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RCSI EMERGENCIES COPY > Neuro > Flashcards

Neuro Flashcards

1
Q

Signs of ischemia on CT (3)

A
  • hyper dense MCA sign
  • sulcal effacement ( DUE TO FOCAL SWELLING)
  • ## loss of grey matter in BG
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2
Q

thrombolysis candidate

A 
Stroke symptom 
ischemic stroke (3 features on CT) 
NIHSS favorable 
no contraindications 
NOT > 4.5h
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3
Q

When to STOP rtPA

A
  1. anaphylaxis
  2. Systolic BP <100
  3. BP > 180/105
  4. MAJOR systemic bleed
  5. GCS lowers by 2 or more points
  6. NIHSS decrease by 4 or more

ABBS (S as in score)

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4
Q

when do you get an urger CT

A

change in NEURO sign
GCS decrease by 1
NHISS decrease by 3

BP S: >180 or < 100  D: >105 or < 50 
HR >120 <50 
RR >24 or <8 
Temp > 38
Urine output <30ml/h
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5
Q

what are you worries about if you do an urgernt CT after thrombolysis

A

Be aware of Malignant MCA syndrome

Involve neurosurgeons for hemicraniectomy if criteria are met

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6
Q

Alteplase dose

A

Alteplase
Dose: total = 0.9mg/kg (max 90mg)
Bolus of 10%: over 1 minute
Infuse remaining 90% over 1 hour

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7
Q

Search for cause to prevent recurrence of stroke

A 
Search for cause to prevent recurrence
ECG, ECHO, HOLTER
TOE if age < 65 years
Carotid doppler
MRI/MRA
< 35 - Thrombophilia screen, vasculitis screen, etc
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8
Q

anti-platlet treatment post stoke

A

Aspirin 300mg PO x 14/7 (if not already loaded)

Then 75mg OD

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9
Q

when do you give warfarin in secondary presevenetion

A

Aim INR 2-3, introduce 7-10days after aspirin

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10
Q

Thrombectomy recommendation

A
  • treat stroke with large vessel occlusion
  • up to 12 hours from symptom onset
  • IV thrombolysis
  • a stent retriever is preferable
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11
Q

C/I to thrombectomy

A

Presence of large infarct on CT may be a contra-indication

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12
Q

Risk factors for Acute bacterial meningitis

A 
< 5 years, > 60years
Immuno-suppression
Non-immunised
Crowding
Exposure to pathogens
Asplenia
Cranial defects/VP-shunt
Sickle cell disease
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13
Q

CSF antigen

A

Meningitidis capsular polysaccharide antigen

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14
Q

what is brain MRI good for in suspicious bacterial meningitis

A

encephalitis

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15
Q

example of antibiotics for bacterial meningitis

A

Ceftriaxone 2g BD or Cefotaxime 2g every 4-6 hours AND
Vancomycin 500-750mg IV QDS (where pneumococcus is resistant)
Add Ampicillin if > 55years (Listeria)… 2g every 4 hours
Benzyl-penicillin (if rash)… 2.4g every 4 hours

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16
Q

definition of delirium

A

acute, fluctuating change in mental status, with…
Inattention
Disorganized thinking
Altered level of consciousness

17
Q

why delirium is serious

A
  • common
  • recognized
    2X increase mortality
    increase Length of stay
    Decline in functional status
    Decline in cognitive function
    Poor rehabilitation
    Institutionalisation, re-hospitalisation
    Persisting delirium (lasting weeks to months)
18
Q

What screening test can you use for dementia

A

CAM - confusion assessment Method
DRS delirium rating scale
MDAS - memorial delirium ass. score
Abbreviated MSE

19
Q

What is CAM

A 
COGNITIVE IMPAITMENT 
FLUCTATINg 
INATTENTION 
ACTUE SYMPTOMS 
TEMPORAL RELATIONSHIP
20
Q

Antipsychotic drug and dose for dementia

A

Halperidol, PO… 0.5mg

Olanzapine, PO… 2.5mg

Risperidone, PO… 0.25mg

Quetiapine, PO… 12.5mg

21
Q

what other medication can you use beside AP in dementia

A

Lorazepam (short acting benzo)

22
Q

status epilepticus

A

Persistent seizure activity within the brain

  • Life threatening
  • Previously 30-minute period

NOT
One continuous unremitting seizure > 5min
Recurrent seizures, without regaining consciousness > 5mins
Persistent seizure activity after use of first & second line AEDs

23
Q

Modifiable risk factors for Status epileptics

A 
AED non-adherence
AED withdrawal
Alcohol use/abuse
Drug: over-dose/toxicity
Prescribed
Illicit
24
Q

Non modifiable RF for status epileptics

A 
Stroke
Cerebral Haemorrhage
CNS infection
Meningitis
Encephalitis
Abscess
Cerebral tumours
Trauma
Metabolic abnormalities
25
Q

treatment of hypoglycaemia or malnutrition in status epileptics

A

If Hypoglycaemic
50mls 50% glucose

If malnourished or high suspicion of alcoholism
Thiamine

26
Q

treatment of status epileptics

A
  1. BENZODIAZEPAM (LMD)
  2. IV PHENYTONIN
  3. PHENOBARBITOL
  4. GEnERAL ANESTHETIC (midazolam, Profil, thiphentone)
27
Q

lorazepam dose

A

Dose: 0.1mg/kg at 2mg/min (need full resus facilities!)
Though usually 2-4mg, wait 10mins before assessing response
Max 8mg/12hours

28
Q

Phenytoin dose

A

Loading: 20mg/kg (not quicker than 50mg/min)…
Then: 5-10mg/kg

29
Q

types of GA for status epileptics

A

Midazolam
Propofol
Thiopentone

30
Q

RF SAF

A

Modifiable

  • smoking
  • HTN
  • Alcohol / cocain
  • OCP
  • bleeding disorder
  • positive fam Hx

Non Modibiable

  • APCKD
  • AVM
  • FMD
  • CTD (ehlers/ marfans)
31
Q

3 severity scales for SAH

A
  1. GCS
  2. Hunt and hess
  3. World federation of neurosurgery
32
Q

2 eye signs SAH

A

DILATED pupil w/ Loss of reflex

Intraocular bleed

33
Q

TERSON syndrome

A

nitrous haemorrhage ass. w/ SAH

34
Q

BP target in SAH

A

BP <150 and Cerebral perfusion pressure < 60mmhg

35
Q

Hydrochepalus Tx in patient with SAH

A

Therapeutic LP
External ventricular drain
Permanent shunt

RCSI EMERGENCIES COPY (5 decks)

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