Neurological Emergencies Flashcards
Type of brainstem herniation that occurs when the cingulate gyrus herniates to area directly below the falx cerebri in the frontal lobe. results in gait problems and possibly coma due to disruption of anterior cerebral artery.
subfalcial herniation (cingulate hernation)
Type of brainstem herniation that occurs when the temporal lobe passes through tentoriium cerebrii. Damage to occulomotor nerve results in eye that is fixated down and outwards and post ganglionic parasympathetic fibers results in a dilated pupil.
uncal herniation
Type of brainstem herniation that occurs when the cerebellar tonsus hernatiates through the foramen magnum. Affect cardiorespiratory centers of the medulla that is life threatening or results in death
tonsillar herniation
What immobilization device should all patients with a head trauma be in as a precaution?
cervical spine collar
Difference in shape of bleeds between subdural and epidural bleeds on CT scans
subdural is cresent shaped whereas epidural has a biconcave shape
What is the glasgow coma scale of a patient who opens eyes spontaneously, is verbally oriented, and obeys motor commands?
15 (best score). 4 pts for spontaneous eye opening, 5 points for orientation, and 6 points for obeying motor commands
What is the glasgow coma scale of a patient who is unable to open eyes, provides no verbal response, and has no motor response?
3 (worse score). 1 pt for each
What are the ranges for mild, moderate, and severe traumatic brain injury using the Glasgow Coma Scale?
mild 13-15, moderate 9-12, and severe < 8
Type of head injury that may be associated with brief LOC followed by vacant stare, inability to focus, memory deficits, incoherent speech, emotionality out of proportion to events. Neuroimaging is normal
concussion
Indirect trauma that greatly stretches and damages nerve cells causing significant damage and even death and in adults may cause permanent brain damage
shaken baby or severe whiplash
Seen in closed head injuries that are the result of result of shearing forces (deceleration). LOC at time of accident. characterized by multiple focal lesions typically located at the grey-white matter junction
diffuse axonal injury
What criteria must a patient with head injury meet in order to be observed as an outpatient?
GCS = 15 and normal CT scan
What should you always do when repairing a scalp laceration besides anesthetizing the wound, removing hair, and irrigation?
palpate the skull to be sure you don’t feel a fracture
What are the layers of the skull from outside to inside?
skin–>periosteum–>bone–>dura mater–>arachnoid –> pia mater
What locations of skull fractures that are particularly significant/concerning?
those that pass through a sinue or ovelie a major dural venous sinus or the middle meningeal artery
Difficult to view on radiographs but can be felt on palpation under scalp laceration. predispose to significant underlying brain injury and to complications of head trauma
depressed skull fractures
Linear fractures at the base of the skull. Usually occurs through the temporal bone. Can cause dural tear predisposing to infection of cranial cavity or CSF leak through the nose
basilar skull fractures
What are the classic signs of a basilar skull fracture?
intraorbital bruising, retroauricular bruising, and hemotympanum
What are the pharmacological treatment options for a migraine?
1st tryptans. 2nd ketorolac + antiemetic (metoclopramide or prochlorperazine)
What are the treatment options for a cluster headache?
1st 100% O2. 2nd line sumatryptan
What is the main difference between decorticate and decerebrate posture?
in decorticate there is flexion of the lower arms whereas with decerebrate there is extension and pronation of the lower arms (worse prognosis)
What needs to be given before dextrose in a seizure patient since they often occur in alcoholics?
thaimine
What is the first line pharmacological treatment of seizures due to their ability to terminate ictal activity?
benzos
2nd line medication for seizure that does not suppress the electrical activity of ictogenic focus and takes 20 min to onset of action
phenytoin
2nd line medication for seizure that causes sedation, depression of respiratory drive and BP so pt must be monitored closely
phenobarbital
How can peripheral causes of vertigo be distinguished from central causes based on symptoms?
N & V more severe w/ peripheral causes. Gait disturbances are more pronounced w/ central etiologies
What is the difference of duration between central and peripheral vertigo etiologies?
central etiologies last for hours to days, while peripheral are recurrent and last for a few minutes to 2-3 hours
Characterization of CVA symptoms that indicate active discharge from CNS neurons (e.g. visual, auditory, somato-sensory, motor)
positive
Characterization of CVA symptoms that indicate absence or loss of function (e.g. loss of vision, feeling or ability to move a part of the body)
negative
What should be ordered immediately to evaluate a potential stroke patient?
noncontrast CT or MRI of brain
In a patient who is suffering from an ischemic stroke and BP is elevated, at what level should you treat?
SBP > 220 or DBP > 120
In a patient who is suffering from a hemorrhagic stroke is also on warfarin, what can be used to reverse its effects?
IV vitamin K and FFP
What should be initiated within 48 hrs of stroke onset?
antiplatelet agent
occurs when there is severe enough muscle weakness to necessitate intubation in order to prevent respiratory failure
myasthenic crisis
When should elective intubation be considered in a patient who is having a myasthenic crisis?
if serial measurements of the FVC or inability to handle oropharyngeal secretions
What is the treatment for a myasthenic crisis besides intubation?
Plasmapharesis or IVIG
What is the treatment for acute exacerbations of multiple sclerosis?
methylprednisolone 1000 mg IV a day for 5 days
What are treatment options for an exacerbation of chronic pain?
1 time IM dose of Demerol or 1 time dose of PO opioid
Presents with Symmetric ascending muscle weakness that begins as paresthesias in hands/feet. May have severe back pain and dysautonia
Guillan-Barre
How is Guillan-Barre diagnosed?
Marked elevation of CSF protein w/ normal WBC count
