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Emergency Medicine > Neurologic Emergency > Flashcards

Neurologic Emergency Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Delirium vs Dementia

A

Delirium: can’t think, arousal level is down - acute onset, reversible

Dementia: chronic degenerative onset - arousal level is fine but cognition is down

  • look for a change compared to baseline
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2
Q

AMS - Immediate life threats

A

Hypoglycemia

Hypo/hypertension

Hypoxia

Abnormal respirations

Hypo/hyperthermia

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3
Q

AMS DDx - AEIOU TIPS

A

Alcohol

Epilepsy; Electrolytes;Encephalopathy

Insulin; Intussusception

Overdose; Opiates

Uremia

Trauma; Temperature

Infection’ Intracerebral hemorrhage

Psych; Poison

Shock

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4
Q

Status Epilepticus

A

5 minutes or more of convulsions or 2 or more convulsions in 5 minutes without return to neuro baseline

R/o hypoglycemia as cause - give thiamine then dextrose

Benzos are 1st line; Fosphenytoin or Valproic acid 2nd; Phenobarbital or Versed for refractory

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5
Q

Status Epilepticus Etiologies

A

Vascular

Toxic

Metabolic

Infectious

Trauma

Neoplastic

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6
Q

Anterior Cerebral Artery Stroke

A

Dysarthria, aphasia

Unilateral contralateral motor weakness - greater in lower extremities

Lower extremity sensory changes

Urinary incontinence

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7
Q

Middle Cerebral Artery Stroke

A

Contralateral hemiparesis greater in face and arms with hemianopsia (1/2 visual field)

Ipsilateral gaze preferred

Aphasia if dominant hemisphere - Brocas, Wernikes, Global

Hemi-neglect if non-dominant

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8
Q

Posterior Cerebral Artery Stroke

A

Contralateral hemiparesis

Cortical blindness

AMS

Impaired memory

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9
Q

Intra-Parenchymal Hemorrhage (IPH)

A

Hemorrhage w/in brain tissue

Often clinically silent - sx depend on location

-MC are hemiparesis, aphasia, hemianopsia; can mimic ischemic stroke

HTN is MC cause - also anticoags, Cocaine/Meth, aneurysms

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10
Q

Intraventricular Hemorrhage (IVH)

A

Often IPH extending into ventricles

HA, N/V, progressive LOC, increased ICP, nuchal rigidity

Increased risk of obstructive hydrocephalus

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11
Q

Subarachnoid Hemorrhage

A

Aneurysm rupture is MC cause

Thunder-clap HA

CN 3 palsy - down and out gaze w/ ptosis

CN 6 palsy - unable to look out (Increased ICP causes)

Retinal hemorrhages, AMS, nuchal rigidity

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12
Q

Cushing’s Triad

A

Caused by Increased ICP

Increased BP with wide pulse pressures

Irregular breathing (impaired brainstem function)

Bradycardia

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13
Q

Mannitol

A

MC osmotic diuretic - used for increased ICP

Have to monitor fluid loss - very potent

Administer with hypertonic saline - keeps fluid in vessels and out of brain

Monitor serum sodium and osmolality, renal function

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14
Q

Increased ICP Treatment

A

Mannitol with hypertonic saline

Sedation with propofol - reduces metabolic demand

-Heavy sedation and paralysis with refractory increased ICP

Craniectomy - 15% decrease; w/ dura removal - 70% decrease

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15
Q

Central Vertigo Causes

A

Migrainous

Brainstem ischemia

Cerebellar infarction and hemorrhage

MS

-Gait disturbances more pronounced; lasts hours to days

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16
Q

Peripheral Vertigo Causes

A

BPV

Vestibular neuritis

Meniere’s disease

Labyrinthitis

Acoustic neuroma

Aminoglycoside toxicity

Otitis Media

-N/V more severe; recurrent and last minutes to 2-3 hours

17
Q

Myasthenic Crisis

A

Myasthenia gravis - neuromuscular transmission disorder to ocular, bulbar, limb and respiratory muscles

Crisis occurs when there is severe enough weakness to require intubation

Generalized weakness is a warning sign - monitor FVC

Intubate when FVC <15 mL/kg - elective

Plasmapheresis or IVIG to treat

18
Q

Multiple Sclerosis Emergencies

A

Acute exacerbation causing functional disabling symptoms with neurologic impairment

Treat with high dose methylprednisolone

MS may cause seizures - treat the seizures

19
Q

Guillian-Barre Syndrome

A

Symmetric ascending muscle weakness - begins in proximal legs

Severe respiratory muscle weakness

Paresthesias in hands/feet, severe back pain

Dx with LP

r/o if: demarcation in sensation; marked, persistent weakness asymmetry; severe bowel and bladder dysfunction; >50 wbcs in CSF

Emergency Medicine (10 decks)

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