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A - Rosen's Neuro > Stroke, Brain, Weakness, Coma > Flashcards

Stroke, Brain, Weakness, Coma Flashcards

1
Q

What is the dosing for tPA?

A

.9 mg/kg IV w/max dose of 90 mg

10% given as bolus, remaining is given as 60 minute infusion

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2
Q

CPP = ?

What is the compensatory mechanism of increased ICP?

A

MAP - ICP

Cerebral arteriolar vasodilation

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3
Q

What is the exclusion criteria for tPA in a pt on Warfarin?

What about NOAC?

A

Excluded if INR > 1.7 or PT > 15s or PTT > 40s

Excluded if using and evidence of anticoagulation on lab tests

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4
Q

What is the BP management in ICH with elevated BP?

CPP?

A

Lower SBP to less than 140 (lowered MRS according to 2013 study)

50-70 mmHg

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5
Q

How long can you do thrombectomy in acute ischemic stroke?

A

6-24 hours

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6
Q

What is the exclusion criteria contraindication of being in the < 3 hour window vs the 3-4.5 hour window for receiving tPA?

A

Age > 80 y/o
Severe stroke (NIH > 25)
On any anticoagulation regardless of INR
Hx of BOTH diabetes and prior ischemic stroke

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7
Q

Based on thennt.com/not/tPA data, what is the NNT for tPA in ischemic stroke?

NNH?

A

0-3 h, NNT of 10 (mRS 0-1)
3-4.5 h, NNT 19

0-3 h, NNH of 40
3-4.5 h, NNT of 50

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8
Q

What are common sx in Posterior strokes?

Why?

Uncommon?

A

LOC, N/V, visual changes, ataxia

Supplies the reticular activating system, cerebellum, brainstem, occipital lobe, brainstem vomiting centers

Ipsilateral CN deficits

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9
Q

According to UpToDate based on a 2014 meta-analysis using 6756 pts of NINDS, ATLANTIS, ECASS, EPITHET, what is the NNH (symptomatic ICH) for tPA? What is the 30 day mortality of these pts?

NNT < 3 hours?, 3-4.5 hours?

Using what measure?

A

18 (6.8%), 50%

10, 20

mRS 0 or 1 (no significant disability) at 3 or 6 months

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10
Q

CN 3 is usually affected by what?

A

Diabetic or hypertensive vasculopathy

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11
Q

Describe binocular diplopia?

A

Resolves when either eye is closed and is the result of misalignment in the visual axis

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12
Q

What meds to give to control BP if you want to give tPA and BP is too high?

A

Labetalol 10/20 mg IV over 1-2 minutes

Nicardipine infusion 5 mg/hr titrations up by 2.5 mg/hr at 5-15 minute intervals w/max dose of 15 mg/hr

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13
Q

Monocular Diplopia is what kind of problem?

A

Eye specifically

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14
Q

What BP is a contraindication to tPA?

A

> 185/110

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15
Q

What FHx do you need to ask about in cases of SAH?

A

Polycystic kidney disease
SAH
Severe HTN
Previous vascular lesion

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16
Q

What causes vertigo, Horner’s, ipsilateral facial numbness, loss of corneal reflex, CL loss of pain/temp?

A

Wallenberg syndrome (lateral medullary syndrome)

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17
Q

Pt presents with drooping of left eyelid, miosis of the pupil, what is going on?

How do dx?

A

Horner’s syndrome caused by Vertebral dissection —> look for MVC

CTA of carotid

18
Q

What are the advantages of Fosphenytoin over phenytoin?

A

Can be give IM and quicker

Less chance to cause HoTN

19
Q

MC sites of ICH?

A

Putamen (44%)
Thalamus (13%)
Cerebellum (9%)

20
Q

What parts of the brain does the Post Cerebral artery supply?

A

Thalamus, red nucleus, Uncus

21
Q

What kind of hallucinations are present in psychiatric cause of delirium?

What is another name for this kind of cause of delirium?

A

Auditory

Functional

22
Q

What part of the brain does the MCA supply?

A

IC, Putamen, Clasutrum, GP, body of caudate

23
Q

What is the post arrest Glucose target?

A

120 < target < 180

24
Q

What does the 2018 PRISMS trial show regarding tPA and ASA?

What else does it show about in regards to treatment outcomes?

What limitations in study?

A

No difference of outcome using mRS (0/1) of tPA vs ASA for Acute ischemic stroke w/in 3 hours of onset for NIHSS score of 0-5

13% of pts had neurovascular mimics means pts were exposed to potentially harmful medication with NO benefit (3.3% risk of SICH)

Stopped early

25
Q

Define status epilepticus

A

Seizure lasts > 5min OR

Recurrent seizures w/out return to baseline

26
Q

What is the TMT hypothermia post-ROSC guideline?

A

Target of 33C

After 24h, target of 35.6C at rate of .15 C/hr

27
Q

What are the 4 emergent/critical causes of confusion?

A

Systemic disease affecting CNS
Primary intracranial disease
Exogenous toxins
Drug withdrawal state

28
Q

What causes amaurosis fugax?

A

Proximal carotid artery plaque embolizes to the ophthalmic artery

29
Q

Triad of Wernicke’s?

A

Nystagmus (CN VI palsy), AMS, ataxia

30
Q

In the 3-4.5 hour window, what is a contraindication?

A

On Warfarin

31
Q

What is the goal PaCO2 in elevated ICP?

Why no hyperventilation?

A

35-40 mmHg

Can result in dec CBF causing cerebral ischemia

32
Q

When is a pt considered to be in refractory status epilepticus?

A

Seizure does not terminate w/Benzo and 2nd antiepileptic drug

33
Q

What is the difference between simple partial (focal) vs complex?

A

Simple has PRESERVED mental status

Complex = impaired mental status

34
Q

What are the inhibitory neurotransmitters?

Excitatory?

A

GABA

Glutamate and acetylcholine

35
Q

What is Todd’s paralysis?

What causes it?

A

Focal motor deficits that may persist up to 24 hours after generalized or complex partial seizures

Transient focal cerebral hypoperfusion

36
Q

What are ACEP’s guidelines for workup in a pt with 1st time seizure and returned to normal baseline?

A

Serum glucose, sodium level, pregnancy test

37
Q

Treatment of Wernicke’s encephalopathy?

What can cause resistance to this tx?

A

100mg IV thiamine

Hypomagnesium bc Mag is a cofactor for thiamine transketolase

38
Q

MOA of Haldol?

Use caution in pts taking what?

A

Anti-dopamine

Class IA and III antiarrhythmics And CYP450 inhibitors

39
Q

What neurotransmitter is decreased in Alzheimer’s disease?

A

ACh

40
Q

What Apolipoprotein puts people at inc risk for Alzheimer’s?

What chromosomes?

A

ApoE4 on ch. 19

1 and 14

41
Q

What is a key feature of Delerium found on clinical exam that is different from dementia?

A

Inattention

42
Q

What maneuver to dx BPPV of the horizontal semicircular canal?

A

BBQ roll

Dix Hallpike is for posterior

A - Rosen's Neuro (2 decks)

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