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Flashcards in Neurologic Emergencies Deck (51):
1

Normally, ___ accounts for up to 85% of the contents of the cranial vault

Brain parenchyma

2

CSF pH that can produce cerebral ischemia

Increase in pH

3

Hallmark of severe TBI

Coma (GCS 3-8)

4

GCS indicating moderate TBI

9-12

5

In TBI, ICP should be maintained at

<20mmHg

6

Reasonable indications for CT imaging in TBI

LOC or amnesia >5 min, persistent dizziness, mental status changes, focal neurologic defects, depressed skull fracture, signs of a basilar skull fracture, drug or alcohol use, age <2, suspected child abbuse, falls from >3m, high speed injuries

7

MCC of death from TBI in infants

Abusive head trauma

8

Leading cause of hypoxic-ischemic insults leading to HIE in infants and children

Asphyxia arrest

9

These define the need for neuroprotective interventions in perinatal asphyxia (3) e.g. therapeutic hypothermia

1) Fetal acidosis 2) 5-min APGAR of 0-3 3) Neurologic dysfunction and/or abnormal EEG findings

10

First goal in HIE

Optimize cardiac output and cerebral perfusion

11

Seizure of sufficient duration to provide an enduring epileptic focus

Status ep

12

Diagnosis of status ep is made with

EEG

13

Development of epilepsy after status ep occurs in up to ___% of children

30

14

Predominant causes of ischemic stroke in children responsibble for ~50% of strokes after the neonatal period

1) Sickle cell disease 2) Heart disease

15

Ischemic strokes in children are generally the result of

Damage to the intima of cerebral arteries which can form a thrombotic nidus

16

Predominant presentation of children with stroke

Abrupt onset of focal neurologic deficits

17

Predominant presentation of children with intracerebral hemorrhage

Coma

18

Major complication of stroke

Hemorrhagic transformation

19

Major complication of aneurysmal SAH

Vasospasm

20

The only approved acute therapy for stroke

rTPA within 3 hours IV or within 6 hours intrarterially into the occlusion

21

Guidelines for the management of pediatric stroke

1) ICP monitoring 2) RBC exchange/transfusion therapy for children with sickle cell disease 3) Anticoagulation and/or thrombolytics IF ICP MANAGEMENT IS NOT WARRANTED 4) Continuous EEG monitoring for children with tracheal intubation 5) Thrombolytics for children with cerebral venous sinus thrombosis

22

Herniation syndromes: Supratentorial to infratentorial

Transtentorial or uncal

23

Herniation syndromes: Increased ICP in one hemisphere

Subfalcine

24

Herniation syndromes: Cerebellar mass or edema

Foramen magnum

25

Herniation syndromes: Compression of the cerebral peduncles

Transtentorial or uncal

26

Herniation syndromes: Compression of the anterior cerebral artery

Subfalcine

27

Herniation syndromes: Compression of the midbrain

Transtentorial/uncal

28

Herniation syndromes: Compression of the cerebellar tonsils

Foramen magnum

29

Herniation syndromes: Compression of CN III

Transtentorial/uncal

30

Herniation syndromes: Compression of the posterior circulation

Transtentorial/uncal

31

Herniation syndromes: Compression of the medulla oblongata

Foramen magnum

32

Herniation syndromes: Dilated ipsilateral pupil

Transtentorial/uncal

33

Herniation syndromes: Hemiparesis

Transtentorial/uncal

34

Herniation syndromes: Bladder incontinence

Subfalcine

35

Herniation syndromes: Bradycardia, bradypnea, htn, death

Foramen magnum

36

Herniation syndromes: Hemiparesis

Transtentorial/uncal

37

Herniation syndromes: Cushing triad

Transtentorial/uncal

38

Herniation syndromes: Decerebrate posturing

Transtentorial/uncal

39

In children, brain death most commonly follows

TBI or asphyxia

40

Standard for diagnosis of brain death

Repeat clinical exam (it is a CLINICAL DIAGNOSIS)

41

3 key components of clinical brain death

1) Irreversible coma/unresponsiveness 2) Absence of brainstem reflexes 3) Apnea

42

Extension of the upper extremities followed by flexion of the arms with the hands reaching to midsternal level

Lazarus sign

43

What does the apnea test assess

Function of the medulla in driving ventilation

44

How do you do the apnea test

Preoxygenate with 100% O2 ~10mins > adjust ventilation to achieve pCO2 of about 40 > CPAP > assess for breathing efforts through observation and auscultation > ABG 10 mins into the test and every 5 mins thereafter until target pCO2 is surpassed

45

Positive apnea test

Absence of respiratory efforts with pCO2 >60 or more than 20 from baseline

46

To establish diagnosis of brain death, findings must remain consistent over a period of observation: For 7 days to 2 mos

2 exams separated by at least 48 hours

47

To establish diagnosis of brain death, findings must remain consistent over a period of observation: For 2 mos to 1 year

2 exams separated by at least 24 hours

48

To establish diagnosis of brain death, findings must remain consistent over a period of observation: Older than 1 y/o

2 exams separated by at least 12 hours

49

Confirmatory testing of brain death should be performed on what population

All children <1 y/o

50

Confirmatory testing of brain death

EEG, nuclear medicine cerebral flow scans etc.

51

EEG finding that supports diagnosis of brain death

Electrocerebral silence