Neuro Flashcards
Signs of ischemia on CT (3)
- hyper dense MCA sign
- sulcal effacement ( DUE TO FOCAL SWELLING)
- ## loss of grey matter in BG
thrombolysis candidate
Stroke symptom ischemic stroke (3 features on CT) NIHSS favorable no contraindications NOT > 4.5h
When to STOP rtPA
- anaphylaxis
- Systolic BP <100
- BP > 180/105
- MAJOR systemic bleed
- GCS lowers by 2 or more points
- NIHSS decrease by 4 or more
ABBS (S as in score)
when do you get an urger CT
change in NEURO sign
GCS decrease by 1
NHISS decrease by 3
BP S: >180 or < 100 D: >105 or < 50 HR >120 <50 RR >24 or <8 Temp > 38 Urine output <30ml/h
what are you worries about if you do an urgernt CT after thrombolysis
Be aware of Malignant MCA syndrome
Involve neurosurgeons for hemicraniectomy if criteria are met
Alteplase dose
Alteplase
Dose: total = 0.9mg/kg (max 90mg)
Bolus of 10%: over 1 minute
Infuse remaining 90% over 1 hour
Search for cause to prevent recurrence of stroke
Search for cause to prevent recurrence ECG, ECHO, HOLTER TOE if age < 65 years Carotid doppler MRI/MRA < 35 - Thrombophilia screen, vasculitis screen, etc
anti-platlet treatment post stoke
Aspirin 300mg PO x 14/7 (if not already loaded)
Then 75mg OD
when do you give warfarin in secondary presevenetion
Aim INR 2-3, introduce 7-10days after aspirin
Thrombectomy recommendation
- treat stroke with large vessel occlusion
- up to 12 hours from symptom onset
- IV thrombolysis
- a stent retriever is preferable
C/I to thrombectomy
Presence of large infarct on CT may be a contra-indication
Risk factors for Acute bacterial meningitis
< 5 years, > 60years Immuno-suppression Non-immunised Crowding Exposure to pathogens Asplenia Cranial defects/VP-shunt Sickle cell disease
CSF antigen
Meningitidis capsular polysaccharide antigen
what is brain MRI good for in suspicious bacterial meningitis
encephalitis
example of antibiotics for bacterial meningitis
Ceftriaxone 2g BD or Cefotaxime 2g every 4-6 hours AND
Vancomycin 500-750mg IV QDS (where pneumococcus is resistant)
Add Ampicillin if > 55years (Listeria)… 2g every 4 hours
Benzyl-penicillin (if rash)… 2.4g every 4 hours
definition of delirium
acute, fluctuating change in mental status, with…
Inattention
Disorganized thinking
Altered level of consciousness
why delirium is serious
- common
- recognized
2X increase mortality
increase Length of stay
Decline in functional status
Decline in cognitive function
Poor rehabilitation
Institutionalisation, re-hospitalisation
Persisting delirium (lasting weeks to months)
What screening test can you use for dementia
CAM - confusion assessment Method
DRS delirium rating scale
MDAS - memorial delirium ass. score
Abbreviated MSE
What is CAM
COGNITIVE IMPAITMENT FLUCTATINg INATTENTION ACTUE SYMPTOMS TEMPORAL RELATIONSHIP
Antipsychotic drug and dose for dementia
Halperidol, PO… 0.5mg
Olanzapine, PO… 2.5mg
Risperidone, PO… 0.25mg
Quetiapine, PO… 12.5mg
what other medication can you use beside AP in dementia
Lorazepam (short acting benzo)
status epilepticus
Persistent seizure activity within the brain
- Life threatening
- Previously 30-minute period
NOT
One continuous unremitting seizure > 5min
Recurrent seizures, without regaining consciousness > 5mins
Persistent seizure activity after use of first & second line AEDs
Modifiable risk factors for Status epileptics
AED non-adherence AED withdrawal Alcohol use/abuse Drug: over-dose/toxicity Prescribed Illicit
Non modifiable RF for status epileptics
Stroke Cerebral Haemorrhage CNS infection Meningitis Encephalitis Abscess Cerebral tumours Trauma Metabolic abnormalities
treatment of hypoglycaemia or malnutrition in status epileptics
If Hypoglycaemic
50mls 50% glucose
If malnourished or high suspicion of alcoholism
Thiamine
treatment of status epileptics
- BENZODIAZEPAM (LMD)
- IV PHENYTONIN
- PHENOBARBITOL
- GEnERAL ANESTHETIC (midazolam, Profil, thiphentone)
lorazepam dose
Dose: 0.1mg/kg at 2mg/min (need full resus facilities!)
Though usually 2-4mg, wait 10mins before assessing response
Max 8mg/12hours
Phenytoin dose
Loading: 20mg/kg (not quicker than 50mg/min)…
Then: 5-10mg/kg
types of GA for status epileptics
Midazolam
Propofol
Thiopentone
RF SAF
Modifiable
- smoking
- HTN
- Alcohol / cocain
- OCP
- bleeding disorder
- positive fam Hx
Non Modibiable
- APCKD
- AVM
- FMD
- CTD (ehlers/ marfans)
3 severity scales for SAH
- GCS
- Hunt and hess
- World federation of neurosurgery
2 eye signs SAH
DILATED pupil w/ Loss of reflex
Intraocular bleed
TERSON syndrome
nitrous haemorrhage ass. w/ SAH
BP target in SAH
BP <150 and Cerebral perfusion pressure < 60mmhg
Hydrochepalus Tx in patient with SAH
Therapeutic LP
External ventricular drain
Permanent shunt
