AMS and head trauma

Question 1

bilateral fixed/dialated pupils, think?

Answer 1

severe anoxia, ICP > 20, herniation and death

Question 2

what is cushings triad?

Answer 2

triad of vital signs in ICP – ↑BP, ↓HR, irregular RR

Question 3

Abnl pupillary light reflex, think?

Answer 3

mass lesions, pupil drugs, hypoxia, eye drops

Question 4

Unilateral fixed/dilated pupil, think:

Answer 4

herniation w/ CN III compression (ipsilateral)

Question 5

Pinpoint pupils, think:

Answer 5

narcotics, ICH (in pons)

Question 6

waxing-and-waning change in
level of consciousness; can also
have visual hallucinations, short
attention span, and impaired
recent memory

How to dx? etiologies?

Answer 6

delirum

Dx with MMSE (<25)

Etiology: 
AEIOU TIPSS – 
Alcoholand drug toxicity or withdrawal,
Electrolyte imbalance,
Iatrogenic, 
Oxygen hypoxia,
Uremia/hepatic encephalopathy,

Trauma, 
Infection, 
Poison,
Seizures, 
Stroke

Question 7

damage to RAS or bilateral
hemispheres → depressed LOC,
unresponsive to any stimuli

how to Dx?

Answer 7

coma

GCS </= 8

Question 8

coma-like state but pt is fully
conscious and can control
blinking, vertical eye movement

where is damage?

Answer 8

locked in syndorme w/ damange to ventral pons

Question 9

duret hemorrhage, think?

Answer 9

brainstem herniation

Question 10

what is the defn of brain death?

how is it Dx?

Answer 10

irreversible absence of brain function despite adequate oxygenation/ventilation, no brainstem reflexes

Dx with EEG showing no activity

Question 11

temporal bone fx → tear in middle meningeal artery → LOC w/ lucid interval

how is it dx? tx?

Answer 11

EDH

dx with head CT (convex lens hemorrhage)
tx with emergent craniotomy

Question 12

tear in bridging veins → ∆MS, headache, cortical dysfxn, possible herniation if acute

how is it dx? tx?

Answer 12

SDH

dx head CT (crescent moon hematoma |)
tx with craniotomy (acute), reassurance (chronic)

Question 13

RF for SDH

Answer 13

shrunken brain states (alcoholics, elderly)

Question 14

defn on concussion

Answer 14

brief LOC following blunt head trauma w/ confusion, dizziness, impaired concentration, etc.

Question 15

how to distinguish between normal aging and dementia

Answer 15

no impairment of daily functioning w/ normal aging

Question 16

typical duration of delirum

Answer 16

3 days to 2 weeks

Question 17

delerium with present with nml or abn EEG

Answer 17

abn

Question 18

dementia will present wiht nml or abn MRI

Answer 18

abn

Question 19

what does not change in dementia

Answer 19

level of conciousness

Question 20

3 MC causes of dementia

Answer 20

Alzheimer (#1), vascular (#2), Lewy body (#3

Question 21

severe depression that can
present like dementia in elderly

tx?

Answer 21

pseudodementia

SSRIs

Question 22

dementia can be secondary to… (remember, it is still not reversible)

Answer 22

hypothyroid 
B12/folate deficiency, 
thiamine deficiency,
neurosyphilis 
medication use

Question 23

pathophys of Alzheimes + how to Dx and treat

Answer 23

dec Ach
Amyloid cascade hypothesis: high risk genes (presenilin I, presenilin II, APP, apoE4) can
predispose to Aβ-amyloidosis)

Dx MMSE (<25), head CT (diffuse atrophy w/ enlarged ventricles, flat sulci)

Tx
AChE-inhibitors for mild/moderate AD (tacrine, donepezil)
NMDA antagonist for severe AD (memantine)

Question 24

Why do downs pt get AD

Answer 24

triple apoE4 expression (on chrom 21)

Question 25

stepwise loss of function + focal neurological sx

how to dx?

Answer 25

vascular dementia

Dx MMSE (<25), head CT (multiple small lacunar infarcts)

Question 26

dementia, waxingand-waning
parkinsonism, visual hallucinations, sensitivity
to antipsychotics

Answer 26

Lewy body dementia

Lewy body and neurite accumulations in the basal ganglia

Question 27

profound changes in personality and social conduct, disinhibition, hyperorality, hypersexuality; good memory and language though

how to dx?

Answer 27

Picks disease (frontotemporal demetia)

Dx MMSE (<25), head CT (marked atrophy of frontal and temporal lobes)

Question 28

neutropenia → infection → rapid decline in memory, cognition, behavior, motor skills; depression and social withdrawal also common

Answer 28

HIV assc dementia

give them HAART

Question 29

abnormal prion accumulation → rapidly progressive dementia, myoclonus (muscle spasms), personality changes

how to dx

Answer 29

Creutzfeldt-Jakob disease

Dx EEG (generalized sharp waves), confirm w/ postmortem brain bx (spongiform change)

Question 30

Wet (urinary incontinence), Wobbly (gait
apraxia), Wacky (dementia)

Dx with? Tx?

Answer 30

normal pressure hydrocephalus

Dx with MRI
Tx CSF shunt