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Nelson - Emergencies > Neurologic Emergencies > Flashcards

Neurologic Emergencies Flashcards

1
Q

Normally, ___ accounts for up to 85% of the contents of the cranial vault

A

Brain parenchyma

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2
Q

CSF pH that can produce cerebral ischemia

A

Increase in pH

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3
Q

Hallmark of severe TBI

A

Coma (GCS 3-8)

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4
Q

GCS indicating moderate TBI

A

9-12

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5
Q

In TBI, ICP should be maintained at

A

<20mmHg

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6
Q

Reasonable indications for CT imaging in TBI

A

LOC or amnesia >5 min, persistent dizziness, mental status changes, focal neurologic defects, depressed skull fracture, signs of a basilar skull fracture, drug or alcohol use, age <2, suspected child abbuse, falls from >3m, high speed injuries

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7
Q

MCC of death from TBI in infants

A

Abusive head trauma

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8
Q

Leading cause of hypoxic-ischemic insults leading to HIE in infants and children

A

Asphyxia arrest

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9
Q

These define the need for neuroprotective interventions in perinatal asphyxia (3) e.g. therapeutic hypothermia

A

1) Fetal acidosis 2) 5-min APGAR of 0-3 3) Neurologic dysfunction and/or abnormal EEG findings

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10
Q

First goal in HIE

A

Optimize cardiac output and cerebral perfusion

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11
Q

Seizure of sufficient duration to provide an enduring epileptic focus

A

Status ep

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12
Q

Diagnosis of status ep is made with

A

EEG

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13
Q

Development of epilepsy after status ep occurs in up to ___% of children

A

30

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14
Q

Predominant causes of ischemic stroke in children responsibble for ~50% of strokes after the neonatal period

A

1) Sickle cell disease 2) Heart disease

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15
Q

Ischemic strokes in children are generally the result of

A

Damage to the intima of cerebral arteries which can form a thrombotic nidus

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16
Q

Predominant presentation of children with stroke

A

Abrupt onset of focal neurologic deficits

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17
Q

Predominant presentation of children with intracerebral hemorrhage

A

Coma

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18
Q

Major complication of stroke

A

Hemorrhagic transformation

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19
Q

Major complication of aneurysmal SAH

A

Vasospasm

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20
Q

The only approved acute therapy for stroke

A

rTPA within 3 hours IV or within 6 hours intrarterially into the occlusion

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21
Q

Guidelines for the management of pediatric stroke

A

1) ICP monitoring 2) RBC exchange/transfusion therapy for children with sickle cell disease 3) Anticoagulation and/or thrombolytics IF ICP MANAGEMENT IS NOT WARRANTED 4) Continuous EEG monitoring for children with tracheal intubation 5) Thrombolytics for children with cerebral venous sinus thrombosis

22
Q

Herniation syndromes: Supratentorial to infratentorial

A

Transtentorial or uncal

23
Q

Herniation syndromes: Increased ICP in one hemisphere

A

Subfalcine

24
Q

Herniation syndromes: Cerebellar mass or edema

A

Foramen magnum

25
Q

Herniation syndromes: Compression of the cerebral peduncles

A

Transtentorial or uncal

26
Q

Herniation syndromes: Compression of the anterior cerebral artery

A

Subfalcine

27
Q

Herniation syndromes: Compression of the midbrain

A

Transtentorial/uncal

28
Q

Herniation syndromes: Compression of the cerebellar tonsils

A

Foramen magnum

29
Q

Herniation syndromes: Compression of CN III

A

Transtentorial/uncal

30
Q

Herniation syndromes: Compression of the posterior circulation

A

Transtentorial/uncal

31
Q

Herniation syndromes: Compression of the medulla oblongata

A

Foramen magnum

32
Q

Herniation syndromes: Dilated ipsilateral pupil

A

Transtentorial/uncal

33
Q

Herniation syndromes: Hemiparesis

A

Transtentorial/uncal

34
Q

Herniation syndromes: Bladder incontinence

A

Subfalcine

35
Q

Herniation syndromes: Bradycardia, bradypnea, htn, death

A

Foramen magnum

36
Q

Herniation syndromes: Hemiparesis

A

Transtentorial/uncal

37
Q

Herniation syndromes: Cushing triad

A

Transtentorial/uncal

38
Q

Herniation syndromes: Decerebrate posturing

A

Transtentorial/uncal

39
Q

In children, brain death most commonly follows

A

TBI or asphyxia

40
Q

Standard for diagnosis of brain death

A

Repeat clinical exam (it is a CLINICAL DIAGNOSIS)

41
Q

3 key components of clinical brain death

A

1) Irreversible coma/unresponsiveness 2) Absence of brainstem reflexes 3) Apnea

42
Q

Extension of the upper extremities followed by flexion of the arms with the hands reaching to midsternal level

A

Lazarus sign

43
Q

What does the apnea test assess

A

Function of the medulla in driving ventilation

44
Q

How do you do the apnea test

A

Preoxygenate with 100% O2 ~10mins > adjust ventilation to achieve pCO2 of about 40 > CPAP > assess for breathing efforts through observation and auscultation > ABG 10 mins into the test and every 5 mins thereafter until target pCO2 is surpassed

45
Q

Positive apnea test

A

Absence of respiratory efforts with pCO2 >60 or more than 20 from baseline

46
Q

To establish diagnosis of brain death, findings must remain consistent over a period of observation: For 7 days to 2 mos

A

2 exams separated by at least 48 hours

47
Q

To establish diagnosis of brain death, findings must remain consistent over a period of observation: For 2 mos to 1 year

A

2 exams separated by at least 24 hours

48
Q

To establish diagnosis of brain death, findings must remain consistent over a period of observation: Older than 1 y/o

A

2 exams separated by at least 12 hours

49
Q

Confirmatory testing of brain death should be performed on what population

A

All children <1 y/o

50
Q

Confirmatory testing of brain death

A

EEG, nuclear medicine cerebral flow scans etc.

51
Q

EEG finding that supports diagnosis of brain death

A

Electrocerebral silence

Nelson - Emergencies (6 decks)

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