Emergency Medicine - Neurologic Emergencies Flashcards Preview

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Flashcards in Emergency Medicine - Neurologic Emergencies Deck (19):
0

Causes of acute bacterial meningitis

Strep pneumo, N. Meningitidis most common. Listeria in 1/4 of >60yo.

1

Classic Sx of acute bacterial meningitis (4)?

HA, stiff neck, fewer and altered mental status

2

Classic Sx of acute bacterial meningitis (4)?

HA, stiff neck, fewer and altered mental status. Almost all patients present with at least two of these.

3

Elderly patients with altered mental status and high white counts in UA most likely have what? Treatment (3)?

Urosepsis.
Empiric antibiotics, aggressive IV fluid resuscitation, and hospital admission.

4

Most common site of embolism for acute ischemic stroke? Most common site of thrombus for acute ischemic stroke?

Heart. Site of an atherosclerotic plaque.

5

Classic presentation of left MCA stroke (4)?

Aphasia. Right sided hemiparesis (worse in face and upper limbs). Left hemianopsia. Gaze preference towards the stroke.

6

Treatment of acute MCA stroke. Stat actions (3)? Other Tests?

Stat Head CT and MRI. Stat neuro consult.
The usuals...Glucose, CBC, BMP, EKG, UA, CXR.

7

Timeline for Thrombolysis in Acute Ischemic Stroke?

Within four hours of onset of symptoms.

8

How to dose tPa?

0.9mg/kg(maxdose90mg); 10% of total dose given as IV bolus, remaining 90% infused over 60 minutes.

9

Absolute contraindications to thrombolytics (7)

Prior hemorrhagic stroke. Any stroke within past three months. Known intracranial neoplasm, AVM, or aneurysm. Active bleeding (except menses). Suspected aortic dissection. Acute pericarditis. Allergy

10

Indications for Head CT Prior to Lumbar Puncture for suspected Meningitis (6)?

Seizure.
Focal neurologic deficit.
Head trauma.
Profoundly depressed mental status.
Immunocompromised state.
Papilledema.

11

CSF findings on LP for patient with bacterial meningitis (5)?

Elevated opening pressure (often> 40 cm H2O).
WBC>5/mm3.
Elevated protein.
Low glucose.
Presence of organism on gram stain.

12

Antibiotic to help cover Listeria?

Ampicillin

13

Which type of meningitis is most responsive to Dexamethasone?

pneumococcal meningitis

14

Does Exposure to a patient with Pneumococcal meningitis require prophylaxis?

Nope. As long as you didnt do mouth to mouth, intubate, or suction.

15

How should a member of a household (with Meningococcal meningitis) be treated prophylactically?

Rifampin OR Ciprofloxacin every 12 hours for 4 doses.

16

Most common cause of subarachnoid hemorrhage?

Ruptured intracranial aneurysm.

17

Family history of polycystic kidney disease or Ehlers–Danlos syndrome predisposes you to what neurological complication?

Subarachnoid hemorrhage.

18

What is Pseudotumor cerebrii?

Idiopathic intracranial hypertension.