Unit 3 Lecture 6

Question 1

normal ICP in adults

Question 2

what are the 3 intracranial components

Answer 2

brain parenchyma, CSF, blood

Question 3

what is a “critical parameter for brain function and survival?”

Answer 3

cerebral blood flow

Question 4

complications a/w elevated ICP

Answer 4

brainstem compression (herniation); reduction in CBF

Question 5

most common herniation

Answer 5

uncal herniation

Question 6

cushing’s triad

Answer 6

bradycardia, respiratory depression, HTN (correlates with brainstem compression)

Question 7

decorticate

Answer 7

hands to the body core

-lesion in the corticospnial tract from cortex to upper midbrain

Question 8

decerebrate

Answer 8

extension of arms

-damage to corticospinal trac at level os the pons or upper medulla

Question 9

what causes a blown pupil

Answer 9

CN III compression

Question 10

CN a/w direct and indirect pupillary repsonse

Answer 10

CN II and CN III

Question 11

CN a/w EOM’s

Answer 11

CN III, IV, VI

Question 12

CN s/w vestibulo-ocular reflexes

Answer 12

CN VIII, III, VI

Question 13

CN a/w mastication

Answer 13

CN V

Question 14

CN a/w corneal reflex

Answer 14

CN V (sensory) and VII

Question 15

CN a/w cough/gag reflex

Answer 15

CN IX and X

Question 16

management of ICH/ICP

Answer 16

refer to neurosurgery (decompressive craniectomy)

• maintain O2 sat >90%
• BP; cerebral perfusion pressure >60mmHg
• ICP

Question 17

leading cause of TBI

Answer 17

falls (esp 65yo+)

Question 18

linear skull fx

Answer 18

single fracture that most often extends throught the entire thickness of the calvarium

Question 19

depressed skull fx

Answer 19

traume and drives a segment of the skull below the level of the adjacent skull
-often injury to brain parenchyma

Question 20

basilar skull fx

Answer 20

at least 1/5 bones that comprise the base of the skull

Question 21

signs of basilar skill fx

Answer 21

hemotypmanum, raccoon eyes, battle sign, CSF otorrhea or rhinorrhea

Question 22

most commonly affected bone in basilar skull fx

Answer 22

temporal bone

Question 23

basilar skull fx at risk for which type of hematoma

Answer 23

epidural hematoma

Question 24

imaging of choice for suspect skull fracture

Answer 24

noncontrast CT

Question 25

what is diffuse axonal injury (DAI)

Answer 25

shearing of white matter tracts | -a/w posttraumatic coma

Question 26

CT of DAI

Answer 26

blurring of gray to white matter margin, cerebral hemorrhages, or cerebral edema

Question 27

epidural hematoma

Answer 27

a/w skull fracture - middle meningeal artery - lucid interval - lens shaped CT

Question 28

subdural hematoma

Answer 28

tears of bridging veins - a/w brain atrophy (elderly and alcholics) - crescent shape CT

Question 29

most common type of intracranial hematoma (hemorrhagic or ischemic)

Answer 29

ischemic

Question 30

a/w "worst HA of my life"

Answer 30

subarachnoid hemorrhage

Question 31

dx of SAH

Answer 31

CT without contrast! | -if normal and no papilledema->LP (bilirubin peak)

Question 32

gold standard for detecting intracranial aneurysms

Answer 32

digital subtraction angiography

Question 33

most common cause of intracerebral hemorrhage

Answer 33

hypertension

Question 34

ICH management

Answer 34

admit to ICU and emergent neurosurg. consult, same as ischemic CVA (BP control, manage elevated ICP, avoid hyperglycemia *keep glucose between 140-180*, seizure prophylaxis and treatment)

Question 35

pts with intraventricular hemorrhage are at risk for what?

Answer 35

hydrocephalus

Question 36

dx of IVH with neuro deterioration

Answer 36

CT

Question 37

tx of IVH

Answer 37

ventriculostomy and external ventricular drainage

Question 38

acute ischemic CVA management

Answer 38

eval for thrombolytic therapy, ASA if not tPA candidate

Question 39

management if not candidate for IV thombolysis

Answer 39

allow for permissive HTN (no intervention unless SBP >220 or DBP >120

Question 40

management if candidate for IV thromblysis

Answer 40

target BP

Question 41

thombolytics inclusion criteria

Answer 41

clinical dx of ischemic stroke, onset of sxs

Question 42

Head CT scan exclusion criteria (slide 64 FYI but this was highlighted)

Answer 42

multilobar infarction with hypodensity involving >33% of the cerebral hemisphere

Question 43

initial tx of seizure

Answer 43

immediate ABC's and IV anticonvulsants (although not indicated during an uncomplicated seizure)

Question 44

management of eclamptic pt with seizure

Answer 44

emergent OB constult, admin magnesium sulfate

Question 45

what is a jefferson fx

Answer 45

most common fracture of C1 (atlas) | -caused by axial compression

Question 46

cause of C2 (axis) fx

Answer 46

forceful flexion or extension | -type I is stable, types II and III unstable

Question 47

C2 fracture involving both pedicles

Answer 47

hangmans fx | -caused by hyperextension with compression

Question 48

most common level of disc herniation in the C spine

Answer 48

C6-7

Question 49

clinical presentation of cauda equina syndrome

Answer 49

urinary retention, radic., BLE weakness, saddle anesthesia, decreased anal sphincter tone

Question 50

following what type of injury does neurogenic shock usually occur?

Answer 50

after cervical spine injury

Question 51

signs/sxs of complete spinal cord injury

Answer 51

early->flaaccid paralysis, absent reflexes, priapism | within 1-3days->hyperactive reflexes, +babinski, spasticity

Question 52

central cord syndrome

Answer 52

- hyperextension injury - UE motor impairment - sensory loss or bladder dysfunction

Question 53

brown-sequard syndrom

Answer 53

- penetration trauma - ips. loss of motor function, proprioception, and vibration sensation - contr. loss of pain and temp. sensation

Question 54

management of CSI

Answer 54

- airway! - immobilize spine - imaging - neuro/spine consult

Question 55

ventilation impairment based on location of SCI

Answer 55

- complete injury above C3: near total ventilatory muscle paralysis - injury at C3-5: variable impairment of diaphragmatic strength and accessory muscles of ventilation - C6 or above (*per notes, but I think it should be below): may compromise resp. function

Question 56

Guillian-Barre Syndrome

Answer 56

- ascending paralysis that is symmetric - mild URI or gastroenteritis precedes 1-3 weeks - progresses over a period of 2 weeks

Question 57

most common demyelination neuropathy

Answer 57

GBS

Question 58

dx of GBS

Answer 58

LP-elevated CSF protein without pleocytosis

Question 59

tx of GBS

Answer 59

admit, neuro consult, high dose IVIG and plasmapheresis

Question 60

when is imaging indicated if bell's palsy is in the differential?

Answer 60

Bi involvement/atypical; forehead sparing; hx of trauma

Question 61

tx of bell's palsy

Answer 61

steroids and antiviral

Question 62

which type of meningitis is a neurologic emergency

Answer 62

bacterial

Question 63

sxs of meningitis

Answer 63

HA, stiff neck, and fever, rash

Question 64

dx of meningitis

Answer 64

LP with CSF analylsis

Question 65

tx of meningitis

Answer 65

early IV dexamethasone and abx

Question 66

encephalitis

Answer 66

- viral infection - culture of blood AND CSF - empiric antiviral tx

Question 67

most common sx of brain abscess

Answer 67

HA

Question 68

when is LP contraindicated when brain abscess is present

Answer 68

focal sx or signs

Question 69

definitive dx of brain abscess

Answer 69

brain bx