Neuro- Seizures/TBI/CVA/CNS infection

Question 1

seizures are caused by

Answer 1

uncontrolled excessive electrical discharges in the brain

Question 2

Epilepsy is defined as

Answer 2

a state of recurrent seizures.

Question 3

A diagnosis of epilepsy is made after _______unprovoked seizures. AED treatment is generally started after the second seizure because the patient has a substantially increased risk (approximately 75%) for repeated seizures after two events.


Answer 3

two or more

Question 3

diagnostics for seizures

Answer 3

• Head CT
• Brain MRI
• routine EEG

Question 4

management of seizures

Answer 4

• Lorazepam 2 mg over 1 minute to stop seizures

intubate if GCS <8

Question 5

Primary injury of CVA occurs

Answer 5

at the time of injury

Question 6

Epidural hematoma are usually seen in

Answer 6

MVC, falls, and skull fractures and

usually causes arterial bleeding

Question 7

Subdural Hematoma usually found in

Answer 7

falls, assaults

Effects are tearing of bridging veins, cortical veins or venous sinuses

Question 8

Subarachnoid Hemorrhage definition

Answer 8

Bleeding between the brain and tissue covering the brain

Question 9

signs of a basilar skull fraction

Answer 9

• Battle sign or raccoon eyes

Question 10

When CBF falls < _________then cell injury or death can occur

Answer 10

20 ml/100g/m

Question 11

Normal cerebral blood flow (CBF) is

Answer 11

45-55 ml / 100g brain tissue / minute

Question 12

Normal ICP

Answer 12

< 10

Question 13

who needs ICP monitoring

Answer 13

Patients with severe head injury (GCS 3-8) with an abnormal CT scan

Question 14

External Ventricular Drains (EVD) are the

Answer 14

gold standard for accuracy
drains excess CSF

Question 15

Early finding to TBI

Answer 15

• Decrease LOC
• Sensory deficits
• motor weakness
• pupillary dysfunction (size, shape, reaction)
• possible seizure

Question 16

Late findings of TBI

Answer 16

• decreased LOC…. possibly coma
• vomiting
• hemiplegia (posturing)
• change in vital signs
• respiratory irregularities
  -impaired brainstem reflexes (corneal, gag)

Question 17

Late sign of herniation in rising ICP

Answer 17

Cushings triad

• hypertension
• Bradycardia
• Abnormal respiratory patterns

Question 18

Treatment of elevated ICP

Answer 18

Nursing care

Management of BP

Optimizing O2, ventilation

Ventricular drainage

Osmotic therapy

Hyperventilation

Sedation / paralytics

High dose barbiturate therapy

Hypothermia

Question 19

Tier 1 interventions for decreasing ICP

Answer 19

Ensure temperature < 38o C.
sedation: Propofol and/or benzodiazepines fentanyl as analgesic.

CSF drainage (if EVD available)

Maintain paCO2 35-40mm Hg.

Mannitol (0.25 – 1.0 g/kg)
Titrate to ICP control and maintain serum osmolality < 320 mOsm or Gap <20.

Hypertonic saline

Question 20

Measures to cool patient to prevent increase ICP

Answer 20

• Antypyretics
• cooling blanket

Shivering increased ICP

Question 21

Decompression craniectomy for

Answer 21

Hematoma
Tumor
Abscess

Question 22

Administration of t-PA must commence within

Answer 22

4.5 hours of stroke onset

Question 23

tPA Exclusion Criteria

Answer 23

1. Previous Intracranial hemorrhage
2. Serious head trauma within 4 months

Question 24

tPA Inclusion Criteria

Answer 24

1. Age≥18yr 2. Clinical diagnosis of ischemic stroke causing disabling neurologic deficit 3.Onset of stroke symptoms well established to be less than 4h30 before treatment would begin

Question 25

ischemic stroke

Answer 25

can be subclassified into atherothrombotic, embolic, hypoperfusion, or hypercoagulable state "clots that decrease perfusion to the brain"

Question 26

2 classifications of strokes

Answer 26

Ischemic or Hemorrhagic

Question 27

SAH presentation

Answer 27

- sudden onset of a severe headache (Thunderclap headache) - Stiff neck . - Sudden weakness

Question 28

Meningitis

Answer 28

Infection of the brain and spinal chord

Question 29

Encephalitis

Answer 29

Inflammation of brain Parenchyma - Fever - HA - AMS

Question 30

brain abscess

Answer 30

A infected puss filled fluid in the brain

Question 31

General symptoms of CNS infections

Answer 31

- Fever Headache - Neck ache (meningitis)

Question 32

Meningitis symptoms (All)

Answer 32

Fever HA Stiff neck/ nuchal rigidity Nausea/ Vomiting Photophobia Rash Kernig sign (hip flex/knee extension), Brudzinski sign (involuntary leg lifting) Normal mental status

Question 33

ANY suspicion for elevated ICP-> YOU MUST get CTH ___________lumbar puncture

Answer 33

BEFORE

Question 34

#1 cause of Meningitis

Answer 34

Strep Pneumonia (Gram + diplococci)

Question 35

Niseria Meningitis is most common in

Answer 35

Adolescents / Young adults (<31y/o)

Question 36

Listeria Meningitis is most common in

Answer 36

children <2 and older adults >55

Question 37

Diagnostic for Meningitis

Answer 37

- CT Head - Lumbar puncture

Question 38

purpuric rash is most commonly seen in which type of meningitis?

Answer 38

Niseria Meningitis (Gram - diplococci)

Question 39

Protein is ________in all cases of meningitis, septic or aseptic.

Answer 39

Elevated

Question 40

normal glucose in CSF indicates it is

Answer 40

not bacterial infection

Question 41

Empiric therapy for Meningitis

Answer 41

Vancomycin & ceftriaxone dexamethasone >60 or immunocompromised ADD Ampicillin

Question 42

Treatment for viral meningitis

Answer 42

supportive care+ Acyclovir (Severe case)

Question 43

Causes of encephalitis are usually

Answer 43

VIRAL HerpesSimplex (HSV)-> Most common in US

Question 44

Diagnostic for encephalitis

Answer 44

Initial: CT Head LP- High protein, lymphocytes and normal glucose

Question 45

Most accurate test to diagnose encephalitis

Answer 45

CSF PCR

Question 46

Treatment for encephalitis

Answer 46

Acyclovir steroids- dexamethasone

Question 47

Brain abscess infections are

Answer 47

Focal Infection of the brain parenchyma. Can occur in: Immunocompromised IV drug users s/p Neurosurgical procedure

Question 48

Diagnostic for Brain abscess

Answer 48

CT Head or MRI Brain CSF not useful

Question 49

Empiric therapy should not be delayed when treating

Answer 49

Brain Abscess

Question 50

Cover 3 classes of Bacteria for treating brain abscess:

Answer 50

Streptococcus: IV beta-lactam, PCN, Nafcillin-> brain has penetration/don’t have to cross the meninges Anaerobes: Clindamycin or Metronidazole Gram Neg Bacilli: 3rd Gen Cephalosporin -> Ceftriaxone or Cefotaxime Amphotericin B

Question 51

Xanthochromia is positive is CSF fluid of

Answer 51

Subarachnoid hemorrhage