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61 Cards in this Set

  • Front
  • Back
What is the mcc of hemorrhage in elderly patients?
Rule of thumb to operate on hematoma?

How to estimate?
Volume of clot > 30mL

Estimate the VOLUME of the clot by (A x B x C) * .5
What peaks 3 days post hemorrhage in ICH?
vasogenic edema
IVC often come from?

common in?
intraparenchymal hemorrhage from the thalamus

patiens with HTN or cocaine uses
Most common place for ruptured SAH?
ACA @ BASE of brain

berry aneurysm
Clot for acute SDH?

Thick, gelatinous clot

ARTERIAL in origin

CRANIOTOMY is necesary!!
Clot for chronic SDH
liquid nature

VENOUS in origin

Cranitomy is NOT necessary...can jsut evacuate liquid with burr holes
Where do aneurysms normally occur?
Where there's a defect in the INTERNAL ELASTIC LAMINA
First step in management of SAH? How (2)?
Protecting the dome from re-rupture

Clipping, Coiling (Pt w/ mild platelet-activating effect)
Advanage of coiling over clipping?
less invasive (open craniotomy)
A major problem with 30% of SAH patients? Mech?

As the clot at the base of brain dissolves, leaches out ENDOTHELIN and other molecues that cause spastic result in artery wall
Factors that increase risk of ICAs?
-Family history (strongest)
-Polycystic kidney disease
-Smoking (biggest modifiable risk)
Is the discover of a small, unruptured, ICA a medical emergency?
No, risk ^ for larger aneurysms and aneurysms in POSTERIOR circulation
Name the 4 kinds of neurosurgical Intracranial Vascular Malformations (IVM)?
1)Arteriovenous Malformations (AVM) (MOST COMMON)

2)Dural arteriovenous (AV) fistulas

3)Venous angioma

4)Cavernous malformations
How do Arteriovenous Malfomations develop?

Potential effects?

Small AVM may be treated by?
Congenitaly (3rd trimester) - contain NIDUS (cluster of abnormal BVs)

Seizures, Mass effect & ruptures

Symptoms of a Dural arteriovenous (AV) fisturla include (2)?
1) Hemorrhage

2) Pulsatile TINNITUS (hear heart beat w/out stethscope)
Venous angiomas are?
Cerebellar veins that are LARGER THAN NORMAL VEINS and

NOT associated with hemorrhage
Describe a Cavernous Malformation
Parenchymal lesion within the brain tissue with typical "popcorn" appearance on MRI

CAN cause hemorrhage (although fairly benign)

typically associated with Venous Angiomas
For what time frame are intra-arterial thrombolytics effective for ischemic stroke patients?
3-8 hours post-stroke
What is the penumbra?
The surrounding area of strock-affected brain tissue that is being kept alive and potentially salvageable by COLLATERAL VESSELS or RECANALIZATION
What is the use of CT perfusion?

Diff from MRI?
Separate patients with reversible (penumbra) versus irreversible brain injury from a stroke

Easier and faster than MRI
25% of people with stroke or TIA have?

measure degree of stenosis by?
Associated atherosclertoic carotid dz

Dividing diameter of stenotic area by th diameter of intact artery and multiplying by 100 (>50% = signifcant)
Preserve normal consciousness during Simple Partial Sz?
Yes, patients are aware of the envitonment
A purely sensory phenomenona is called an?
Most common presentation of Simple Partial Sz?
Aura that progresses into a complex partial sz (spreads across brain)

-if it effects entire brain, then called Secondary generalized seizure

Sz CANNOT reverse in severity (just increase & spread)
Preserve normal consciousness during Complex Partial Sz?
Yes, but ALTERATION of consciousness (not loss)

-retain some ability to intreact w/ envionment

-usually dont remember anything
Main factors that different causes of simple vs complex partial sz?
1) amount

2) location of involved cortex

-region determined by symptoms (Todd's paralysis)
Sz that starts in WHOLE brain at SAME time from the onset?
Generalized Onset Sz
If absence seizure began as an adult suspect what?
Temporal lobe complex partial sz
Name the 4 types of Generalized Onset Sz and key characteristics?
1)Tonic-Clonic ("Grand mal") - blood-curdling cry, clonic phase: high freq/low amp to low freq/high amp jerking

2) Absence ("Petit Mal")- ALWAYS starts during childhood (usually grow out of it)

3) Myoclonic - like clonic jerks but isolated event (non-epileptic), no LOC

4) Atonic - brief & sudden loss of tone, opposite of myoclonus; mainly occurs in kids w/ encephalopathies
Dosing off in class causes?
physiologic myoclonus
Atonic sz mainly occur in what population?
Kids w/ encephalopathies
Cortical orgin of jerking?
motor cortex
Classic features of temporal lobe sz (important!)...aura, complex partial symp, duration, post-ictal symp?
1) Aura - epigastric rising sensation, deja vu, jamais vu & foul smell/metallic taste

2)Complex partial - staring, oral automatisms (ie lip smack), manual automatisms (ie picking; ipsi to sz-side), dystonia (contra to sz-side

Duration - 30sec to 2 min

Post-ictal - confusion, Todd's paralysis, fatigue

Primary Epilepsy syndrome characteristics?

More common in CHILDREN

NOT associated with MR

usually grow out of it

Secondary Epilepsy syndrome characteristics?
Cryptogenic (partial), Lennox Gastaut (generalized)

more common in ADULTS

Arises from either 1)acquired damage or 2)manifestation of dz with broader clinical scope (ie MR or cerebral palsy)
Recurrent sezures that are not epilepsy can be caused by (3)?
1) Alcohol withdrawal

2) Hypoglycemia

3) Cocaine
When do you look for abnormalities on of brain wave with EEG for sz?

how do you make the EEG more sensitive?
when patient is NOT having a seizure

make patient SLEEP DEPRIVED
Reason for completing an MRI for sz patients?
to R/O underlying pathology such as tumor or AV malformation
____ is the gold standard for sx diagnosis

when is it necessary?
Video EEG monitoring

During surgical evaluation (but otherwise not normally necessary)
Never _____ when a patient is having a seizure?
Never put anything in mouth
When are CT's useful for sz dx?
MEDICAL EMERGENCIES (otherwise MRI will suffice)
Can all New Generation AEDs be used in monotherapy?
Yes, but not all are approved for monotherapy by FDA
Choice of AED is usually made on the basis of?

One key differentiation?

Most common idiosyncratic SE of AEDs?
Dose related SE of AEDs usually problems where?

fatigue, dizziness, diplopia
Beneficial SE of AEDs?
Drug with highest incidence of birth defects?
Change medication if woman is pregnant and seizure free?
Most common type of epilepsy surgery?
Mesial temporal lobe epilepsy
T or F...If patient does not become sz free on one of the 1st few AEDs, then will probably never be sz-free
Traditional 1st choicce amongst neurologists for PARTIAL-onset seizures?
DOC for Primary Generalized epilepsy
Great AED for migraines
Great AED for weight loss
Least sedating drug in most patients (esp elderly)
Starting dose is dose for this AED
No known drug interactions for this AED
Less potent as add-on than other AEDs
AED w/ very long 1/2 life (QD dosing)
AED w/ Enormous OFF-LABEL USE especially for PAIN