Neurological Emergencies Flashcards

A 58-year-old patient presents with sudden-onset 'worst headache of my life.' CT head is negative. What is the next most important diagnostic step?

Answer: Lumbar puncture for xanthochromia

A negative CT does not rule out subarachnoid hemorrhage; lumbar puncture looking for xanthochromia (yellow discoloration) is essential to confirm or exclude the diagnosis.

A patient presents with right-sided facial droop, left arm weakness, and slurred speech that started 45 minutes ago. CT shows no hemorrhage. The patient has no contraindications. What is the priority treatment?

Answer: IV alteplase (tPA) within the 3–4.5 hour window

IV alteplase is the standard of care for ischemic stroke presenting within 3–4.5 hours of symptom onset when there are no contraindications.

Which of the following is a contraindication to administering IV tPA for acute ischemic stroke?

Answer: Recent ischemic stroke within the last 3 months

A prior ischemic stroke within 3 months is an absolute contraindication to IV tPA due to significantly increased risk of hemorrhagic transformation.

A patient is brought in seizing continuously for 10 minutes. Lorazepam has been given twice without effect. What is the next drug to administer?

Answer: Levetiracetam or fosphenytoin IV

For benzodiazepine-refractory status epilepticus, second-line agents include fosphenytoin, valproate, or levetiracetam IV per current guidelines.

A patient with bacterial meningitis should receive which treatment combination as soon as possible?

Answer: Vancomycin + ceftriaxone + dexamethasone

Empiric treatment for bacterial meningitis includes vancomycin (for resistant organisms) plus ceftriaxone (broad coverage) plus dexamethasone (to reduce inflammation and neurological sequelae).

The Glasgow Coma Scale (GCS) assesses which three components?

Answer: Eye opening, verbal response, motor response

The GCS evaluates eye opening (1–4), verbal response (1–5), and motor response (1–6) for a maximum score of 15 and minimum of 3.