Neuro Flashcards
Delirium and confusion caused by
Syndrome caused by a medical
condition, substance intoxication,
withdrawal, or medication side
effect
Delirium and confusion characterized by
disturbance of consciousness
with reduced ability to focus,
sustain, or shift attention
Delirium labs
Serum electrolytes, creatinine, glucose,
calcium, complete blood count, urinalysis, urine
drug screen, and urine culture are reasonable
for most patients when a cause is not
immediately obvious
• Drug levels should be ordered where
appropriate.
blood gas
Liver function tests, ammonia, thyroid function
and vitamin B12 levels
What therapeutic drugs may cause delirium
digoxin, lithium, or
quinidine
The classic triad of acute bacterial meningitis
consists of:
• Fever (Most common usually > 38ºC • Nuchal rigidity (Stiff Neck) • Change in mental status • Small percentage may have hypothermia. (Rarely patients have a normal temperature)
Workup for bacterial meningitis
CBC
• Blood Cultures
• Lumbar Puncture: Examination of the
cerebrospinal fluid (CSF) is crucial for
establishing the diagnosis of bacterial
meningitis:1000 to 5000/microL (range of <100
to >10,000) with a percentage of neutrophils
usually > than 80 percent, protein >200 mg/dL,
and glucose <40 mg/dL (with a CSF:serum
glucose ratio of ≤0.4)
• Consider CT if Mass or High ICP suspected
symptoms of Bells Palsy
Sudden onset (Hours) unilateral facial paralysis
• Eyebrow sagging, mouth drooping
• Inability to close eye
• Disappearance of nasolabial fold
• +/- Loss of taste anterior 2/3 of tongue
• Altered secretion lacrimal & Salivary gland
Diagnosis of Bells Palsy
Clinical Diagnosis
• Acute facial nerve paralysis of facial muscle
• +/- Loss of taste of anterior tongue
• Altered lacrimal & salivary glands
• Acute onset (1-2 days)
• Progressive (Plateaus at 3 weeks or less)
• Recovery of some degree in six months
Diagnosis of Carpal Tunnel
EMG is used to exclude other conditions such
as polyneuropathy, plexopathy, and
radiculopathy
• Pain or paresthesia (numbness and tingling) in
a distribution that includes the median nerve
territory, with involvement of the first three digits
and the radial half of the fourth digit
• Typically worse at night and characteristically
awaken affected patients from sleep
Guillain Barre clinical features
Weakness usually starts in the legs
• Facial nerve palsies occur in more than 50
percent, and oropharyngeal weakness
eventually occurs in 50 percent
• Oculomotor weakness occurs in about 15
percent of patients.
• Decreased or absent reflexes in affected arms
or legs are found in approximately 90 percent
• Paresthesias in the hands and feet accompany
the weakness in more than 80 percent
Dysautonomia (failure of the sympathetic or parasympathetic components of the ANS) occurs in 70 percent of patients • GBS usually progresses over a period of about two weeks • Initial diagnosis of GBS is based upon the clinical presentation
SNOOP - red flags for headaches
•Systemic symptoms, illness, fever, weight loss,
cancer, pregnancy, immunocompromised
• •Neurologic symptoms or abnormal signs confusion,
impaired alertness or consciousness, papilledema,
focal neurologic symptoms or signs, meningismus, or
seizures
Onset is new (particularly for age >50 years) or
sudden (eg, “thunderclap”)
• •Other associated conditions or features, head
trauma, illicit drug use, or toxic exposure; headache
awakens from sleep, is worse with Valsalva
maneuvers, or is precipitated by cough, exertion, or
sexual activity
• •Previous headache history with headache
progression or change in attack frequency, severity, or
clinical features
diagnostics for Headache
CT
MRI
CTA
MRA
Parkingsons Disease diangosis
Accurate diagnosis of PD rests on the clinician’s ability
to recognize its characteristic signs and associated
symptoms, especially early
• Tremor,
• Bradykinesia (Slow movement)
• Rigidity
• Postural instability is another feature commonly
mentioned in this category
Labs for stroke pt
glucose
Complete blood count including platelets
• Troponin
• Prothrombin time and international normalized
ratio (INR)
• Activated partial thromboplastin time
• Ecarin clotting time, thrombin time, or
appropriate direct factor Xa activity assay if
known or suspected that the patient is taking
direct thrombin inhibitor or direct factor Xa
inhibitor
Serum electrolytes, urea nitrogen, creatinine
• Liver function tests
• Toxicology screen
• Blood alcohol level
• Pregnancy test in women of child-bearing age
• Arterial blood gas if hypoxia is suspected
• Chest radiograph if lung disease is suspected
• Electroencephalogram if seizures are
suspected
worst headache of my life ….think
Subarachnoid hemorrhage (SAH)
