Neuro Flashcards
cerebral perfusion pressure (CPP) =
MAP - ICP
Intracranial epidural abscesses (ICEAs) typically present as…
while spinal epidural abscesses (SEAs) often present as…
…fever, mental status changes, and neck pain
…fever, localized spinal tenderness, and back pain.
Harrison’s, Chapter 147
According to the published guidelines, the prophylactic use of phenytoin may reduce early post-traumatic seizures (within _ days; Class I) but this or other AEDs are not recommended for preventing late post-traumatic seizures (>7 days of injury; Class I).
7 days
[ From “Levetiracetam Use in the Critical Care Setting”
(DeWolfe & Szaflarski)]
How soon after a thrombotic stroke should chemical VTE prophylaxis be started?
As soon as the bleeding risk becomes acceptably low (often within 24 - 48 hours), but if the stroke is large and risk of hemorrhagic conversion is high, it can wait 7 days.
[UpToDate, “Prevention of venous thromboembolic disease in acutely ill hospitalized medical adults”]
Define brain death.
irreversible cessation of cerebral and brainstem function. There is no respiratory drive, and thus there are no spontaneous breaths regardless of hypercarbia or hypoxemia. There are no responses arising from the brain (including cranial nerve reflexes and motor responses) to stimuli, although spinal reflexes may persist.
[From UpToDate “Hypoxic-ischemic brain injury in adults: Evaluation and prognosis”]
Define and characterize persistent vegetative state.
A state of wakefulness without awareness.
Characteristics include:
●No evidence of awareness of self or environment and an inability to interact with others
●No evidence of sustained, reproducible, purposeful, or voluntary behavioral responses to visual, auditory, tactile, or noxious stimuli
●No evidence of language comprehension or expression
●Intermittent wakefulness manifested by the presence of sleep-wake cycles
●Sufficiently preserved hypothalamic and brainstem autonomic function to permit survival with medical and nursing care
●Bowel and bladder incontinence
●Variably preserved cranial nerve reflexes and spinal reflexes
[From UpToDate “Hypoxic-ischemic brain injury in adults: Evaluation and prognosis”]
PVS is judged to be permanent after __ months if induced nontraumatically. For traumatic brain injury, __ months in this state is generally required to be considered permanent.
3 months
12 months
[From UpToDate “Hypoxic-ischemic brain injury in adults: Evaluation and prognosis”]
What happens in a case of “upward herniation”?
Ascending transtentorial herniation is a situation where space-occupying lesions in the posterior cranial fossa cause superior displacement of superior parts of the cerebellum through the tentorial notch.
[Retrieved from https://radiopaedia.org/articles/ascending-transtentorial-herniation]
What is a Lazarus sign?
It is a brain death–associated reflex
[Retrieved from Critical Care Medicine by Parrillo, et al.]
It is described as a complex reflex movement involving bilateral arm flexion to the chest, shoulder adduction, and hand crossing.
[Retrieved from “Chronic Brain-Dead Patients Who Exhibit Lazarus Sign”, by Ji Won Moon and Dong Keun Hyun]
Name the five layers of the scalp:
skin (epidermis, dermis) dense superficial fascia galea aponeurotica (a.k.a. aponeurosis epicranialis) loose areolar connective tissue periosteum
[From https://www.sciencedirect.com /topics/neuroscience/galea-aponeurotica]
The galea is a key anchoring structure of the _________ muscle. If the frontalis loses its anchoring point, contraction of that muscle can become asymmetric and noticeable.
frontalis
[From UpToDate article “Assessment and management of scalp lacerations”]
Acute disseminated encephalomyelitis (ADEM), also known as __________ __________, is an autoimmune demyelinating disease of the central nervous system. Commonly triggered by viral infections, ADEM is caused by an inflammatory reaction in the brain and spinal cord. Its onset is acute and often rapidly progressive. ADEM is typically monophasic, but some patients may either have recurrences or have an ADEM-like presentation as the first attack of a chronic demyelinating disease such as multiple sclerosis or neuromyelitis optica.
postinfectious encephalomyelitis
[From UpToDate, “Acute disseminated encephalomyelitis”]
Although the pathogenesis is incompletely understood, ADEM appears to be an autoimmune disorder of the central nervous system that is triggered by an _____________ ________ in genetically susceptible individuals. One proposed mechanism is that myelin autoantigens such as ______ _____ ________, proteolipid protein, and myelin oligodendrocyte protein share antigenic determinants with those of an infecting ________. Anti-viral antibodies or a cell-mediated response to the pathogen cross react with the myelin autoantigens, resulting in ADEM.
environmental stimulus
myelin basic protein
pathogen
[From UpToDate, “Acute disseminated encephalomyelitis”]
There is a low probability of injury to the cervical spine if patients meet all five of the following criteria (NEXUS criteria):
- no tenderness at the posterior midline of the cervical spine
- no focal neurologic deficit
- normal level of alertness
- no evidence of intoxication
- no clinically apparent, painful injury that might distract them from the pain of a cervical-spine injury
[“Validity of a Set of Clinical Criteria to Rule Out Injury to the Cervical Spine in Patients with Blunt Trauma”, NEJM, July 2000]
Both the National Emergency X-Radiography Utilization Study (NEXUS) low-risk criteria and the Canadian C-spine Rule (CCR) are well validated and sensitive, and either can be used to determine the need for cervical spine imaging in adult trauma patients not at high risk but also not at negligible risk of injury. These rules are NOT applicable to the following patients:
●With ______ _____ to the neck
●With ___________ trauma
●NEXUS is not applicable to adults > __ years
direct blows
penetrating
60
[From UpToDate, “Evaluation and initial management of cervical spinal column injuries in adults”]
