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Neurology 2 > Neurologic Emergencies 2 > Flashcards

Neurologic Emergencies 2 Flashcards

1
Q

signs of basilar skull fracture

A
  • raccoon eyes (periorbital hematoma)
  • CSF rhinorrhea or otorrhea
  • battle sign
  • hemotypmanum
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2
Q

battle sign

A

postauricular hematoma

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3
Q

subdural hematoma

A
  • closed head injruy
  • tearing of bridging veins
  • acute, subacute, or chronic
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4
Q

epidural hematoma

A
  • skull fracture
  • tearing of middle meningeal a.
  • concussion, lucid interval
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5
Q

cerebral contusion

A

traumatic intracerebral hemorrhage

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6
Q

who is more prone to subdural hematomas and why

A
  • elderly

- d/t their brain atrophy pulling on the bridging veins

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7
Q

what is the best initial imaging to detect ACUTE blood and skull fracture?

A

CT w/o

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8
Q

what imaging modality is best to detect subacute blood?

A

MRI w/o

-isodense and hard to see on CT

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9
Q

shape of subdural hematoma on CT

A

concave to the bone (crescent shape)

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10
Q

shape of epidural hematoma on CT

A

convex to the bone

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11
Q

what are the 2 MC types of cerebral herniation after head trauma?

A
  1. subfalcine herniation

2. uncal herniation

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12
Q

subfalcine herniation

A
  • shift across midline

- causes bicerebral dysfunction w/ depressed consiousness

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13
Q

uncal herniation

A
  • unilateral transtentorial
  • causes midbrain compression w:
  • depressed consciousness (RAS)
  • ipsilateral ptosis and ophthalmoplegia
  • contralateral decerebrate posturing
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14
Q

management of uncal herniation

A
  • elevate head 30 degrees w/ head straight
  • intubate and hyperventilate
  • insert cath
  • give mannitol 100 g IV rapidly
  • give dexamethasone 10-20 mg IV
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15
Q

when do you not use steroids in tx of uncal herniation

A

if it’s d/t large ischemic stroke

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16
Q

penumbra

A

zone of reversible ischemia around core of irreversible infarction during first hours to day after ischemic stroke onset

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17
Q

two tx option to try and save penumbra

A
  1. IV tPA

2. mechanical thrombectomy

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18
Q

mechanical thrombectomy

A
  • removing certain large clots
  • in addition to tPA w/i 6 hrs of onset
  • or instead of tPA w/i 6-24 hrs of onset
  • may save penumbra neurons and improve outcome
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19
Q

what conditions to avoid when trying to save penumbra

A
  • low BP
  • hyperglycemia
  • fever
  • seizure
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20
Q

goal of primary care providers for stroke

A

-prevent the first stroke (primary prevention)
or
-prevent a recurrent stroke (secondary prevention)

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21
Q

goal of prehospital and emergency providers for stroke

A
  • preserve penumbra (AIS)

- prevent complications

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22
Q

goal of hospital providers for stroke

A
  • preserve penumbra (AIS)
  • prevent complications
  • promote recovery
  • pinpoint etiology
  • prevent recurrent stroke
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23
Q

what complications are important to prevent in stroke?

A
  • aspiration pneumonia: elevate head of bed and keep pt NPO
  • UTI
  • hematuria
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24
Q

what conditions most commonly fool physician into mistaking for stroke?

A
  • old stroke or lesion w/ either partial seizure / postictal state or reactivated
  • partial seizure
  • migraine aura
25
things that cause abnormal CT that mimic stroke
- ICH - tumor w/ bleed or seizure - abscess w/ seizure - subdural hematoma
26
MC cause of stroke mimic?
ICH
27
things that mimic stroke that are normal on CT
- hypoglycemia | - somatic sx
28
stroke reactivation mechanism
- after stroke, new brain cells form and grow around stroke damaged area - new neurons are less resilient - a trigger could cause temporary worsening of the old deficit
29
what are possible triggers that could reactivate old stroke deficit?
- toxic metabolic insults like - infection - alcohol - sedating meds - fever - fatigue
30
important to remember about stroke / TIA
-no one has the same stroke or TIA over and over
31
if a pt has repeat spell that are always the same, one of what 3 things is happening?
1. old stroke temporarily reactivated 2. seizures from old stroke 3. migraine aura
32
what is the exception that allows for lowering BP in AIS
- if necessary to give IV tPA | - if pt also has acute MI, CHF or aortic dissection
33
if you do need to slightly lower BP during AIS to give tPA, what are the tx options?
- nicardipine IV - clevidipine IV - lebetalol IV
34
BP targets pre and post tPA
- pre-tPA: < 185/110 | - post-tPA: < 180/105
35
tPA dose
- 0.9 mg/kg MAX 90 mg | - give 10% via bolus, remaining via 1 hr infusion
36
absolute contraindications for tPA
- glucose < 50 - BP > 185/110 - took NOAC w/i 48 hrs - endocarditis - aortic dissection - abnl coag panel -also: head trauma, intracranial or spinal surg, ischemic stroke w/i 3 mos, hx of intracranial hemorrhage
37
relative contraindications of tPA
- seizure at onset - glucose > 400 - major surg or trauma w/i 2 weeks - left anterior STEMI w/i 3 mos
38
review
- cerebral arterial territories on CT | - slide 92
39
MCA supplies
- cortex: face and arm | - subcortex: face, arm and leg
40
blockage of distal end of M1 causes
-only face and arm weakness
41
blockage of proximal beginning of M1 causes
face, arm and leg weakness (same as distal ICA)
42
labs to get before tPA admin
- FSBG - noncontrast CT brain - contrast CTA
43
labs to get to determine if thrombectomy candidate > 4.5 hrs
- FSBG - noncontrast CT brain - contrast CTA - CT perfusion
44
which type of stroke is good for thrombectly b/c often resistant to tPA alone?
large clot blocking MCA
45
3 MC causes of ischemic stroke
- large artery atherosclerosis - smalla artery dz - cardioembolism
46
3 less common but not rare causes of ischemic stroke
- nonatherosclerotiv vasculopathies - hypercoagulable state - hypoperfusion
47
ICH =
- intracerebral hemorrhage | - bleedin ginto brain tissue d/t nontraumatic vessel rupture
48
two type of ICH
- hypertensive | - non-hypertensive
49
hypertensive ICH
- d/t chronic HTN - damage small penetatory arteries in medial brain: - basal ganglia, thalamus, pons, cerebellum
50
non hypertensive ICH
- outer brain (lobar hemorrhage) | - causes: amyloid angiopathy in dementia pts, ruptured AVMs, bleeding tumors, bleeding disorders
51
MC cause of subarachnoid hemorrhage (SAH)
- trauma | - MC nontraumatic cause: saccular aneurysm rupture
52
MC locations of cerebral saccular aneurysms
- Ant. communicating - post. communicating - MCA - basilar a.
53
MC area for saccular aneurysm d/t chronic HTN
tip of basilar a. (very dangerous)
54
hx and exam of SAH
- sudden severe HA, perhaps after valsalva maneuver (commonly sex) - stiff and painful neck, photophobia - depressed consciousness - n/v
55
eval of SAH
- find the blood (CT or lumbar puncture) - find the aneurysm (cath or CTA) - use Hunt and Hess scale to get prognosis
56
tx of SAH
- prevent rebleeding w/ clip or coil | - manage complications like vasospasm
57
vasospasm
- delayed cerebral ischemia - basically is clamping down of arteries in the brain - d/t effect on arteries of blood breakdown products
58
tx of vasospasm
- nimodipine 60 mg PO q 4 hr x 21 days | - maintain high-normal BP
59
other complications w/ SAH
- seizure - hyponatremia - hydrocephalus - cardiac arrythmias

Neurology 2 (21 decks)

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