Neurology (Alice) Flashcards
6 early sx of local anesthetic toxicity
tinnitus
perioral/tongue numbness
metallic taste
blurred vision
muscle twitches
drowsiness
perioperative vision loss is very rare, but is associated w. what surgeries (3)
cardiac
spine
head/neck
mcc of post op ocular injury
corneal abrasion
3 mcc of permanent perioperative vision loss
CRAO
ischemic optic neuropathy
cerebral vision loss
most frequent clinical presentation of perioperative vision loss
ischemic optic neuropathy
rf for perioperative vision loss (9)
long surgeries
excessive blood loss
hypotn
anemia
hypoxia
excessive IVF
vasoconstricting agents
elevated venous pressure
head positioning
3 causes of post op transient blurring of vision
ocular ointments
excessive drying
corneal trauma
4 causes of complete or partial perioperative visual loss
surgical trauma
embolic events
anemia
hypotn
ischemia or poor circulation to the short posterior ciliary blood vessels that supply the front or anterior portion of the optic nerve
anterior ischemic optic neuropathy (AION)
2 sx of AION
painless abrupt vision loss
optic disc pallor/swelling
life threatening condition caused by sudden hemorrhage or infarction w.in the pituitary gland
pituitary apoplexy
transient perioperative visual loss after absorption of glycine solution
glycine induced visual loss
rf for glycine induced vision loss
TURP
sx of AION
starts in one eye -> then affects both eyes
major rf for AION
hypotn
what n is easily damaged in thyroid surgery leading to hoarseness
recurrent laryngeal
7 causes of aphasia
CVA - mc
MS
ICH
migraine
carotid dz
recurrent laryngeal n damage
apraxia of speech (AOS)
motor speech disorder resulting from neurological injury of the motor component of the motor speech system
dysarthria
causes of dysarthria (lots!)
TBI
CVA
parkinson’s
ALS
MS
huntington’s
wilson’s dz
drowning
central pontine myelinolysis
brain tumor
cereral palsy
guillain barre
hypothermia
lyme
stroke
intracranial htn (pseudotumor cerebri)
tay-sachs
what is ICH
bleeding into brain parenchyma
mcc of ICH
htn/atherosclerosis dz
also: coagulopathies, AVMs, amyloid angiopathy, tumor, trauma
mc location for ICH
basal ganglia -> putamen
6 sx of ICH
coma
contralateral hemiplegia
hemisensory deficits
lateral gaze
aphasia
homonymous hemianopsia
surgical indications for ICH (2)
CN III palsy
progressive alteration of consciousness
4 syndromes associated w. spinal cord injury
anterior cord
central cord
complete cord
brown sequard (hemisection(
sx of anterior cord syndrome
loss of pain/temp below the level of injury
preserved proprioception/vibration
sx of central cord syndrome
loss of pain/temp at the level of injury
preserved proprioception/vibration
sx of complete cord transection
reduced sensation caudally
no sensation below the injury
urinary retention/bladder distension
sx of brown sequard/hemisection
-loss of proproception/vibration on the side of injury
-loss of pain/temp on the opposite side of injury and a few levels below the injury
2 types of sensory neuropathies
distal sensory/stocking glove
axonal
causes of axonal neuropathies (lots!)
DM
etoh
B12
syphilis
HIV
lyme
uremia
chemo
vasculitis
paraneoplastic
amyloidosis
excruciating HA in the absence of focal neuro findings
SAH
2 PE findings of SAH
elevated bp
fever
sx of a herald bleed
less severe/atypical HA
focal neuro signs
usually precedes severe SAH by 1-3 weeks
pathophys of SAH
ruptured cerebral aneurysm (mc) OR AVM -> bleeding into CSF of subarachnoid space
mcc of SAH
berry aneurysm
mc age for SAH
60-70
4 rf for SAH
smoking
htn
hypercholesterolemia
etoh
gs dx for SAH
noncontrast CT
order of dx imaging for SAH
- noncontrast CT
- LP - if CT neg and high suspicion for SAH
- cerebral angiography once stable - look for additional aneurysms
- EEG
2 LP findings of SAH
elevated opening pressure
grossly bloody fluid
SAH bleeding occurs btw the _ and _ layers
arachnoid
pia
supportive tx for SAH aims to
prevent elevated arterial pressure ->
prevent re-rupture of affected vessel
tx for SAH
manage htn
avoid hypotn
clip vs wrap aneurysm
embolectomy via catheter
tx for vasospasm caused by SAH
nimodipine
causes of SAH (3)
trauma - mc
ruptured aneurysm
AVM
saccular outpouching of vessels in the COW, usually at bifurcations
berry aneurysm
mc location for SAH
- anterior communicating a
- posterior communicating a
- middle cerebral a
what 2 conditions increases risk of berry aneurysm
polycystic kidney dz
marfans
mc location for AVMs
supratentorial
mcc of sdh
trauma
hallmark hpi for sdh
elderly pt w. hx of multiple falls
presents w. neuro sx
sdh result from inury to what brain structure
bridging veins
classification of sdh
acute: sx w.in 48 hr of injury
subacute: sx w.in 3-14 days of injury
chronic: sx after >/= 2 weeks
chronic sdh are commonly seen in what pt pop
alcoholics
2 hallmark findings of sdh
AMS
focal neuro sx
what shape does sdh bleeding appear on a CT
crescent/concave
what is this showing
sdh
path of bleeding: sdh vs epidural hematoma
sdh: may cross suture line
epidural: does not cross suture line
tx for sdh based on severity
small/mild sx: obs, +/- repeat imaging
severe: burr holes vs craniotomy vs craniectomy
7 rf for atherosclerosis
smoking
dm
male
fam hx
hld
htn
advanced age
2 conditions associated w. atherosclerosis
pad
cad
if symptomatic, atherosclerosis commonly presents w. (5)
amaurosis fugax
unilateral m weakness/paresthesia
dizziness
tinnitus
aphasia
carotid bruit is typically heard at what % stenosis
60-70
dx for atherosclerosis
- duplex US
- angiography (MRI vs CT)
classification of stenosis
moderate: 50%
severe: 70%
management of atherosclerosis (4)
smoking cessation
asa vs clopidogrel vs both
statins for all
endarterectomy vs stenting
2 indications for revascularization
stenosis > 70%
TIA/stroke
what type of revascularization is first line
endarterectomy (cea)
what is RIND
reversible ischemic neuro deficit
basically a TIA but lasts 24-72 hr
gs invasive method to evaluate carotid dz
angiogram/arteriogram
indication for CEA in asymptomatic vs symptomatic pt
asymptomatic: > 60%
symptomatic: > 50%
complication of CEA
stroke
microemboli to retinal arterioles seen as bright defects
hollenhorst plaque
hallmark presentation of epidural hematoma
injury -> transient loc -> lucid perior -> increasing drowsiness, HA, unilateral/contralateral weakness
mcc of epidural hematoma
traumatic ICH
epidural hematomas are mc caused by tearing of the _ a
middle meningeal
the middle meningeal a passes thru the _ of the _ bone
foramen spinosum
sphenoid
epidural hematoma causes bleeding between the _ and the _
dura
skull
CT findings of epidural hematoma bleeding
lenticular/lens shaped
unilateral convexity
temporal region
what is this showing
epidural hematoma
tx for epidural hematoma
craniotomy
bp control
how is increased intracerebral pressure managed w. epidural hematoma (4)
mannitol
hyperventilate
steroids
ventricular shunt
how does trauma lead to epidural hematoma
skull fx -> bone fragments lacerate meningeal a
mc sign of epidural hematoma
ipsilateral blown pupil
indications for craniotomy w. epidural hematoma
symptomatic
> 1 cm
