acute neuro pt 2

Question 1

bacterial meningitis most common pathogens

Answer 1

step pneumoniae
nisseria meningitidis

Question 2

bacterial meningitis CM

Answer 2

triad - fever, nuchal rigidity, mental status change/confusion

also kernig and brudzinski signs

neuro sx

n/v

skin petechiae/purpura

arthritis

Question 3

kernig’s sign

Answer 3

inability to fully extend knee when hip is flexed 90 degrees.

positive if pain or resistance

Question 4

brudzinskis sign

Answer 4

spontaneous flexion of hips during attempted passive flexion of neck

Question 5

meningitis diagnosis

Answer 5

LP
- elevated opening pressure (>200)
- WBC 1000-5000 (high)
-neutrophils >80%
-protein 100-500 (high)
-glucose <45 (low)

Question 6

meningitis treatment

Answer 6

empiric abx - vanc + 3rd gen cephalosporin

add ampicillin if concern for Listeria meningitidis

viral coverage? acyclovir

supportive tx - fluids, ICU support, steroids, ICP monitoring/support

Question 7

epidural hematoma

Answer 7

arterial hematoma development between skull and dura

“lucid interval” w few symptoms, then progressive neuro decline

dilated pupil on side of hematoma

CT is diagnostic

neurosurg cure

“lemon”

Question 8

SDH

Answer 8

venous hematoma under surface of brain

often servere brain injury and comatose

CTH diagnostic

poor prognosis >60, neurosurg cure

“banana”

Question 9

cerebral contusion/intracerebral hemorrhage

Answer 9

bruising of the brain with accumulation of extracellular fluid and bleeding

acceleration/deceleration mechanism

may have midline shift

neurosurgery may be necessary

Question 10

diffuse axonal injury

Answer 10

caused by rapid acceleration/deceleration or rotational force to the brain

Question 11

brain death clinical criteria

Answer 11

• clinical or neuroimaging evidence of acute CNS catastrophe
• exclusion of complicating medical condition
• no drug intoxication or poisoning
• core temp >36
• SBP>100

Question 12

brain death exam findings

Answer 12

all of the following:
- coma
- absent brain-originating motor response
- absent pupillary light reflex
- absent corneal reflex
- absent oculovestibular reflexes “dolls eyes”
- absent jaw jerk
- absent gag, sucking, or roting
- absent cough with suctioning
- apnea during apnea test

Question 13

apnea test

Answer 13

ABG first, then disconnect ventilator

positive test - pCO2>60 or increase 20 mm Hg above baseline w pH <7.28

Question 14

coma

Answer 14

unarousable and unable to respond to external events or inner needs, although reflex movements and posturing may be present

Question 15

stupor

Answer 15

unresponsive except when subjected to repeated vigorous stimuli

Question 16

vegetative state

Answer 16

an awake but nonreponsive state in a patient who has emerged from a coma

Question 17

neurogenic shock VS

Answer 17

hypotension & bradycardia

Question 18

wernicke’s encephalopathy

Answer 18

thiamine deficiency

triad of confusion, ataxia, ophthalmoplegia

tx with IV thiamine