neuro Flashcards
how to use the VAN tool to identify LVOs
Pt must have extremity weakness + at least 1 of the V/A/N to be VAN positive
- visual disturbance: field cut, diplopia, blindness
- aphasia: expressive or receptive
- neglect: inability to track, extinction, hemineglect
tonic gaze deviation toward lesion (2 options)
internal carotid or MCA
contralateral lower extremity motor/sensory deficits (spares hands/face), urinary incontinence
WITH
- mute, transcortical motor aphasia (understand and can repeat but can’t speak well)
L ACA
LLE motor/sensory deficits (spares hands/face), urinary incontinence
WITH
hemimotor neglect
R ACA
hemiparesis, facial plegia, contralateral sensory loss
- usually face/upper extremity > lower extremity
- gaze toward lesion
WITH
- aphasia
L MCA
hemiparesis, facial plegia, contralateral sensory loss
- usually face/upper extremity > lower extremity
- gaze toward lesion
WITH
- dysarthria w/o aphasia, contralateral neglect
R MCA
posterior circulation stroke: 5 Ds
dizziness, dysarthria, dystaxia, diplopia, dysphagia
- must have multiple simultaneous complaints
crossed neuro deficits should make you think of
a posterior circulation stroke
- example: ipsilateral CN deficit, contralateral motor deficit
quadriplegic stroke
basilar artery
unilateral headache w/visual agnosia (can’t recognize objects)
PCA
pure contralateral motor deficits
posterior limb of internal capsule
pure contralateral sensory deficits
thalamus
contralateral motor + sensory deficits
internal capsule + thalamus
how to age a stroke on MRI
I be iddy biddy baby doodoo
T1/T2 when compared to brain: I = isointense, B = bright, D = dark
hyperacute: IB
acute: ID
early subacute: BD
late subacute: BB
chronic: DD
bright areas on DWI: DDx
- ischemic brain: if also dark on ADC (if ADC is also bright, it’s shine-through)
- cerebral abscess: if also dark on ADC
- active MS plaque (old plaques aren’t bright)
- some tumors
7 dangerous causes of dizziness
posterior fossa stroke posterior fossa tumor dysrhythmia hypoglycemia ACS anemia drug toxicity
length of a typical post-ictal period
20-30m
immediate action post-sz
CTH (unless you have a clear explanation otherwise by hx)
Fentanyl dose for neurointubation
2-5 mcg/kg
Keppra dosing in neuroemergencies
- exception
60 mg/kg
- exception: 30 mg/kg for HD pts
avoid benzos in
cirrhotics
elderly
ischemic stroke BP thresholds
< 220/120
after tPA < 185/110
hemorrhagic stroke SBP threshold
< 140
Explain the HINTS exam.
all 3 must suggest a peripheral cause to r/o central cause
- head impulse: saccade = peripheral
- nystagmus: unilateral/nonrotary = peripheral
- test of skew: no deviation to realign eyes = peripheral
CN IV palsy and compensatory head position
eye drifts superomedially > vertical diplopia > head tilts contralaterally and down
diabetic CN III palsy
down and out w/pupillary sparing
expected nystagmus during caloric testing
COWS (if the pt follows these rules, it’s peripheral)
if not, consider vestibular dysfunction
sudden hearing loss
develops over 3d or less
- conducteive: OM, cerumen
- sensorineural: infx, autoimmune, neoplasm, CVA, ototoxic meds
tx: prednisone
Meniere disease
vertigo, tinnitus, hearing loss
Alport syndrome
hearing loss, glomerulonephritis
cavernous sinus thrombosis
S. aureus > fever, periorbital edea, chemosis, CN VI palsy
GCS
E 4 = normal 3 = to speech 2 = to pain 1 = nothing
V 5 = normal 4 = confused 3 = inappropriate 2 = incomprehensible 1 = nothing
M 6 = normal 5 = to pain 4 = withdraws 3 = decorticate 2 = decerebrate 1 = nothing
pulsatile tinnitus
idiopathic intracranial hypertension
mechanism of central cord syndrome
forced hyperextension makes the ligamentum flavum buckle into the spinal cod, causing contusion or hemorrhage in the central portion of the cord
Guillain-Barre: tx
IVIG
most common secondary condition to hypoK periodic paralysis
hyperthyroidism (and ultimately, thyrotoxicosis)
VP shunt failure
usually proximal 2/2 choroid plexus or CSF protein in catheter
distal is usually 2/2 thrombus
sx: bulging fontanelle, sundown eyes, HA, nausea
most common focal encephalitis in AIDS
toxoplasmosis
- prefers the basal ganglia
toxo tx
pyrimethamine, sulfadiazine, folinic acid
presentation of primary CNS lymphoma
progressive altered mental status
