12 - neuro Flashcards
Patient has dysarthria, aphasia, vision change, ataxia, and focal weakness. What is the MOST LIKELY cause?
acute ischemic stroke (most common)
What is your DDx for ischemic stroke symtpoms?
1) hemorrhagic stroke
2) TIA
3) metabolic derangement
4) atypical migraine
5) mass
6) ischemic stroke
What’s the difference b/t TIA and ischemic CVA?
duration
What do you order for acute stroke symptoms?
1) CT without!! Order first.
2) CBC
3) BMP (r/o metabolic derangement)
4) glucose
5) coags
6) ESR (for HA, etc)
7) tox screen
If patient has ischemic stroke symptoms and is malignantly hypertensive, what is your target BP?
t want to worsen the ischemia)
tPA criteria:
1) onset < 4.5 hours
2) INR < 1.7
3) No recent major sx (14 days)
4) No h/o SAH, ever
5) PLT > 100
6) BP < 180/120
7) No MI in last 90 days
pt c/o bad headache, neck stiffness, n/v, and AMS. What is this most typical for?
SAH (couldn’t give it away with the thunder)
SAH is typically a ruptured ____________ or what congenital problem?
berry aneurysm, or AV malformation
SAH work up:
1) CT without
2) LP with xanthochromia if CT is negative
Tx of SAH?
1) intubate
2) BP reduction by 20%, then titrate to <140 over next hour
3) sx clip or coil ASAP, even if clotted and not actively bleeding
Sudden severe HA with neuro deficits or sz, n/v. What do you suspect?
intracerebral hemorrhage (different from SAH b/c this bleed is more massive and will involve neuro deficits) Presentation similar to ischemic
If you see a brain bleed, what do you do?
1) lower BP!
a) aggressively with IV if > 200
b) intermittently with po if > 180
2) Neuro consult
1) Convulsive sz lasting longer than _____ minutes
2) Back to back convulsive sz without return to baseline between
3) Recurrent non-convulsive sz…..are the definitions of __________?
5, status epilepticus
Tx of status epilepticus:
1) airway
2) r/o hypoglycemia
3) stop the sz!!
What medications stop sz?
1) benzo (repeat, repeat Q2min x 3 total)
2) anticonvulsants (to prevent recurrence, PHENYTOIN)
3) conscious sedation (propofol) is last resort, LASTLY general anesthesia.
Muscle weakness that improves with rest
myasthenia gravis
complication of myasthenia gravis
fatigue of diaphragm leads to respiratory failure, admit to support airway
pathophys of myasthenia gravis
Depletion of ACH
AI dz that attacks peripheral myelin, characterized by ascending paralysis
guillian-barre (vs MS, which is central myelin)
admit and support airway
What is the first sign of guilian-barre?
hyporeflexia
Patients with _________ have worse symptoms at night. _________ patients have rapid progression of symptoms
myasthenia, guillian-barre
Other than intubation, how are myasthenia and GBS treated?
IVIG, plasmapheresis
muscle protein destruction with pain and weakness (proximal) of muscles (often thighs).
rhabdomyolysis
causes of rhabdo
1) muscle compression
2) exercise
3) sz–status epi
4) DT’s
5) viral inf
6) drugs (statins)
