Acute Neurological Issues Flashcards

1
Q

Treatment & Surgical tx for TIA

A

Medical-Statin, AntiHtn tx, Antiplatelet, AC

Surgical-carotid endarterectomy-in cases of TIA caused by cervical internal carotid artery stenosis

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2
Q

Imaging

A

-Head CT first: Not sensitive acute phase 0-6h
Screens for hemorrhagic stroke
Screens for tumors to r/o imitators of stroke
Allows for TPA to be started (bleed ruled out)

MRI: Volume of blood in head-guide management

CTA-vessel occlusion

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3
Q

Hemorrhagic Stroke

A

-HTN; generally BG or cerebellar
-Amyloid; generally lobar
-Aneurysmal
-Arteriovenous Malformation; AVM
-Dural sinus thrombosis
-SBP control, Identify cause; treat if possible.
-External ventricle, clot removal, hemi-craniectomy

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4
Q

Differentiating Stroke-diagnosis

A

-Hemorrhagic: Hyperdense lesion in a non-contrast head CT
-TIA: Normal MRI head
-PRES: hypertension that can lead to confusion, visual changes, and seizures
MRI demonstrating cerebral edema in the posterior hemispheres

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5
Q

Posterior Reversible Encephalopathy Syndrome

A

-HA, Confusion, seizures, visual loss
-Risk; severe pre-eclampsia, eclampsia, malignant hypertension.
-MRI) of the brain, areas of edema (swelling) are seen. The symptoms tend to resolve after a period of time, although visual changes sometimes remain.

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6
Q

Contraindications to TPA

A

-hx of stroke/head trauma in the past 3 months
-hx of intracranial hemorrhage
major surgery in the past 14 days
-GI or urinary tract bleeding in the past 21 days
-MI in the previous 3 months
-arterial puncture at a non-compressible site in past 7 days
resolving stroke symptoms
-very minor and isolated neurological symptoms
seizure at the onset of stroke
-persistent hypertension SBP > 185 mmHg or DBP > 110 mmHg
-use of direct thrombin inhibitors, use of factor Xa inhibitors

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7
Q

Hydrocephalus

A

Abnormal accumulation of CSF within the ventricular system either from inability to resorb, or obstruction of flow
-Non-communicating
-Communicating
-NPH

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8
Q

Hydrocephalus s/s

A

–HA (esp postural), nausea, emesis, gait disorder, urinary difficulty, difficulty with memory, cognition, apathy.

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9
Q

Hydrocephalus management

A

-Lumbar puncture w/opening pressure
-High volume tap with video (Shows what CSF diversion will accomplish.)
-CSF diversion (VP shunt, VA shunt, VPI shunt)

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10
Q

Acute hydrocephalus

A

-Quick build up of CSF in ventricles:

-Pinching off of aqueducts, shunt failure, herniation.

-Coma, obtunded and death.
100% mortality in 24-48 hours if untreated.

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11
Q

Diffuse axonal injury

A

-Most common type of TBI, found in mild to severe injury. Most destructive injury.
-Result of accel/decel with rotational component
-Damage; shearing of axons and destruction of functional (myelinated) tracts.
-Common in MVC, shaken baby.
—MRI Flair sequence can demonstrate findings suggestive of DAI; dx only by autopsy
—-TX; supportive

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12
Q

Closed head injury are at risk for what?

A

-Swelling

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13
Q

Acute Subdural Hematoma

A

-common in the elderly and alcoholics due to cerebral atrophy.
–There is more strain on the bridging veins, which tear easily with minor trauma, and cause a venous bleed.
–SUB-dural = under the dura mater, andove the arachnoid mater.
Appearance:Crescent-shaped

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14
Q

Acute SDH Conservative & operative management

A

-monitored carefully if no significant mass effect and there is little or no cerebral edema.
-Acceptable in elderly patients: brain atrophy.
-Reimage at 6 h and again 24 h
-hematoma>1 cm in thickness
-hematoma causing>5 mm of midline shift, regardless of initial examination
-or a unilateral fixed and dilated pupil.
-Generally, mortality is lower if surgery is performed within 4 h of injury

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15
Q

Epidural hematomas

A

-Injury to the middle meningeal artery (MMA)
-Associated with skull fractures that lead to bone bleeding or injury to the middle meningeal artery (MMA)
-Risk of herniation
-Lucid moment
-&raquo_space;30 cm need evacuation
- surgical emergency
-Conservative management: Less than 30cm3, <5mm shift, >8 GCS
-Low threshold to reimage—go to OR

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16
Q

Subarachnoid Hemorrhage

A

-Trauma: AVMs, Berry aneurysms
-Symptoms-sudden onset of extreme severe pain “thunderclap HA” “Worst HA of life” -symptoms can resemble: blood in the subarachnoid space can cause meningeal irritation

17
Q

Appearance on imaging SAH

A
  • High density blood in the sulci, basal cisterns and fissures:
  • suprasellar cistern (large pentagon/star shape),
  • quadrigeminal cistern (smaller W/smile shape below suprasellar)
    -Blood may also extend into the ventricles.
18
Q

Workup and management for SAH

A

-HCT or LP
-CTA or 4 vessel angio
-Tranexamic acid , liberal SBP management, CSF diversion as necessary,
-Nimodipine, TCDs, Tx of vasospasm as necessary (plasty or thecal CCB). Secure; open or endovascular surgery.