Neurological Emergencies Flashcards
What drug is often used to control blood pressure in SAH or hemorrhagic stroke?
Nimodipine
What study found that t-PA might improve survival in ischemic stroke?
NINDS
Symptoms of dominant hemisphere stroke?
- Contralateral numbness and weakness
- Contralateral visual field deficit
- Gaze preference
- Dysarthria
- Aphasia
Symptoms of non-dominant hemisphere stroke?
- Contralateral numbness and weakness
- Visual field cut
- Hemineglect
- Dysarthria
Posterior cerebral artery stroke symptoms?
- Lack of visual recognition
- AMS with impaired memory
- Cortical blindness (reflexes still intact)
Vertebrobasilar stroke symptoms?
- Dizziness, vertigo
- Diplopia
- Dysphagia
- Ataxia
- Ipsilateral cranial nerve palsies
- Contralateral weakness
Basilar artery stroke symptoms?
- Quadriplegia
2. Locked-in syndrome (except for upward gaze)
Lacunar infarct symptoms?
Pure motor or sensory deficit
What are blood pressure goals in hypertensive urgency and emergency?
Lower MAP 20-25% over first hour
What are commonly used agents for hypertensive urgency?
- Nitroprusside
- Labetalol
- Nicardipine
What is the probable cause of AMS in HTN emergency?
Endothelial cell dysfunction leading to cerebral edema
DOC for BP control in preeclampsia and eclampsia?
- Hydralazine
2. Labetalol 2nd line
Side effect of sodium nitroprusside
Cyanide toxicity
How does sodium nitroprusside work?
Peripheral vasodilator that decreases preload and afterload
β blockers are contraindicated in what patient populations?
- COPD
- Acute asthma
- Heart failure
- Sympathomimetic use
Why is adding esmolol with nitroprusside sometimes helpful?
It can help blunt reflex tachycardia from nitroprusside
What drug can be helpful with BP control in HTN encephalopathy?
Nicardipine. It crosses BBB.
It acts quickly and can cause reflex tachycardia
NTG is contraindicated in what patient populations?
Preload dependent states
- Right sided MI
- Severe aortic stenosis
- LV outflow obstruction
NTG is indicated in what patients with HTN emergency?
Those with myocardial ischemia
Fenoldopam is indicated in what patients with HTN emergency?
Those with renal failure.
It causes vasodilation and natriuresis. It increases RBF and improves creatinine clearance.
Enalaprilat is indicated in with patients with HTN emergency?
It’s the active form of enalapril.
It lowers SVR, pulmonary capillary pressure and heart rate.
Therefore it’s good for patients with pulmonary edema.
What is the only sequela of HTN emergency that requires rapid lowering of blood pressure?
Aortic dissection.
The preferred medication is labetalol alone. Add sodium nitroprusside if this doesn’t work.
What sensory function can be affected by Bell’s palsy?
Taste sensation from anterior 2/3 of tongue
What diseases are differential of Bell’s palsy?
- Lyme
- Temporal zone tumors
- Ramsey Hunt syndrome (Herpes Zoster of geniculate ganglion)
- Acoustic neuroma
- Many more
What are associated symptoms of Bell’s palsy?
- Pain behind ear
- Ipsilateral loss of taste sensation
- Overflow tearing
- Hyperacusis
Treatment options for Bell’s Palsy
- Corticosteroids
- Eye patch while sleeping
- Artificial tears hourly
In neisseria meningitis, antibiotics can sterilize CSF who quickly?
Within 1 hour
In S. pneumo meningitis, antibiotics will sterilize fluids how quickly?
4-10 hours
What will H. influenzae look like on gram stain of CSF?
Small pleomorphic gram-negative coccobacilli
What are the most common causes of meningitis in adults?
- N. meningitidis
- S. pneumo
Rocephin or cefotaxime
Why is vanc added to most meningitis regimens in adult?
To cover for resistant s. pneumo until resistance profile is obtained
Which adults should have ampicillin for meningitis?
- Immunocompromised
2. Alcoholics
If you are going to give steroids for meningitis, when should they be given?
With or before first dose of antibiotics (might decrease inflammatory response from endotoxin release)
Which patients need prophylaxis for meningitis?
- Close contacts of patients with n. meningitidis (household, daycare, anyone that handles their secretions)
- No longer recommended if contact has H. influenzae (as long as immunized)
Use fluoroquinolone or rifampin
Does a patient with AMS need a CT before an LP?
Yes
Why is status epilepticus a problem?
The catecholamine response can cause tachycardia, hypertension, hypotension, cardiac arrhythmias, respiratory failure, hyperglycemia, acidosis, and rhabdo.
What should not be missed after a seizure?
Fractures or dislocations
What is the preferred first line agent for a seizure?
Lorazepam (Ativan)
If a benzo doesn’t terminate a seizure, what are second line agents?
Phenytoin or fosphenytoin
Phenytoin does not directly suppress electrical activity but you still need to add benzos to this
What is a third line agent to break a seizure?
Phenobarbital. Takes 15-30 minutes to start working.
What drug can cause seizures?
Cocaine
How do you treat an INH seizure
IV pyridozine
What is the treatment of choice for neurocysticercosis (T. Solium)
Albendazole
What is the most common metabolic cause of seizures?
Hypoglycemia
What is the most common cause of status epilepticus?
Noncompliance with AEDs
