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Emergency Medicine > Neurologic Emergencies > Flashcards

Neurologic Emergencies Flashcards

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1
Q

In the presence of HA, the below are indicative of…

 Nausea/vomiting
 Papilledema
 Unilateral or bilateral fixed pupil
 consciousness
 Decorticate or decerebrate posturing
A

elevated ICP

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2
Q

Ominous finding of elevated ICP…

A

Cushing’s triad

bradycardia, hypertension, resp. depression

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3
Q

Lab workup for elevated ICP

A 
type and cross
CBC
CMP
Osmolality
BAL/Tox Screen
Glucose
Coags

CT/MRI

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4
Q

Initial Tx of elevated ICP… (5)

A 
Head of bed 30 degrees
O2
hyperventilation
BP control/NS
Mannitol
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5
Q

Gold standard of ICP monitoring…

A

Intraventricular monitor

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6
Q

The below are indications for what ICP intervention?

at risk
GCS < 8
aggressive medical care

A

Intraventricular monitor

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7
Q

In increased ICP hyperventilation, what is the target PCO2?

A

26-30 mmHg

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8
Q

Neuro presentation of linear skull fx?

A

no neuro sxs

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9
Q

3 MC regions of linear skull fx

A

temporoparietal
frontal
occipital

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10
Q

A linear skull fx on the _____ bone can disturb vascular structures and cause bleeding…

A

temporal bone

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11
Q

Linear skull fx can be managed with ED observation for 4-6 hours if what two things are present…

A

neg CT

no neuro deficit

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12
Q

_____ skull fx often involves injury to brain parenchyma

A

depressed

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13
Q

mgmt of depressed skull fx…

A

CT
neuro admit
+/- Td

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14
Q

What skull fx can tear the dura, causing communication in subarachnoid space, sinuses, and middle ear?

A

basilar skull fx

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15
Q

A basilar skull fx of the ______ increases risk of epidural hematoma

A

temporal bone

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16
Q

What is an important facet of mTBI assessment?

A

mental status testing

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17
Q

Closed head injury home disposition…4 factors…

A

GCS 15
normal CT
no bleeding risk
can monitor at home

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18
Q

The below are ED precautions for…


Unable to awaken the patient

Severe or worsening headaches

Somnolence or confusion

Restlessness, unsteadiness, or seizures

Vison changes

Vomiting, fever, or stiff neck

Urinary or bowel incontinence

Weakness or numbness involving any part of the body
A

closed head injury

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19
Q

This is the shearing of white matter tracts from traumatic deceleration/blunt trauma

A

diffuse axonal injury

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20
Q

this is a cause of persistent vegetative state

A

diffuse axonal injury

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21
Q

CT shows blurring of grey-to-white margin, small lesions in white tracts, cerebral hemorrhage and/or edema

A

diffuse axonal injury

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22
Q

surgery for diffuse axonal injury?

A

no

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23
Q

Brief LOC –> lucid interval
–> rapid clinical
deterioration

A

epidural hematoma

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24
Q

this intracranial hematoma is associated with adolescents and young adults w/ skull fx and trauma

A

epidural hematoma

middle miningeal artery

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25
Q

most subdural hematomas occur via…

A

falls

bridging vein tear

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26
Q

The below describes what “rule”:


Age ≥40 years

Neck pain or stiffness

Limited neck flexion on examination

Witnessed loss of consciousness

Onset during exertion

Thunderclap headache (instantly peaking pain)
A

Ottowa SAH rule

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27
Q

If CT is negative and SAH is suspected, what diagnostic is mandated?

A

LP

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28
Q

what can be done in lieu of LP in SAH?

A

CTA

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29
Q

Pt. p/w:

Acute onset of focal neurologic deficit 

Increasing neurologic signs/symptoms over time

Headache

Vomiting

Decreased LOC

Seizures
A

ICH

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30
Q

MC etiology of ICH?

A

HTN

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31
Q

Imaging for ICH?

A

stat non-contrast CT or MRI (smaller lesions)

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32
Q

important facet of ICH management

A

BP 140-160/90

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33
Q

Labs for CVA… (5)

A 
coags
CBC
CMP
Tox
fingerstick glucose
34
Q

Imaging for CVA…

A

state noncontrast CT w/in 20 min

35
Q

If non-hemorrhagic CT, what can be administered?

A

ASA

36
Q

3 MC findings for Ischemic Stroke…

A

facial paresis

arm drift/weakness or paresis

abnormal speech

37
Q

tPA infusion should be _____ from time of arrival in ED and ______ from onset of sxs

A

less than 60 min

less than 4.5 hours

38
Q

2 criteria for status epilepticus

A

5+ minutes

2+ seizures w. incomplete recovery

39
Q

Initial mgmt of status epilepticus…

A

BZ + anticonvulsants x 2 dose max

40
Q

If continued seizure activity after administration of BZs and anticonvulsants?

A

IV midazolam/propofol/pentobarbital

41
Q

continuous _____ monitoring is required for status epilepticus

A

EEG

42
Q

C-spine nexus criteria (5)…(no imaging needed)

A

no midline tenderness, intoxication, painful injury

normal LOC, neuro exam

43
Q

What type of c-spine fx?

vertical compression transmitted to lateral masses of atlas…

fx of arches of c1

A

Jefferson/Burst fx

44
Q

Imaging for Jefferson/Burst fx…

A

X-Ray –> CT

45
Q

What type of c-spine fx?

MOI: extreme hyperextension via abrupt deceleration

bilateral pedicle fx

A

C2 pedicle fx (hangman’s)

46
Q

Why minimal spinal cord damage in pedicle fx?

A

AP diameter at C2 is greatest

47
Q

what is the MOI of an odontoid fx?

A

forceful flexion or extension

48
Q

What type of C2 fx?

Stable

occurs above transverse ligament

A

Type 1

49
Q

What type of C2 fx?

unstable
base of dens at C2 attachment

non-union in 50%

A

Type 2

50
Q

What type of c-spine fx?

Fx thru upper body of C2
unstable

A

Type 3

51
Q

What type of c-spine fx?

MOI: direct axial load

fragment displacement

A

burst fx

52
Q

What time of complete SCI?


Absent reflexes

Flaccid muscles

Loss of sensation

Priapism in men

Urinary retention
A

acute ( < 1 day)

53
Q

What time of complete SCI?


Hyperreflexia

\+Babinski

Spasticity
A

1-3 days post injury

54
Q

Patient presents with:

motor impairment

loss of reflexes

bilateral loss of pain/temp sensation

bladder dysfunction

A

Anterior cord syndrome

55
Q

What sensations are preserved in anterior cord syndrome?

A

tactile, proprioception, vibratory

56
Q

Etiology: cord infarct, disc hernation

A

anterior cord syndrome

57
Q

Patient p/w:

motor impairment UE > LE

variable sensory loss below injury

+/- bladder dysfunction…

A

central cord syndrome

58
Q

What is preserved in central cord syndrome?

A

vibration, proprioception

59
Q

MOI extension injury, compression, slow growing lesion

A

central cord syndrome

60
Q

Pt. p/w:

motor weakness
hyperreflexia
gait ataxia
paresthesia

A

posterior cord syndrome

61
Q

what is initially preserved in posterior cord syndrome?

A

bladder function

62
Q

MOI: MS, tumors, subluxation

Etiology: bilateral dorsal column, corticospinal tract involvement

A

posterior cord syndrome

63
Q

Pt. p/w:

ipsilateral motor paralysis and loss of proprioception/vibration

contralateral loss of pain/temp

A

brown sequard

64
Q

What is preserved in brown sequard?

A

bladder fxn

65
Q

MOI: penetrating injury

etiology: lateral hemi section, dorsal column unilateral

A

brown sequard

66
Q

prognosis of brown sequard?

A

good

67
Q

Which imaging for spinal alignment/fracture?

A

radiograph

68
Q

Which imaging for ligamentious/spinal cord injury?

A

high res CT or MRI

69
Q

Roots of the phrenic nerve emerge where? (diaphragm innervation)

A

C3/4/5

“C3,4,5 keep the diaphragm alive”

70
Q

Unstable lesions above ____ may cause immediate respiratory paralysis

A

C3

71
Q

The below can cause…


Intervertebral disc herniation

Epidural abscess

Tumor

Lumbar spinal stenosis

Metastatic disease

Infectious

Autoimmune
A

cauda equina syndrome

72
Q

patient presents with:

LBP + LE radiation
LE weakness
Atrophy of calves
Perineal sensory loss

A

cauda equina

73
Q

Imaging for cauda equina syndrome

A

stat non-contrast MRI

74
Q

Clinical suspicion of cauda equina warrants immediate admin of…

A

dexamethasone 10mg IV x 1

75
Q

What preceeds onset of guillen barre?

A

URI/gastroenteritis 1-3 weeks prior

c. jejuni mc

76
Q

pt p/w:

absent/depressed DTRs
CN involvement
gait problems
paralysis/paresthesia
Dysautonomia
A

guillen barre

77
Q

is there fever with guillen barre?

A

no

78
Q

30% of guillen barre results in…

A

severe respiratory involvement

79
Q

Diagnostics for guillen barre

A

CSF studies

EMG-NCS (not in ED)

80
Q

CSF findings in guillen barre

A

elevated protein

normal WBCs

81
Q

Tx for guillen barre that usually occurs outside of ED

A

IVIG or plasmapheresis

Emergency Medicine (12 decks)

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