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Emergency Medicine: Neuro Injuries
Emergency Medicine: Neuro Injuries
74
Anatomy
Graduate
02/06/2012

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Cards

Term
Cranial nerve/s responsible for pupillary reactions:
Definition
CNII and III
Term
Cranial nerves responsible for conjugate/disconjugate gaze?
Definition
III, IV, VI
Term
roles of CN II:
Definition
- visual acuity
- visual fields
- fundoscopic exam
- pupillary responses
Term
Cranial nerve responsible for sensation to face and chewing muscles?
Definition
CN V
Term
Cranial nerve responsible for facial symmetry:
Definition
CN VII
Term
Cranial nerve/s responsible for corneal reflex:
Definition
V and VII
Term
How to assess CN IX and X:
Definition
palate elevation and gag reflex
Term
How to assess CNXI:
Definition
head turn and shoulder shrug
Term
How to assess CNXII:
Definition
tongue movement
Term
Achille's Reflex:
Definition
S1, S2
Term
Biceps reflex:
Definition
C5, C6
Term
Brachioradialis reflex:
Definition
C5,C6
Term
Triceps Reflex:
Definition
C7, C8
Term
Patellar Reflex:
Definition
L4
Term
clavicles:
Definition
C5
Term
thumb:
Definition
C6
Term
pointer and middle finger:
Definition
C7
Term
ring and little finger:
Definition
C8
Term
bottom of the foot:
Definition
L5, S2, L4
Term
Tests for meningeal irritation:
Definition
Kernig
Brudzinski
Term
Test for nerve root irritation:
Definition
Straight leg raise
Term
Dementia affects __ without affecting ___.
Definition
- affects cognition
- without affecting consciousness
Term
Coma is due to dysfunction of:
Definition
- both cerebral hemispheres and/or the upper brain stem
Term
Signs of infection/sepsis:
Definition
- Increased heart rate
- Decreased blood pressure
Term
Signs of impending herniation:
Definition
- Decreased heart rate
- Increased blood pressure
Term
causes of Cheyne stokes breathing:
Definition
- Metabolic encephalopathy
- Bihemispheric lesions
Term
causes of central neurogenic hyperventilation (Kussmaul's repsirations):
Definition
- metabolic acidosis
- herniation
Term
Apneustic breathing:
Definition
pontine damage
Term
Cluster breathing/Biot's breathing:
Definition
Pontine/Cerebellar Breathing
Term
Ataxic (Biot's) respirations:
Definition
medullary damage
Term
findings of cortical lesions:
Definition
- hyperactive DTRs
- clonus
- Babinski sign positive
Term
Decorticate posturing:
Definition
- corticospinal tract lesion from cortex to upper midbrain
Term
Decerebrate posturing:
Definition
- corticospinal tract lesion at pons or upper medulla
Term
Gaze preference __ the hemiparesis and __ the lesion is consistent with a large ceerebral hemisphere lesion.
Definition
- AWAY from the hemiparesis
- TOWARDS the lesion
Term
Frontal eye fields normally moves eyes to the __ side, while lateral eye fields normally move eyes to the ___ side.
Definition
- contralateral
- ipsilateral
Term
Gaze preference ___ the hemiparesis and __ from the lesion is consistent with a lesion in the pons of the brainstem.
Definition
- towards the hemiparesis
- away from the lesion
Term
Looking away from the hemiparesis signifies a ___ lesion, while looking towards the hemiparesis significes a __ lesion.
Definition
- hemispheric
- pons
Term
Roving eye movements:
Definition
- slow, horizontal conjugate eye movements
- intact brainstem
- bilateral hemispheric dysfunction (anoxia)
Term
Ocular Bobbing:
Definition
- downward jerking of both eyes followed by slow return to mid-position
- pontine lesion
- need to rule out locked in state
Term
Locked-In Syndrome:
Definition
- Awake but quadriplegic with paralyzed horizontal eye movements
- Vertical eye movement intact
- Communicate by looking down/blinking
- Large pontine lesions (hemorrhage/infarct)
- Prognosis favorable, recovery possible
Term
Oculocephalic:
Definition
- normally eyes should move in opposite direction of rotated head (present doll's eyes= normal)
- if lesion in MIDBRAIN OR PONS (CN III-VIII)- eyes will remain fixed and move in the same direction as the head= dolls eyes absent- abnormal
Term
Abnormal Oculovestibular aka Calorics aka COWS signifies a lesion where?
Definition
- Brainstem (CN III-CNVIII)
Term
Oculocephalic- Doll's Eyes
Oculovestibular- Calorics- COWS
Definition
Term
Exam findings and causes of pt with non-focal exam wdn intact brainstem reflexes:
Definition
- Exam: reactive pupils, full eye movements, symmetric motor responses
- Causes: Toxic/Metabolic, CNS infection, Hydrocephalus
Term
A patient with focal hemispheric signs will have __ __, __ __ __, and __ __. These patients require neuroimaging. The cause is most likely __ like a __, __, or ___ ___.
Definition
- contralateral hemiparesis
- visual field defects
- gaze paresis
- structural
- stroke
- tumor
- subdural hematoma
Term
A pt with focal brainstem signs would have __ __ __, __ __, and ___. These require neuroimaging. Most likely caused by a brainstem lesion like a __ or __, or a __ __ that is ___.
Definition
- abnormal pupil responses
- CN palsies
- posturing
- tumor or stroke
- cerebral mass that is herniating
Term
tmt of opiate overdose:
Definition
naloxone
Term
neurosconsult for:
Definition
- Trauma
- Tumor
- Hemorrhagic stroke
Term
GCS Mild CHI:
Definition
> 13
Term
GCS moderate CHI:
Definition
9-13
Term
GCS Severe CHI:
Definition
<9
Term
Brain dead GCS:
Definition
3
Term
artery involved with epidural hematoma:
Definition
middle meningeal artery
Term
immediate LOC followed by lucid interval:
Definition
Epidural hematoma (middle meningeal artery)
Term
Bulging convex pattern on head CT:
Definition
Epidural hematoma
Term
Subdural hematoma:
Definition
tearing of bridging veins
Term
Acute subdural hematoma:
Definition
symptoms within 24 hours
Term
Subacute subdural hematoma:
Definition
symptoms after 24 hours and up to 2 weeks after the injury
Term
Chronic subdural hematoma:
Definition
symptoms develop 2 weeks or more after the injury
Term
crescent hematoma on CT scan:
Definition
subdural hematoma
Term
For pts with GCS < 8, __ and __ to keep PCO2 between__ and __. Use osmotic diuresis with __ 20% 1.0-1.5 mg/kg IV.
Definition
- intubate and hyperventilate
- 28 and 32
- Mannitol
Term
Discharge intstruction:
Definition
Call or return for any of these:
- Increased or persistent headache unrelieved by Tylenol or ASA
- Persistent vomiting
- Inability to concentrate
- Dizziness
- Problems walking, talking, chewing, or swallowing
- Seizures
- Incontinence
- Change in personality or behavior
- Inceraseing drowsiness or inability to be aroused
Term
Pathognomic for spinal cord injury:
Definition
- bilateral weakness with sensory level
Term
Indicated with spinal cord injuries:
Definition
- Methylprednisolone, 30 mg/kg IV bolus over 15 minutes, follwed by 5.4 mg/kg IV over 23 hours
Term
Characteristics of a T10 cord lesion:
Definition
- Spastic paraplegia (arms motor 5/5)
- T10 sensory level (UE intact)
- Biceps and Triceps DTR 1+
- Knee and ankle jerk reflexes 3+
- (+) Babinski sign
- FTN and RAMs intact in bilateral upper extremeties
Term
Brown Sequard Lesion:
Definition
Hemisection of the cord, Rigth T10

- disruption of right corticospinal tract> RLE plegia, +3 RLE knee jerk and ankle reflex, RLE Babinksi sign
- disruption of right posterior columns> decreased vibration and proprioception on right
- disruption of right spinothalamaic tract> decreased light touch and pin prick on LLE
Term
Non-modifiable risk factors for CVA:
Definition
- increasing age
- male
- AA
- family history
Term
Modifiable risk factors for CVA:
Definition
- Smoking
- HTN
- DM
- Hyperlipidemia
- Atrial fibrillation
- history of TIAs
Term
Manifestations of Anterior Cerebral Artery Stroke:
Definition
DeeP CD Face spared.
- Decreased concentration
- Personality changes
- Contralateral sensorimotor deficits
- Distal > Proximal
- Face spared
Term
Manifestatinos of Middle Cerebral Artery Stroke:
Definition
CCCAA
- Contralateral visual field defects (homonymous hemianopsia)
- Contralateral sensorimotor deficits (proximal> distal)
- Contralateral CNVII palsy
- Aphasia if dom hemisphere affected
- Apraxia and hemi-neglect with involvment of nondominant hemisphere
Term
Manifestations of posterior cerebral artery stroke:
Definition
CCCV
- Contralateral hemisensory loss
- Contralateral visual field deficit (homonymous hemianopsia)
- Cortical blindness
- Visual agnosia
Term
symptoms of vertebrobasilar insufficiency:
Definition
ACMSA
- Altered mental status/coma
- Cranial nerve palsies: diplopia,vertigo, dysarthria
- Motor weakness
- Sensory loss
- Ataxia
Term
BP contraindication for thrombolytics:
Definition
systolic >185 OR diastolic > 110
Term
Guillaine-Barre tmt:
Definition
- Supportive care
- Neuro consult
- DVT prophylaxis
- Plasmaphoresis
- IV immunoglobulins
- Ventilatory support if needed

majority recover in 3 months to 1 year
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