EM 6 - Neuro pt2

Question 1

Intracerebral hemorrhage has a HIGHER risk of ___ than SAH.

Answer 1

seizure

Question 2

Why does ICH have a higher risk of seizures?

Answer 2

b/c risk of high ICP

Question 3

Treatment of ICH (2 meds)

Answer 3

Labetalol, Nicardipine (CNS protective CCB)

Question 4

What’s a CNS-protective CCB used in ICH?

Answer 4

Nicardipine

Question 5

2 MC presentations of a lucanar stroke

Answer 5

1. Pure motor stroke/hemiparesis - face, arm, leg affected equally on both sides
2. Ataxic hemiparesis - weakness and clumsiness on one side of body, usually affects legs > arms

Question 6

True or false: Lacunar strokes require anticoagulation tx.

Answer 6

False.

Tx: avoid tobacco use, aspirin 325 mg PO QD is of uncertain benefit.

Question 7

Dx & Tx:

Headache, facial pain, neck swelling, pulsatile tinnitus, horner syndrome sx may be found in:

Answer 7

Arterial Dissection

Tx: Heparin then Warfarin

Question 8

Arterial dissection frequently happens in __ people

Answer 8

young people

Question 9

define Amaurosis fugax.

What is it seen with?

Answer 9

Embolus to retinal artery that causes
Transient monocular blindness
Seen in TIA

Question 10

Medication tx after TIA (3)

Answer 10

Aspirin 75-1300mg/d
Clopidogrel 75mg/d
Warfarin INR 2.0-3.0 (need heparin first though, right?)

Question 11

In TIA, what med would you give if the patient is intolerant of aspirin?

Answer 11

Ticlopidine 250 mg BIDq

Question 12

Most common pathology of Spinal Cord Compression

Answer 12

Metastatic cancers

Question 13

Tx of spinal cord compression:

What if there’s an infection?

Answer 13

Dexamethasons 10-40mg IV (steroids)
Infection: antibiotics too

and emergency neurosurgical consultation

Question 14

What’s happening in Transverse myelitis?

Answer 14

Acute inflammatory process affecting a focal area of the spinal cord -may lead to irreversible paraplegia
Pathology: edema, necrosis, demyelination, white>gray matter changes

Question 15

2 initial manifestations of Transverse myelitis

Answer 15

MS or SLE

Question 16

weakness, back or limb pain, urinary retention & sensory deficit.

Dx, next appropriate step? (2)

Answer 16

Transverse myelitis

Imaging studies of spine – rule out compression
LP (to culture organism [usually viral])

Question 17

Lumbar puncture for Transverse myelitis might show what causing it? (8)

Answer 17

VZV, HSV-2, CMV, EBV, west nile, TB, bacterial, fungal

Question 18

Transverse myelitis

Prognosis

Answer 18

*1/3 recover, 1/3 retain a moderate degree of residual disability, 1/3 remain severely disabled

Question 19

Patient presents w/ complaint of Sudden onset of isolated, unilateral, peripheral facial paralysis

Dx. What other 2 sx might he have too?

Answer 19

Bell’s Palsy (CN 7 paralysis)

2 other sx: hyperacusis, impaired taste

Question 20

Patient presents w/ complaint of Sudden onset of isolated, unilateral, peripheral facial paralysis, but you notice his forehead is NOT affected.

Answer 20

Cortical stroke

Question 21

Bell’s palsy is Attributed to an inflammatory reaction of the facial nerve near the ___ or in the ___

Answer 21

stylomastoid foramen

bony facial canal

Question 22

Mgmt of Bell’s Palsy (3)

Answer 22

Prednisone
Eye protection with lubricating drops
Acyclovir

and Refer to neurologist, otolaryngologist, primary care

Question 23

Patient complains of Weakness with forearm extension & unable to extend their hand
Dx, what muscle is preserved?

Answer 23

Radial n. neuropathy

triceps are preserved

Question 24

Ulnar n. compression has weakness of what muscles?

Answer 24

interossei muscles

Question 25

Main sx of Common Peroneal Nerve Palsy

Answer 25

Foot drop