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EM 2 > Neuro emergencies > Flashcards

Neuro emergencies Flashcards

1
Q

test to distinguish peripheral and central vertigo

A

dix hallpike maneuver

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2
Q

describe positive dix hallpike

A

dizziness WITH nystagmus during the maneuver

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3
Q

positive hallpike. now what?

A
  • repeat 3x.
  • if fatiguable= BPPV
  • non-fatiguable suggests central cause
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4
Q

Illusion of self or environmental rotation; usually d/t vestibular lesions

A

vertigo

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5
Q

5 peripheral causes of vertigo

A
  • BPPV
  • vestibular neuritis
  • labrynthitis
  • menieres dz
  • ototoxic meds (loops, aminoglycosides)
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6
Q

exam to help differentiate vestibular neuritis from stroke; used in patients with hours to days of vertigo & nystagmus

A

HINTS exam

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7
Q

3 parts of HINTS exam

A
  • nyastagmus observed in primary and lateral gaze– bidirectional is worrisome
  • vertical skew is worrisome for stroke
  • head impulse test– abnormal is good (suggests vestibular neuritis)
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8
Q

when do you get imaging with vertigo? which imaging is preferred?

A
  • if not cooperative with HINTS or dix hallpike
  • MRI/MRA head preferred
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9
Q

3 meds used in vertigo treatment that act as a band-aid

A
  • meclizine
  • benzos (diazepam)
  • anti-nausea meds
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10
Q

thing you do to move otoliths in semicircular cananals

A

Epley maneuver

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11
Q

5 things that suggest central cause of vertigo?

A
  • older age
  • CAD
  • focal neuro deficit (diplopia)
  • no N/V
  • constant for days
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12
Q

most common cause of peripheral vertigo vs central vertigo

A

peripheral– BPPV
central– vestibular migraine

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13
Q

having no prodrome is associated with what category of syncope?

A

cardiogenic

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14
Q

when should you admit someone who passed out?

aka CHESS criteria

A

CHF hx
Hematocrit under 30%
EKG or cardiac abnormality
SOB hx
SBP under 90

admit if they have any of these

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15
Q

all patients with ____ require EKG & cardiac monitoring

A

syncope or near syncope

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16
Q

most common HA type

A

tension

17
Q
  • triptans
  • metoclopramide
  • chlorpromazine
  • diphenhydramine
  • ketrorolac

NOT EXHAUSTIVE

A

treats migraine HA

18
Q
  • abrupt onset of retro-orbital, deep, excruciating HA; days-wks of episodes
  • associated sx: tearing, nasal congestion, rhinorrhea, diaphoresis
A

cluster HA

tx: oxygen or SC/IN triptans

19
Q
  • pressure/tightness; waxes and wanes; bitemporal
  • no associated sx
  • tx: chlorpromazine, metoclopramide, ketorolac, diphenhydramine
A

tension HA

20
Q

severe headache that is worse when standing up, and better when lying down

A

intracranial HYPOtension

21
Q
  • Pressure/HA worse lying down that is relieved when upright
  • precipitated by valsava or exertion
  • papilloedema
A

elevated intracranial pressure (ICP)

22
Q

imaging for IPH, EDH, SDH, SAH

A

non con CT

23
Q

imaging for CSVT, vasculitis, dissections

A

MRI/MRA with contrast

CT WITH contrast if they cant get MRI

24
Q

imaging for tumors, abscess (2)

A

CT non con
MRI w/ con

25
Q

what should you ask about before LP for meningitis or SAH

A

ask about anti-platelet meds

26
Q

what should be done for any patient presenting with HA?

A

thorough neuro exam

27
Q

if patient has “red flag” HA, what now?

A

non con CT

28
Q

seizure disorder diagnosed when a person has had two or more seizures which have not been provoked by specific events like trauma, fever, infections, etc
* chances of recurrence increases after 1st one

A

epilepsy

29
Q

what is something that can help differentiate seizures from syncope?

A

presence of post ictal period

30
Q

simple vs complex partial seizures

A
  • simple: NO impaired awareness
  • comples: altered mental status
31
Q
  • most common type of seizure
  • stiff limbs then jerking of limbs & face
A

tonic clonic seizures

32
Q

rapid, brief contractions of bodily muscles which usually happen at the same time on both sides of the body (looks like sudden jerks)

A

myoclonic

33
Q

produces abrupt loss of muscle tone; head droop to falls

A

atonic seizures

34
Q

treament for medical emergency SE seizures

A

always admit– IV lorazepam

35
Q

great first line agent for seizures (NOT actively seizing)

A

keppra/levetiracetam

36
Q

how long should patients refrain from driving after a seizure

A

3 months

37
Q

what should you give to patients with known epilepsy

A

loading dose of their home AEDs in the ED prior to discharge

EM 2 (4 decks)

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