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Neuro 6 Hemorrhage

Hemorrhage

QuestionAnswer
A child presents to ER with mental status changes, hypoglycemia, and lesions suggestive of chicken pox. What is the most likely dx? Reye syndrome
What type of HA causes unilateral, severe periorbital HA with tearing? Cluster HA
CSF analysis shows low glucose, elevated neutrophils, and Gram-positive diplocci. What is the diagnosis? Bacterial meningitis 2/2 Strep pneumo (remember Neisseria meningitidis is gram neg diplococci)
What is the desired systolic BP (if adequate cerebral perfusion) in the case of a subarachnoid hemorrhage? What is the drug of choice to accomplish this? Syst BP <150. Labetalol.
Which BP lowering drugs should be avoided in the case of subarachnoid hemorrhage? Why? Nitroprusside and nitroglycerine b/c they can increase ICP.
What drug can be added to prevent vasospasm in the case of subarachnoid hemorrhage? Nimodipine (CCB)
Should phenytoin be given to a pt with subarachnoid hemorrhage for seizure prophy? NO WAY! Controversial and generally avoided due to poorer outcomes.
In which scenario is seizure prophy with anticonvulsants recommended-- parenchymal hemorrhage or subarachnoid hemorrhage (SAH)? Parenchymal hemorrhage (Prophy that Parenchyma!). Only give anticonvulsants in SAH if pt actually develops seizures; don't prophy them.
What are 3 feared complications of parenchymal hemorrhage? 1. Uncal herniation 2. Obstruction of CSF flow 3. Death
How does one differentiate between SAH and a traumatic LP as a cause of bloody CSF? SAH: All 3 tubes will be bloody; no decrease in RBC ct. Traumatic tap will decrease in bloodiness by third tube and show serial decrease in RBC ct.
An aphasic pt has great trouble producing words but understands everything you say. What type of aphasia does he most likely have? Broca's
What are the MCC of an epidural hematoma and subdural hematomoa? Epid: rupture of middle meningeal a Subd: rupture of bridging vv
Which can appear to cross the midline in CT scan: epidural or subdural hematoma? Epidural
Which type of hematoma: convex on CT scan Epidural
Which type of hematoma: crescent on CT scan Subdural
A subdural hematoma w/u should be done in an elderly pt with what history? H/o falls and altered mental status
SAH and chronic meningitis can cause what wacky, wobbly, wet syndrome? Normal pressure hydrocephalus
How can you differentiate normal pressure hydrocephalus from pseudotumor cerebri on MRI and LP? NPH: enlarged ventricles on MRI but no elev CSF pressure. Pseudotumor: elevated CSF opening pressure, but normal imaging
Which hematoma is assoc'd with a lucid interval? Epidural (more severe than subdural)
Created by: sarah3148
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