Clinical Perspective of Neurological Emergencies Flashcards
What are the four types of cerebral herniation syndromes?
Uncal, central, tonsillar, subfalcine herniations
What compensatory mechanisms may the body take in response to increased intracranial pressure?
Movement of CSF out of the head, movement of venous blood out of the head, collapse of the ventricular system
This type of brain herniation compresses the brainstem and may lead to loss of respiratory functioning.
Tonsillar herniation
This type of herniation is often associated with a blown pupil.
Lateral tentorial herniation
The Cushing Reflex may be indicative of a brain herniation. What symptoms would a patient present with?
Increased blood pressure, irregular breathing, bradycardia
What major symptoms are indicative of cauda equina syndrome?
Saddle anesthesia, bowel/bladder incontinence, sexual dysfunction, low back pain
Where does the cauda equina begin?
L2 and runs to the coccyx
What is the most common cause of cauda equina syndrome?
Central disc herniation or prolapse
What is the gold standard for diagnosis of cauda equine syndrome?
MRI, followed by CT myelogram
What dermatomal region surrounds the anus?
S2
Most lumbar discs herniate in what direction?
Posterolateral
Disc herniation is most likely to occur at what levels?
L4/5 or L5/S1
Cauda equina syndrome may be treated surgically by a microdiscectomy or laminectomy. How do these procedures differ?
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
A seizure must last how long for a diagnosis of status epilepticus?
Longer than 5 minutes
What is the most common toxin/drug implicated in status epilepticus?
Alcohol
Early treatment is directly related to better patient outcomes in patients with status epilepticus. What drugs are considered first-line treatment?
Benzodiazepines (Lorazepam is considered most effective)
What are second-line treatments for status epilepticus?
Levetiracetam, Fosphenytoin, Valproate
Refractory status epilepticus may be treated with what drugs?
Propofol, Midazolam, Ketamine, Lacosamide, Phenobarbital
What considerations must be taken when using propofol to treat refractory epilepticus?
Propofol induces unconsciousness so an EEG must be utilized to determine when the seizure has stopped
What considerations must be taken when using Phenytoin to treat status epilepticus?
Phenytoin is cardiotoxic and must be administered slowly over time
What are the classical symptoms presented with spinal epidural abscesses?
Spinal pain, fever, neurologic deficits
What is the etiology of spinal epidural abscesses?
Collection of inflammatory material between the dura and vertebral column, extending several spinal segments
True/False. Most neurologic deficits due to spinal epidural abscesses are irreversible.
True.
What is the most common bacterial agent implicated in spinal epidural abscesses?
Staph aureous
