LP not needed if neg CT w/in 6 hrs of HA onset

2. SAH = a/w xanthochromia on LP

41
Q

Tx of hemorrhagic strokes (ICH)

  1. what can be given for incr ICP
  2. what can be done for large bleeds near surface
  3. otherwise what is Tx
  • note: no great Tx options
A

Tx of hemorrhagic strokes (ICH)

  1. incr ICP –> mannitol
  2. large bleeds near surface –> surgical decompression
  3. otherwise Tx = supportive + rehab
42
Q

Tx of hemorrhagic strokes (SAH)

  1. what can be done for large bleeds
  2. what 3 meds can be given to prev an incr in ICP
  3. what is given to decr vasospasm
A

Tx of hemorrhagic strokes (SAH)

  1. large bleeds –> surgical decompression
  2. prev an incr in ICP w/ anticonvulsants, cough suppressants and anti-emetics
  3. Nimodipine –> decr vasospasm
43
Q

Ischemic strokes

- what are the 3 types (+ brief description/cause)

A

Ischemic Stroke Types

  1. Thrombotic (narrowed lumen –> clot formation
  2. Embolic (emboli from heart/carotids)
  3. Hypoperfusion (HF or abrupt decr in BP)
44
Q

Ischemic Strokes

  1. when do they show up on CT
  2. how do they appear on CT
A

Ischemic Strokes

  1. show up on CT 3-6 hrs after
  2. appear dark on CT
45
Q

Ischemic Strokes

- if CT doesnt show them for few hrs then why is CT done

A

Ischemic Strokes

- CT is done to r/o hemorrhage –> to give tPA must r/o it out

46
Q

Criteria for giving tPA for ischemic strokes

  1. what cant be present
  2. what lab values must be norm
  3. what med can pts NOT be on
  4. what is BP consideration
  5. what can pts NOT have Hx of or dont give high suspicion of
A

Criteria for giving tPA for ischemic strokes

  1. bleeding CANT be present
  2. coag + plts must be normal
  3. pts CANNOT be on anti-coags
  4. pt CANT be acutely hypertensive
  5. pts CANT have Hx of hemorrhagic stroke or dont give if high suspicion of SAH
47
Q

If criteria met and < 4.5 hrs since Sx onset what can be given for pts w/ischemic stroke

A

criteria met and < 4.5 hrs since Sx onset –> tPA

48
Q
A

tx for ischemic strokes for Sxs w/in 6 hrs after Sxs onset
- intra-arterial injection w/ tPA

shown to be better than tPA alone!!!

49
Q

What is tx for pts w/ ischemic stroke > 4.5 hrs after Sx onset (+ what meds considered)

A

Tx for pts w/ ischemic stroke > 4.5 hrs after Sx onset

  • supportive care
  • consider giving anti-plt therapy (ASA, plavix)
50
Q

AHA/ASA Stroke Algorithm

  1. general assessment + order for CT w/in ____
  2. neuro assessment + CT performed w/in ____
  3. CT interpreted w/in _____
  4. tPA given w/in _____ or _____
A

AHA/ASA Stroke Algorithm

  1. general assessment + order for CT w/in 10 min (of hosp arrival)
  2. neuro assessment + CT performed w/in 25 min
  3. CT interpreted w/in 45 min
  4. tPA given w/in 1 hr of hosp arrival or 4.5 hr since sxs
51
Q

What are the 2 types of traumatic head bleeds

A

Traumatic Head bleeds

  1. Subdural Hematoma
  2. Epidural Hematoma
52
Q

Traumatic head bleeds:

  1. which a/w sudden accel –> deceleration w/tearing of bridging veins
  2. whic a/w rupture of middle meningeal artery
A

Traumatic head bleeds

  1. Subdural Hematoma = sudden accel –> deceleration w/tearing of bridging veins
  2. Epidural hematoma = rupture of middle meningeal artery
53
Q

Traumatic head bleeds: #1 Subdural Hematoma

  1. 3 common MOI
  2. what 3 groups of pts more at risk for this type + why
  3. what is shape seen on CT
A

Traumatic head bleeds: #1 Subdural Hematoma

  1. 3 common MOI = falls, assault, MVA (not restrained)

2.incr risk = elderly, alcoholics, CNS dz (dementia, Alz)
b/c cerebral atrophy –> stress on bridging veins

  1. crescent shape on CT
54
Q

Pt presents w/ bruising and laceration to head, he is confused, vomiting, cant walk properly and smells of alcohol. He tells you he recently fell after walking home from the bar. on CT you seen crescent shaped bleed

Dx?

A

Dx = Subdural hematoma

55
Q

Traumatic head bleeds: #2 Epidural Hematoma
(middle meningeal artery)

  1. where is the blood located
  2. MC MOI and to what areas of brain
  3. why is this type so dangerous
  4. what shaped seen on CT
A

Traumatic head bleeds: #2 Epidural Hematoma

  1. blood located b/t skull and dura mater
  2. MC MOI= blunt forced trauma to temporal/parietal areas
  3. dangerous b/c high pressure arterial bleed –> rupture middle meningeal artery –> herniation quickly
  4. Egg/balloon shape on CT
56
Q

Tx of Traumatic head bleeds
- what is the main tx for both Subdural and Epidural Hematoma

note both can have mass effect/midline shift on CT but more likely w/Epidural

A

main tx for both Subdural and Epidural Hematoma

- surgical evacuation of blood

Emed (10 decks)

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