Clinical Perspective of Neurological Emergencies Flashcards

1
Q

What are the four types of cerebral herniation syndromes?

A

Uncal, central, tonsillar, subfalcine herniations

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2
Q

What compensatory mechanisms may the body take in response to increased intracranial pressure?

A

Movement of CSF out of the head, movement of venous blood out of the head, collapse of the ventricular system

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3
Q

This type of brain herniation compresses the brainstem and may lead to loss of respiratory functioning.

A

Tonsillar herniation

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4
Q

This type of herniation is often associated with a blown pupil.

A

Lateral tentorial herniation

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5
Q

The Cushing Reflex may be indicative of a brain herniation. What symptoms would a patient present with?

A

Increased blood pressure, irregular breathing, bradycardia

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6
Q

What major symptoms are indicative of cauda equina syndrome?

A

Saddle anesthesia, bowel/bladder incontinence, sexual dysfunction, low back pain

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7
Q

Where does the cauda equina begin?

A

L2 and runs to the coccyx

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8
Q

What is the most common cause of cauda equina syndrome?

A

Central disc herniation or prolapse

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9
Q

What is the gold standard for diagnosis of cauda equine syndrome?

A

MRI, followed by CT myelogram

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10
Q

What dermatomal region surrounds the anus?

A

S2

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11
Q

Most lumbar discs herniate in what direction?

A

Posterolateral

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12
Q

Disc herniation is most likely to occur at what levels?

A

L4/5 or L5/S1

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13
Q

Cauda equina syndrome may be treated surgically by a microdiscectomy or laminectomy. How do these procedures differ?

A

A microdiscectomy involves removal of a portion of the disc that is protruding into the spinal canal. A laminectomy involves complete removal of the bony segments, including the facets, lamina, and spinous process. A laminectomy has increased risk of spinal instability

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14
Q

A seizure must last how long for a diagnosis of status epilepticus?

A

Longer than 5 minutes

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15
Q

What is the most common toxin/drug implicated in status epilepticus?

A

Alcohol

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16
Q

Early treatment is directly related to better patient outcomes in patients with status epilepticus. What drugs are considered first-line treatment?

A

Benzodiazepines (Lorazepam is considered most effective)

17
Q

What are second-line treatments for status epilepticus?

A

Levetiracetam, Fosphenytoin, Valproate

18
Q

Refractory status epilepticus may be treated with what drugs?

A

Propofol, Midazolam, Ketamine, Lacosamide, Phenobarbital

19
Q

What considerations must be taken when using propofol to treat refractory epilepticus?

A

Propofol induces unconsciousness so an EEG must be utilized to determine when the seizure has stopped

20
Q

What considerations must be taken when using Phenytoin to treat status epilepticus?

A

Phenytoin is cardiotoxic and must be administered slowly over time

21
Q

What are the classical symptoms presented with spinal epidural abscesses?

A

Spinal pain, fever, neurologic deficits

22
Q

What is the etiology of spinal epidural abscesses?

A

Collection of inflammatory material between the dura and vertebral column, extending several spinal segments

23
Q

True/False. Most neurologic deficits due to spinal epidural abscesses are irreversible.

A

True.

24
Q

What is the most common bacterial agent implicated in spinal epidural abscesses?

A

Staph aureous