Neurologic Emergencies Flashcards
What are the high risk features of headaches?
- age > 50 (tension and cluster HA tend to decrease with age)
- abrupt onset of severe headache
- thunderclap
- change in pattern. frequency, etc etc
Diagnostics for HA:
- CT =
- MRI with and without contrast, MRA, CTA
- LP =
- ICH, SAH, cerebral venous thrombosis, tumor
- meningitis, SAH
SAH is hemorrhaging resulting from rupture of an _________________ only caries a _______________ survival rate.
CT alone MAY not suffice if obtained within _______________.
If beyond this timeframe, the CT is negative, then must do a ________________ to detect __________ or ____________ in the CSF.
intracranial aneurysm
30 day
6 hours
LP, blood, xanthochromia
What imaging is the gold standard for detecting aneurysms?
angiography
What is the definitive treatment for SAH?
surgical clipping or endovascular coiling
prevent the risk of rebleeding (nimodpipine) and seizures (phenytoin)
Intracerebral hemorrhage presents as severe and sudden headache likely with some neurologic deficit indistinguishable from a stroke.
What are the most common causes?
What are the most common bleeding sites?
Diagnostic test?
the most common cause is advancing age and damage of intracerebral arterioles by long standing HTN
common bleeding sites: basal ganglia, thalamus, internal capsule
NON contrast CT
What is the treatment for intracranial hemorrhage?
treat elevated BP (not too aggressive)
if systolic is over 200, then treat with IV nicardipine 5mg/hr or labetalol 20 mg bolus q 10 minute- targets sbp of 140-160
elevate HOB if suspected elevated ICP
What is the initial treatment of migraine headaches?
Which medication is NOT first line therapy?
Which med would be useful in decreasing risk for headache recurrence after ED discharge?
Which meds are contraindicated during pregnancy?
What is the goal ?
- IV with dopamine receptor antagonist
- keterolac 30/60 mg IV
- sumpatriptan 6 mg
not first line = OPIATES
steroids= DEXAMETHASONE
in pregnancy, triptans are contraindicated, no nsaids in 3rd trimester.
to reduce SEVERITY of HA not to reduce it
A non-traumatic spontaneous subdural hematoma presents as ________________ that is more insidious rather than acute in the elderly population. This headache is activation of _____________ within the dura. This is common in patients on _____________________ agents.
These patients may also have signs of….
new headache
nocioceptors
antiplatelet/anticoagulation
signs:
light headedness, cognitive impairment, apathy or depression, parkinsonism, gait ataxia, somnolence, seizures
Carotid/vertebral artery dissection aka cervical artery dissection is a major cause of stroke in __________________ population.
What are the causes?
What are the symptoms?
Internal carotid dissection will present with __________________ symptoms
Vertebral artery dissection will present with ___________________ symptoms
young and middle aged
causes: minor cervical trauma (chiro), coughing, sneezing and physical activity.
symptoms: HA, neck pain, neruo sx, dizziness/vertigo, visual loss,*** HORNER SYNDROME WITH PTOSIS AND MIOSIS OF THE AFFECTED SIDE ****
int carotid: ant circulation sx
vertebral: post circulation
What is the diagnostic study of choice and treatment for patients with carotid artery stroke?
diagnostic: CTA
Tx: treat like stroke pt
thrombolytics or endovascular therapy
Temporal arteritis/giant cell arteritis is an inflammatory condition affecting the small and medium sized ______________ and ____________ vessels. This is primarily a disease of those > _____________ years old, its incidence increases with age. In addition to HA, other symptoms may include…
You want to begin treatment with _________________ daily upon suspicion to minimize morbidity from visual impairment.
intracranial, extracranial
> 50
fever, fatigue, proximal muscle weakness, JAW CLAUDICATION*
or TIA symptoms** especially transient visual loss.
prednisone 60 mg
Cluster headaches have a ________________ and ______________. What is the treatment ?
circadian, circannual pattern: recurring daily for more than a week and remitting for at least 4 weeks.
100% oxygen administed at 12L/min for 15 minutes through a nonebreathing face mask.
Sumatripatin 6 mg
Intranasal lido 10&
Stroke - ischemic - thrombosis vs embolic, majority are from __________________, or hemorrhagic. This results in cerebral ischemia or infarction. A stroke presents as ___________________ or ______________. The door to CT time for a potential stroke patient is within _____________ of ED arrival. Head CT rules out ________________.
atherosclerosis.
focal/global neuro deficits or AMS
20 minutes
hemorrhagic stroke
For patients that had a stroke, the exact time of onset of symptoms is important because thrombolytic window is ___________ and some say __________.
3 hours, 4.5