Neurology risk factors CC

Question 1

Critical illness polyneuropathy and myopathy (CIP/CIM)

Answer 1

• Prolonged ICU stay
• Sepsis
• Steroids
• Neuromuscular blocking agents
• Hyperglycemia during ICU stay
• immobility,
• vasopressor use,
• renal replacement therapy,
• trauma
• Female sex

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Question 2

Risk factors for hemorrhagic transformation after TPA for acute ischemic stroke

Answer 2

• Hypodensity, edema or mass effect on CT (Especially > 1/3 MCA distribution)
• Hyperglycemia, HO diabetes
• History of heart failure
• Time from symptom onset to TPA
• Age

Question 3

Risk factors for ICU delirium

Answer 3

• Pre-existing dementia or cognitive impairment
• History of alcohol or drug abuse
• History of hypertension
• High severity of illness on admission
• Sedative-induced and multifactorial coma
• Age (data is variable)

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Question 4

Risk factors for postoperative neurocognitive decline

Answer 4

• Age
• Aortic atherosclerosis
• History of neurological disease
• Female gender
• Carotid artery disease

Question 5

ICH after fibrinolysis risk factors

Answer 5

• Elderly
• Women
• Low body weight
• Uncontrolled hypertension

Question 6

SAH risk factors

Answer 6

• Hypertension
• Smoking
• Alcohol excess
• Cocaine use
• Family history
• Genetic: Ehlers-Danlos syndrome, polycystic kidney disease
• Female sex
• Amyloid angiopathy
• Vasculitides
• Very low body mass index

Question 7

Risk factors for aneurysmal rupture

Answer 7

Patient factors:

• Smoking,
• Female sex
• Patient age inversely (younger patients at higher risk)

Aneurysm factors:

• Larger size > 7 mm in anterior circulation and > 6 mm in posterior circulation,
• Multilobulated aneurysm,
• Posterior circulation, and
• Aneurysm growth in serial imaging

Question 8

Paroxysmal sympathetic hyperactivity (PSH) following TBI risk factors

Answer 8

• severity of initial injury,
• younger age
• male gender

Question 9

Markers of poor prognosis when assessed 3 days after cardiopulmonary resuscitation

Answer 9

• absent pupillary light response or corneal reflexes
• extensor or no motor response to pain

Question 10

Risk factors for spinal cord ischemia (SCI) post TEVAR

Answer 10

• Prior aneurysm repair
• magnitude of the repair
• coverage of the left subclavian artery
• pre-existing chronic renal insufficiency

Question 11

External ventricular drain (EVD) infection risk factors

Answer 11

• subarachnoid hemorrhages
• Duration of EVD catheterization
• Reinsertion of the EVD,
• CSF leak from ventriculostomy site,
• frequent CSF sampling

Question 12

Factors associated with poor neurological outcome post cardiac arrest

Answer 12

Clinical history:

• Initial non-shockable rhythm
• Factors that increase time to ROSC (unwitnessed arrest, no bystander or prolonged cardiopulmonary resuscitation)

Clinical examination:

• Absent pupillary and corneal reflexes are not specific enough to use immediately but are useful ≥72 hours post-arrest
• Absent or extensor motor response to pain (M 1-2 on GCS scoring) especially ≥72 hours post-cardiac arrest
• Confirmed myoclonic status (≥30 minutes not just the presence of myoclonic jerks) that develops ≤48 hours post-ROSC

Neurophysiological investigations:

• EEG findings of an unreactive baseline in response to external stimuli, presence of burst suppression or refractory status epilepticus ≥72 hours post-arrest
• The bilateral absence of N20 SSEPs ≥72 and ≥24 hours post-arrest from those patients treated with and without TTM, respectively

Imaging:

• Either CT ≤24 hours demonstrating evidence of cerebral oedema: sulcal effacement and loss of grey-white matter differentiation
• Magnetic resonance imaging (MRI) 2 to 5 days post-ROSC, compared with CT, provides more detailed information regarding the hypoxic-ischaemic brain injury

Biomarkers:

• Elevated biomarker (neurone specific enolase [NSE] and S-100ẞ) levels are associated with poor neurological outcomes but are not sensitive or specific enough to be used in isolation

The ERC/ESICM advice recommends a multimodal approach to prognostication. Initial clinical assessment should occur on day 3 post-arrest, following rewarming after TTM and after the cessation of residual effects of sedation and neuromuscular blocking drugs and exclusion of other reversible causes. If the patient remains unconscious, with a GCS motor score of 1 to 2 ≥72 hours post-arrest and with absent pupillary and corneal reflexes and/or bilaterally absent N20 SSEPs they are likely to experience a poor neurological outcome. Repeat assessment should occur >24 hours later if the preceding criteria are not met. The patient’s likely neurological outcome is poor if his or her clinical assessment remains unchanged and he or she has two or more of the following:

• Myoclonic status ≤48 hours post-ROSC
• High NSE levels 48-72 hours post-ROSC
• Unreactive malignant EEG pattern
• Diffuse anoxic injury on CT ≤24 hours or MRI at 2 to 5 days

Continued care and ongoing observation is recommend for patients not meeting these criteria.