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Emergency Medicine > Neurologic Emergencies > Flashcards

Neurologic Emergencies Flashcards

1
Q

In the presence of HA, the below are indicative of…

 Nausea/vomiting
 Papilledema
 Unilateral or bilateral fixed pupil
 consciousness
 Decorticate or decerebrate posturing
A

elevated ICP

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2
Q

Ominous finding of elevated ICP…

A

Cushing’s triad

bradycardia, hypertension, resp. depression

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3
Q

Lab workup for elevated ICP

A 
type and cross
CBC
CMP
Osmolality
BAL/Tox Screen
Glucose
Coags

CT/MRI

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4
Q

Initial Tx of elevated ICP… (5)

A 
Head of bed 30 degrees
O2
hyperventilation
BP control/NS
Mannitol
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5
Q

Gold standard of ICP monitoring…

A

Intraventricular monitor

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6
Q

The below are indications for what ICP intervention?

at risk
GCS < 8
aggressive medical care

A

Intraventricular monitor

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7
Q

In increased ICP hyperventilation, what is the target PCO2?

A

26-30 mmHg

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8
Q

Neuro presentation of linear skull fx?

A

no neuro sxs

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9
Q

3 MC regions of linear skull fx

A

temporoparietal
frontal
occipital

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10
Q

A linear skull fx on the _____ bone can disturb vascular structures and cause bleeding…

A

temporal bone

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11
Q

Linear skull fx can be managed with ED observation for 4-6 hours if what two things are present…

A

neg CT

no neuro deficit

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12
Q

_____ skull fx often involves injury to brain parenchyma

A

depressed

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13
Q

mgmt of depressed skull fx…

A

CT
neuro admit
+/- Td

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14
Q

What skull fx can tear the dura, causing communication in subarachnoid space, sinuses, and middle ear?

A

basilar skull fx

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15
Q

A basilar skull fx of the ______ increases risk of epidural hematoma

A

temporal bone

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16
Q

What is an important facet of mTBI assessment?

A

mental status testing

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17
Q

Closed head injury home disposition…4 factors…

A

GCS 15
normal CT
no bleeding risk
can monitor at home

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18
Q

The below are ED precautions for…


Unable to awaken the patient

Severe or worsening headaches

Somnolence or confusion

Restlessness, unsteadiness, or seizures

Vison changes

Vomiting, fever, or stiff neck

Urinary or bowel incontinence

Weakness or numbness involving any part of the body
A

closed head injury

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19
Q

This is the shearing of white matter tracts from traumatic deceleration/blunt trauma

A

diffuse axonal injury

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20
Q

this is a cause of persistent vegetative state

A

diffuse axonal injury

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21
Q

CT shows blurring of grey-to-white margin, small lesions in white tracts, cerebral hemorrhage and/or edema

A

diffuse axonal injury

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22
Q

surgery for diffuse axonal injury?

A

no

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23
Q

Brief LOC –> lucid interval
–> rapid clinical
deterioration

A

epidural hematoma

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24
Q

this intracranial hematoma is associated with adolescents and young adults w/ skull fx and trauma

A

epidural hematoma

middle miningeal artery

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25
most subdural hematomas occur via...
falls | bridging vein tear
26
The below describes what "rule": ```  Age ≥40 years  Neck pain or stiffness  Limited neck flexion on examination  Witnessed loss of consciousness  Onset during exertion  Thunderclap headache (instantly peaking pain) ```
Ottowa SAH rule
27
If CT is negative and SAH is suspected, what diagnostic is mandated?
LP
28
what can be done in lieu of LP in SAH?
CTA
29
Pt. p/w: ``` Acute onset of focal neurologic deficit  Increasing neurologic signs/symptoms over time  Headache  Vomiting  Decreased LOC  Seizures ```
ICH
30
MC etiology of ICH?
HTN
31
Imaging for ICH?
stat non-contrast CT or MRI (smaller lesions)
32
important facet of ICH management
BP 140-160/90
33
Labs for CVA... (5)
``` coags CBC CMP Tox fingerstick glucose ```
34
Imaging for CVA...
state noncontrast CT w/in 20 min
35
If non-hemorrhagic CT, what can be administered?
ASA
36
3 MC findings for Ischemic Stroke...
facial paresis arm drift/weakness or paresis abnormal speech
37
tPA infusion should be _____ from time of arrival in ED and ______ from onset of sxs
less than 60 min less than 4.5 hours
38
2 criteria for status epilepticus
5+ minutes 2+ seizures w. incomplete recovery
39
Initial mgmt of status epilepticus...
BZ + anticonvulsants x 2 dose max
40
If continued seizure activity after administration of BZs and anticonvulsants?
IV midazolam/propofol/pentobarbital
41
continuous _____ monitoring is required for status epilepticus
EEG
42
C-spine nexus criteria (5)...(no imaging needed)
no midline tenderness, intoxication, painful injury normal LOC, neuro exam
43
What type of c-spine fx? vertical compression transmitted to lateral masses of atlas... fx of arches of c1
Jefferson/Burst fx
44
Imaging for Jefferson/Burst fx...
X-Ray --> CT
45
What type of c-spine fx? MOI: extreme hyperextension via abrupt deceleration bilateral pedicle fx
C2 pedicle fx (hangman's)
46
Why minimal spinal cord damage in pedicle fx?
AP diameter at C2 is greatest
47
what is the MOI of an odontoid fx?
forceful flexion or extension
48
What type of C2 fx? Stable occurs above transverse ligament
Type 1
49
What type of C2 fx? unstable base of dens at C2 attachment non-union in 50%
Type 2
50
What type of c-spine fx? Fx thru upper body of C2 unstable
Type 3
51
What type of c-spine fx? MOI: direct axial load fragment displacement
burst fx
52
What time of complete SCI? ```  Absent reflexes  Flaccid muscles  Loss of sensation  Priapism in men  Urinary retention ```
acute ( < 1 day)
53
What time of complete SCI? ```  Hyperreflexia  +Babinski  Spasticity ```
1-3 days post injury
54
Patient presents with: motor impairment loss of reflexes bilateral loss of pain/temp sensation bladder dysfunction
Anterior cord syndrome
55
What sensations are preserved in anterior cord syndrome?
tactile, proprioception, vibratory
56
Etiology: cord infarct, disc hernation
anterior cord syndrome
57
Patient p/w: motor impairment UE > LE variable sensory loss below injury +/- bladder dysfunction...
central cord syndrome
58
What is preserved in central cord syndrome?
vibration, proprioception
59
MOI extension injury, compression, slow growing lesion
central cord syndrome
60
Pt. p/w: motor weakness hyperreflexia gait ataxia paresthesia
posterior cord syndrome
61
what is initially preserved in posterior cord syndrome?
bladder function
62
MOI: MS, tumors, subluxation Etiology: bilateral dorsal column, corticospinal tract involvement
posterior cord syndrome
63
Pt. p/w: ipsilateral motor paralysis and loss of proprioception/vibration contralateral loss of pain/temp
brown sequard
64
What is preserved in brown sequard?
bladder fxn
65
MOI: penetrating injury etiology: lateral hemi section, dorsal column unilateral
brown sequard
66
prognosis of brown sequard?
good
67
Which imaging for spinal alignment/fracture?
radiograph
68
Which imaging for ligamentious/spinal cord injury?
high res CT or MRI
69
Roots of the phrenic nerve emerge where? (diaphragm innervation)
C3/4/5 "C3,4,5 keep the diaphragm alive"
70
Unstable lesions above ____ may cause immediate respiratory paralysis
C3
71
The below can cause... ```  Intervertebral disc herniation  Epidural abscess  Tumor  Lumbar spinal stenosis  Metastatic disease  Infectious  Autoimmune ```
cauda equina syndrome
72
patient presents with: LBP + LE radiation LE weakness Atrophy of calves Perineal sensory loss
cauda equina
73
Imaging for cauda equina syndrome
stat non-contrast MRI
74
Clinical suspicion of cauda equina warrants immediate admin of...
dexamethasone 10mg IV x 1
75
What preceeds onset of guillen barre?
URI/gastroenteritis 1-3 weeks prior | c. jejuni mc
76
pt p/w: ``` absent/depressed DTRs CN involvement gait problems paralysis/paresthesia Dysautonomia ```
guillen barre
77
is there fever with guillen barre?
no
78
30% of guillen barre results in...
severe respiratory involvement
79
Diagnostics for guillen barre
CSF studies | EMG-NCS (not in ED)
80
CSF findings in guillen barre
elevated protein | normal WBCs
81
Tx for guillen barre that usually occurs outside of ED
IVIG or plasmapheresis

Emergency Medicine (12 decks)

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