Seizures, Strokes, Intracranial Bleeding

Question 1

Definition of “Refractory Status Epilepticus”?

Answer 1

Failed 2 anticonvulsants. Seizures >= 2 hrs. >=2 seizures per hour.

Question 2

1st line Tx for seizures are BZDs. What 3 drugs are 2nd line?

Answer 2

Levetiracetam, Fosphenytoin, Valproate.

Question 3

Tox of Fosphenytoin?

Answer 3

Hypotension.

Question 4

Tox of Valproate?

Answer 4

Liver dysfunction. Hyperammonemia

Question 5

How is keppra cleared?

Answer 5

renally

Question 6

In monitoring continuous EEG for status, what is the goal pattern?

Answer 6

burst-suppression

Question 7

Patient population who benefit from prophylactic anticonvulsants?

Answer 7

TBI, SDH

Question 8

duration of prophylactic anticonvulsants?

Answer 8

7 days. (TBI, SDH patients only).

Question 9

Initial imaging if suspect acute CVA?

Answer 9

• Dry CT
• CTA r/o proximal occlusions (thrombectomy)
• CTA Perfusion r/o penumbra (thrombectomy, tPA)

Question 10

Dose of IV tPA in acute ischemic CVA?

Answer 10

0.9mg/kg up to 90mg.

Question 11

Time limit for tPA in acute CVA with normal head CTs?

Answer 11

4.5 hours (FDA approval for 3 hours)

Question 12

Time limit for tPA in acute CVA with penumbra on perfusion imaging?

Answer 12

9 hours (FDA approval for 3 hours)

Question 13

tPA for acute CVA is contraindicated with what BP?

Answer 13

185/110

Question 14

tPA for acute CVA is contraindicated with head trauma within how long?

Answer 14

3 months

Question 15

tPA for acute CVA is contraindicated with what platelet level?

Answer 15

100k

Question 16

tPA for acute CVA in the 3-4.5 hour timeframe is contraindicated with what age?

Answer 16

> 80yo

Question 17

tPA for acute CVA in the 3-4.5 hour timeframe is contraindicated with what NIHSS?

Answer 17

NIHSS > 25

Question 18

tPA for acute CVA in the 3-4.5 hour timeframe is contraindicated with what anticoagulation?

Answer 18

NOAC w/ normal coags

Question 19

tPA for acute CVA in the 3-4.5 hour timeframe is contraindicated with what PMH?

Answer 19

DM w/ prior CVA

Question 20

tPA for acute CVA is RELATIVELY contraindicated with surgery in how long?

Answer 20

14 dyas

Question 21

tPA for acute CVA is RELATIVELY contraindicated with GI/GU surgery within how long?

Answer 21

21 days

Question 22

tPA for acute CVA is RELATIVELY contraindicated with what PMH?

Answer 22

Seizures, MI w/in 3 months, pregnancy

Question 23

BP target in acute CVA after tPA?

Answer 23

<180

Question 24

SBP target in acute CVA if tPA not given?

Answer 24

<220

Question 25

Time limit for endovascular therapy for acute ischemic CVA if tPA not given and favorable CTA-Perfusion scan?

Answer 25

24 hours

Question 26

MCC of hemorrhagic CVA?

Answer 26

HTN

Question 27

Percentage of hemorrhagic CVA patients who will have intraventricular hemorrage?

Answer 27

half

Question 28

In hemorrhagic CVA, edema peaks at what day?

Answer 28

5-7

Question 29

Indications for ICP monitoring in hemorrhagic CVA?

Answer 29

intraventricular hemorrhage, coma, hydrocephalus, possible herniation.

Question 30

SBP target in hemorrhagic CVA?

Answer 30

<140

Question 31

DVT ppx within how long for hemorrhagic CVA?

Answer 31

48 hours

Question 32

Timeline to restart full AC for hemorrhagic CVA?

Answer 32

same hospitalization

Question 33

MCC of SAH?

Answer 33

aneurysm (usually anterior circulation) or TBI.

Question 34

Coiling or clipping better with SAH?

Answer 34

coiling (mortality benefit)

Question 35

Timeline for vasospasm after SAH?

Answer 35

7-14 days

Question 36

Ppx for vasospasm after SAH?

Answer 36

Nimodipine 60mg po q4h x3 weeks. Mg.