Lecture 8 (neuro)- Exam 3 Flashcards

Question

Hemorrhagic strokes * What is the presentation due to?

Answer 1

Hemorrhagic strokes are less predictable – presentation is variable due to complications of blood dispersion, cerebral edema, and increased ICP. * account for 23% of all strokes

Answer 2

* 10 minutes from arrival or sooner: Evaluation by physician * ≤ 20 minutes: Stroke or neurologic expertise contacted with pre-notification from EMS or upon arrival POV * ≤ 20 minutes: Non contrast CT * ≤ 45 minutes or sooner: Interpretation of the non contrast CT scan * ≤ 45 minutes - Initiation of thrombolytic therapy * up to 24hrs is allowed for intra-arterial fibrinolysis by IR from last known well, symptom onset unknown, or wake up stroke based on advanced imaging

Answer 3

up to 24hrs is allowed for intra-arterial fibrinolysis by IR from last known well, symptom onset unknown, or wake up stroke based on advanced imaging

Answer 4

* ≤ 90 minutes – door to puncture time for endovascular intervention * 120 minutes – Door to revascularization procedure * 3 hours – Admission to stroke unit or ICU * All can be achieved with use of Telemedicine

Answer 5

* Vital signs * Supplemental oxygen to maintain saturation ≥ 94% * Determine time of onset/last known well (LKW) * Determine NIHSS score * CT, CTA with perfusion (0-24 hours of LKW) or MRI (4.5 – 9 hours of LKW and ineligible for thrombectomy) * Medication list – ask specifically about anticoagulants and when medication was last taken/administered * IV access – 18g peripheral IV * Labs: Fingerstick glucose, CBC with platelets, PT/INR, PTT, and beta-HCG for women of childbearing age. * EKG

Answer 6

* Immediately on arrival to an ED, patients should be screened for stability, undergo rapid clinical stroke assessment, then taken directly for rapid imaging with a non contrast CT scan of the head. * If the non-contrast head CT is negative for hemorrhage, an acute ischemic stroke or TIA must be considered for acute onset of neurological symptoms.

Answer 7

* There are several stroke mimics including seizures, hypoglycemia, sepsis, fever, migraine and Bell’s palsy. * Goal is to rule out stroke mimics as soon as possible but given that acute ischemic stroke treatment is time sensitive, it is not uncommon for them to be treated with thrombolysis.

Answer 8

* Most important information that guides therapy is the last known well (LKW) time or time of symptom onset. * All patients with LKW time less than 24 hours should be emergently evaluated for an acute ischemic stroke. * Last time they were known to be normal without neurological deficits must be established from either the patient or a bystander.

Answer 9

* If the patient went to bed and awoke with the stroke symptoms, the last known normal time is when they went to bed. * Thrombolytics should be administered to all patients with LKW time less than 4.5 hours that meet the inclusion and exclusion criteria and should be considered for all patients who present between 4.5 to 9 hours, of which they could be wake up strokes.

Answer 10

* Pulse oximetry should guide whether the patient needs supplemental oxygen to achieve oxygen saturation of 94% * Blood pressure measurements are vital and must be obtained frequently. * Hypotension is uncommon – may be due to symptoms of previous stroke due to poor perfusion of previously injured tissue.

Answer 11

Blood pressure in excess of 220/120 mmHg should be lowered, regardless of the ultimate diagnosis. Permissive hypertension * allowing the blood pressure to rise naturally to 220/120 mmHg for those not a candidate for thrombolysis * this has been suggested as a method to maintain cerebral perfusion

Answer 12

* Target blood pressure for patients eligible for IV alteplase is less than 185/110 mmHg. * Once it is given, BP must be maintained below 180/105 mmHg for 24 hours after administration to limit risk of ICH.

Answer 13

Short acting agents such as labetalol, nicardipine or hydralazine are preferred to achieve and MAINTAIN BP less than 180/105 mmHg and are OPTIONS to be considered. * There is variability in the specific agent used for BP lowering.

Answer 14

* If BP is < 220/120 mm Hg, treatment of HTN within the first 48 to 72 hours after acute ischemic stroke (AIS) is of no benefit. * If BP is 220/120 mm Hg or higher, the benefit of lowering BP is unknown, but lowering by 15% in the first 48 to 72 hours after AIS is reasonable. (hypotension= worsen strokes)

Answer 15

If mechanical thrombectomy: It is reasonable to maintain BP below 185/110 mm Hg during and for 24 hours after the procedure.

Answer 16

* Complete CBC for acute ischemic stroke includes capillary blood glucose, CBC with platelets, chemistries, PT/PTT, INR as well as beta-HCG for women of childbearing age. * A fingerstick glucose check is a requirement as it can quickly rule out hypoglycemia as a stroke mimic.

Answer 17

* What about tests for anticoagulants like direct thrombin inhibitors or direct factor Xa inhibitors – many hospitals do not have these laboratory tests/results available quickly within the thrombolysis window. * History is important – compliant with medications, last time dose taken.

Answer 18

* Non contrast CT of the brain should always be obtained before thrombolytic therapy administration – if ruptured aneurysm is the cause, then bleeding will be worse. * Non-invasive CT angiogram of the head and neck should be obtained as well to expedite the identification of a large vessel occlusion.

Answer 19

* CT angiogram will also identify any perfusion deficits that may be caused by the LVO. * A chest x-ray is not routinely done in the acute workup phase.

Answer 20

* Acute stroke team should evaluate the patient within minutes of the patient entering the hospital. * Consist of members specifically trained in recognition and acute management of acute ischemic stroke. * They can help to expedite patient assessment on arrival and in CT, thereby decreasing time to determine thrombolytic therapy.

Answer 21

* The National Institutes of Health Stroke Scale (NIHSS) is the preferred stroke severity rating scale recommended as a standardized method for examiners to evaluate severity of strokes. * Scores range from 0 (no deficit) to 42, severe stroke. * NIHSS score may also be used as a guideline to predict a relative risk of ICH after thrombolytics are given.

Answer 22

Over 5, you can give TPA

Answer 23

* Hypovolemia should be corrected as in acute ischemic stroke can worsen ischemic injury because of impaired perfusion to the brain tissue. * Hypovolemia may exacerbate ischemic brain edema and increase stress on the heart.

Answer 24

* Euvolemia is desired and IV fluids should be normal saline. * Hypotonic and dextrose containing fluids should be avoided.

Answer 25

* Alteplase is a thrombolytic medication and is only approved for treatment of acute stroke in the US. * When patients presents less than 4.5 hours since their LKW time, then eligibility for IV thrombolytic therapy should be assessed. * If still significant stroke-like symptoms without contraindications, treatment with thrombolytics should proceed.

Answer 26

* In the US, FDA has not approved thrombolytic use between 3-4.5 hours. * However, its use in this timeframe has been endorsed by the AHA and is widely used in the US. * Additional inclusions to consider if you give thrombolytics in this time frame include meeting all the criteria if under 3 hours since onset and if they are taking Warfarin, INR is less than 7.

Answer 27

Eligibility * Ischemic stroke symptoms causing measurable neurological deficits. These range from mild to disabling to serve stroke symptoms. * Onset less than 3-4.5 hours from start of symptoms. * Patient is greater than 18 years of age. Generally, is avoided with NIHSS of ≤5

Answer 28

* Time from last known well is greater than 4.5. * History of intracerebral hemorrhage or intracranial neoplasm. * Signs and symptoms suggestive of subarachnoid hemorrhage, ineffective endocarditis or aortic arch dissection. * GI malignancy or recent bleeding within 21 days.

Answer 29

* Taking direct thrombin inhibitors or direct factor Xa inhibitors unless a PTT, INR, platelet count are normal or unless they have not taken the dose within last 48 hours. * Platelets less than 100K * Currently taking full treatment dose of low molecular weight heparin within previous 24 hours.

Answer 30

CT shows severe hypoattenuation, hypodensity or intracerebral hemorrhage * Platelets less than 100 * Internal hemorrhage within the past three weeks.

Answer 31

* Once deemed a candidate for treatment, minimum of two IVs must be placed. * Accurate weight dosing since Alteplase is a weight-based drug. * Initial 10% of total alteplase dose is given by bolus over 1 minute, rest is infused over an hour.

Answer 32

* Continued observation for complications of thrombolytics including airway obstruction due to angioedema, hemorrhage, and sudden change in GCS. * Blood pressure check should occur every 15 minutes for the first 2 hours, then every 30 minutes for the next 6 hours, then hourly over 16 hours.

Answer 33

* Hemorrhagic conversion often occurs following reperfusion therapy, believed to occur because of the disruption of blood-brain barrier integrity. * Acute onset of headache, nausea, vomiting, worsening neurological examination during or following administration of thrombolytics may indicate ICH. * 50% mortality rate if bleed occurs after administration. * Treatment consists of stopping infusion if still ongoing.

Answer 34

* Obtain CBC, PT, PTT, INR, fibrinogen levels, type and cross-match. * Obtain non contrast CT scan of the head. * Vital signs every 15 minutes. * Consider Cryoprecipitate and fresh frozen plasma based on fibrinogen levels- - also transaxemic acid administr

Answer 35

* Mechanical thrombectomy by way of an Interventional Radiologist to retrieve a clot that has created a large vessel occlusion. * Intraarterial thrombolysis can occur up to 24 hours from last know well, symptom onset, or wake up stroke based on advanced imaging.

Answer 36

Endovascular therapy with stent retrievers is recommended over intraarterial fibrinolysis as first-line therapy * to be able to remove the clot all together instead of waiting for the chemical to break down the clot causing the large vessel occlusion is more effective.

Answer 37

* Aspirin to be administered within 24hrs for those that did NOT qualify for thrombolytic therapy medications, or 24hrs after they received it. * Strokes associated with intracranial atherosclerosis, use of high-intensity statin such as atorvastatin therapy for secondary stroke prevention is associated with a reduced long-term risk of ischemic stroke. * An MRI is usually obtained after admission and the initial stroke is treated to evaluate extent of damage from perfusion deficits.

Answer 38

* Although the optimal trigger for decompressive craniectomy is unknown, it is reasonable to use a decrease in level of consciousness attributed to brain swelling as selection criteria. * In patients ≤60 years of age who deteriorate neurologically (decrease GCS) within 48 hours from brain swelling, decompressive craniectomy is reasonable ## Footnote Can give them a lot of Na to decrease edema

Answer 39

Transient episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischemia without acute infarction, can lead to: * transient monocular blindness (Amaurosis Fugax) * Amaurosis fugax is typically caused by a transient ischemic event in the retina or optic nerve, often due to emboli from carotid artery disease or cardiac sources. * vertebral basilar syndromes (Dizziness/Vertigo)

Answer 40

* Frequently referred to by patients as a mini-stroke. * Lasts from minutes up to 24hrs * Additional diagnostic testing includes carotid ultrasound for high grade stenosis, EKG for arrythmias, TEE for possible clot present. * Treat with ASA/Plavix or Warfarin or Eliquis if due to atrial fibrillation.

Answer 41

Initial testing as part of TIA or ischemic stroke workup could have identified various levels of carotid stenosis. Occlusive carotid stenosis treatment options * carotid endarterectomy vs carotid angioplasty and stent * carotid stenting is as effective in preventing recurrent stroke as endarterectomy.

Answer 42

* Symptomatic carotid stenosis 50-69% if onset of symptoms <2 weeks can be treated with stent placement or endarterectomy. * **Asymptomatic carotid stenosis between 60-80% can also be treated with a high intensity statin, aspirin.** * Carotid stent placement can be conducted for asymptomatic carotid stenosis >70%

Answer 43

Hypertension – secondary stroke prevention guidelines endorse maintaining a blood pressure of < 130/80 mmHg as a target for patients with a stroke or transient ischemic attack. Hyperlipidemia – benefit of targeting LDL with a goal of < 70 mg/dL in patients with atherosclerosis with a high intensity statin. * Fasting lipid profile

Answer 44

* Diabetes – guidelines recommend a goal of hemoglobin A1c less than or equal to 7% for most patients. * Cardiovascular disease - address atrial fibrillation with an anticoagulant * Lifestyle and behavior changes for stroke prevention.

Answer 45

Intracerebral hemorrhage (ICH) – A focal collection of blood within the brain parenchyma or ventricular system. Includes parenchymal hemorrhage after cerebral infarction from a stroke. * does not include subdural or epidural hemorrhage

Answer 46

Silent Cerebral Hemorrhage – A focal collection of chronic blood products within the brain parenchyma, subarachnoid space, or ventricular system on neuroimaging without a history of acute neurological dysfunction attributable to the lesion. * blood present but does not cause any symptoms of brain compression

Answer 47

* ICH increases with age, doubling every 10 years after age 35. * ICH has a higher morbidity and mortality than ischemic stroke * ICH mortality rate is approximately at 44%.

Answer 48

Hypertension resulting in damage and rupture of vessels is the leading cause of ICH (60%) * other causes include malignancies, AVMs, drug abuse or previous thrombolysis to name a few

Answer 49

* Sudden Focal Neurologic Deficit * HTN (~90%) * Headache (~40%) * Nausea and Vomiting (~50%) esp. with posterior fossa strokes * AMS (~50%) – not common with ischemic strokes-> They cause neurological deficits seen on one side of the body * Seizures (~7%)

Answer 50

* Airway/Ventilation Management * Non contrast CT of the head and evaluate for change in GCS. * CBC/PT/PTT/INR * Coagulopathy reversal

Answer 51

* Warfarin: (INR goal less than 1.5) Vitamin K IV based on INR, combined with KCENTRA * Factor Xa inhibitors like Eliquis/Xarelto – KCENTRA * Pradaxa (Diabigatran) – Use of Praxbind, (Idaricizumab) as a reversal * Plavix, ASA – DDAVP (Desmopressin) – reduces hematoma growth, improves platelet activity

Answer 52

Goal to maintain systolic blood pressure (SBP goal of 140) Intracranial pressure management (ICP) monitoring and management * Mannitol or CSF drainage through an external ventricular drain Neurosurgical management (if indicated) for hematoma evacuation

Answer 53

Subarachnoid hemorrhage - bleeding into the subarachnoid space (the space between the arachnoid membrane and the pia matter of the brain or spinal cord). * Trauma is the MOST common cause of all SAH * 85% are spontaneous, related to aneurysm rupture, such as rupture of a saccular aneurysm * less commonly caused by an arteriovenous malformation (AVM)

Answer 54

* Risk factors for developing aneurysms include smoking, hypertension, high cholesterol levels and heavy alcohol use. * Most are found incidentally – patient gets a CT scan of the head w/o contrast for a headache, vascular malformation found – leads to identification of cerebral aneurysms. * Vigorous physical activity and cocaine use are associated with triggering SAH, presumably causing elevation of blood pressure.

Answer 55

Aneurysm – a bulging or ballooning area in a weakened area. It is 50% or more of the vessel’s normal diameter.

Answer 56

Digital retractable angiogram

Answer 57

Subarachnoid hemorrhage aka funky chicken

Answer 58

* Classic presentation of SAH includes the onset of a thunderclap headache with exertion or Valsalva maneuver, this only occurs in a minority of patients. * Some develop symptoms during sleep. * Those with altered mental status may not be able to provide a history of the headache onset, others may present in a coma.

Answer 59

In 10-40% of patients, the acute presenting headache is precented by a warning aneurysmal leak leading to a “sentinel headache” which occurs about 2-8 weeks prior to the overt SAH. May develop a fever, frequently display confusion, coma – nuchal rigidity or other signs of meningeal irritation * blood travels in CSF down to tailbone along spinal cord, irritant, thus neck and back pain may be a complaint as well

Answer 60

* Isolated neck pain (cervical muscle strain or degenerative arthritis) * Fever and headache * Nausea and vomiting * Elevated blood pressure or EKG abnormalities

Answer 61

Aspecific finding such as a third nerve palsy may also suggest the diagnosis of SAH. * Isolated third nerve palsy should always be further imaged with a non-contrast CT as well as CTA * Can be caused by ischemia but also caused by a compressive aneurysm – most likely it is due to a **Posterior Communicating Artery Aneurysm.**

Answer 62

You can have an aneursym so big that is it pushing up against the nerve

Answer 63

* Airway, breathing and circulation * Head computed tomography (non contrast CT scan as well as a CT angiogram of the head and neck with perfusion) * Labs: PT/INR, PTT, CBC, chemistries, troponin, toxicology screen * 12 Lead EKG * Target SBP goal <140 mmHg * Consult neurosurgery team * Address hydrocephalus if present

Answer 64

Focused clinical evaluation includes determining level of consciousness, assessment of potential neurological deficits Grading systems that use radiological studies to determine severity of the SAH * Fisher Grading Scale helps predict development of vasospasm as well as delayed cerebral ischemia

Answer 65

Hunt-Hess classification helps to correlate presenting clinical status with long term neurological outcome

Answer 66

* Lumbar puncture with evaluation of cerebrospinal fluid reveals markedly elevated opening pressures and grossly bloody fluid. * MRI – highly sensitive for intracranial hemorrhage, including SAH. * CT angiogram – designed to diagnose the presence of an aneurysm, not to detect SAH

Answer 67

Cerebral angiography (Digital Subtraction Angiogram) should be done to evaluate the entire vasculature if additional evaluation and identification is needed: * Gold standard for identification of cerebral aneurysms * Accurate identification of size of aneurysm * Also used to treat through stent and/or coiling

Answer 68

* Risk of re-rupture is 4-14% in the first 24 hours after a SAH and remains elevated for 30 days. * Treating severe hypertension is critical during this time.

Answer 69

* Treatment such as securing the aneurysm within the first 24 hours by Interventional Radiologist. * Treatment of hydrocephalus by placement of an external ventricular drain.

Answer 70

Seizure prophylaxis – for new onset seizures after aSAH, treatment with antiseizure medication for 7 days is recommended. * may increase the risk of aneurysm re-rupture and elevated ICP if they have another seizure * short term treatment is recommended out of concern for seizure-related precipitation of aneurysm re-rupture * generally given Keppra twice daily for 7(seven) days

Answer 71

* Like a hemorrhagic stroke, those taking anticoagulant medications should have reversal agents administered. * Patients taking Warfarin with an INR greater than or equal to 1.4 should be treated with IV vitamin K and fresh frozen plasma.

Answer 72

* Thrombocytopenia, those with a platelet count less than 100,000 should be treated with platelet transfusion. * If taking aspirin then platelet transfusion can be given IF going to surgery, if not then can consider administering desmopressin (DDAVP).

Answer 73

* Primary goal to assist with achieving patient comfort, treatment of pain, vomiting and anxiety. * Tylenol is generally given for pain medication to include headaches. * Titration of sedative and analgesic medications is paramount – avoid over sedation which can mask subtle mental status changes.

Answer 74

* In some cases, short acting benzodiazepines can help with anxiety. * Objective is help control a BP elevation due to pain and anxiety

Answer 75

* Not a lot of data on blood pressure control parameters – goal is to “balance risk of stroke, hypertension-associated rebleeding, and maintenance of the cerebral perfusion pressure.” * Titratable BP control - SBP between 110-140 if an unsecured aneurysm. * If aneurysm is secured through placement of coiling and/or a stent, then can allow SBP to be higher, 110-180.

Answer 76

* A clinical syndrome that occurs in SAH resulting in a decline in neurological status. * Develops because of narrowing of cerebral arterial vessels, or vasospasm.

Answer 77

Oral Nimodipine administered * **delayed cerebral ischemia** caused by intracranial vasospasm occurs in 70% of patients and starts around day 3 after rupture, peaks 7-10 days and resolves by day 10-14 * blood in the subarachnoid is an irritant, breaks down and factors cause vasospasm * administering a calcium channel blocker can help reduce the vasospasm and ICP

Answer 78

Daily CMP – important are the sodium, hemoglobin and electrolytes * Sodium: maintain between 135-145 * Hemoglobin: keep greater than 8.0 * Magnesium: keep greater than 2.0 * Potassium: keep greater than 3.5 Daily Transcranial Doppler Ultrasound testing – watch for development of arterial vasospasms

Answer 79

* Presentation is often “worst headache of their life”. * Noncontrast CT scan of the head is highly sensitive if done within the first hours of the symptom onset. * Lumbar puncture should be done if CT is negative, and history is suggestive of a subarachnoid hemorrhage.

Answer 80

* CT angiogram is helpful for the detection of bleeding sources. Remember that a digital subtraction angiogram is the gold standard for identification of and treatment of cerebral aneurysms. * Monitor for and decrease risk of rebleeding prior to securing the aneurysm, through blood pressure control, minimize overstimulation.

Answer 81

* Treat hydrocephalus * Initiate nimodipine for the prevention of delayed cerebral ischemia (vasospasms)

Answer 82

* Abnormal and tangled connection between arteries and veins, bypassing the normally capillary system. * Congenital defect, usually present at birth, not symptomatic until later in life. * Complex, tangled web of arteries and veins.

Answer 83

* Can present with headaches, seizures, weakness or numbness in part of the body. * Intracranial hemorrhage which can lead to stroke-like symptoms. * Discovered incidentally in some cases but if ruptures, may not be identified as source until additional diagnostic testing is done.

Answer 84

* Diagnostic testing can include MRI as well as cerebral angiography. * Treatment can consist of monitoring if they are small, surgical removal as well as endovascular embolization and radiosurgery.

Answer 85

* Approximately half of all primary intracranial neoplasms are gliomas – remainder are meningiomas, pituitary adenomas, neurofibromas. * Most common sources of intracranial metastasis are carcinoma of the **lung**, breast, kidney, and GI tract.

Answer 86

Spinal tumors may lead to spinal cord dysfunction by direct compression or ischemia secondary to arterial/venous obstruction.

Answer 87

* Frontal lobe – progressive intellectual decline, personality changes * Temporal lobe – seizures, emotional and behavioral changes * Parietal lobe – contralateral disturbances of sensation

Answer 88

* Occipital lobe – visual field defects, inability to recognize objects * Brain stem and cerebellar lesions– cranial nerve palsies, ataxia, incoord

Answer 89

* Headache * Seizures * Weakness, upper or lower extremities, combination of the two * Sensory loss * Aphasia * Cognitive impairment, memory loss, confusion * Visual spatial dysfunction

Answer 90

* morning HA * vomiting * lethargy

Answer 91

* HTN * bradycardia * HYPOventilation

Answer 92

* Meningiomas are the most common primary central nervous system (CNS) noncancerous tumors and account for approximately one-third of all primary brain and spinal tumors * Peak incidence in middle age, very uncommon in children and occur more frequently in women than men. ## Footnote Think the brain as a large balloon, and the meningioma as a tennis ball that you push into the balloon. It is not inside the brain, but rather outside pushing in.

Answer 93

Arise from the arachnoid layer of the meninges – most common spot is the parasagittal region. Clinical presentation consists of raised ICP, focal neurological signs and epilepsy * location determines presentation * slow growing, many years of symptoms before diagnosis

Answer 94

Treatment usually observation/surgical removal followed by radiation is reoccurrence.

Answer 95

Acoustic schwannomas arise from the 8th cranial nerve and first neurologic abnormality is auditory – hearing loss is found in 98% of these patients.

Answer 96

Clinical presentation depends on the size with early symptoms are associated with 8th nerve involvement * tinnitus and unilateral partial or complete sensorineural hearing loss * vertigo present – maybe confused with Menieres’ disease * numbness over the face may appear later

Answer 97

Essential to check the corneal reflex because loss or depression of this reflex is the most consistent early sign – fifth nerve is lifted by the tumor and fibers for corneal reflex are sensitive.

Answer 98

* Glioblastoma is the most common malignant primary brain tumor in adults, with a median age of onset of approximately 55 to 60 years. * Even with adjuvant chemo and radiation therapy following surgical resection, GBM has a high rate of recurrence and rate of survival of about 10-12 months * MRI characteristically shows heterogeneous-ring enhanced pattern associated with significant edema

Answer 99

* WHO grade of a GBM is done after surgical resection is completed or a biopsy has been obtained. * Four grades of astrocytoma – which is the most common type of glioma that arise from the astrocyte cells.

Answer 100

WHO Grades I through IV * Grade 1 generally associated with pediatrics * Grade 3- 4, aggressive biological characteristics and poor prognosis – require multiple resections, radiation and chemotherapy treatment. * surgical procedures are to reduce the symptoms, extends life for a period, not curative.

Answer 101

* surgery * radiotherapy * other adjuvant treatments – like chemotherapy, radiation therapy

Answer 102

* make a definitive diagnosis * tumor reduction to alleviate the symptoms of raised intracranial pressure * reduction of tumor mass as a precursor to adjuvant treatments

Answer 103

CT of the head without contrast, MRI of the head with/without contrast as well to detect the lesion, define its location and size, evaluate extent to which the normal anatomy is distorted, and identify cerebral edema.

Answer 104

If no previous history known, a CT of the chest, abdomen and pelvis to look for any other suspected masses – is the mass in the head primary or a result of metastasis. * 60% of those without any known primary tumor that present with brain metastasis have a primary lung cancer.

Answer 105

Treatment generally consists of dexamethasone for reduction of cerebral edema – helps reduce the symptoms. * generally, start with 10 mg every 4-6 hours initially

Answer 106

Seizure prophylaxis by administration of Keppra daily – if new onset seizure * generally, continued for another seven days after surgery is conducted

Answer 107

A biopsy if obtained, is diagnostic only. Gives a preliminary and final pathology is completed in two weeks.

Answer 108

hunting by way of an external ventricular drain to reduce obstructive hydrocephalus may dramatically reduce clinical deficits that the patient experiences because of the compression of the MASS.

Lecture 8 (neuro)- Exam 3 Flashcards

(133 cards)