acute neuro pt 1

Question 1

acronym for remembering cranial nerves sensory vs motor

Answer 1

some say marry money but my brother says big brains matter more

Question 2

normal ICP

Answer 2

5-15 mm Hg

> 20 emergency

Question 3

CPP =

Answer 3

MAP-ICP

60-80

Question 4

s/s of IICP

Answer 4

cushing’s triad - bradycardia, resp depression, hypertension

decreased LOC, HA, pappiledema, pupil changes/coma - herniation, hypo/hyperventilation

Question 5

strategies to decrease ICP

Answer 5

ventriculostomy
elevate HOB
mannitol/hypertonic saline
glucocorticoids
sedation
hyperventilation (CO2 30-35)
pressers to ensure CP >60

Question 6

gold standard for ICP monitoring

Answer 6

ventriculostomy

Question 7

type of hydrocephalus most common in adults

Answer 7

normal pressure hydrocephalus

d/t trauma, aneurysm, meningitis, Paget disease

Question 8

3 cardinal features of hydrocephalus

Answer 8

gait difficulty (not responsive to levodopa)
cognitive disturbance
urinary incontinence

Question 9

hydrocephalus diagnostics & mgmt

Answer 9

B12, thiamine, electrolytes
MRI - ventriculomegaly in absence of sulcal enlargement
CSF removal

mgmt via shunting (VP or VA)

Question 10

first line for seizures

Answer 10

loraz 2mg (up to 10)
diazepam 5-10 mg q 5-15 min

Question 11

lacunar infarct

Answer 11

small (<5 mm), non cortical ischemic stroke

associated w poorly controlled DM/HTN

Question 12

cerebral infarct

Answer 12

thrombotic stroke - atherosclerosis causes embolus

may develop over hours, pt likely has history of TIAs

embolic stroke - particles of debris (not atherosclerosis) block arterial access to brain

Question 13

CVA diagostics/mgmt

Answer 13

ABCs / glucose
non contrast head CT stat
H&P - last known normal?
NIHHS
reverse coagulopathy (Coumadin)

permissive HTN - hold home antiHTN, lytics <185/110, no lytics <220/110

Question 14

contraindications to thrombolytics

Answer 14

> 4.5 hours
unknown LNK
recent bleeding
MI
surgery
thrombocytopenia
SBP>185

Question 15

CVA interventions

Answer 15

thrombolysis if candidate
endovascular intervention within 6 h
ASA 325 ASAP or 3 hr post thrombolysis

ASA & plavix 21 days, then just aspirin

Question 16

ICH treatment

Answer 16

d/c anticoagulation/antiplatelets, reverse if possible

fever mgmt
manage glucose
isotonic IVF, osmotic diuretics,

ICP drains

BP - treat <160/90 labetalol/nicardipine

Question 17

SAH presentation, diagnostics

Answer 17

“worst HA of my life” progress to obtundation

HCT with angiography to ID source
LP with xanthrochromic fluid

Question 18

SAH treatment

Answer 18

phenytoin to prevent seizures
tx with surgical clipping

BP mgmt - DBP <100 nimodipine

Question 19

AVM

Answer 19

congenital vascular malformations that result from localized poorly developed part of the primitive vascular plexus and abnormal arteriovenous communications that are without intervening capillaries

sudden onset SAH and ICH

recurrent seizures, HA, misc complaints

CT for symptoms, then MRI arteriogram

treatment - neurosurgery excision of AVM, embolization