5) Neuro Flashcards
Anterior Cerebral Artery Stroke
- contralateral extremity weakness (lower > upper)
- altered mentation, reasoning
- bowel and bladder incontinence
Middle Cerebral Artery Stroke
- contralateral face and arm weakness greater than leg
- contralateral sensory deficits
- dysphasia (if dominant brain hemisphere affected)
Posterior Cerebral Artery Stroke
- contralateral visual field deficits
- altered mentation
- cortical blindness
Vertebrobasilar Arteries Stroke
- vertigo or nystagmus
- dysarthria
- dysphagia
- contralateral pain and temperature sensory deficits
- syncope
Tx of Ischemic Stroke
- 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
Tx of Hemorrhagic Stroke
- Controversial to tx hypertension after hemorrhagic stroke
- most experts support reducing the BP to 140-160/80-90
CSF characteristics in bacterial meningitis
Opening pressure >300mmHg WBC >1000microliters Differential >80% polymorphonuclear Glucose 200mg/dL Gram Stain Positive Culture Positive
CSF characteristics in viral meningitis
Opening pressure 40mg/dL
Protein <200mg/dL
Gram Stain Negative
Culture Negative
Pathogens and Empiric Abx for Bacterial Meningitis in Neonates
Group B strep, E. coli, Listeria
Tx: Ampicillin and Cefotaxime
Pathogens and Empiric Abx for Bacterial Meningitis in 1-3 mo
Strep Pneumo, n. meningitidis, h. influ
Tx: ampicillin, ceftriaxone, cefotaxime, and dexamethasone
Pathogens and Empiric Abx for Bacterial Meningitis in ages 3 mo to 50y
strep penumo, n. mening, h. influ
Tx: ceftriaxone or cefotaxime, vanco, and dexamethasone
Pathogens and Empiric Abx for Bacterial Meningitis in ages >50 or alcoholic
S. pneumo, Listeria
Tx: Ampicillin, ceftriaxone or cefotaxime and dexamethasone
What is kernigs sign?
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
What is brudzinski sign?
spontaneous flexion of the hips during attempted passive flexion at the neck
Gold standard for dx of meningitis
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
Steroids in meningitis
Corticosteriods may be considered BEFORE initiation of antibiotic therapy in patients older than 1yr of age
Prophylactic ABx for household contacts
(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
Generalized seizures
originate from nearly simultaneous activation of both cortical hemispheres
(loss of consciousness and rhythmic tonic clonic)
Focal seizures
initiate from a specific point w/in one cerebral cortex and manifest symp relative to to anatomic portion of brain affected
Simple partial
consciousness is maintained
Complex partial
loss of consciousness, indicates spreading or generalizing of aberrant neuronal activity to both cortical hemispheres
SE
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
1st line agents for tx of active seizure
benzos (midazolam, lorazepam, diazepam)
short acting barbs (phenobarb, thiopental)
2nd line agents for tx of active seizure
phenytoin/ fosphenytoin
magnesium (if thought to be from eclampsia)
valproate
Drugs for refractory SE
Phenobarb infesion
isoflurane anesthesia
Tx of migraines
Phenothiazines Ex: prochlorperazine (antiemetic and analgesic)
- Serotin agonists Ex: sumatriptan (antiemetic and analagesic)
- **avoid both of these if HTN, CAD, focal neuro findings
RF for SAH
HTN, smoking, cocaine, first degree relative w/ dz, prior SAH
**SAH has been associated w/ PCKD, connective tissue dz, coarctation of the aorta
Patho of SAH
- 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
Tests for SAH
- 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*
Tx of SAH
Operative resection or embolization
- control HTN (nitroprusside, labetolol)
- offer analgesics
- often give phenytoin prophylactically for seizures
Manifestations of temporal arteritis
- fever, malaise, weight loss, visual defects
* **ESR is usually elevated
Tx of temporal arteritis
steroids to reduce inflam
can lead to blindness if not recognized and tx promptly
Peripheral vertigo vs Central vertigo
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
Cause of BPV and tx
free floating otoliths in semicircular canals
-elderly
Tx: antivertigo rx and epley maneuver
Cause of labrythitis and tx
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
Cause of meniere’s dz and tx
-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
