Neuro Flashcards
3 most common classifications AMS?
- Delerium
- Dementia
- Psychosis
In which class are vital signs irregular?
Delirium
In which class are visual and audial hallucinations seen?
Visual: delirium
Audial: Psychosis
What part of brain manages arousal? Cognition?
Arousal: Brainstem nuclei (RAS)
Cognition: Cortical functioning
Most common causes delirium?
Almost always caused by underlying medical problem that has toxic or metabolic effects on the brain
How to test pronator drift?
- Hold arms outstretched with palms facing upward
- Eyes closed: w/o vision, patient relies on proprioception alone to maintain position
- UMN lesion, supinator muscles in upper limb are weaker than pronator muscles, and arm drifts downward and palm turns toward floor
Definition stroke?
Acute onset of neurologic deficit caused by disruption of cerebral blood flow to a localized region of the brain
Majority of strokes ischemic or hemorrhagic?
87% ischemic
Risk factors stroke?
- Hypertension / diabetes / hyperlipidemia
- Smoking
- Advanced age
- A fib / prosthetic heart valve
- Prior stroke
Timeframe for giving TPA?
Door to decision to give: 45 minutes
Door to drug administration: 60 minutes (and less than 3 hours from onset)
Imaging in suspected stroke?
Head CT w/o contrast on all patients to exclude hemorrhage
Contradiction to tPA in head imaging?
Frank hypodensity on CT is indicative of completed stroke and may be a contraindication to thrombolytic therapy
Inclusion criteria for tPA?
- Diagnosis of ischemic stroke causing measurable neurological deficit
- Onset of symptoms less than 3 hours
- Aged ≥18 years
Blood pressure goal after tPA?
Below 180/105 in first 24 hours
Use of aspirin in stroke?
Aspirin within 24 – 48 hours of stroke onset is recommended
- Aspirin should not be administered for at least 24 hours after administration of rtPA
Classic meningitis presentation?
- Fever
- Neck Stiffness
- AMS
What is papilledema?
Condition in which increased pressure in or around the brain causes optic nerve inside eye to swell. Symptoms may be fleeting disturbances in vision, headache, vomiting, or a combination
Glucose in bacterial meningitis?
Less than 40 or ratio of CSF/blood glucose less than 0.40
Rx HSV encephalitis?
Acyclovir
Class presentation SAH?
- Acute onset “thunderclap” HA
- LOC
- Vomiting
- Neck stiffness
- Seizure
RFs intracerebral bleeds?
- ***FH 3 - 5x risk
1. Recent exertion
2. Hypertension
3. Excessive alcohol consumption
4. Sympathomimetic use
5. Smoking
What is an epidural hematoma?
Accumulations of blood between the skull and dura
- Typically occur after significant blunt head trauma
Presentation EDH?
Brief LOC after blow to head, followed by a lucid period. - Soon after, level of consciousness deteriorates again
What is a subdural hemorrhage?
Extra axial blood collections between the dura and the arachnoid mater
What is cushings Triad?
Physiologic response to rapidly increasing ICP and imminent brain herniation. Its features are:
- Hypertension
- Bradycardia
- Abnormal respiratory patterns
How does bleeding appear on head CT?
Hyperdense (whiter) relative to the surrounding tissues
How to control rising ICP?
- Monitoring/lowering BP
- Elevating head of bed to 30 degrees
- Providing adequate sedation and analgesia
- Mannitol
- Mild hyperventilation
Two categories seizure?
- Generalized: involving both hemispheres of brain with loss of consciousness
- Focal (partial): only one hemisphere is involved
Two types focal seizures?
- Simple partial: cognition is not impaired
2. Complex partial: when cognition is impaired
Evidence of seizure if not witnessed?
- Tongue trauma from biting
2. Urinary or bowel incontinence
What is Todd’s Paralysis?
Focal neurologic deficit mimicking a stroke which can be seen with seizure
Secondary causes of seizure?
- Alcohol withdrawal
- Drug use
- HYPOglycemia
- HYPOnatremia
Definition status epilepticus?
Seizure of greater than 5 minutes duration, or 2 or more seizures in a row without a return to baseline
When are patients with primary seizures prone to seize?
- Medical noncompliance: #1
- Sleep deprivation
- Emotional or physical stress
Labs for first seizure?
- CMP
2. Pregnancy test
Additional test in status?
LP, CT must be done first
When to CT seizure?
- First time
- New type of seizure
- Trauma
- Fever
- Prolonged post ictal
- Status
When to MRI seizure?
First time but as outpatient
When is EEG need?
- First seizure as o/p
2. Status to make sure seizure has stopped
Vitals in etoh withdrawal?
tachycardia, hypertension, hyperthermia and tachypnea
Meds known to cause seizure?
- Tricyclics
2. Isoniazid
Signs of PNES?
Rhythmic, controlled shaking activity, ability to talk or follow commands during the seizure, recall of a seizure that involves both sides of the body, or lack of a postictal period
Can you place something in mouth in seizure?
Bite block or oropharyngeal airway to protect the tongue.
Lines of therapy in status?
First line: benzodiazepines (usually lorazepam)
Second line: fosphenytoin/phenobarbital/valproic acid
Third line: versed/pentobarbital/propofol infusions
Seizure meds that can be given IM?
Lorazepam, midazolam, and diazepam can all be given intramuscularly
Rx secondary seizures?
Eclampsia – Magnesium sulfate
Hyponatremia – Hypertonic saline
Isoniazid – Pyroxidine
Hypoglycemia – Dextrose
When not to use NIPPV?
Respiratory arrest/absent respiratory drive Hemodynamic instability Aspiration Risk Airway obstruction Unable to tolerate mask Mask does not fit Altered mental status
When to use NIPPV?
Moderate to severe dyspnea Accessory muscle use Paradoxical abdominal movement Fatigue RR > 25 bpm pH < 7.35, pCO2 >45
DDx for slow and rapid onset respiratory distress?
Rapid: 1. PE 2. Spontaneous pneumothorax Gradual: 1. COPD 2. Pneumonia 3. CHF
