Neurological Emergencies

Question 1

The Monroe Kelli Doctrine states that we have what percentage of each in our Brain? Brain, CSF and blood? It also states that they must remain relatively equilibrium with each other.

Answer 1

80% brain matter
40% blood
10% CSF

Question 2

What is a deep tendon test that can be performed on the bottom of the foot?

Answer 2

Babinski Reflex test

Question 3

What is the leading cause of death in trauma?

Answer 3

Head injuries

Question 4

What are 3 common symptoms with Meningitis?

Answer 4

Throbbing, progressing headache
Photophobia (sensitive to light)
Nuchal rigidity (neck stiffness)

Question 5

Which form of Meningitis spreads the quickest?

Answer 5

Bacterial

Question 6

What is Kernig’s sign?

Answer 6

Severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to a 90 degree angle

Question 7

What is the Brudzinki’s sign?

Answer 7

Involuntarily lifting the legs when lifting the head

Question 8

What is a normal Mean Arterial Pressure?

Answer 8

70-110 mmHg

Question 9

What is normal intracranial Pressure (ICP)?

Answer 9

0-15 mmHg

20 mmHg has a high mortality rate

Question 10

What is a normal Cerebral Perfusion Pressure?

Answer 10

70-90mmHg

Minimum pressure to perfuse brain must not go below 70

Question 11

What is the formula to calculate the mean arterial pressure (MAP)?

Answer 11

DBP +1/3 pulse pressure (SBP -DBP)
or
(2xDPB) +SBP / 3

Question 12

What is the formula to calculate Cerebral Perfusion Pressure?

Answer 12

MAP - ICP

Question 13

When monitoring ICP, where should the transducer be placed?

Answer 13

Approximately at the tragus (middle cartilage) of the ear

Question 14

What is a diastatic skull fracture?

Answer 14

Occurs along the suture line, causing a widening or separation. Most often seen in infants or pediatrics

Question 15

What is a unique risk of using air to transport a depressed skull fracture?

Answer 15

Pneumocephalus

Question 16

What is a linear Fracture?

Answer 16

Multiple fractures radiating away from point of impact.

Question 17

What is a sign of a basilar skull fracture?

Answer 17

Raccoon eyes or battle sign

Question 18

Describe the different LeForte fractures?

Answer 18

LeForte I is horizontal across the maxilla where the maxillary teeth are moveable.
LeForte II is the bridge of the nose and around the mouth
LeForte III Craniofacial disassociation

Question 19

Are subdural hematomas venous or arterial bleeds?

Answer 19

Venous

Question 20

Are epidural hematomas arterial or venous bleeds?

Answer 20

Arterial

Question 21

What are more common, Epidural or subdural hematomas?

Answer 21

Subdural are 6x more common

Question 22

Epidural hematomas are described to be in what shape?

Answer 22

Lenticular in shape

Question 23

What type of injury is described as having a loss of consciousness, brief lucid interval and a 2nd episode of LOC?

Answer 23

Epidural Hematoma

Question 24

What type of brain injury shows up on a CT in a starfish pattern?

Answer 24

Sub-Arachnoid Hemorrhage

Question 25

What is the complaint heard from patient's when they have a sub-arachnoid hemorrhage?

Answer 25

The worst headache of their life

Question 26

What is Cushing's Triad?

Answer 26

Hypertension, bradycardia and irregular respirations

Question 27

What are some clinical findings in patient's with rising ICP?

Answer 27

``` Decreased LOC Pupil reaction Posturing Changes in vital signs Cushing's Triad ```

Question 28

Describe anterior cord syndrome?

Answer 28

Motor paralysis below the level of the injury with loss of pain and temp sensation

Question 29

Describe Central cord Syndrome?

Answer 29

Often due to hyperextension not fractures. | Presents with greater loss of function in upper extremities than lower, with variable loss of sensation of pain or temp.

Question 30

Describe Brown Sequard lesion?

Answer 30

Resulted by penetrating trauma accompanied by damage to all spinal tracks on the involved side. Presents with motor loss, sensation to touch proprioception and vibration loss on same side and loss of sensation to pain and temp on opposite side.

Question 31

Describe spinal shock?

Answer 31

Temporary local neurologic condition after trauma. Typically subsides in 24-72 hours.

Question 32

Describe neurogenic shock?

Answer 32

Temporary loss of sympathetic nervous system outflow Hypotension with bradycardia Warm, flushed and dry below lesion

Question 33

What is considered hypertensive urgency?

Answer 33

Patient has extremely elevated blood pressure with no signs of end organ damage. BP should be lowered slowly

Question 34

What is a hypertensive Crisis?

Answer 34

Elevated blood pressure with symptoms of end organ damage Headache, nausea/vomiting, vision changes Creatinine and RBC's in urine BP should be lowered no more than 25% per hour.

Question 35

What is the most common cause of encephalitis in the US?

Answer 35

Herpes Simplex virus