Neurology
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Monro-Kellie Doctrine: | Total intracranial volume is fixed
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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
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Trauma-induced alteration in mental status that may or may not involve a loss of consciousness = | Concussion
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Concussion Grade I | No LOC, transient confusion
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Concussion Grade II | No LOC, transient confusion; sx last longer (>15 min)
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Concussion Grade III | LOC of any duration
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Layers of SCALP: | skin, connective tx, aponeurosis, loose areolar tx, pericranium
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EDH s/s | lucid interval in 30%; late: ipsilateral fixed/dilated pupil, contra hemiparesis
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CPP = | MAP - ICP (cerebral perfusion P = mean art P - intracranial P)
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SDH = | venous blood btw dura & arachnoid; bridging v.; often 2/2 accel/decel, in EtOH/elderly
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SDH acute vs chronic | acute usu s/s in 24 hr; chronic >2 wks
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On CT: concave density adjacent to skull, crosses suture lines = | SDH
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On CT: biconvex density adj to skull, does not cross suture lines = | EDH
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Cushing triad | HTN, bradycardia, resp irregularity; 2/2 markedly elevated ICP
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brain ischemia results from CPP less than: | 40 mm Hg
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GCS ≥ 13 = | mild brain injury
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GCS 9-12 = | moderate brain injury
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GCS ≤ 8 = | severe brain injury
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GCS eye 1 = | no response
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GCS eye 2 = | to painful stimuli
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GCS eye 3 = | to verbal command
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GCS eye 4 = | spontaneously
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GCS verbal response 1 = | no response
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GCS verbal response 2 = | incomprehensible sounds
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GCS verbal response 3 = | inappropriate words
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GCS verbal response 4 = | confused conversation
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GCS verbal response 5 = | oriented
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GCS motor 1 = | no response
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GCS motor 2 = | decerebrate posturing (arms & legs held straight out, toes pointed downward, & head & neck arched backwards)
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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)
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GCS motor 4 = | flexion withdrawal
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GCS motor 5 = | localizes pain
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GCS motor 6 = | obeys commands
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Most sig cause of mortality in pts with TBI | Diffuse axonal injury (DAI)
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meningitis PE | fever, HA, photophobia, seizure; petechiae/purpura (60-80% of Neisseria pts), poss AMS, +Kernig & Brudzinski
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Hunt-Hess scale grades severity of: | SAH (I = mild HA, stiff neck; V = coma)
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SAH RFs | HTN, smoking, cocaine, FH, prior SAH, PKD, CTD, coarctation
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SAH tx | control HTN (labetalol / nitroprusside); nimodipine for vasospasm; surg (resect / embolization)
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s/p Fall w/ bilateral LE weakness, urinary and rectal incontinence, decreased rectal tone | Cauda equina syndrome = neurosurgical consult
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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
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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
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Loss of consciousness requires: | Both cerebral hemispheres damaged OR brainstem lesion
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Brown-Sequard lesion: findings | Ipsilateral loss of position, motor, vibration. Contralateral loss of pain & temperature
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Created by:
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