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Acute Gero 1 > Neuro- Seizures/TBI/CVA/CNS infection > Flashcards

Neuro- Seizures/TBI/CVA/CNS infection Flashcards

1
Q

seizures are caused by

A

uncontrolled excessive electrical discharges in the brain

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2
Q

Epilepsy is defined as

A

a state of recurrent seizures.

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3
Q

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.


A

two or more

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3
Q

diagnostics for seizures

A
  • Head CT
  • Brain MRI
  • routine EEG
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4
Q

management of seizures

A
  • Lorazepam 2 mg over 1 minute to stop seizures

intubate if GCS <8

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5
Q

Primary injury of CVA occurs

A

at the time of injury

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6
Q

Epidural hematoma are usually seen in

A

MVC, falls, and skull fractures and

usually causes arterial bleeding

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7
Q

Subdural Hematoma usually found in

A

falls, assaults

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

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8
Q

Subarachnoid Hemorrhage definition

A

Bleeding between the brain and tissue covering the brain

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9
Q

signs of a basilar skull fraction

A
  • Battle sign or raccoon eyes
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10
Q

When CBF falls < _________then cell injury or death can occur

A

20 ml/100g/m

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11
Q

Normal cerebral blood flow (CBF) is

A

45-55 ml / 100g brain tissue / minute

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12
Q

Normal ICP

A

< 10

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13
Q

who needs ICP monitoring

A

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

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14
Q

External Ventricular Drains (EVD) are the

A

gold standard for accuracy
drains excess CSF

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15
Q

Early finding to TBI

A
  • Decrease LOC
  • Sensory deficits
  • motor weakness
  • pupillary dysfunction (size, shape, reaction)
  • possible seizure
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16
Q

Late findings of TBI

A
  • decreased LOC…. possibly coma
  • vomiting
  • hemiplegia (posturing)
  • change in vital signs
  • respiratory irregularities
    -impaired brainstem reflexes (corneal, gag)
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17
Q

Late sign of herniation in rising ICP

A

Cushings triad

  • hypertension
  • Bradycardia
  • Abnormal respiratory patterns
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18
Q

Treatment of elevated ICP

A

Nursing care

Management of BP

Optimizing O2, ventilation

Ventricular drainage

Osmotic therapy

Hyperventilation

Sedation / paralytics

High dose barbiturate therapy

Hypothermia

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19
Q

Tier 1 interventions for decreasing ICP

A

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

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20
Q

Measures to cool patient to prevent increase ICP

A
  • Antypyretics
  • cooling blanket

Shivering increased ICP

21
Q

Decompression craniectomy for

A

Hematoma
Tumor
Abscess

22
Q

Administration of t-PA must commence within

A

4.5 hours of stroke onset

23
Q

tPA Exclusion Criteria

A
  1. Previous Intracranial hemorrhage
  2. Serious head trauma within 4 months
24
Q

tPA Inclusion Criteria

A
  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
25
Q

ischemic stroke

A

can be subclassified into atherothrombotic, embolic, hypoperfusion, or hypercoagulable state

“clots that decrease perfusion to the brain”

26
Q

2 classifications of strokes

A

Ischemic
or
Hemorrhagic

27
Q

SAH presentation

A
  • sudden onset of a severe headache (Thunderclap headache)
  • Stiff neck .
  • Sudden weakness
28
Q

Meningitis

A

Infection of the brain and spinal chord

29
Q

Encephalitis

A

Inflammation of brain Parenchyma

  • Fever
  • HA
  • AMS
30
Q

brain abscess

A

A infected puss filled fluid in the brain

31
Q

General symptoms of CNS infections

A
  • Fever
    Headache
  • Neck ache (meningitis)
32
Q

Meningitis symptoms (All)

A

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

33
Q

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

A

BEFORE

34
Q

1 cause of Meningitis

A

Strep Pneumonia (Gram + diplococci)

35
Q

Niseria Meningitis is most common in

A

Adolescents / Young adults (<31y/o)

36
Q

Listeria Meningitis is most common in

A

children <2 and older adults >55

37
Q

Diagnostic for Meningitis

A
  • CT Head
  • Lumbar puncture
38
Q

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

A

Niseria Meningitis (Gram - diplococci)

39
Q

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

A

Elevated

40
Q

normal glucose in CSF indicates it is

A

not bacterial infection

41
Q

Empiric therapy for Meningitis

A

Vancomycin & ceftriaxone
dexamethasone

> 60 or immunocompromised ADD Ampicillin

42
Q

Treatment for viral meningitis

A

supportive care+ Acyclovir (Severe case)

43
Q

Causes of encephalitis are usually

A

VIRAL

HerpesSimplex (HSV)-> Most common in US

44
Q

Diagnostic for encephalitis

A

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

45
Q

Most accurate test to diagnose encephalitis

A

CSF PCR

46
Q

Treatment for encephalitis

A

Acyclovir
steroids- dexamethasone

47
Q

Brain abscess infections are

A

Focal Infection of the brain parenchyma.

Can occur in:
Immunocompromised
IV drug users
s/p Neurosurgical procedure

48
Q

Diagnostic for Brain abscess

A

CT Head or MRI Brain
CSF not useful

49
Q

Empiric therapy should not be delayed when treating

A

Brain Abscess

50
Q

Cover 3 classes of Bacteria for treating brain abscess:

A

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

51
Q

Xanthochromia is positive is CSF fluid of

A

Subarachnoid hemorrhage

Acute Gero 1 (13 decks)

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