Neurological emergencies

Question 1

What are some things you can do if you see someone having a seizure (general knowledge)?

Answer 1

• do not restrain extremities
• cushion head, remove glasses
• loosen tight clothing
• do not stick you fingers or anything in person’s mouth
• turn pt on side (don’t vomit and aspirate the vomit)
• time the seizure
• look for id
  Don’t hold them down
  offer help as the seizure ends.

Question 2

What do you need to rule out when someone under 40 comes in with seizure?

Answer 2

brain mass

Question 3

what is status epilepticus?

Answer 3

potentially life-threatening condition in which the brain is in a state of persistent seizure.
one continuous, unremitting seizure lasting longer than 5 minutes or recurrent seizures without regaining consciousness

Question 4

what is syncope? would you send to ER?

Answer 4

a transient loss of consciousness and postural tone, characterized by rapid onset, short duration, and spontaneous recovery, due to global cerebral hypoperfusion to the brain [that most often results from hypotension.]
- if there is a concerning underlying cause then send to ER (i.e. trauma)

Question 5

what are the 3 major categories of cerebrovascular disease/accident

Answer 5

Ischemic (embolus)
Hemorrhagic
Transient ischemic attack

Question 6

what is the survival of ischemic tissue dependent on?

Answer 6

availability of collateral circulation, duration, magnitude of reduction, and rapidity of reduction.

Question 7

What is a focal cerebral ischemia generally due to?

Answer 7

embolus or thrombus in a large vessel or vasculitis in medium or small sized vessel
- may result in cerebral infarct in a well circumscribed area of necrosis

Question 8

TIA can last how long?

Answer 8

a few seconds or up to 24 hours (max range)

can return to full neurological condition (also a Rind)

Question 9

what are some risk factors for cerebral infarct (stroke)?

Answer 9

advanced age, hypertension, DM, high cholesterol, tobacco use, and A. Fib. (irreg- greater chance of embolization, esp left atrium)

Question 10

what are some sxs that are more common in hemorrhage stroke vs. ischemic?

Answer 10

N/V, HA, and change in level of consciousness.

[no PE finding, Hx,

Question 11

what population has a greater risk of hemorrhagic stroke in the US?

Answer 11

African Americans

Question 12

what is the most common cause of thrombotic stroke?

Answer 12

Thrombotic occlusion –usually at carotid bifurcation or in vertebrobasilar system ( mc vessel: middle cerebral artery)

Question 13

What is the most common type of stroke?

Answer 13

Ischemic

Question 14

what type of stoke is the most deadly?

Answer 14

hemorrhagic

for all stokes, increased mortality rate in the first month post stroke, need to monitor

Question 15

what are some common sxs of stroke?

Answer 15

abrupt onset of mono/hemi/quadriparesis, mono/binocular visual loss, visual field deficits, diplopia, dysarthria, ataxia, vertigo, aphasia or a sudden change in the patient’s level of consciousness.

Question 16

Dominant hemisphere stroke

Answer 16

(usually left) is involved, a classic syndrome consisting of right hemiparesis, right hemisensory loss, left gaze preference, right visual field cut and aphasia may result.

Question 17

non dominant hemisphere stroke

Answer 17

(usually right sided) hemisphere is involved, a syndrome of left hemiparesis, left hemisensory loss, right gaze preference and left visual field cut may result.

Question 18

what is a key factor when considering thrombolytic therapy?

Answer 18

The time since the stroke has occurred [also location–get a CT scan]

Question 19

The biggest offender of cerebral embolism?

Answer 19

middle cerebral artery (MCA)

Question 20

hemorrhagic stroke is generally due to…?

Answer 20

intracerebral hemorrhage, subarachnoid hemorrhage, subdural hemorrhage, or epidural hemorrhage.

Question 21

what is the primary underlying cause of intracerebral hemorrhage?

Answer 21

Hypertension

Question 22

Hemorrhagic stroke risk is increased with:

Answer 22

Advanced age
Hypertension (up to 60% of cases)
Previous history of stroke
Alcohol abuse
Use of illicit drugs (i.e. cocaine, other sympathomimetic drugs)
- anticoagulant pts

Question 23

What happens to the brainstem with a stroke in that area?

Answer 23

Edema- which increases risk for brainstem herneation and compression –> decrease LOC, apnea, and risk of death.

Question 24

Signs of brainstem involvement?

Answer 24

Gait or limb ataxia 
Vertigo or tinnitus 
Nausea and vomiting 
Hemiparesis or quadriparesis  
Eye movement abnormalities resulting in diplopia or nystagmus 
Oropharyngeal weakness or dysphagia

Question 25

what is the most clinically significant cause of subarachnoid hemorrhage?

Answer 25

rupture of berry (saccular) aneurysm

[an out pouching on the circle of Willis]

Question 26

most clinically significant vascular malformation?

Answer 26

Arteriovenous (AV) malformations

Question 27

What are some symptoms of acute hypertensive encephalopathy?

Answer 27

characterized by diffuse cerebral dysfunction including: headaches, confusion, vomiting, convulsions and possible coma.

Question 28

what someone has a trauma what do you need to document?

Answer 28

Take a good history, did they lose consciousness, palpate scalp for step off phenomena, make sure you do a good neurological exam, check papillary size, document pertinent neg/pos (don’t just list WNL)

Question 29

anisocoria

Answer 29

unequal pupil size, can be a sign of brain injury that is more serious than a concussion (can also be benign- congenital, previous injury, response to lateral light)

Question 30

Where is the location of impact when an individual falls while awake?

Answer 30

occipital portion

Question 31

Where is the location of impact when an individual falls from a syncopal event?

Answer 31

frontal impact

Question 32

Basal skull fracture

Answer 32

linear fractures extending through the petrus portion of the temporal bone that leak spinal fluid from an ear. (associated with hearing loss, instability of gait and vertigo)

Question 33

**what is battle’s sign?

Answer 33

mastoid ecchymosis. Suspect basilar skull fracture (know for final!)

Question 34

**What are raccoon’s eyes?

Answer 34

bilateral periorbital ecchymosis. If the patient is unconscious or has a hx of head trauma, suspect basilar skull fracture. (final)

Question 35

which is venous bleed?

Answer 35

subdural

Question 36

most common symptoms of meningitis

Answer 36

most common symptoms are fever, headache and neck stiffness (nuchal rigidity). severe HA, confusion or altered consciousness, vomiting, and an inability to tolerate light or loud noises.

Question 37

what tests would you do for meningitis?

Answer 37

Kernigs, Brudzinskis’ signs… do CT (cerebral edema),

Question 38

what differentiates bacterial meningitis caused by Neisseria meningitidis?

Answer 38

a petechial rash that frequently develops with meningococcal meningitis. (does not blanch when you press on it) , dangerous bc it can cause death within 48 hours dt vascular disruption

Question 39

in premature babies and newbornes what is the most common bacterial cause of bacterial meningitis?

Answer 39

group B streptococci which normally inhabit the vagina and Escherichia coli that normally inhabit the digestive tract. Listeria monocytogenes is a bacteria that may be transmitted by the mother before birth and may cause meningitis in the newborn

Question 40

In older children: what is the most common bacterial cause of bacterial meningitis?

Answer 40

Neisseria meningitidis and Streptococcus pneumoniae and in countries that do not offer vaccination, Haemophilus influenzae, type B.

Question 41

In adults: what is the most common bacterial cause of bacterial meningitis?

Answer 41

Neisseria meningitidis and Strep pneumoniae together cause approximately 80% of all bacterial meningitis cases.
Risk of infection with Listeria monocytogenes is increased in individuals over 50 years of age

Question 42

what are some non-infectious causes of meningitis?

Answer 42

spread of cancer to the meninges and certain drugs (mainly non-steroidal anti-inflammatory drugs, antibiotics and intravenous immunoglobulins). sarcoidosis, connective tissue disorders such as SLE and certain forms of vasculitis.