EM 6 - Neuro pt1 Flashcards
What med treats cerebral edema (found in stroke)
Mannitol
Most common pathology of ischemic stroke:
atherosclerosis of carotid & vertebrobasilar arteries cardiac abnormalities (a fib)
True or false: you can distinguish ischemic from hemorrhagic stroke based on the patient’s history
false
What is the general assessment of Stroke?
ABCDE
d = deformities (impaired gag reflex, etc)
e = exposure (search for trauma)
Decerebrate posture indicates: Arms: \_\_ & \_\_ at elbow Wrists: \_\_ fingers: \_\_ Legs: \_\_ Feet: \_\_
Damage to upper brain stem Arms: adducted & extended at elbow Wrists: pronated Fingers: flexed Legs: stiffly extended Feet: plantar-flexed
What is this indicative of/called?
Arms: adducted & extended Wrists: pronated Fingers: flexed Legs: stiffly extended Feet: plantar-flexed
Decerebrate posture
Damage to upper brain stem
Decorticate posture indicates: Arms: \_\_ & \_\_ at elbow Wrists: \_\_ fingers: \_\_ Legs: \_\_ & \_\_ Feet: \_\_
Damage to one or both corticospinal tracts
Arms: adducted & flexed at elbow
Wrists: on chest
fingers: on chest
Legs: stiffly extended & internally rotated
Feet: plantar-flexed
What is this indicative of/called?
Arms: adducted & flexed at elbow Wrists: on chest fingers: on chest Legs: stiffly extended & internally rotated Feet: plantar-flexed
Decorticate posture
Damage to one or both corticospinal tracts
Name 2 maneuvers to check if the brainstem is intact following a stroke.
The patient must also be __
- Oculocephalic reflex
- Oculovestibular reflex
the patient must also be comatose.
Describe Oculocephalic reflex
Which CN are tested?
it’s a maneuver to check if brainstem was involved or not w/ stroke.
Open up their eyes, turn their head side to side.
Normally the eyes will move the opposite direction the head is being turned.
CN: 3,4,6 (olfact, trochlear, abducens)
Describe Oculovestibular reflex
Which CN are tested?
What if this was done in a conscious patient?
Instill cold water into an ear
Normally they look in that direction
CN 3,4,6,8 (olfact, trochlear, abducens, vestibulococh)
a conscious patient would have nystagmus to the opposite side.
NIH stroke scale grading system (6)
0: Normal 1-4: Minor 5-15: Moderate 15-20: Moderately severe >20: Severe >42: Devastating
t-pa dosing
0.9 mg/kg.
10% as bolus, 90% continuous infusion over 1 hour.
t-pa must be given within how long?
Unless…
3 hours
Unless stroke is due to occlusion in MIDDLE CEREBRAL artery, then it is 6 hours. (AHA endorsement)
2 types of hemorrhagic stroke (Intracranial hemorrhages)
SAH, Intracerebral hemorrhage
MC cause of SAH (according to piccirillo)
berry aneurysm
Most common finding in SAH
nuchal rigidity
several sudden headaches for weeks, as well as nuchal rigidity and pain. What must you check for?
Sentinel bleed (not classic presentation of SAH)
these could be leaks from an aneurysm that will evolve into a full SAH, or even if they don’t it is still deadly.
Glasgow coma scale:
Eye opening section:
How many points possible?
List the points!
4 points possible
- No response
- Opens to pain that is not applied to face
- Opens to verbal command
- Spontaneous, open with blinking
Glasgow coma scale:
Verbal response section:
How many points possible?
List the points!
5 points possible
- No response
- Incomprehensible speech
- Inappropriate responses, words discernible
- Disoriented, confused conversation. Able to answer questions.
- Oriented conversation
Glasgow coma scale:
Motor response section:
How many points possible?
List the points!
6 points possible
- No resopnse
- Extensor (rigid) response, decerebrate posture
- Abnormal (spastic) flexion, decorticate posture
- Withdraws from pain
- Purposeful movements to painful stimulus
- Obeys commands for movement.
Non-enhanced CT will dx Subarachnoid blood by
visualizing the high-density of acute blood
outlining: (2)
cerebral sulci and subarachnoid cisterns
Even though you’d do a CT, then LP for SAH…what is the gold standard to dx?
CT Angiography
Why is low pCO2 an emergency in SAH?
b/c hyperventilation can cause vasospasm
Formula to calculate MAP*
(2 x diastolic + systolic) / 3
What med is given to prevent the spasms that increase risk of another occlusion?
Nimodipine (CCB)
