Clinical Perspective of Neurological Emergencies

Question 1

What are the four types of cerebral herniation syndromes?

Answer 1

Uncal, central, tonsillar, subfalcine herniations

Question 2

What compensatory mechanisms may the body take in response to increased intracranial pressure?

Answer 2

Movement of CSF out of the head, movement of venous blood out of the head, collapse of the ventricular system

Question 3

This type of brain herniation compresses the brainstem and may lead to loss of respiratory functioning.

Answer 3

Tonsillar herniation

Question 4

This type of herniation is often associated with a blown pupil.

Answer 4

Lateral tentorial herniation

Question 5

The Cushing Reflex may be indicative of a brain herniation. What symptoms would a patient present with?

Answer 5

Increased blood pressure, irregular breathing, bradycardia

Question 6

What major symptoms are indicative of cauda equina syndrome?

Answer 6

Saddle anesthesia, bowel/bladder incontinence, sexual dysfunction, low back pain

Question 7

Where does the cauda equina begin?

Answer 7

L2 and runs to the coccyx

Question 8

What is the most common cause of cauda equina syndrome?

Answer 8

Central disc herniation or prolapse

Question 9

What is the gold standard for diagnosis of cauda equine syndrome?

Answer 9

MRI, followed by CT myelogram

Question 10

What dermatomal region surrounds the anus?

Answer 10

S2

Question 11

Most lumbar discs herniate in what direction?

Answer 11

Posterolateral

Question 12

Disc herniation is most likely to occur at what levels?

Answer 12

L4/5 or L5/S1

Question 13

Cauda equina syndrome may be treated surgically by a microdiscectomy or laminectomy. How do these procedures differ?

Answer 13

A microdiscectomy involves removal of a portion of the disc that is protruding into the spinal canal. A laminectomy involves complete removal of the bony segments, including the facets, lamina, and spinous process. A laminectomy has increased risk of spinal instability

Question 14

A seizure must last how long for a diagnosis of status epilepticus?

Answer 14

Longer than 5 minutes

Question 15

What is the most common toxin/drug implicated in status epilepticus?

Answer 15

Alcohol

Question 16

Early treatment is directly related to better patient outcomes in patients with status epilepticus. What drugs are considered first-line treatment?

Answer 16

Benzodiazepines (Lorazepam is considered most effective)

Question 17

What are second-line treatments for status epilepticus?

Answer 17

Levetiracetam, Fosphenytoin, Valproate

Question 18

Refractory status epilepticus may be treated with what drugs?

Answer 18

Propofol, Midazolam, Ketamine, Lacosamide, Phenobarbital

Question 19

What considerations must be taken when using propofol to treat refractory epilepticus?

Answer 19

Propofol induces unconsciousness so an EEG must be utilized to determine when the seizure has stopped

Question 20

What considerations must be taken when using Phenytoin to treat status epilepticus?

Answer 20

Phenytoin is cardiotoxic and must be administered slowly over time

Question 21

What are the classical symptoms presented with spinal epidural abscesses?

Answer 21

Spinal pain, fever, neurologic deficits

Question 22

What is the etiology of spinal epidural abscesses?

Answer 22

Collection of inflammatory material between the dura and vertebral column, extending several spinal segments

Question 23

True/False. Most neurologic deficits due to spinal epidural abscesses are irreversible.

Answer 23

True.

Question 24

What is the most common bacterial agent implicated in spinal epidural abscesses?

Answer 24

Staph aureous