Neuro Emergencies -Mistry

Question 1

What is the most common blood vessel damaged in an Epidural Hemorrhage? What will this look like on CT?

Answer 1

Middle meningeal A

-lens shaped or football (slide 60)

Question 2

What is the most common cause of a Subarachnoid Hemorrhage? What will this look like on CT?

Answer 2

trauma!* (2nd most common is a ruptured berry aneurysm)

-“star of death” on CT –> slide 19

Question 3

What is the first line treatment for status epilepticus?

Answer 3

1. Benzos (Ativan)
2. Phenytoin (Dilantin)
3. Barbiturates
4. Propofol

Question 4

What type of stroke is the most common? What is the most common cause of this?

Answer 4

-ischemic stroke

atherosclerosis

Question 5

What are the 2 main risk factors for an intercerebral hemorrhage? Should you give ASA to these pts? *know what this looks like on CT (slide 15)

Answer 5

age and HTN

do not give a bleed ASA!

Question 6

What is the definition of a Transient Ischemic Attack?

Answer 6

a temporary loss of neurological function that resolves completely in < 24 hours

Question 7

When would you do a head CT with contrast? Without contrast?

Answer 7

CT with contrast==> infection or tumor

CT without contrast=normally done unless infection or tumor are suspected

Question 8

What vessel is most commonly involved in an occlusion stroke?

Answer 8

Middle cerebral A

Question 9

A young pt (<35) that lives in a crowded place like military or jail presents with a fever and a petechial rash. What is suspected?

Answer 9

neisseria meningitides (meningococcemia)

rash on slide 30

Question 10

If a young woman presents with DOUBLE VISION (not blurry), what should you suspect? What test should be ordered? What do you expect to find?

Answer 10

Multiple sclerosis

MRI –> Dawson’s fingers (slide 41)

Question 11

What is affected in Guillain Barre Syndrome? What PE finding can be seen?

Answer 11

• Peripheral nerves are demyelinated
• decrease/loss of DTR’s

(can also do an LP –> elevated protein up to 100 lymphocytes)

Question 12

What is the glasgow coma scale? What are the 3 categories? What is the lowest score? The highest?

Answer 12

-scale for consciousness.

-eye opening:
4=spontaneous
3=to voice
2=to pain 
1=no response 

-verbal 
5=oriented 
4=confused 
3=inappropriate words 
2=unintelligible sounds 
1=none 

-motor:
6=follows commands 
5=localizes to pain
4=withdraws from pain 
3=flexed
2=extended 
1=none 

lowest=3, highest =15

Question 13

What does a subdural hemorrhage look like on CT? What vessels are most commonly injured?

Answer 13

crescent shaped (slide 58)

-bridging veins in the elderly and in alcoholics