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Neuro > Neuro Emergencies > Flashcards

Neuro Emergencies Flashcards

1
Q

What is Meningitis?

A

Inflammation of the meninges that line the brain and spinal cord

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2
Q

What are hallmark S/Sx of Meningitis?

A
  • Headache
  • Fever
  • Stiff neck
  • Change in mental status
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3
Q

What is the 2 MCC of Meningitis in all ages?

A

Streptococcus pneumonia

Neisseria meningitides

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4
Q

What is the MCC of Meningitis in infants <2 months of age?

A

Group B streptococcus

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5
Q

What should not be delayed in a pt who is suspected to have Meningitis?

A

Empiric therapy

- IV Rocephin and IV Acyclovir

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6
Q

What viral family is the MC cause of viral Meningitis?

A

Enterovirus family

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7
Q

What 2 types of fungus are the MC cause of fungal Meningitis?

A
  • Candida albicans

- Cryptococcus neoformans

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8
Q

What parasite is the MC cause of parasitic Meningitis?

A

Naegleria fowleri

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9
Q

What are non-infectious causes for Meningitis?

A
  • Cancer
  • Open head trauma
  • Medical procedures
  • Medications: NSAIDS, Amoxicillin, sulfur-base
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10
Q

What is the pathophysiology of Meningitis?

A

Encapsulated bacteria colonized in the nasopharynx and/or oropharynx and penetrate of the intravascular space and enter the subarachnoid space via blood-brain barrier

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11
Q

What are other routes of pathogen entry that cause Meningitis but are less likely to occur?

A
  • Direct inoculation
  • Direct sending of para-meningeal structures
  • Contact and aspiration of maternal intestinal and/or genital tract secretions during birth
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12
Q

When does sxs usually appear in a pt with acute bacterial meningitis?

A

24-72 hrs

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13
Q

What are 2 LP risks?

A
  • Post-procedure headache: can last a few hours or days

- CSF leak. Resolved with “blood patch

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14
Q

What are risk factors for an intracranial abscess?

A
  • Inadequately treated sub-acute or chronic ear, nose, mastoid, or dental infections
  • Endocarditis
  • Congenital heart disease
  • Recent neurosurgical procedure
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15
Q

An intracranial abscess usually presents with what?

A

A mild headache in the weeks to months prior to the emergency department visit

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16
Q

What is encephalitis?

A

Inflammation of the brain itself

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17
Q

What is the MCC of encephalitis?

A

Viral infections

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18
Q

What is Dysautonomia?

A

Several medical conditions that cause a malfunction or failure of the ANS

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19
Q

What is Pleocytosis?

A

Presence of a greater than normal number of cells in cerebrospinal fluid

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20
Q

What is Parenchyma?

A

Functional tissue of a specific organ

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21
Q

What is Parenchymal contusion?

A

Micro-hemorrhages with small vessel leakage into surrounding tissue

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22
Q

What is Parenchymal laceration?

A

Complete separation of tissue

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23
Q

What is Parenchymal Coup injury?

A

Occurs under the site of impact with an object

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24
Q

What is Parenchymal Contra-coup injury?

A

Occurs on the side opposite the area that was initially impacted

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25
Q

What is Meningoencephalitis (meningitis + encephalitis)?

A

Inflammation/infection of the meninges and brain

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26
Q

What is the 2 MCC of Viral Encephalitis (aseptic encephalitis)

A
  • Herpes simplex virus

- Arboviruses

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27
Q

What is Aseptic Meningitis (viral meningitis)?

A

Clinical and laboratory evidence of meningeal irritation with negative results of bacterial cultures

28
Q

What are Meninges?

A

Three membranes lining the skull and vertebral canal which enclose the brain and spinal cord

29
Q

What makes up the meninges?

A

Dura mater, arachnoid mater, pia mater

30
Q

What is the Cushing’s Syndrome triad?

A

As you increase ICP you get

  1. Elevated BP
  2. Decreased pulse rate
  3. Irregular breathing patterns
31
Q

What is a coma?

A

A state of prolonged unconsciousness

32
Q

What is a prion?

A
  • Infectious agents composed entirely of a protein-like material
33
Q

What causes a prion?

A
  • Transmissible spongiform encephalopathy that are a family of rare progressive neurodegenerative disorders
    (affects both humans and animals)
34
Q

What diseases are responsible for a number of degenerative brain diseases?

A
  • Creutzfeldt-Jakob Disease
  • Fatal Familial Insomnia
  • Kuru disease
35
Q

What is a concussion?

A

A brain tissue insult with transient alteration in mental status

36
Q

What is post-concussion syndrome?

A

Complex disorders in which various symptoms: HA, dizziness, concentration difficulties

37
Q

What is hypoxia?

A

Deficiency in the amount of oxygen reaching tissues

38
Q

What is ataxia?

A

Neurological abnormality affecting muscle coordination and movements

39
Q

How is arboviruses transmitted?

A

By arthropod vectors

40
Q

How are enteroviruses named by?

A

Named by their transmission-route through the intestine.

41
Q

What is dolls eyes referring to?

A

Referred to as oculocephalic reflex

42
Q

What is positive dolls eye reflex?

A

Eyes move in direction opposite to that of the head movement

43
Q

What is negative dolls eye reflex?

A

Eyes move in the direction of the head movement

44
Q

What does a negative dolls eye reflex signify?

A

Severe brain damage or brain death

45
Q

What is Guillain-Barre Syndrome?

A

Acute inflammatory demyelinating polyradiculopathy

46
Q

Classic Guillain-Barre Syndrome generally is preceded by what?

A
  • Viral prodromal sx’s

- Followed by acute/subacute ascending symmetric weakness/paralysis and loss of DTR’s

47
Q

What part of the body is often affected by Guillain-Barre Syndrome?

A

Diaphragm- airway management if first order of tx.

48
Q

What do you want to avoid giving when treating a pt with Guillain-Barre Syndrome?

A

Corticosteroids

49
Q

What nerve is affected by Bell’s Palsy?

A

Acute peripheral facial nerve palsy

50
Q

Who is Bell’s Palsy MC’ly seen in?

A

Pregnant females

- Especially during 3rd trimester and 1 week post partum.

51
Q

What are some risk factors for Bell’s Palsy?

A
  • Recent fever
  • Viral infection
  • Tooth extraction
  • Chilling episode from cold exposure
52
Q

Bell’s Palsy is most often secondary to what?

A

Viral inflammatory process

53
Q

What is the hallmark physical exam finding in a pt with Bell’s Palsy?

A
  • Loss of wrinkles on forehead and nasolabial folds

- Inability to raise eyebrow and furrow forehead

54
Q

What is the treatment plan for Bell’s Palsy?

A
  • Oral medications: antiviral, corticosteroids, analgesia
  • Ocular care: lubricants (artificial tears), patching at night
  • Patient education and reassurance
55
Q

What are 5 causes for a coma?

A
  • Traumatic head injury
  • Stroke
  • Brain tumor
  • Drug or alcohol intoxication
  • Underlying illness
56
Q

What is a arousal consciousness?

A

Defined as the awareness of self and surroundings

57
Q

Cognition consciousness is located where and is responsible for what?

A

Located primarily in the cerebral cortex and responsible for:

  • Orientation
  • Judgement
  • Memory
58
Q

What are s/sx of a coma?

A
  • Increased sleepiness
  • Periods of confusion and disorientation
  • Trouble maintaining focus
  • Complete unresponsiveness
59
Q

What should a clinician pay particular attention to in a pt with has been diagnosed with a coma?

A

ABC’s and specific vital signs (P-Ox, Temperature)

60
Q

What are sxs of a parenchymal contusion?

A
  • Memory loss
  • Attention problems
  • Emotional disturbances
  • Difficulty with motor coordination
  • Numbness
  • Loss of ability to understand or express speech
61
Q

What is the tx for a parenchymal contusion?

A
  • Bed rest, fluids, analgesia
  • Close follow up for assessment of potential complications (post concussion syndrome) of concussion such as: memory issues, cognitive issues, and, personality issues
62
Q

What are the 3 types of intracranial hemorrhages?

A
  • Epidural
  • Subdural
  • Subarachnoid
63
Q

What is an epidural bleed?

A

Blood collection in potential space between skull and dura mater

64
Q

What is a classic history of an epidural bleed?

A

Blunt trauma with LOC or altered metal status followed by lucid interval and subsequent rapid neurological demise

65
Q

What is a subdural bleed?

A
  • Sudden acceleration/ deceleration of brain parenchyma with subsequent tearing of bridge veins
  • Hematoma formation between dura mater and arachnoid space
66
Q

What are 3 frequent signs and symptoms of cranial hemorrhages (increased ICP)?

A
  • HA
  • Nausea/ vomiting
  • Seizures
67
Q

What is the tx plan for cranial hemorrhages (increased ICP)?

A
  • Immediate resuscitation and aggressive evaluation of ABC’s and “life threats”
  • Oxygen, IV’s, cardiac monitor, Foley catheter
  • Rapid neurosurgical consultation/transfer/admission
  • Medications: Mannitol
  • Monitor/treat ICP

Neuro (14 decks)

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