Neuro Emergencies (Exam #3) Flashcards
What is considered increased ICP?
15+ mmHg
What two sxs may be seen with increased ICP? What triad may be seen as a late finding?
- HA
- N/V
LATE = Cushing’s Triad (bradycardia, HTN, respiratory depression)
What are the two primary tx for increased ICP? What monitoring is the gold standard?
- O2
- Mannitol
May need intraventricular monitoring
What type of skull fracture involves a single fracture?
Linear Skull Fracture
What type of skull fracture often involves NO neuro sxs?
Linear Skull Fracture
What is the recommended tx for a Linear Skull Fracture (2)?
- Observe for 4-6 hours if NO neuro sxs and normal CT
- ADMIT/observe if suspected brain injury
What type of skull fracture often involves a brain parenchyma injury?
Depressed Skull Fracture
What is the recommended tx for a Depressed Skull Fracture (3)?
- ADMIT
- Td
- Prophylactic abx
What two signs are often seen with a Basilar Skull Fracture?
- Battle sign
- Raccoon eyes
What is the recommended tx for a Basilar Skull Fracture?
ADMIT ALL for observation
What is the recommended dx for a Penetrating Injury Skull Fracture?
EMERGENT CT without contrast
What is the recommended tx for a Penetrating Injury Skull Fracture (2)?
- IMMEDIATE NS CONSULT
- IV abx
When would a disposition of home be considered for a brain contusion (4)?
ALL MET…
- GCS of 15
- Normal PE and CT scan
- NO bleed
- Good home monitoring available
What condition involves shearing of white matter secondary to blunt trauma? What is seen on CT scan (2)?
Diffuse Axonal Injury (DAI)
- Blurred grey/white matter margins
- Small lesions in white motor tracts
What layers are affected with an Epidural Hematoma? What type of blood is involved, and vessel(s) specifically?
Skull and dura
- ARTERIAL = Middle Meningeal a.
What layers are affected with an Subdural Hematoma? What type of blood is involved, and vessel(s) specifically?
Dura and arachnoid
- VENOUS = bridging veins
What condition involves a “lucid interval”?
Epidural Hematoma
What condition involves a lens-shape on CT?
Epidural Hematoma
What condition involves a crescent-shape on CT?
Subdural Hematoma
What condition involves a bleed in the CSF, and what is the most common cause?
Subarachnoid Hemorrhage (SAH) - Aneurysm
What are the two ways by which a Subarachnoid Hemorrhage (SAH) presents?
- WHOL
- Thunderclap HA (TCH)
What is the dx criteria used for Subarachnoid Hemorrhage (SAH), and what are the six components?
Ottawa SAH Rule = CT before LP
- 40+ years
- Neck pain/stiffness
- Limited neck flexion
- Witnessed LOC
- Onset during exertion
- Thunderclap HA (TCH)
What dx test is ALWAYS required for a Subarachnoid Hemorrhage (SAH)?
LP
What complication should especially be avoided with Subarachnoid Hemorrhage (SAH)?
Increased ICP
What is the most common NON-trauma cause of an Intracranial Hemorrhage?
HTN
What is the target BP in tx of a Intracranial Hemorrhage?
160-140/90
Of the cerebral hemorrhages, which is considered an EMERGENCY?
This is dumb bc they’re all “emergencies”…
Intracranial Hemorrhage
What SC injury is considered an EMERGENCY?
Cauda Equina Syndrome
When would IV thrombolytics be considered for an Ischemic CVA?
If sxs onset is <4.5 hours
What is the target BP in order to use IV thrombolytics in the tx of an Ischemic CVA?
<185/<110
What are the two definitions of Status Epilepticus?
- Continuous for 5+ minutes
- 2+ seizures with incomplete recovery
What two classes of medications can be considered in the tx of Status Epilepticus, and what are examples of each (2, 3)?
- Benzos = Lorazepam, Diazepam
- Anticonvulsants = Phosphenytoin, Levetiracetam, Valproate
What are the two Benzos that can be used in the tx of Status Epilepticus?
- Lorazepam
- Diazepam
What are the three anticonvulsants that can be used in the tx of Status Epilepticus?
- Phosphenytoin
- Levetiracetam
- Valproate
If seizures continue after tx with Benzos and anticonvulsants for Status Epilepticus, what three meds should be considered?
- IV Midazolam
- IV Propofol
- IV Pentobarbital
What spine level is a Jefferson fracture seen, and what part of the vertebra is affected?
C1/Atlas
- Ant. or post. arches of C1
What are the two types of fractures seen at the C2/Axis level, and what is another name for each?
- Pedicle (Hangman’s)
- Odontoid (Dens)
Which two Types of Odontoid (Dens) fracture are unstable?
- Type II
- Type III
With what type of spinal cord fracture is spinal cord damage minimal, and why?
Pedicle (Hangman’s)
- C2 has the greatest AP diameter
What type of spinal cord fracture is displaced in all directions, and what general area is this typically seen?
Burst Fracture
- Lower C spine
What type of shock can develop from Spinal Cord Injuries?
Neurogenic shock
What are the two timings of symptom presentations in COMPLETE Spinal Cord Injury, and what specific sxs are seen with each?
- <1 day = absent reflexes, flaccid
- 1-3 days = hyperreflexia, spastic, + Babinski’s
What are the four types of INCOMPLETE Spinal Cord Injuries?
- Anterior (Ventral)
- Central
- Posterior (Dorsal)
- Brown Sequard = one sided
Which type of INCOMPLETE Spinal Cord Injury presents with bilateral pain/temperature loss and bladder dysfunction?
Anterior (Ventral)
Which type of INCOMPLETE Spinal Cord Injury presents with motor in UE > LE, DTRs lost?
Central
Which type of INCOMPLETE Spinal Cord Injury presents with hyperreflexia, gait ataxia?
Posterior (Dorsal)
Which type of INCOMPLETE Spinal Cord Injury presents with ipsilateral motor paralysis and proprioception/sensory loss AND contralateral pain/temperature loss?
Brown Sequard
What two signs present with a Brown Sequard INCOMPLETE Spinal Cord Injury?
- Ipsilateral motor paralysis and proprioception/sensory loss
- Contralateral pain/temperature loss
What is the recommended dx test for Cauda Equina Syndrome?
EMERGENT MRI with AND without contrast
What is the recommended tx for Cauda Equina Syndrome?
Dexamethosone
What condition presents with LBP radiating unilaterally, weakness and “saddle anesthesia”?
Cauda Equina Syndrome
