Neuro Emergencies II

Question 1

Brain injury can result from

Answer 1

• brainstem compression (herniation)

- reduction in cerebral perfusion pressure (CPP important to deliver Oxygen & nutrients to the brain)

Question 2

Sx of ICP

Answer 2

h/a, n/v
papilledema
unilateral/bilateral fixed pupil
decreased consciousness
decorticate or decerebrate posturing
cushings triad: bradycardia, HTN, respiratory depression

Question 3

Cushings triad

Answer 3

bradycardia
HTN
respiratory depression

Question 4

GCS

Answer 4

15 points max
<8: intubate
Max for intubated pt: 10
GCS 3: decreased or state of deep coma

Question 5

Decorticate posturing

Answer 5

flexor response
flexion w/ adduction of arms and extension of legs;

lesion in corticospinal tract from cortex to upper midbrain

Question 6

Cerebrate posturing

Answer 6

extensor posturing, extension, adduction & interval rotation of arms & extension of legs

Assocaite w/ damage to corticospinal tract at level of brainstem (pons/upper medulla)

Question 7

Causes of intracranial HTN

Answer 7

traumatic brain injruy/intracranial hemorrhage
CNS infection
Ischemic stroke
Neoplasm
Vasculitis
Hydrocephalus
Hypertensive encephalopathy

Question 8

Dx for ICP

Answer 8

type/cross
CBC, BMP
Osmolality
Tox screen
BAL
Glucose
INR/PT/PTT
CT/MRI - brain, C/T/L/Spine

Question 9

Management of ICP

Answer 9

refer to neuro

• decompressive craniectomy
• ventriculostomy

Resuscitation

• oxygenation (>90%)
• BP (avoid HTN/hypotension)
• maintain end-organ perfusion

HOB 30 degrees
analgesia/sedation
treat fever (even mechanical cooling)
ICP monitors (ICP <20)
IVF
Mannitol (decreases brain volume)
Anti-seizure therapy

Question 10

Ventriculostomy

Answer 10

draw fluid from ventricles

Question 11

When to protect airway in skull fx

Answer 11

AMS
cranial nerve/neuro deficit
scalp laceration/contusions
bony "step-off" of skull
periorbital or retroauricular ecchymosis

Question 12

Types of skull fx

Answer 12

linear
depressed
basilar

Question 13

Linear skull fx

Answer 13

single fx; no clinical significance

no neuro sx; very few develop intracranial hemorrhage (except temporal)

Question 14

Temporal bone fx

Answer 14

can disturb vascular structure w/ significant bleeding

Question 15

Management of linear skull fx

Answer 15

if CT shows no brain injury and pt has no neuro deficit: observe in ED for 4-6 hours then d/c w/ home supervision
Neuro consult

Question 16

Depressed skull fx

Answer 16

segment of skull is driven below the level of the adjacent skull; often involve injury to brain parenchyma

Question 17

Risk of depressed skull fx

Answer 17

CNS infection
Seizures
Death

Question 18

Types of depressed skull fx

Answer 18

closed (simple)

open (compound)- examine but don’t probe

Question 19

Dx of depressed skull fx

Answer 19

CT scan

Question 20

Tx for depressed skull fx

Answer 20

Admit to neuro - may need surgical intervention
Td if need
Prophylactic antibiotics a& anticonvulsants