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Neuro online course > Trauma / Critical care > Flashcards

Trauma / Critical care Flashcards

0
Q

ICP waveforms P1, P2, P3: what do they represent

A

P1: percussion wave: arterial pulsation
P2: tidal wave, represents compliance (decreased leads to high wave)
P3: dicrotic: ao valve closure

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1
Q

duret hemorrhages occur in what herniation

A

central

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2
Q

goal cerebral perfusion pressure

A

> 60

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3
Q

Dose of osmotic treatment for ICP (2 choiceS)

A
  1. Mannitol 0.25-1g/kg bolus, can repeat q8

2. 23% NaCl 30 mL bolus

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4
Q

what causes duret hemorrhages

A

shearing of basilar perforators

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5
Q

type of herniation that causes midbrain findings and CN 3 pupil dilation

A

tentorial / uncal herniation

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6
Q

what is kernohan’s notch phenomenon

A

compression of contralateral cerebral peduncle against tentorium with uncal herniation

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7
Q

stroke scale scores that may be suggestive of increased risk of herniation with malignant ischemic stroke

A

left hem >20

rt hem >15

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8
Q

Mild TBI / concussion, define three grade?

A
  1. transient confusion < 15m, NO LOC
  2. longer transient confusion > 15m, NO LOC
  3. any LOC
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9
Q

dose of steroids that can possibly used in traumatic spinal cord injury (not clearly beneficial)

A

< 3 hrs, 30mg/kg methylpred, then 5.4mg/kg/hour for 23h (longer if presenting from 3-8 hrs : 2 d)

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10
Q

steroid dosing for cord compression

A

10-100mg dexamethasone, then 4mg q4H 3-5 d

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11
Q

patient arouses but no awareness, eyes open and may track. There are diurnal/nocturnal cycles

A

persistent vegetative state

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12
Q

mild to moderate reduced alertness, slow psychologic response to stimulation

A

obtundation

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13
Q

arousal only with vigorous continuous stimulation

A

stupor

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14
Q

no arousal

A

coma

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15
Q

in persistent vegetative disease, what happens with day/night

A

preservation of cycles

16
Q

in cold calorics, what drives eyes toward cold stimulus vs nystagmus away

A

toward cold: brainstem only

saccadic component of nystagmus away (COWS: Cortical)

17
Q

if you get tonic deviation of eyes to cold water in cold calorics what is the issue

A

cortical lesion (you get brainstem drive only)

18
Q

cold calorics with no response indicates what

A

no cortical or brainstem response

19
Q

right way eyes look where

What happens with oculocephalics

A

frontal cortical lesions toward the lesion (not the weakness)
oculocephalics will overcome

20
Q

wrong way eyes look where and what lesion and what happens with oculocephalics

A

look toward weakness not lesion, as in with pontine lesions and this is due to a CN VI palsy and will not be overcome by oculocephalics

21
Q

what causes skew deviation of eyes

A

midbrain lesion

22
Q

what location of lesion causes ocular bobbing

A

pons lesion

23
Q

respiration pattern:

what causes cheyne strokes (2 types of lesions and expected motor responses)

A

bihemispheric or diencephalic lesions, can tell which based on whether hemiplegic or whether decorticate

24
Q

hyperventilation occurs in what type of lesion and what do you see for motor?

A

midbrain lesion causes decorticate posture

25
Q

what is decorticate posturing and where is lesion

A

arms flexed pointing to head due to involvement of red nucleus

26
Q

decerebrate posturing indicates a lesion where, what posture

A

arms down, not involving red nucleus, lesions below

27
Q

apneustic or cluster breathing and decerebrate posturing indicates lesion where

A

pontine

28
Q

where is lesion causing ataxic or frank apnea and no motor response

A

medulla

29
Q

cells very susceptible to hypoxic injury (5)

A

CA1 pyramidal cells in hippocampus
cortical layers III and V
purkinje cells/dentate
GP

30
Q

man in barrel syndrome

what else may be present sx

A

transcortical motor aphasia

watershed infarct in ACA/MCA borderzone

31
Q

typical presentation of mca/pca watershed infarct

A

balint’s syndrome and transcortical sensory aphasia

32
Q

what NSE level when may predict poor prognosis in coma

neuronal specific enolase

A

Day 1-3, NSE >33

33
Q

when is absent N20 response most predictive of bad prognosis in coma

A

day 1-3

34
Q

define parameters for brain death apnea test

A

if there is no resp drive with PaCO2 of 60 or 20mmHg above baseline

35
Q

what temp do you need for brain death exam

A

<36.5

Neuro online course (21 decks)

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