Neurology

Question 1

what is carotid disease caused by?

Answer 1

atherosclerosis

Question 2

what’s a major cause of stroke?

Answer 2

carotid disease

Question 3

what’s the most common location of emboli causing CVA?

Answer 3

carotid bifurcation

Question 4

what’s the RFs for carotid disease?

Answer 4

h/o TIA, HTN, high cholesterol, DM, age, obesity, sleep apnea, lack of exercise

Question 5

what are sx’s of carotid disease?

Answer 5

maybe TIAs & CVAs

carotid bruits (“cervical bruit), Hollenhorst plaques (small, yellow particles on retinal vessel)

can be asx

Question 6

what is the classic finding in a pt with carotid stenosis?

Answer 6

cervical bruit (high-pitched systolic murmur)

Question 7

what’s the GOLD STANDARD dx for carotid artery disease?

Answer 7

CTA

Question 8

what imaging can you do to dx carotid artery disease?

Answer 8

Doppler U/S to evaluate blood flow

CTA = definitive study & gold standard

Question 9

what’s the tx for carotid artery disease?

Answer 9

Meds: low dose ASA & statin

Surgery: Carotid endarterectomy OR Carotid angioplasty & stenting

Question 10

when is Carotid endarterectomy indicated for tx?

Answer 10

if pt has 70-99% occlusion & if peri-op morbidity & mortality risk is <6% & easily surgical

Question 11

when is carotid stenting done?

Answer 11

for pts w/ carotid lesion w/ poor surgical accessibility, previous endarterectomy, or other concerning comorbidities

Question 12

what kind of bleed is a subarachnoid hemorrhage and what’s the location? what’d it due to?

Answer 12

arterial bleed b/w arachnoid & Pia mater in subarachnoid space

d/t rupture of an intracranial aneurysm (MC saccular “berry” aneurysms)

Question 13

what are the MC causes of subarachnoid hemorrhage?

Answer 13

MCC = berry aneurysm rupture, AVM

Question 14

what are risk factors for subarachnoid hemorrhage?

Answer 14

fam hx, smoking, HTN, heavy drinking, h/o AVM

Question 15

what are the s/s of a subarachnoid hemorrhage

Answer 15

SUDDEN THUNDERCLAP HEADACHE “WORST HA OF MY LIFE”

Meningeal sx’s: stiff neck, photophobia, delirium

No focal neurologic deficits (usu.)

Question 16

how do you dx a subarachnoid hemorrhage?

Answer 16

CT performed first
-If CT negative -> LP: xanthochromia (RBC’s), incr. CSF pressure

CTA (performed after initial dx w/CT)
-if negative then do MRA

Question 17

what’s the first dx imaging test for subarachnoid hemorrhage?

Answer 17

CT scan

Question 18

what does LP for subarachnoid hemorrhage show?

Answer 18

xanthochromia (Hgb breakdown), increased CSF pressure

Question 19

what’s the tx for subarachnoid hemorrhage?

Answer 19

surgical clipping or endovascular coiling of rupture aneurysm

Supportive: bed rest, lower ICP

Admin Nicardipine*, Nimodipine -> lower BP gradually

***ALWAYS RE-IMAGE HEAD AFTER TX

Question 20

what should be done after tx of subarachnoid hemorrhage?

Answer 20

re-imaging of head

Question 21

what’s the MC arterial bleed?

Answer 21

epidural hematoma (hemorrhage)

Question 22

where does epidural hematoma occur?

Answer 22

b/w skull & dura

Question 23

what’s the MC mechanism of an epidural hematoma?

Answer 23

Temporal bone fracture -> middle meningeal artery lacerated

Question 24

what artery is MC ruptured in epidural hematoma?

Answer 24

middle meningeal artery

Question 25

what are the s/s of epidural hematoma?

Answer 25

brief loss of consciousness at the time of injury, followed by a normal mental status that progressively decreases over time as the hematoma expands

Question 26

how do you dx epidural hematoma?

Answer 26

CT -> CONVEX (LENS-SHAPED) BLEED (the separation of the dura mater from the skull)

Does NOT cross suture lines and usu. in TEMPORAL AREA

Question 27

what is seen on CT for dx of epidural hematoma?

Answer 27

CONVEX (LENS-SHAPED) BLEED usu. in temporal area

Question 28

what area is epidural hematoma usually in?

Answer 28

temporal area (b/c that’s where middle meningeal artery is located)

Question 29

what’s the tx for an epidural hematoma?

Answer 29

observation if small

Limit incr. ICP

• keep HOB elevated and pt in neural position
• sedation
• removal of CSF

IVFs, monitor for seizures

surgical evacuation of hematoma

Question 30

what’s the MC venous bleed?

Answer 30

subdural hematoma (hemorrhage)

Question 31

what’s the location of a subdural hematoma? d/t what?

Answer 31

b/w dura mater and brain d/t tearing of cortical bridging veins

Question 32

who is subdural hematoma MC in?

Answer 32

elderly or alcohol abuse

Question 33

what’s the MC cause of subdural hematoma?

Answer 33

blunt trauma (often causes bleeding on other side of injury “contra-coup”)

Question 34

what type of bleed is subdural hematoma?

Answer 34

MC venous bleed

Question 35

what’s the s/s of subdural hematoma?

Answer 35

varies, may have focal neuro sx

Question 36

how do you dx subdural hematoma?

Answer 36

CT: concave (crescent-shaped) bleed

***Bleeding CAN cross suture lines (vs epidural can’t)

Question 37

what is seen on CT for dx of subdural hematoma?

Answer 37

concave (crescent-shaped) bleed

Question 38

what’s the tx of subdural hematoma?

Answer 38

hematoma evacuation vs supportive

evacuation if massive or >/= 5mm midline shift

Question 39

what’s Amaurosis fugax?

Answer 39

transient monocular blindness d/t emboli in the ophthalmic artery