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ER > 5) Neuro > Flashcards

5) Neuro Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Anterior Cerebral Artery Stroke

A
  • contralateral extremity weakness (lower > upper)
  • altered mentation, reasoning
  • bowel and bladder incontinence
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2
Q

Middle Cerebral Artery Stroke

A
  • contralateral face and arm weakness greater than leg
  • contralateral sensory deficits
  • dysphasia (if dominant brain hemisphere affected)
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3
Q

Posterior Cerebral Artery Stroke

A
  • contralateral visual field deficits
  • altered mentation
  • cortical blindness
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4
Q

Vertebrobasilar Arteries Stroke

A
  • vertigo or nystagmus
  • dysarthria
  • dysphagia
  • contralateral pain and temperature sensory deficits
  • syncope
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5
Q

Tx of Ischemic Stroke

A
  • IV, oxygen
  • hypertension shouldn’t be treated unless severe (>220/>120) if you tx = nitroprusside or labetolol
  • Aspirin if no contraindication
  • IV thrombolysis (tPA) if ischemic stroke <3 h duration and w/o evidence of hemorrhage on CT scan of head
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6
Q

Tx of Hemorrhagic Stroke

A
  • Controversial to tx hypertension after hemorrhagic stroke

- most experts support reducing the BP to 140-160/80-90

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7
Q

CSF characteristics in bacterial meningitis

A 
Opening pressure >300mmHg
WBC >1000microliters
Differential >80% polymorphonuclear
Glucose 200mg/dL
Gram Stain Positive
Culture Positive
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8
Q

CSF characteristics in viral meningitis

A

Opening pressure 40mg/dL
Protein <200mg/dL
Gram Stain Negative
Culture Negative

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9
Q

Pathogens and Empiric Abx for Bacterial Meningitis in Neonates

A

Group B strep, E. coli, Listeria

Tx: Ampicillin and Cefotaxime

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10
Q

Pathogens and Empiric Abx for Bacterial Meningitis in 1-3 mo

A

Strep Pneumo, n. meningitidis, h. influ

Tx: ampicillin, ceftriaxone, cefotaxime, and dexamethasone

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11
Q

Pathogens and Empiric Abx for Bacterial Meningitis in ages 3 mo to 50y

A

strep penumo, n. mening, h. influ

Tx: ceftriaxone or cefotaxime, vanco, and dexamethasone

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12
Q

Pathogens and Empiric Abx for Bacterial Meningitis in ages >50 or alcoholic

A

S. pneumo, Listeria

Tx: Ampicillin, ceftriaxone or cefotaxime and dexamethasone

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13
Q

What is kernigs sign?

A

pain in the neck or back that occurs when a patient w/ meningitis attempts to stringed the leg at the knee when the thigh is held at 90degrees of flexion

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14
Q

What is brudzinski sign?

A

spontaneous flexion of the hips during attempted passive flexion at the neck

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15
Q

Gold standard for dx of meningitis

A

LP

  • **all should have Ct of head to rule out mass lesion before LP
  • **empiric abx must be started immediately, ideally within 30 min of the patients arrival to the ED
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16
Q

Steroids in meningitis

A

Corticosteriods may be considered BEFORE initiation of antibiotic therapy in patients older than 1yr of age

17
Q

Prophylactic ABx for household contacts

A

(only for household contacts or those exposed to respiratory droplets, not routine daily contacts) offer to prevent subsequent infection in meningitis due to n. men:
-rifampin = recommended
alt =
-cipro = only for adults (bad for kid cartilage)
-ceftrixone

18
Q

Generalized seizures

A

originate from nearly simultaneous activation of both cortical hemispheres
(loss of consciousness and rhythmic tonic clonic)

19
Q

Focal seizures

A

initiate from a specific point w/in one cerebral cortex and manifest symp relative to to anatomic portion of brain affected

20
Q

Simple partial

A

consciousness is maintained

21
Q

Complex partial

A

loss of consciousness, indicates spreading or generalizing of aberrant neuronal activity to both cortical hemispheres

22
Q

SE

A

continuous seizure activity x 30 or greater without intervening return to normal baseline neuro functioning
(seizures that last >30-60 min may result in irreversible brain injury

23
Q

1st line agents for tx of active seizure

A

benzos (midazolam, lorazepam, diazepam)

short acting barbs (phenobarb, thiopental)

24
Q

2nd line agents for tx of active seizure

A

phenytoin/ fosphenytoin
magnesium (if thought to be from eclampsia)
valproate

25
Q

Drugs for refractory SE

A

Phenobarb infesion

isoflurane anesthesia

26
Q

Tx of migraines

A

Phenothiazines Ex: prochlorperazine (antiemetic and analgesic)

  • Serotin agonists Ex: sumatriptan (antiemetic and analagesic)
  • **avoid both of these if HTN, CAD, focal neuro findings
27
Q

RF for SAH

A

HTN, smoking, cocaine, first degree relative w/ dz, prior SAH
**SAH has been associated w/ PCKD, connective tissue dz, coarctation of the aorta

28
Q

Patho of SAH

A
  • arterial aneurysm usually within or near the circle of willis or AVM dilates and ruptures into subarachnoid space
  • *dural inflame may extend down the spine causing neck and back pain
29
Q

Tests for SAH

A
  • CT is positive in 90% (most sensitive w/in 1st 12h)
  • SAH is 98% sensitive (most curate after 12h)
  • if there is suspicion for SAH don’t not stop w/ normal head CT, do LP*
30
Q

Tx of SAH

A

Operative resection or embolization

  • control HTN (nitroprusside, labetolol)
  • offer analgesics
  • often give phenytoin prophylactically for seizures
31
Q

Manifestations of temporal arteritis

A
  • fever, malaise, weight loss, visual defects

* **ESR is usually elevated

32
Q

Tx of temporal arteritis

A

steroids to reduce inflam

can lead to blindness if not recognized and tx promptly

33
Q

Peripheral vertigo vs Central vertigo

A

peripheral =arises from the inner ear (more severe; positional, no associated headache)
Ex: BPV, labrin, menieres

central = arises from brainstem or cerebellum (mild but present longer, possible assoc HA, associated neuro findings)
Ex: CVA, neoplasms, demyelinating dz like MS

34
Q

Cause of BPV and tx

A

free floating otoliths in semicircular canals
-elderly
Tx: antivertigo rx and epley maneuver

35
Q

Cause of labrythitis and tx

A

viral infection (#1), toxins: aminoglycosides, furosemide, NSAIDs
-describe sudden onset of vertigo, nausea, and vomiting
-nystagmus often present at rest
Tx: tx underlying infection, stop toxic exposures, symptom relief

36
Q

Cause of meniere’s dz and tx

A

-endolymphatic hydrops: extra endolymph in semicircular canals
-late 20s thru early 50s
-characterized by periodic severe vertigo, nausea, vomitng, tinnnitus, low frequency hearing loss and a sense of ear pressure or fullness
**low frequency hearing loss
Tx: supportive, and antiemertics
**short course of steroids may be helpful
long term = low salt diet
diuretics are reserved for severe cases

ER (11 decks)

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