Neuro Flashcards

Question

Spinal Cord Injury C1-C6

Answer 1

Most severe injury. The higher the injury-more severe paralysis. Quadraplegia C1-C5: complete inability to ventilate/use diaphragm. C5-C6: weakened ventilation impaired/reduced speech no voluntary control of bowel/bladder.

Answer 2

Corresponding nerves affect muscles, upper chest, mid back and abdominal muscles -Arm & hand function is usually normal -Injuries usually affect the trunk & legs—paraplegia

Answer 3

Nerves affect muscles of the trunk, abdominal and back muscles—usually paraplegia -Normal upper body movement -Fair to good ability to control and balance trunk while in the seated position -Should be able to productively cough -Little to no voluntary control of bowel or bladder

Answer 4

L1-L5 -Some level of injury and loss of function to hips & legs -May need a wheelchair, but most can use braces -Little to no voluntary control of bowel or bladder

Answer 5

S1-S5 -Generally some loss of function to the hips and legs -Little to no voluntary control of bowel or bladder -Most likely able to walk

Answer 6

temporary loss of all sensorimotor function below level of injury. Lasts for several days until reflex arcs recover. Venous pooling & hypovolemia. 4 phases of recovery.

Answer 7

0-1 days loss of descending facilitation areflexia(absent/diminished reflexes)

Answer 8

1-3 days Denervation supersensitivity Initial reflex return

Answer 9

1-4 weeks Axon-supported synapse growth Hyperreflexia

Answer 10

1-12 months Soma-supported synapse growth Hyperrelexia spasticity

Answer 11

Impairment of sympathetic nervous system below injury. leaves parasympathetic nervous system unopposed. Triad of vasodilation (hypotension, hypothermia, bradycardia). Unlikely to occur below T6 injuries

Answer 12

imbalance of sympathetic reflex discharges below level of injury such as bowel/bladder distention. see massive arterial vasoconstriction & reflex hypertension and severe headaches. Parasympathetic produces profound sweating/skin flushing and bradycardia to control htn.

Answer 13

Brain parenchyma 80% Blood 10% CSF 10%

Answer 14

Peak 24-72 hrs after injury Caused by: intracellular swelling, capillary endothelial cell dysfunction, increased permeability or increased periventricular fluid.

Answer 15

Most common cause of death. Epidural hematoma – does not cross suture line, typically on side of direct impact, rapid accumulation of blood, often with fracture. Subdural hematoma: crescent shape, may cross suture line, but not midline, counter coup injury Intraparenchymal hemorrhage: bleeding within brain tissue Intraventricular hemorrhage: bleeding inside or around the ventricles of the brain Hypoxic-ischemic injury: initial CT may be normal, occurs and progresses over 24 – 48 hours, CT appears hyperdense

Answer 16

GCS of 13-15 brief LOC, disorientation, HA, and vomiting. Concussion is mild TBI. not seen on Head CT. Refrain from routine imaging.

Answer 17

GCS of 9-12 Injury seen on head CT

Answer 18

GCS 8 or less Injury seen on head CT abnormal pupillary response posturing unstable vital signs Cushing's triad

Answer 19

Burst fracture caused by axial loading. Occipital condyles driven into the lateral masses of C1. Break in ring of C1 bone.

Answer 20

fracture of the dens (odontoid process) which is bony process of C2.

Answer 21

Traumatic spondylolisthesis of axis Bilateral Fx through the pars interarticularis (pedicles) of C2. Caused by extreme cervical hyperextension & associated with subluxation of C2 on C3.

Answer 22

D. CT scan to evaluate for increased intracranial pressure and hemorrhage

Answer 23

B. Glucose should be obtained on arrival.

Answer 24

LOC, AMS, vomiting, increased FOC, tense fontanel, sz's, Status epilepticus, coma

Answer 25

ICP monitoring Sedation, drain CSF, mannitol, hypertonic saline, HOB elevated. Hypertonic saline helps by creating an osmotic gradient that draws water out of swollen brain tissue (edema) and into the vascular space, reducing brain volume. It also increases plasma volume and improves cerebral perfusion pressure (CPP) by reducing blood viscosity and improving microcirculation.

Answer 26

Autoimmune triggered by infection or immunizations. URI most common.

Answer 27

progressive neuromuscular weakness Presents 4 – 6 weeks after a viral illness or prior infection. Symptoms are progressive, symmetrical with ascending paralysis. Pain, numbness, tingling of the extremities and sensory loss with gait disturbances.

Answer 28

LP EMG (see diffuse dymyelination & delayed motor conduction).

Answer 29

IVIG, plasmapheresis, supportive care, PT. airway protections.

Answer 30

Autosomal dominant Genetic disorder that causes tumors to grow within skin and nervous system. Type 1: birth-1st yrs of life. Type 2: early adulthood.

Answer 31

Type 1: cafe au lait spots, linch nodules, neurofibromas, scoliosis, short stature, tibial dysplasia, sphenoid bone abnormality, HTN, vasculopathies, renal artery stenosis. optic gliomas. Type 2: hearing loss or ringing in ear d/t vestibular schwannomas. Have cutaneous schwannomas.

Answer 32

Type 1: 6 or more cafe au lait spots, 2 or more neurofibromas, tumor on optic nerve, abnormal development of spine. Type 2: CN 8 mass, unilateral vestibular schwannomas, glioma, meningiomas.

Answer 33

no specific tx options. surgery for tumors that are symptomatic. Follow up: Type 1: twice a year during childhood then yearly (they should undergo neuro and optho exam yearly) Type 2: Neuro and optho yearly in addition with audiologic test and brain MRI yearly

Answer 34

exposure to Clostridium botulinum bacteria that causes a progressive neurological disorder leading to general weakness & resp failure. See in unpasteurized honey. Toxin from bacteria affects neuromuscular junction blocking the release of acetylcholine from nerve endings causing paralysis. Young age & absence of bowel flora predisposes infants to disease.

Answer 35

Constipation, poor feeding, lethargy & increased weakness. hypotonia, symmetrical CN palsies. weak cry, expressionless face, ptosis, sluggish pupils. diminished gag, suck & swallow.

Answer 36

Bacteria found in stool sample.

Answer 37

supportive care give human botulism immune globulin (BIGIV), obtained only from California Dept of Health.

Answer 38

Abnormal electrical discharge in the brain with an associated altered level of consciousness and rhythmic movements followed by a post-ictal state.

Answer 39

bowel & bladder incontinence, apnea, cyanosis. May be preceded by an aura.

Answer 40

fever, ingestion, electrolyte disturbance, infections or tumors.

Answer 41

Detailed history (most important) of event, type of seizure, what happened before & after, was there a resulting disability? Family history of seizures, travel history, sick contacts. Labs: CBC, electrolytes (glucose, calcium sodium and magnesium), drug levels and toxicology screen. Go to ED: lasts >5 minutes, head injury, high fever, compromised neuro status, resp or cardiac function.

Answer 42

Generalized: Bilateral hemispheres are engaged. Atonic: Sudden loss of tone. Focal: Originates in one hemisphere Clonic: Rhythmic repetitive movements. Tonic: Sustained extension or flexion of head trunk or extremities.

Answer 43

General seizure that lasts less than 15 minutes and do not recur within 24 hours. Occurs early in the illness. No testing or neuroimaging unless meningeal signs. Increased risk of recurrence if <12mos of age at first seizure. No medication management needed-risk vs benefit. No pre-existing neurologic abnormality.

Answer 44

Focal or localized to a specific part of the body, lasts longer than 15 minutes. but less than 30 minutes, or involves recurrence of seizure in a 24 hour period. 20-25% are complex. Presence of pre-existing neurologic abnormality. Higher chance of developing epilepsy (6-8%).

Answer 45

A single seizure lasting longer than 30 minutes or two or more consecutive seizures without returning to baseline LOC.

Answer 46

Stabilize-0-5 min, ABCD’s, critical labs, drug/dextrose levels. Phase 1- 5-20 min, Benzodiazepines-IM,IV, IN, PR (may repeat x2 doses). Phase 2- 20-40 min, Keppra, Phosphenytoin, valproate(>2yrs), and phenobarbital(<6mos). Phase 3- 40-60 min, repeat dosing of above, then if refractory: anesthetic dosing of midazolam, propofol, thiopental or pentobarbital with continuous EEG monitoring(neurology). Considerations: surgical resection or Vagal nerve stimulator implantation. Seizure associated injury can occur within 30 minutes*

Answer 47

EEG: Non-invasive, provides seizure location and abnormalities: focal spikes, slow, diffusely slow or silence. Records the frequency, amplitude and characteristics of brain waves. Indication: AMS, seizures, subclinical seizures, identify location of seizures or adjunct in brain death. Type-short, sleep deprived, 24hour or continuous.

Answer 48

Identifies:Bony abnormalities, Intracranial hemorrhage, Hydrocephalus, Cerebral edema, Space occupying lesions and calcifications.

Answer 49

Sensitive to presence of blood, bones and lesions. Can be done quickly. More readily available. Fluid changes seen-hydrocephalus/cerebral edema.

Answer 50

Exposure to radiation-highest with abdomen.Need to think of cumulative radiation affect.

Answer 51

Ischemia or Infarcts, Degenerative diseases, Congenital anomalies, Arteriovenous malformations, Posterior fossa or spinal cord lesions

Answer 52

Eliminates radiation exposure, Higher resolution and differentiation of gray/white matter. Higher resolution of skull base and orbits.

Answer 53

Loud, dark and noisy. Longer time of study-many children need sedation.Metallic devices will prohibit the study.

Answer 54

infectious, autoimmune or inflammatory process to include meningeal signs of neck stiffness & + Kernig/Brudzinski signs. Age Specific- infant aged 6 to 12 months has a seizure and fever without immunizations for Haemophilus influenzae type b (Hib) or Streptococcus pneumoniae or if his or her immunization status is unknown. Adolescent: Therapeutic to remove CSF in Pseudotumor cerebri. LP also should be considered when a child with a seizure and fever has been pre-treated with antibiotics, because antibiotics can mask the signs and symptoms of meningitis but may not be sufficient to eradicate it. Measure opening pressure-normal is 6-25cm H20 Contraindicated with high ICP-perfom CT first, skin infection or thrombocytopenia.

Answer 55

Infants have poorly developed cervical musculature, head is disproportionately large(25% of total body). Children less than age 9 have wedge shaped vertebral bodies, angled horizontally and more immature bones. Young children have cartilaginous endplates with lax interspinous ligaments, so they are more prone to SCIWORA (spinal cord injury without radiological abnormality). Children with Down syndrome are prone to atlanto-axial subluxation as a result of acute flexion injury. Children 8-10yrs old more adult like anatomic proportions.

Answer 56

Diagnostics: Screening with Radiographs with normal exam: head and neck films with lateral view. Detects 80% of injuries. Neck CT: Superior at detecting injuries. Radiation exposure. CTA: vascular injuries more likely with fracture. Neck MRI: Great for soft tissue injury and ligamentous injury. DWI can identify edema, contusion, and hemorrhage within the spinal cord. Give info on prognosis.

Answer 57

Manage ABCD’s, Immobilize C-spine, Manage neurogenic shock with fluids, alpha-adrenergic agents, continuous monitoring. Spinal shock can last several days, causing paralysis and loss of tone with resultant hypovolemia and hypotension. Surgical decompression-bleeding or bone. Early surgery can impair bone growth & result in scoliosis. Bracing, progressive halo traction. Syringomyelia which occurs in 50% of adults and children afflicted with SCI, and can cause future motor neuron loss

Answer 58

Management: Rapid Sequence Intubation, Minimize episodes of increased intracranial pressure, seizures and secondary brain injury Follow Critical Pathway for Treatment of Established Intracranial Hypertension in Pediatric Trauma (Society of Critical Care Medicine. Continued evaluation of symptoms is extremely important in children with moderate to severe brain injuries, but children with mild injury should also be monitored for changes in status and sequelae.

Answer 59

Acute inflammatory process of the brain parenchyma, often caused by a viral, bacterial, autoimmune or fungal process. Herpes simplex encephalitis(HSE), occurs in neonates infected at birth and in other young infants and is potentially lethal if not treated. Varicella-zoster virus encephalitis(VZVE) is life threatening in immune- compromised patients. Symptoms: HA, aphasia, fever, AMS, ataxia, visual disturbances,seizures. Diffuse and/or focal neuropsychological dysfunction. Management: treatment of known cause and neurology consult with recommended diagnostic work up. EEG abnormal 90% cases. Therapy should be initiated with acyclovir in any young infant or child who is suspected of having viral encephalitis, especially those who appear ill. Cause often never known, may have irreversible brain damage

Answer 60

Communicating: CSF flows out and within the ventricular system but is blocked from exiting. * Non-communicating or obstructive: Blocked drainage occurs in any of the narrow passages that connect the ventricles. * Acquired: Caused by injury or disease state * Congenital: Genetic or fetal abnormality causes formation (myelomeningocele)

Answer 61

Tubing and valve automatically drains fluid when pressure rises to set point to another body space for drainage. Types: VP-Ventriculo-peritoneal or pleural. VA-Ventriculo-atrial VG-Ventriculo-gall bladder-less common Named by where they drain. All have valves and tubing

Answer 62

Premature fusion of one or more of the cranial suture lines causing abnormal skull growth deformities and restriction if corrective surgery is not performed. Syndromes found in 40% of cases-Aperts, Crouzons, Pierre-Robin, Turner, Goldenhar, VATER, Dandy-Walker. Associated brain abnormalities-hydrocephalus, Chiari malformation and increased ICP. Other associated abnormalities when syndromes present: Hearing loss, vision problems or limb abnormalities. May have cognitive or behavioral impairments.

Answer 63

Diagnostics: skull film, CT, 3-D CT, MRI Management: Complex surgical vault repair that is based on defect, where bones are broken. Endoscopic approaches now used with less complications but may be more costly. Post-op Complications: Pain and Bleeding! May also see: SIADH, bradycardia, fever, seizures and facial edema or transfusion related complications. Younger patients have less complications, many have late diagnosis, surgical recovery is more difficult.

Answer 64

Administer loading dose of Keppra. After giving a benzo, give an AED. Could also give phosphenytoin or phenobarbital.

Answer 65

C. Blood culture In order of importance, blood culture with blood gas, start antibiotics, shunt series and CT scan. No MRI needed in acute time frame, special considerations with some tracheostomies.

Answer 66

A. Corticospinal Injury This is a descending white matter injury with loss of strength. Spinothalamic injury: anterior cord with loss of temperature and pain sensations. Dorsal Column injury: Lose proprioception and tactile stimulation.

Answer 67

CT Brain and administration of hypertonic saline. Could do mannitol but this may cause hypotension with osmotic diuresis and lower CPP. Keep good BP and CPP, keep head midline and elevated. Sedate and monitor ICP.

Answer 68

B. Ischemia. Craniosynostosis results when there is a premature fusion of one or more of the cranial suture lines causing abnormal skull growth deformities and restriction if corrective surgery is not performed.

Answer 69

C. CTA When a cervical fracture is detected, a CTA should be performed as vascular injuries are more likely with fractures & could lead to bleeding. A neck CT may be performed as it is Superior at detecting injuries and an MRI is great for soft tissue injury and ligamentous injury. Diffusion weighted imaging can identify edema, contusion & hemorrhage within the spinal cord & give information & prognostication.

Answer 70

Spinal Muscular Atrophy (SMA): neuromuscular disease of childhood. S ymptoms include weakness at birth or within the first year of life, feeding, breathing difficulties. New treatment: FDA approved-Spinraza helps regulate gene expression on Chromosome 5q * Type I or Werdnig Hoffman, early diagnosis by 6 months. * Type 2 = Intermediate, usually can sit, but not stand or ambulate. Fine motor tremor of hands, tongue fasiculations * Type 3 or Kugelberg-Welander, presents after age 18 months and walk. Weakness to proximal muscle groups. Weak lower extremities. Could live full life but wheelchair dependent.

Answer 71

Brief but widespread inflammation of the brain & spinal cord that damages the myelin(white matter)-usually follows bacterial or viral illness. Symptoms: Rapid onset of Encephalitis like illness-fever, fatigue, HA, N/V. Severe-seizures and coma, vision loss, weakness or paralysis. Treatment: Steroids, IVIG or plasmapheresis, can relapse.

Answer 72

Constellation of symptoms and radiologic abnormalities resulting from disruption in the BBB with radiologic evidence of vasogenic edema that occurs most frequently in the posterior brain circulation. Can also be seen in other areas of brain. Most cases are reversible. Most common in renal, hem/onc & autoimmune population.

Answer 73

Most common is seizures. Others: HTN, HA, visual disturbances, focal neurological deficits, n/v, AMS.

Answer 74

Rapid reproduction of ones’ own cerebral spinal fluid. Visual loss is a potential complication so goal of treatment is vision preservation & alleviation of sx's. Visual field testing, dilated fundoscopic exam & imaging of optic disks are necessary for proper diagnosis of papilledema. May have cranial nerve 6 palsy. Normal CT findings and CSF composition. Lumbar puncture is diagnostic and is a treatment for IIH. Hallmark opening pressure would be >280 mmHg in children or >25cm H2O. Revised Dandy Criteria for full diagnosis in 2013.

Answer 75

Congenital intracranial malformation distinguished by a persistently abnormal connection between arteries & veins within the brain without an interposed or developed capillary bed. Associated with neurological deficits such as hemiparesis, sz's, and possibly speech affected. Management includes ABCD, close ICP control. Cerebral angiography is considered the gold standard study to identify the arteries involved. May need surgical clipping, craniectomy or embolization.

Answer 76

Autosomal dominant disorder, develop benign tumors that develop in the brain, skin, kidneys. Features: hypomelanotic fibromas, cortical tubers, subependymmal nodules or astrocytoma, facial angiofibromas, lymphangioleiomyomatosis, hamartomas, bone or renal cysts.

Answer 77

Diagnosis: Definite: 2major features, 1major and 2 minor. Mild to severe. Infants with refractory seizures, cardiac rhabdomyomas, ash leaf spots. Management: Symptom dependent. Seizure control. Immunosuppressant therapy may be helpful (not approved). Tumor removal

Answer 78

C. Cerebral Angiography Cerebral Angiography is considered the gold standard study to identify the arteries involved & for surgical identification of flow & drainage of vessels.

Answer 79

Neuromuscular disorder-presents with muscle fatigue/weakness. Etiology: Autoimmune mediated-antibodies are produced against the AchR on skeletal muscle cells. Diagnosis: Exam, PFT’s, Serologic test for AchR antibodies, EMG Myasthenic gravis crisis: rapid decompensation due to infection, stress or change in baseline medications. Treatment: Anticholinesterase meds, supportive care, plasmapheresis, gamma globulin, steroids, azathioprine

Answer 80

B. Lumbar puncture For diagnosis of suspected Idiopathic Intracranial Hypertension, an LP with an opening pressure of > 280mmHg would confirm diagnosis & provide treatment for this overproduction of CSF. It is imperative to have careful eye exams and fundoscopic exam can provide diagnosis.

Answer 81

D. IVIG Guillen-Barre Syndrome is a progressive, symmetrical disease with ascending paralysis. It is associated with pain, numbness, tingling of the extremities, & sensory loss with gait disturbances. Management: diagnose with CSF protein measurements & clinical findings. Treat with IVIG or plasmapheresis.

Answer 82

C. May require delayed live vaccines. After IVIG administration, vaccine administration is delayed. Rapid onset of encephalomyelitis: like illness-fever, fatigue, HA, n/v. Severe sz's, coma, vision loss, weakness or paralysis. Tx is steroids, IVIG, plasmapheresis. Can relapse.

Answer 83

D. Prone to injury with normal radiological images. Infants have poorly developed cervical musculature, head is disproportionately large (25% of total body). Children <9yrs have wedge shaped vertebral bodies, angled horizontally with more immature bones. Young children have cartilaginous endplates with lax interspinous ligaments, so they are more prone to SCIWORA .

Neuro Flashcards

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