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emerg med exam III > neurologic emergencies and surgical intervention > Flashcards

neurologic emergencies and surgical intervention Flashcards

1
Q

normal intracranial pressure in adults

A
  • <10-15 mmHg
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2
Q

intracranial components by volume percentage

A
  • brain parenchyma: 80%
  • CSF: 10%
  • blood: 10%
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3
Q

following a significant increase in ICP, brain injury can result from

A
  • brainstem compression (herniation)
  • reduction in CBF (cerebral blood flow)
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4
Q

uncal herniation will present as

A
  • CN III compression
    • unilateral fixed, dilated pupil
  • progressive deterioration in LOC
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5
Q

papilledema is a sign of

A
  • increased intracranial pressure
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6
Q

Cushing’s triad is an ominous finding of elevated ICP. what does it involve?

A
  • bradycardia
  • respiratory depression
  • hypertension
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7
Q

decorticate posturing. describe it? Reflects destructive lesion in the

A
  • arms flexed: hands to the body core
  • lesion in the corticospinal tract from cortex to upper midbrain
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8
Q

decerebrate posturing. describe it? Reflects destructive lesion in the

A
  • arms extended
  • corticospinal tract at level of pons or upper medulla
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9
Q

describe rating scale for motor function of extremities

A
  • 1/5 minimal flicker
  • 2/5 movement with gravity eliminated
  • 3/5 movement against gravity
  • 4/5 weakness
  • 5/5 complete
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10
Q

managememt of elevated ICP

A
  • referral to neurosurgery
  • oxygenation: maintain O2 sat >90%
  • control HTN/avoid hypotension: maintaine cerebral perfusion pressure > 60 mmHg
  • elevate head of bed to 30 deg
  • analgesia/sedation
  • IV mannitol: osmotic diuresis
  • mechanical ventilation to lower PaCO2
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11
Q

what are the three types of skull fractures

A
  • linear
  • depressed
  • basilar
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12
Q

define linear skull fracture

A
  • single fracture that most often extends through the entire thickness of the calvarium
    • majority have minimal or no clinical significance
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13
Q

define depressed skull fracture

A
  • segment of skull is forced below the level of adjacent skull
    • may be open or closed
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14
Q

depressed skull fractures often involve injury to the brain parenchyma and are associated with increased risk of

A
  • infection
  • seizure
  • death
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15
Q

define Basilar skull fracture

A
  • involves at least one of the bones that comprise the base of the skull
    • ​temporal bone, occipital bone, sphenoid bone, and/or ethmoid bone.
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16
Q

Basilar skull fractures occur most commonly through which bone

A
  • temporal bone
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17
Q

signs of Basilar skull fracture

A
  • hemotypmanum
  • “raccoon eyes”
  • battle sign
  • CSF otorrhea or rhinorrhea
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18
Q

imaging modality of choice for a suspected skull fracture

A
  • noncontrast CT scan
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19
Q

a brain contusion - area of bruising on the brain- is associated with localized

A
  • ischemia
  • edema
  • mass effect
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20
Q

what is a diffuse axonal injury (DAI)

A
  • shearing of white matter tracts from traumatic sudden deceleration injury (blunt trauma) -> severe intracranial injury
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21
Q

CT scan of diffuse axonal injury will show

A
  • blurring of gray to white matter margina
  • cerebral hemorrhage
  • cerebral edema
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22
Q

which type of intracranial hematoma is most associated with a skull fracture

A
  • epidural hematoma
    • middle meningeal artery
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23
Q

which intracranial hematoma is characterized by a collection of venous blood between the dura matter and the arachnoid

A
  • subdural hematoma
    • tearing of bridging veins
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24
Q

clinical presentation

  • brief LOC
  • lucid interval
  • rapid clinical deterioration

what will CT scan likely show

A
  • epidural hemotoma
    • lens-shaped
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25
Q

what will CT scan of subdural hematoma likely show

A
  • crescent shape
26
Q

differentiate betwen acute, subacute, and chronic subdural hematoma

A
  • acute: symptoms within 24-48 hours after onset
  • subacute: sx 3-14 days after onset
  • chronic: sx > 2 weeks after onset
27
Q

nontraumatic causes of subarachnoid hemorrhage

A
  • aneurysm
  • vascular malformation
28
Q

clinical presentation

  • “worst headache of my life”
A
  • subarachnoid hemorrhage
29
Q

evaluation of subarachnoid hemorrhage

A
  1. CT scan noncontrast
  2. LP
    1. RBC and xanthochromia
30
Q

what is the gold standard for detecting intracranial aneurysms

A
  • digitial subtraction angiography
31
Q

most common cause of hemorrhagic stroke

A
  • hypertension
32
Q

management of hemorrhagic stroke

A
  • neurosurgical consult
  • BP control, avoid hyperglycemia
  • sz prophylaxis
  • hemostatic therapy
  • reversal of anticoagulation
33
Q

intraventricular hemorrhage puts a person at risk for

A
  • hydrocephalus
34
Q

causes of intraventricular hemorrhage

A
  • primary uncommon
  • more commonly extension of intracerebral hemorrhage or SAH
35
Q

target BP for patient with an ischemic stroke who is not a candidate for IV thrombolysis

A
  • no intervention unless BP
    • > 220 systolic or > 120 diastolic
36
Q

target BP for patient with an ischemic stroke who is a candidate for IV thrombolysis

A
  • SBP < 185
  • DBP < 110
37
Q

inclusion criteria for thrombolytics

A
  • clinical diagnosis of ischemic stroke
  • onset of symptoms < 4.5 hours before tx
  • age > or = 18 yo
38
Q

treatment of status epilepticus (sz lasting 5 minutes)

A
  • Iv lorazepam (or diazepam) + IV phenytoin
39
Q

what is indicated for all patients with a new seizure

A
  • CT or MRI
40
Q

patients with a new onset seizure can be discharged with outpatient f/u if

A
  • returned to baseline
  • normal CT scan
  • normal lab evaluation
41
Q

what is a jefferson fracture? cause

A
  • most common fracture of C1 atlas
  • caused by axial compression
42
Q

is jefferson fracture usually associated with spinal cord damage?

A
  • no
  • because canal diameter is not compromised
43
Q

C2 (axis) fractures, fractures of dens are usually associated with what type of injury

A
  • forcefull flexion or extension
44
Q

C2 (axis) fractures, fractures of dens are broken down into what types? which are stable?

A
  • Type 1: stable
  • Type 2, 3: unstable
45
Q

What is the hangman’s fracture?

A
  • C2 fracture involving both pedicles
46
Q

hangman’s fracture. type of injury associated with it?

A
  • hyperextension with compression
  • if death occurs: usually instantaneous due to spinal cord transection
47
Q

What is a burst fracture

A
  • direct axial load -> fragments displacing in all directions
  • spinal cord may be injured if fragments enters spinal canal
48
Q

disk herniation diagnosed with what imaging modality

A

MRI

49
Q

clinical presentation

  • urinary retention
  • radiculopathy
  • bilateral lower extremity muscle weakness
  • saddle anesthesia
  • decreased anal spincter tone
A

cauda equina syndrome

50
Q

evaluation of cauda equina syndrome

A
  • emergent MRI or CT myelography
51
Q

neurogenic shock occurs most commonly after

A
  • cervical spine injury
52
Q

anterior cord syndrome will present with

A
  • complete motor paralysis below level of lesion
  • loss of pain and temperature sensation below level of lesion
  • retained proprioception and vibratory sensation
53
Q

central cord syndrome will present with

A
  • hyperextension injury of cervical spine
  • motor impairment, greatest in upper extremities
54
Q

brown sequard syndrome presents wtih

A
  • spinal cord hemisection
    • ipsilateral loss of motor function, proprioception and vibration sensation
    • contralateral loss of pain and temperature
55
Q

near total ventilatory muscle paralysis will occur with injury to spinal cord at what level

A
  • above C3
56
Q

what is the most common demyelination neuropathy

A
  • guillain-barre syndrome
57
Q

clinical presentation

  • previous mild URI or gastroenteritis, influenza immunization or surgery
  • acute onset of ascending paralysis starting distally
  • weakness symmetric
A
  • guillain-barre syndrome
58
Q

LP in guillain-barre syndrome will show

A
  • elevated CSF protein without pleocytosis (increase in white blood cell)
59
Q

which type of meningitis is a neurologic emergency

A
  • bacterial
60
Q

patients with meningitis should be given early IV

A

dexamethasone

61
Q

definitive diagnosis of brain abscess

A
  • stereotactic (open) brain biopsy

emerg med exam III (6 decks)

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