Neurological Emergencies

Question 1

Define Pia Mater

Answer 1

Thin cerebral cortex cover, Inner most layer

Question 2

Subarachnoid space

Answer 2

Located between Arachnoid and Pia Mater. Contains CSF

Question 3

Define Dura Mater

Answer 3

Tough outer covering. (2 layers, outer covering adhesed to skull.)

Question 4

Epidural space

Answer 4

Potential space between skull and dura mater. (requires high pressure to create bleed, usually arterial and eye shaped on CT scan)

Question 5

Subdural space

Answer 5

Potential space between dura mater and the arachnoid

Question 6

Normal ICP

Answer 6

0-10 mmHg

Question 7

Transducer location for monitoring ICP

Answer 7

Even with the Foramen of Munro (even with ear canal)

Question 8

Normal CPP

Answer 8

> 60 mmHg

Question 9

CPP formula

Answer 9

CPP = MAP - ICP

Question 10

MAP formula

Answer 10

MAP = DBP + 1/3 pulse pressure

Question 11

Pulse pressure formula

Answer 11

SBP - DBP

Question 12

S/S of increased ICP

Answer 12

Change in LOC, pupil size and reaction
Abnormal motor response
Decorticate posturing
Decerebrate posturing
Cushing's Triad

Question 13

What is Decorticate posturing?

Answer 13

Adduction of arms towards core.

Indicates damage above cerebellum and brainstem

Question 14

What is Decerebrate posturing?

Answer 14

Extension and hyperpronation of arms.

Indicates damage to brainstem or compression of thalamus and brainstem

Question 15

Cushing’s Triad

Answer 15

Hypertension
Bradycardia
Respiratory changes
(Widening pulse pressure)

Question 16

Treatment of ICP

Answer 16

Position patient (eyes forward with c-collar)
Limit noxious stimuli (suction, noise, pressure change, invasive procedures)
Maintain euvolemia, normothermia, electrolytes
Sedation (benzos, Propofol)
Analgesia (opioids, fentanyl)
NMBA (non-depolarizing)

Question 17

Subdural Hematoma

Answer 17

Blood between dura and arachnoid layer (usually venous)

Question 18

3 types of subdural hematoma

Answer 18

Acute = symptomatic within 24 hours
Subacute = symptomatic within 2-10 days
Chronic = symptomatic after 2 weeks

Question 19

Subdural hematoma in different age groups

Answer 19

Elderly = larger subdurals with slowly developing symptoms due to cerebral atrophy

Younger = Rapid onset of symptoms with marked increased ICP

Pediatric = Typically occur <18 months, look for bulging fontanelle and retinal hemorrhage

Question 20

Epidural Hematoma

Answer 20

Bleeding between skull and dura mater (usually arterial)

Laceration of the middle meningeal artery in the temporal lobe

Question 21

Classical symptom of Epidural hematoma

Answer 21

Transient loss of consciousness followed by lucid period

Question 22

Define Subarachnoid Hemorrhage

Answer 22

Bleeding between arachnoid membrane and pia mater.

Question 23

Common causes of subarachnoid hemorrhage

Answer 23

#1 - Trauma
#2 - Berri aneurysm (rupture due to HTN)

Question 24

Classical symptoms of subarachnoid hemorrhage

Answer 24

Worst headache of my life
N/V, stiff neck, vision disturbances, altered LOC
(commonly confused with meningitis, do not do lumbar puncture)

Question 25

Define Intracerebral hemorrhage

Answer 25

Hemorrhage in the brain parenchyma Produced from shearing and tensile forces Frequently occurs in the white matter of the frontal and temporal regions

Question 26

Define Intraventricular hemorrhage

Answer 26

Bleeding in the ventricles due to trauma Results from shearing forces Greatly increased mortality rate

Question 27

Define mild concussion

Answer 27

Short duration of retrograde amnesia

Question 28

Define classic concussion

Answer 28

Brief LOC, retrograde and post-traumatic amnesia

Question 29

Define Diffuse Axonal Injury (DAI)

Answer 29

Usually coma Increased ICP Profound neuro, psych, personality deficits

Question 30

Three classifications of stroke

Answer 30

Emboli Hemorrhagic Thrombotic

Question 31

Stroke treatment

Answer 31

Thrombolytic therapy within 3 hours of onset (clot only) | Maximize cerebral blood flow, control ICP, supportive care

Question 32

Linear fracture

Answer 32

A line that extends towards base of skull

Question 33

Linear Stellate fracture

Answer 33

Multiple fractures that radiate from the compressed area

Question 34

Diastatic fracture

Answer 34

Separation of the bones at a suture line

Question 35

Depressed skull fracture

Answer 35

May be closed or open

Question 36

Define basilar skull fracture

Answer 36

Fracture at base of skull

Question 37

S/S of basilar skull fracture

Answer 37

Battle's sign (bruising behind ears - late) Periorbital ecchymosis (Raccoon eyes - late) Otorrhea - bleeding from ear with CSF leak (early or late) Rhinorrhea - bleeding from nose with CSF leak (early or late)

Question 38

Skull fracture complications

Answer 38

Pneumocephalus (Boyle's law can increase) | Infections, hematoma, nerve damage, palsies

Question 39

Lefort I fracture

Answer 39

Fracture of maxillae

Question 40

Lefort II fracture

Answer 40

Fracture of nose and maxillae

Question 41

Lefort III fracture

Answer 41

Fracture of midorbit, nose, and maxillae

Question 42

Presentation of Lefort fractures

Answer 42

Epistaxis Trismus Rhinorrhea "Floating facial regions"

Question 43

Treatment of Lefort fractures

Answer 43

Secure airway | Avoid accessing nose (ETT, NG, NPA)

Question 44

Neurogenic shock

Answer 44

Flaccid paralysis immediately or shortly after injury | Parasympathetic dominance below lesion

Question 45

S/S of neurogenic shock

Answer 45

Hypotension Warm red skin below injury Absence of tachycardia

Question 46

Anterior cord injury S/S

Answer 46

Complete motor, pain, and temperature loss below the lesion

Question 47

Brown-Sequard injury S/S

Answer 47

Loss of movement on the same side as the cord damage. | Loss of pain, temp, and sensation on opposite side

Question 48

Central cord injury S/S

Answer 48

Greater motor weakness in upper extremity than in lower extremity with varying degrees of sensory loss

Question 49

Autonomic dysreflexia S/S

Answer 49

Urinary retention, massive increase in sympathetic tone causing HTN, treat with foley

Question 50

Cranial Nerve I

Answer 50

Olfactory: Smell

Question 51

Cranial Nerve II

Answer 51

Optic: Visual acuity

Question 52

Cranial Nerve III

Answer 52

Oculomotor: constricts pupil, opens eyelid

Question 53

Cranial Neve IV

Answer 53

Trochlear: look down and outward

Question 54

Cranial Nerve V

Answer 54

Trigeminal: forehead, cheek, and chin movement

Question 55

Cranial Nerve VI

Answer 55

Abducens: rotate eyeball outward

Question 56

Cranial Nerve VII

Answer 56

Facial: smile, close eyelid, facial movement

Question 57

Cranial Nerve VIII

Answer 57

Acoustic: hearing and balance

Question 58

Cranial Nerve IX

Answer 58

Glossopharyngeal: swallow and gag reflex

Question 59

Cranial Nerve X

Answer 59

Vagus: sympathetic / parasympathetic responses - HR, BP, Breathing

Question 60

Cranial Nerve XI

Answer 60

Spinal Accesory: shoulder shrug, head turning

Question 61

Cranial Nerve XII

Answer 61

Hypoglossal: toungue movement

Question 62

GCS of 13-15 indicates?

Answer 62

Minor injury

Question 63

GCS of 9-12 indicates?

Answer 63

Moderate injury

Question 64

GCS of <8

Answer 64

Severe injury

Question 65

TPA administration

Answer 65

IV TPA if <3 hours Intrarterial TPA <6 hours MERCI if 8-12 hours (roto-rooter)