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Neuro Emergencies
Neurology
| Question | Answer |
|---|---|
| Monro-Kellie Doctrine: | Total intracranial volume is fixed |
| Epidural hematoma | temporal/temporoparietal; btw skull & dura; usu younger pts (not elder or <2 yo); 80% meningeal art inj; parenchyma compressed to midline; lens shape on CT |
| Trauma-induced alteration in mental status that may or may not involve a loss of consciousness = | Concussion |
| Concussion Grade I | No LOC, transient confusion |
| Concussion Grade II | No LOC, transient confusion; sx last longer (>15 min) |
| Concussion Grade III | LOC of any duration |
| Layers of SCALP: | skin, connective tx, aponeurosis, loose areolar tx, pericranium |
| EDH s/s | lucid interval in 30%; late: ipsilateral fixed/dilated pupil, contra hemiparesis |
| CPP = | MAP - ICP (cerebral perfusion P = mean art P - intracranial P) |
| SDH = | venous blood btw dura & arachnoid; bridging v.; often 2/2 accel/decel, in EtOH/elderly |
| SDH acute vs chronic | acute usu s/s in 24 hr; chronic >2 wks |
| On CT: concave density adjacent to skull, crosses suture lines = | SDH |
| On CT: biconvex density adj to skull, does not cross suture lines = | EDH |
| Cushing triad | HTN, bradycardia, resp irregularity; 2/2 markedly elevated ICP |
| brain ischemia results from CPP less than: | 40 mm Hg |
| GCS ≥ 13 = | mild brain injury |
| GCS 9-12 = | moderate brain injury |
| GCS ≤ 8 = | severe brain injury |
| GCS eye 1 = | no response |
| GCS eye 2 = | to painful stimuli |
| GCS eye 3 = | to verbal command |
| GCS eye 4 = | spontaneously |
| GCS verbal response 1 = | no response |
| GCS verbal response 2 = | incomprehensible sounds |
| GCS verbal response 3 = | inappropriate words |
| GCS verbal response 4 = | confused conversation |
| GCS verbal response 5 = | oriented |
| GCS motor 1 = | no response |
| GCS motor 2 = | decerebrate posturing (arms & legs held straight out, toes pointed downward, & head & neck arched backwards) |
| GCS motor 3 = | decorticate posturing (rigidity, flexion of arms, clenched fists, & extended legs (held out straight); arms are bent inward toward body w/wrists & fingers bent & held on chest) |
| GCS motor 4 = | flexion withdrawal |
| GCS motor 5 = | localizes pain |
| GCS motor 6 = | obeys commands |
| Most sig cause of mortality in pts with TBI | Diffuse axonal injury (DAI) |
| meningitis PE | fever, HA, photophobia, seizure; petechiae/purpura (60-80% of Neisseria pts), poss AMS, +Kernig & Brudzinski |
| Hunt-Hess scale grades severity of: | SAH (I = mild HA, stiff neck; V = coma) |
| SAH RFs | HTN, smoking, cocaine, FH, prior SAH, PKD, CTD, coarctation |
| SAH tx | control HTN (labetalol / nitroprusside); nimodipine for vasospasm; surg (resect / embolization) |
| s/p Fall w/ bilateral LE weakness, urinary and rectal incontinence, decreased rectal tone | Cauda equina syndrome = neurosurgical consult |
| Pediatric with fever or Hx URI with encephalopathy, emesis, hyperactive reflexes, hepatomegaly, elevated liver enzymes | Reye’s syndrome from URI/post-flu or aspirin use |
| Orbital blowout fx | comminuted floor fx: herniated orbital contents; inf rectus mx entrap or vert diplopia d/t edema; blood in max sinus when orbital trauma |
| Loss of consciousness requires: | Both cerebral hemispheres damaged OR brainstem lesion |
| Brown-Sequard lesion: findings | Ipsilateral loss of position, motor, vibration. Contralateral loss of pain & temperature |
Created by:
Abarnard
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