Neuro Flashcards
Muscle group test for C-5
Biceps
Muscle group test for C-7
Triceps
*Anterior Cord Syndrome
- Loss of pain/temperature and motor but not light touch
- Due to contusion of the anterior cord or occlusion of the anterior spinal artery
- Associated with burst fractures of the spinal column with fragment retropulsion by the axial compression
Initial treatment for spinal cord compression (with defects) due to malignancy/neoplasm:
(If confirmed or suspected, ie sx’s in pt w/ known malignancy)
Steroids:
Dexamethasone 10 mg IV loading dose followed by 4 mg oral/IV every 6 hours as maintenance
*Initial treatment for epidural abscess:
(Sx’s with known infection or suspected ie IVDU)
Draw blood cultures and ESR
- An ESR of less than 20 has excellent sensitivity for excluding a diagnosis
of spinal epidural abscess
Start empirical antibiotics with broad-spectrum coverage
- Abscesses are often multi-microbial
- MRSA coverage – start vancomycin
- Gram-negative coverage – start third or fourth generation cephalosporin
- Anaerobic coverage with metronidazole should be considered
Neuro exam in a headache pt:
- Mental status
- Cranial nerves
- Meningeal signs (nuchal rigidity, Kernig and Brudzinski’s)
- Motor strength
- Reflexes?
- Gait and coordination
When is it safe to do an LP without imaging?
- Normal sensorium
- No focal neurologic deficit
- No hx of immunosuppression
*Internal carotid dissection presents with:
Anterior circulation symptoms
*Vertebral artery dissection presents with:
Posterior circulation symptoms
Tool for ruling out subarachnoid hemorrhage:
Ottawa Subarachnoid Hemorrhage Rule
Reversal agent for heparin
Protamine
Dosing of protamine
1 mg per 100 units of heparin (over the last 3 hours). Max dose 50 mg.
*Comatose pt with normal results on CT, consider thrombosis of:
Basilar artery - only finding may be by a hyperdense basilar artery.
Vertigo in 2 minute (or less) episodes, initiated by head movement.
Benign paroxysmal positional vertigo
Vestibular neuritis:
Prolonged, continuous bout of vertigo that is intense for several days and then resolves over days, weeks, or months. No ear pain, hearing loss, or tinnitus. Likely caused by a virus.
Labyrinthitis:
A complication of acute otitis media, days of ongoing continuous vertigo that is associated with ear pain, hearing loss, or tinnitus as well as vertigo.
Ramsay Hunt Syndrome (herpes zoster oticus)
Sx, findings, tx
Deafness, vertigo, and facial nerve palsy. Confirmed by grouped vesicles on an erythematous base inside the external ear canal. Treat with antivirals within 72 hours of vesicles.
Wallenberg’s syndrome (lateral medullary infarction)
Ipsilateral facial numbness, loss of corneal reflex, Horner’s syndrome, and paralysis or paresis of the soft palate, pharynx, and larynx (dysphagia & dysphonia). Contralateral loss of pain and temp in trunk and limbs. Emergent MRI
CN II (name and function/test)
Optic Nerve
- afferent function of light and visual perception
- Test w/ swinging flashlight test
CN III (name and function/test)
Oculomotor nerve
- eyelid opening, eye movement (except those of IV & VI), consensual light reflex
- Test w/ eye movement, light reflex
CN III palsy findings:
- ptosis
- mydriasis (dilated pupil)
- eye turned down and out
CN IV (name and function/test):
Trochlear nerve
- motor function of superior oblique muscle
- On H eye movement unable to lookdown when eye adducted
CN V (name and function/test)
Trigeminal nerve
- motor: muscles of mastication (test for masseter bulk)
- sense: facial sensation (V1-3)
- corneal reflex
CN VI (name and function/test)
Abducens nerve
- abduction of the eye (lateral movement)
- H eye movement
CN VII (name and function/test)
Facial Nerve
- Motor: facial expression
- Sense: taste
Test w/ facial movements
CN VIII (name and function/test)
Vestibulocochlear nerve
- hearing and vestibular movement/position sensation
Test w/ hearing
CN IX (name and function/test)
Glossopharyngeal nerve
- taste and muscles of swallowing
- gag reflex
CN X (name and function/test)
Vagus nerve
- Motor: pharynx and larynx muscles
- Taste
- Visceral sensation
Test by assessing for uvula deviation (deviates to normal side)
CN XI (name and function/test)
Accessory nerve
- Motor: sternocleidomastoid and trapezius muscles
Test w/ shoulder shrug, neck rotation
CN XII (name and function/test)
Hypoglossal nerve
- Motor: tongue muscles
Test w/ tongue protrusion (deviates toward affected side)
Sedations meds s/p RSI in status epilepticus
Ketamine, versed or propofol
Causes to consider in persistent seizures:
Eclampsia
Isoniazid overdose
Hypoglycemia
Hyponatremia
Hypocalcemia
Other causes of provoked seizures
Theophylline toxicity
Most common complications from status epilepticcus:
Hyperthermia
Rhabdomyolysis
Pulmonary edema
Resulting injuries, eg, tongue laceration, shoulder dislocation, etc.
Second line drugs in status epilepticcus:
Phenytoin/fosphenytoin: 20 mg/kg (max 1.5 g)
Valproic acid (depakote): 40 mg/kg (max 3g)
Levetiracetam (keppra) : 60 mg/kg (max 4.5g)
Presentation of cartoid artery dissection:
Sudden onset, severe headache usually unilateral with neck pain and pulsatile tinnitus. Symptoms of retinal or cerebral ischemia. May have partial Horner Syndrome (ptosis & miosis).
