Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CCFP EM > Neuro > Flashcards

Neuro Flashcards

1
Q

red flags for secondary HA?

A

S: systemic s/s eg fever, immunocomp, known malignancy, autoimmune dz, coagulopathy,
N: neuro signs, new HA
O: sudden onset
O: age over 50
P: positional, papilledema, pulsatile tinnitus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

define thunderclap HA

A

pain that reaches 7/10 in less than 1 minute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

thunderclap HA ddx

A

bleeds: ICH, sentinel aneurysmal bleed
vascular: carotid dissection, RCVS, cerebral venous thrombosis, PRES
other: acute angle closure glaucoma, acute hydrocephalus,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

criteria for LP without CT

A

normal sensorium, no focal neuro deficits, not immunosuppressed. can get LP before CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

RF for cerebral venous thrombosis

A

basically anything promoting hypercoag:
peripartum, OCP, recent surgery, protein c or s deficiency, factor 5 leiden etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

cerebral venous thrombosis presentation

A

variable: from progressive over weeks to thunderclap
can have benign presentation or also pt can have s/s raised ICP, seizures, coma etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

CT for cerebral venous thrombosis

A

CT venogram and NCCTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

4 types of HA pt who get neuroimaging (NCCTH) in ED

A
  1. HA and abn neuro finding (inclu aLOC)
  2. new sudden onset severe HA aka thunderclap
  3. HIV + with new HA
  4. new HA and age > 50 with normal neuro exam
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is PRES

A

a hypertensive emergency, pts have HTN, encephalopathy and severe HA or visual changes, seiures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what dx needs to be ruled out before dx of RCVS?

A

SAH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

age at which GCA needs to be considered?

A

> 50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

criteria for cluster HA

A

5 attacks that are:
sevre, unilateral, last 15-180 mins, have circadian or circannual pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

POUND for migraines?

A

pulsatile, onset 4-72 hours, unilateral, n/v, disabling

also photo/phonobia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

migraine cocktail

A

toradol, NS and maxeran.
can consider dex, benadryl,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

occipital neuraligia? symptoms and cause

A

shooting/electric pain at posterior of head in distribution of occipital nerve, caused by chrnoic neck tension

can try occipitla nerve block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

3 findings of IIH aka pseudotumour cerebri

A

HA, papilledema, normal neuro exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

most effective tx for post LP HA

A

epidural blood patch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

carotid vs vertebral artery dissection symtptoms

A

both have HA, neck pain etc,
carotid will have anterior circ stroke s/s
vertebral will posterior stroke s/s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

multiple ppl from same area presenting with HA, consider?

A

CO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

ct findings of pituitary apoplexy?

A

cellar mass (it is a hemorrhage of pituiatary adenoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Post LP headache presentation and tx

A

Occurs within 2 days of LP, worse sitting/standing,
Give simple analgesics, give caffeine, or blood patch if refractory
Happens about 10% of LPs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

2 types of hemorrhagic stroke

A

spontaneous SAH and intrcerebral hemm (aka intraparenchymal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

causes of spont SAH

A

75% aneurysm rupture, idiopathic, AVM, sympathomimetic drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

SAH risk factors

A

HTN, smoking, excessive etoh, PCKD, famhx of SAH, marfan’s Ehlers-Danlos,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

rule for SAH r/o

A

ottawa SAH rule: r/o’s SAH
under 40
no neck pain/stiffness
no LOC
non-exertional onset
not thunderclap
full neck ROM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

work up for SAH

A

if < 6 hrs get NCCTH only, unless extremely high rish for SAH (even if very high risk, liklihood is <1 %)

if > 6 hrs and negative NCCTH –> need an LP or a CTA, there may be a clear indication for either (ie meningitis w/u or known aneurysm or r/o vascular lesion etc)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

two CSF tests in SAH

A

xanthochromia and RBC count ( no definitive cutoff for this)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what is xanthochromia, what cutoff used in SAH LP

A

= yellowing of CSF d/y bilirubin

it is either + or negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

mgmt of SAH

A

try and prevent re-bleeding while balancing CPP.

aim for SBP between (ie may need to decrease)120-160 (but MAP > 80), using labetalol or nicardipine

reverse coagulopathy

pain and emsis control (can do before specific BP mgmt)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

mgmt of raised ICP (A CLINICAL DIAGNOSIS)

A

-rasie HOB to 30 deg
-treat pain and emesis
-3 mL/kg of 3% saline (about 250 mL) or mannitol
-can hyperventilate for 1-2 hrs max, target pcos of 30-35 (last resort)
-neurosurg consult
-keep MAP > 80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what is more common spont SAH or spont intracerebral hemm

A

spont ICH is twice as common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

RF for intracranial hmm

A

chornic HTN, aneurysm, AVM, brain tumour, cocaine, anticoagulants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

blood pressure target for intracerebral hemm,

other big consierdation

A

SBP about 120-160, MAP> 80

reversal of anticoagulant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

acute reversal of warfarin vs DOAC

A

warfrain: 10 mg vitamin K IV AND PCC dose varies with INR

DOAC: PCC 2000 IU

PCC =octaplex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

3 main stroke types and %ages

A

ischemic 87%
non traumatic SAH 3%
intracerebral = 10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

3 types of ischemic strokes

A

embolic, thrmobotic, low-flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

onset of symptoms: stuttering vs immediate

A

suttering can be seen in thrombotic or low-flow

immediate is embolic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

list stroke mimics

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

dont find time of onset in stroke, find the ______

A

last known well time = time pt was last seen normal, can be extrapolated rom texts messages, freshly made coffee etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

anterior cerebral artery strokes

A

contralateral leg weakness/numbness
Lt sided: motor aphasia
rt sided: motor hemineglect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Large vessel stroke syndromes

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

4 classic symptoms of posterior circ stroke

A

Ataxia
Nystagmus
Ams
vertigo

or 5 D’s
dizziniess
dysarthria
dystaxia
dysphagia
drowsiness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what vessels are postior circ

A

basilar, post cerebral, vertebral, cerebellar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

MCA strokes

A

-hemiplegia (face and arms), sensory loss contralateral to lesion
-if left sided: aphasia, left gaze preference
if rt sided: left neglect, right gaze preference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

%age of left side dominant

A

all right handed ppl and 80% Lt handed ppl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

posterior cerebral artery stroke

A

contralateral hemianopsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

treatment of carotid and cerebral artery dissection

A

basically same as all other strokes, if within window can consider lytics, if not candidate give antiplatelets in consultation with neuro

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

target door to needle time:

A

<60 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

why do ppl get CT and CTA in ? stroke
what is only imaging study strictly required to give lytics

A

NNCTH: r/o bleed, abcess, tumour etc - often acute strokes are not seen on non-con in the first few hours
CTA: look for vessel occlusion/stenosis and ID EVT candidates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

BP mgmt in acute ischemic stroke

A

if no lytics let auto reg up to SBP 220

if lytics, need < 180/105 (including during tpa admin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

lytics inclusion criteria

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

lytics exclusion criteria

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

antiplatelets in acute ischemic stroke

A

if lytics given, no antiplatelets for first 24 hrs
if no lytics, give ASA in first 48 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

EVT criteria

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

TIA work up/mgmt

A

clinical diagnosis. same work up as stroke, ie exclude mimics, then et NCCTH and then CTA. if lesions ID’d d/w neuro, but likely dapt for 3 weeks with loading doses then ASA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

meds for lowering BP in acute atroke

A

labetalol 10-20 mg IV, then 2-8 mg/min
nicardipine
hydralazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

5 broad categories of delirium

A

primary CNS
systemic dz secondarily affecting CNS (legit almost anything)
exogenous toxins
drug withdrawl and pain
major trauma/surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

delirium hallucination: auditory or visual?

A

visual usually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

define delirium

A

fluctuating levels of attention and cognition

60
Q

delirium screen?

A

DTS (highly sensitive) if + do B-cam (highly specific)

61
Q

ddx of AMS/coma

A

DIMS- E where E is environment: CO, hypo/hyperthermia, hypercarbia, hypoxia

62
Q

uncal herniaiton syndrome

A

medial temporal lobe compresses brainstem –> dLOC, then CN 3 gets compresesd leading to blown ipsilateral pupil that s down and out

63
Q

when to consider non-convulsive status epilepticus?

A

when seizure activity has stopped, but pt is not awake in 30 mins

64
Q

acute gait disturbance and AUD?

A

Wernicke’s, tx with IV thiamine

65
Q

epilepsy definition

A

someone at risk for recurrent seizures

66
Q

define status epilepticus and refractory status

A

seizure for >5 mins or 2 seizures without regaining normal consciousness in between
-refractory = seizing despite 2 or more IV anti-epileptics

67
Q

general seizure classification (by morphology)

A
68
Q

how long do absence seizure generally last?

A

a few seconds

69
Q

simple vs complex focal seizure

A

simple = no alteration in consciousness
complex= consciousness is affected

70
Q

important historical questions in ?seizure

A

presence of aura, abrupt vs gradual onset, loss of bowel/bladder, presence of oral injury, focal vs general

71
Q

common seizure triggers

A

med changes (including new med, dose, brand name to generic), non-compliance, sleep deprivation, infection, electrolyte abn, increased strenuous activity, substance use/wd, head trauma/ICH, glucose, eclampsia hypo/hyperthermia

72
Q

sequalae of seizures

A

aspiration, oral trauma/laceration, posterior should dislo,

73
Q

todd’sparalysis

A

transient focal deficit after seizure that resolves within 48 hrs

74
Q

common seizure mimic

A

syncope, PNES, hyperventilation syndrome, hypoglycemia, movement d/o, migraine

75
Q

one test that can differentiate PNES from seizure

A

normal lactate shortly after seizure makes PES more likely… note usually clears within 30 mins

76
Q

only tests needed if known seizure d/o and presenting with one seizure

A

glucose, pertinent medication levels

77
Q

who gets CT head in seizure

A

first time seizure or change in seizure morphology or clinical concern for intracranial lesion (even if other cause ID’d)

78
Q

mgmt of uncomplicated (ie < 5 mins of seizure)

A

turn on side, be ready to suction airway/bag when seizure stops, get IV access, have meds ready in case still seizing at 5 mins

79
Q

does a first time seizure usually get anti-convulsants?

A

nope, not unless they are at known risk for more seizure (ie epileptic based on w/u)

80
Q

status epilepticus algo

A
81
Q

tx of eclamptic seizure

A

4 g magsul then 1g/hr infusion

82
Q

ddx based on AVS, t-EVS, s-EVS

A
83
Q

BPPV

A
84
Q

vestibular neuritis

A
85
Q

labyrinthitis

A
86
Q

Meniere’s

A
87
Q

Vesibular schwanoma

A
88
Q

perilymph fistula

A
89
Q

vestibular migraine

A
90
Q

cereberlla/brainstem stroke

A
91
Q

posterior circ TIA

A
92
Q

cerebellar hemorrhage

A
93
Q

what 2 criteria need to be present to do HINTS?

A

ongoing persistent vertigo AND spont or gaze evoked nystagmus

94
Q

if pt cannot stand on own from vertigo, what needs to be ruled out?

A

central cause of vertigo

95
Q

if s-EVS and DHT negative, what test is next? how do you do it?

A

suppine roll test, looks for Horizontal canal BPPV (second most common type).
pt lays on back, turn head to either side, + test if pure horizontal nystagmus

96
Q

how to do DHT? what nystagmus is +?

A

upbeat and rotational.
pt wits up, lay them flat quickly with head hanging and turned to 45deg

97
Q

how to do Epley?

A

start with DHT, then rotate head to other side, then turn onto lateral deubitus, then sit up.
hold each position for 30 seconds or for time the have vertigo plus another 30 seconds

98
Q

how to do HINTS plus?

A

Head impulse: test vestibulo-ocular reflex (should be impaired in perpherla vertigo).
-gently move head back and forth, then move quickly to midline, pt should be looking at drs nose. if there is catch up saccade, reflex is effed and indicates peripheral vert
nystagmus: test for spont and gaze evoked nystagmus. if biderctional= central
test of skew: cover-uncover test
hearing loss- ifnew hearing loss, think central

99
Q

how do you test for spont and gaze evoked nystagmus?

A

spont; pt looks straight ahead
gaze evoked, ask them to look side to side “staring through paper” as fixation can mask nystagmus

100
Q

criteria for DHT?

A

vertigo, < 2 mins, brought on by head movement
AND
no spont or gaze evoked nystagmus

101
Q

post epley plan

A

pt will still feel “off” for a few days.
if successful, d/c
if unsuccessful rpt once in ED
if second attempt not successful, pt to do at home bid until symptoms resolve and have them f/u with FP or physio

102
Q

3 types of nytagmus on DHT

A

vertical/rotational = post canal (most common)
horizontal –> horizontal canal –> do supine roll test
if downward on DHT they may have ant canal BPPV

103
Q

can AVS/central vertigo also worsen with head movement

A

YES

104
Q

vertigo + what is central

A

dizziniess
dysarthria
dystaxia
dysphagia
drowsiness

aka D’s

105
Q

typical nystagmus in vestibular neuritis

A

horizontal with rotational component, unidirectional… find this by testing for spont or gaze evoked nystagmus

106
Q

should you ever do DHT and HINTS+ in same pt?

A

FUCK NO

107
Q

what imaging should you get in ? cerebellar/brainstem stroke (aka post circ stroke)/

A

CT/CTA, obvs MRI is best but wont happen

108
Q

second most common cause of vertigo in ED? very often missed

A

vestibular migraine (tx like migraine)

109
Q

Diagnostic criteria for vestibular migraine

A
110
Q

how does GBS present?

A

bilateral, ascending paralysis/weakness and hyporeflexia
typically preceded by infection or vaccination

111
Q

mgmt of GBS

A

-assess resp status (use vital capacity)
- intubate prn, earlier the better
-IVIG and admission

112
Q

what is Bell’s palsy

A

cranial nerve 7 palsy, results in unilateral facial parlaysis (whole face) as “stroke spares” forehead

113
Q

2 things to r/o in Bells palsy

A

stroke and ear pathology (OM, mastoiditis, Ramsey Hunt)

114
Q

tx of Bell’s palsy

A

steroids and antivirals, thought to be benefit but also no difference in a/e

pred 60 mg od for 1 week with valtrex 1 g po tid for 1 week

115
Q

expected course of Bell’s palsy

A

most recover in 3/52, 15% will have permanent damage

116
Q

potential complication of bell’s palsy

A

corneal injury, can prophylaxes with artificial tears

117
Q

what is Ramsey Hunt

A

can cause bells palsy and is from HSV inner ear infection.. tx with steroids and antivirals

118
Q

if acute or chronic neuropathy (central or peripheral) AND erythema migrans, tick bite or arthritis, consider _____

A

Lyme disease

119
Q
A
120
Q

Hall mark of ALS

A

Upper and lower motor neuron pathologies

121
Q

Myasthenias pathophys

A

Autoimmune destruction of acetylcholine receptors at NMJ

122
Q

Symptoms/signs of MG

A

Fatigable weakness, ocular muscle weakness (diploia, ptosis),

123
Q

Ddx of MG

A

Botulism, lambert eaton

124
Q

Acute myasthenic crisis

A

MG with resp distress, needs intubation, IVIG, PLEX

Often precipitated by meds, aka the “antis”

125
Q

MG vs lambert eaton?

A

Similar pathophys, clinically weakness of LE gets better with repetition

Similar tx
Note LE is associated with underlying malignancy 1/2 the time

126
Q

Treatment for acute MS flare?

A

Methyl prednisolone burst and taper

127
Q

most common bact meningitis pathogens

A

strep pneumo
GBS
Neisseria meningitidis
H influenza
listeria

128
Q

two of what 4 features are seen in most pts with bact meningitis

A

HA (most common), fever (second most common), neck stiffness, AMS

note: focal neuro symptoms/seizure happen 25% of time

129
Q

RF for bact meningitis

A
130
Q

coag related contraindications to LP

A

INR > 1.5, plts < 20

131
Q

what to send CSF for in LP

A

Gram stain, culture, glucose, protein

132
Q

how quickly can CSF sterilize after starting ABX

A

2 hours for meningococcal, 6 hrs for pneumococcal

133
Q
A
134
Q

Ct before LP criteria

A
135
Q

CSF findings for bact vs viral meningitis

A
136
Q

do you delay abx for neuroimaging or LP for ?meningitis

A

NEVER

137
Q

empiric abx for ?batc meningitis in adults

A

CTX 2g and vanc 20 mg/kg
-add ampicillin if etoh, immunocomp or >50 years to cover listeria
-also add acyclovir if ?HSV

138
Q

when is dex helpful in bact meningitis

A

if given at same time or before, in pneuomcoccal can reduce hearing loss and morbidity/mortality
10 mg IV q6h X 3 days

139
Q

proph against close meningitis contacts

A

helpful in meningococcal or H influenza, give cipro 500 mg od X1 or ctx 250 IM X1.

to close contacts: household, exposed to secretions or those who intubate w/o PPE

dont need to give if exposure beyond 2/52

140
Q

treatment for viral meningitis?

A

usually supportive, admit if toxic looking and wait for CSF culture to come back w/o bacteria, treat HSV meningitis with acyclovir

141
Q

viral meningitis vs encephalitis symptoms

A

enceph has AMS, focal neuro symptoms, seizures

142
Q

sources of brain abcess

A

otogenic
odontogenic
sinogenic
penetrating trauma
post neuroSx
idopathic

143
Q

most common organism for spinal epidural abcess?

A

MSSA/MRSA

144
Q

triad of spinal epidural abcess?

A

back pain (most common), fever, neuro deficits (only about 30% have all 3)

145
Q

SEA diagnosis

A

need high index of suspicion
-normal CRP is sensitive, but obvs not specific
-BCx + 60% of time
-do not do LP if considering SEA
- MRI with gad is gold standard, CT no overly helpful

146
Q
A

CCFP EM (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions