Obj. 25: Neurologic emergencies - aa

Question 1

71 year old male with hx of HTN and DM presents with sudden onset of slurred speech and unilateral weakness. What is your first diagnostic procedure/test?

Answer 1

CT of head to determine if hemorrhage is present.

Question 2

What is the “classic triad” of bacterial meningitis?

Answer 2

1. fever
2. nuchal rigidity
3. altered mental status

Question 3

What neurologic emergency is a complication of antipsychotic therapy?
What is the tetrad of symptoms of this syndrome?
What would you expect to find in blood and urine tests?

Answer 3

~Neuroleptic malignant syndrome
1. fever
2. muscular rigidity
3. autonomic dysfunction
4. altered mental status
~many abnormalities, including elevated WBC, LFTs, BUN, metabolic acidosis, and myoglobinuria

Question 4

What should you administer as soon as you suspect bacterial meningitis (without waiting for culture results)?

Answer 4

1. ceftriaxone
2. vancomycin
3. dexamethasone

Question 5

How does a complete CN III palsy present? (3)

Answer 5

1. sudden inability to open one eye
2. eye fixed in down and out position
3. pupil enlarged and does not react normally to light

Question 6

PCR testing of CSF is the gold standard for diagnosing what?

Answer 6

HSV encephalitis

Question 7

What treatment should be started as soon as you suspect HSV encephalitis?

Answer 7

IV acyclovir

Question 8

Your patient presents with fever, HA, seizures, altered consciousness, and focal neurologic signs. What do you suspect?

Answer 8

HSV encephalitis

Question 9

The early finding of this problem is BACK PAIN that is aggravated by lying down or sneezing.
A late finding of this problem is BOWEL/BLADDER INCONTINENCE.
What is the problem?
What should be done immediately?

Answer 9

~spinal cord compression

~IV dexamethasone

Question 10

What is the most common cause of status epilepticus? Name a second cause, too.

Answer 10

~most common cause: poor compliance to anticonvulsant drug therapy
~other causes: alcohol withdrawal, intracranial infection or neoplasm, metabolic disorder

Question 11

What 3 things will you administer for status epilepticus?

Answer 11

1. IV dextrose
2. lorazepam
3. phenytoin

Question 12

Mrs. Roth is a 53 yo female presenting with a tender, temporal HA with jaw claudication and fever. She has a hx of polymyalgia rheumatica.
What do you suspect?
What lab test and procedure will you perform?
What is the treatment?

Answer 12

~Giant cell arteritis
~ESR elevated > 50; temporal artery biopsy
~prednisone

Question 13

Your patient has severe HA, depressed consciousness, papilledema, and projectile vomiting. What phenomenon are these signs of?

Answer 13

increased intracranial pressure

Question 14

Usually, treating increased intracranial pressure involves treating the underlying cause. However, what can be administered in a life-threatening situation of ICP before any underlying cause is discovered?

Answer 14

IV mannitol