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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
Q

things that cause abnormal CT that mimic stroke

A
  • ICH
  • tumor w/ bleed or seizure
  • abscess w/ seizure
  • subdural hematoma
26
Q

MC cause of stroke mimic?

A

ICH

27
Q

things that mimic stroke that are normal on CT

A
  • hypoglycemia

- somatic sx

28
Q

stroke reactivation mechanism

A
  • 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
Q

what are possible triggers that could reactivate old stroke deficit?

A
  • toxic metabolic insults like
  • infection
  • alcohol
  • sedating meds
  • fever
  • fatigue
30
Q

important to remember about stroke / TIA

A

-no one has the same stroke or TIA over and over

31
Q

if a pt has repeat spell that are always the same, one of what 3 things is happening?

A
  1. old stroke temporarily reactivated
  2. seizures from old stroke
  3. migraine aura
32
Q

what is the exception that allows for lowering BP in AIS

A
  • if necessary to give IV tPA

- if pt also has acute MI, CHF or aortic dissection

33
Q

if you do need to slightly lower BP during AIS to give tPA, what are the tx options?

A
  • nicardipine IV
  • clevidipine IV
  • lebetalol IV
34
Q

BP targets pre and post tPA

A
  • pre-tPA: < 185/110

- post-tPA: < 180/105

35
Q

tPA dose

A
  • 0.9 mg/kg MAX 90 mg

- give 10% via bolus, remaining via 1 hr infusion

36
Q

absolute contraindications for tPA

A
  • 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
Q

relative contraindications of tPA

A
  • seizure at onset
  • glucose > 400
  • major surg or trauma w/i 2 weeks
  • left anterior STEMI w/i 3 mos
38
Q

review

A
  • cerebral arterial territories on CT

- slide 92

39
Q

MCA supplies

A
  • cortex: face and arm

- subcortex: face, arm and leg

40
Q

blockage of distal end of M1 causes

A

-only face and arm weakness

41
Q

blockage of proximal beginning of M1 causes

A

face, arm and leg weakness (same as distal ICA)

42
Q

labs to get before tPA admin

A
  • FSBG
  • noncontrast CT brain
  • contrast CTA
43
Q

labs to get to determine if thrombectomy candidate > 4.5 hrs

A
  • FSBG
  • noncontrast CT brain
  • contrast CTA
  • CT perfusion
44
Q

which type of stroke is good for thrombectly b/c often resistant to tPA alone?

A

large clot blocking MCA

45
Q

3 MC causes of ischemic stroke

A
  • large artery atherosclerosis
  • smalla artery dz
  • cardioembolism
46
Q

3 less common but not rare causes of ischemic stroke

A
  • nonatherosclerotiv vasculopathies
  • hypercoagulable state
  • hypoperfusion
47
Q

ICH =

A
  • intracerebral hemorrhage

- bleedin ginto brain tissue d/t nontraumatic vessel rupture

48
Q

two type of ICH

A
  • hypertensive

- non-hypertensive

49
Q

hypertensive ICH

A
  • d/t chronic HTN
  • damage small penetatory arteries in medial brain:
  • basal ganglia, thalamus, pons, cerebellum
50
Q

non hypertensive ICH

A
  • outer brain (lobar hemorrhage)

- causes: amyloid angiopathy in dementia pts, ruptured AVMs, bleeding tumors, bleeding disorders

51
Q

MC cause of subarachnoid hemorrhage (SAH)

A
  • trauma

- MC nontraumatic cause: saccular aneurysm rupture

52
Q

MC locations of cerebral saccular aneurysms

A
  • Ant. communicating
  • post. communicating
  • MCA
  • basilar a.
53
Q

MC area for saccular aneurysm d/t chronic HTN

A

tip of basilar a. (very dangerous)

54
Q

hx and exam of SAH

A
  • sudden severe HA, perhaps after valsalva maneuver (commonly sex)
  • stiff and painful neck, photophobia
  • depressed consciousness
  • n/v
55
Q

eval of SAH

A
  • find the blood (CT or lumbar puncture)
  • find the aneurysm (cath or CTA)
  • use Hunt and Hess scale to get prognosis
56
Q

tx of SAH

A
  • prevent rebleeding w/ clip or coil

- manage complications like vasospasm

57
Q

vasospasm

A
  • delayed cerebral ischemia
  • basically is clamping down of arteries in the brain
  • d/t effect on arteries of blood breakdown products
58
Q

tx of vasospasm

A
  • nimodipine 60 mg PO q 4 hr x 21 days

- maintain high-normal BP

59
Q

other complications w/ SAH

A
  • seizure
  • hyponatremia
  • hydrocephalus
  • cardiac arrythmias

Neurology 2 (21 decks)

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