Neuro 3 Flashcards
(42 cards)
What is the water in ear test called and what does it do
Cold caloric testing
Ice water in ear and observe for conjugate eye deviation toward the ear injected (with nystagmus in the opposite direction?)
Cranial nerves involved in pupillary reflex
II (afferent) and III (efferent)
CN involved in oculocephalic reflex
VIII (afferent); III, IV, VI (efferent)
CN involved in caloric reflex
VIII (afferent); III, IV, VI (efferent)
CN involved in corneal reflex
V1 (afferent); VII (efferent)
CN involved in gag reflex
IX (afferent), X/XI (efferent)
CSF findings of bacterial meningitis (cells, protein, glucose, other)
♣ Cells = polymorphs
♣ Protein = high
♣ Glucose = low
♣ Other = culture and gram stain may be positive
CSF findings of viral meningitis (cells, protein, glucose, other)
♣ Cells = lymphocytes
♣ Protein = high
♣ Glucose = Normal
♣ Other = Viral PCR may be positive
CSF findings of TB meningitis
♣ Cells = lymphocytes
♣ Protein = high
♣ Glucose = very low
♣ Other = positive for acid-fast bacilli
CSF findings of Guillain-Barre
♣ Cells = none
♣ Protein = high
♣ Glucose = normal
CSF findings of MS
♣ Cells = Few lymphocytes
♣ Protein = slightly high
♣ Glucose = normal
♣ Other = oligoclonal bands usually present
CSF findings of Acute disseminated encephalomyelitis
♣ Ells = Lymphocytes or polymorphs
♣ Protein = usually high
♣ Glucose = normal
♣ Other = oligoclonal bands usually absent
CSF findings of SAH
♣ Cells = lymphocytes and many RBCs
♣ Protein = may be high
♣ Glucose = normal
♣ Other = Xanthochromia
Structural causes of depressed consciousness
Indicated by presence of focal signs
o Acute ischemic stroke ♣ Brainstem ♣ Unilateral cerebral hemisphere (with edema) o Acute intracranial hemorrhage ♣ Intraparenchymal ♣ Subdural ♣ Epidural o Brain tumor (with edema or hemorrhage) ♣ Primary ♣ Metastatic o Brain abscess
Diffuse cuases of depressed consiousness
Indicated by absence of focal signs
o Metabolic
♣ Electrolyte abnormality
• Hyponatremia, hypernatremia, hypocalcemia, hypercalcemia, hypomagnesemia, hypermagnesemia, hypophosphatemia
♣ Glucose abnormality
o Hypoglycemia, nonketotic hyperosmolar coma, diabeteic ketoacidosis
♣ Hepatic failure, uremia, thyroid dysfnction, adrenal insufficiency
o Toxic
♣ Alcohol, sedatives, narcotics, psychotropic drugs
♣ Other exogenous toxins (CO, heavy metals)
o Infectious
♣ Meningitis
♣ Diffuse encephalitis
o Hypoxic-ischemic
♣ Respiratory failure
♣ Cardiac arrest
o Others
♣ Subarachnoid hemorrhage
♣ Carcinomatous meningitis
♣ Seizures or postictal state
What should you always do before LP in a patient with decreased consciousness
CT head - to avoid precipitating brain herniation if a large intracranial mass is present
Next step in management of coma patient with focal signs
Urgent head CT imaging - looking for signs of stroke, hemorrhage, or mass lesion
Next step in managment of coma patient without focal signs
Extensive workup for metabolic, toxic, or infectious cause
Name 3 non-surgical ways to lower ICP
Elevate head
Hyperventilation
Mannitol (osmotic diuretic)
What is the difference between Wernicke encephalopathy and Korsakoff syndrome
Wernicke encephalopathy
o Triad: confusion, ophthalmoplegia, ataxia
o Reversible with Thiamine administration
Korsakoff syndrome:
o Confabulation, personality change, memory loss (permanent)
Describe vision with defect at optic nerve
Single eye blindness (anopia)
Describe vision with defect at optic chiasm
Bitemporal hemianopia (no vision in temporal fields)
Describe vision with defect at optic tract
Homonymous hemianopia (loss of vision on either R or L side)
Describe vision with defect at temporal optic radiation (Meyer’s loop)
Homonymous superior quadrantanopia (Pie in the sky)
