| Test 1 | Test 2 | Test 3 | Test 4 | Test 5 |
|---|---|---|---|---|
|
This condition is persisting despite administration of at least two appropriately selected and dosed parenteral medications including a benzodiazepine
Refractory status epilepticus
|
1) Fulminant Guillain-Barré syndrome, botulism, high cervical cord injuries, snake bites, and rabies
2) Hypotension (SBP>100, MAP>60), hypothermia(>35C or 36C), hypoglycemia
Mimics and confounders of BD/DNC
|
- loss of grey-white matter differentiation
- cortical hypoattenuation and sulcal effacement - loss of insular ribbon or obstruction of Sylvian fissure
These are earliest ischemic changes on CTH
|
Susceptibility-Weighted imaging (SWI) and Gradient Echo Sequence(GRE)
MRI sequences to detect blood products
|
ICH
Failure to restore the flow Re-occlusion Futile recanalization phenomenon - a lack of clinical benefit despite angiographic recanalization
Complications of thrombectomy
|
|
This condition is persisting at least 24 hours after onset of anesthesia, either without interruption despite appropriate treatment with anesthesia, recurring while on appropriate anesthetic treatment, or recurring after withdrawal of anesthesia and requiring anesthetic reintroduction
Super-refractory status epilepticus
|
- AED
- Antibiotics - Baclofen - Barbiturates - Benzodiazepines - IV/inhaled anesthetics - Narcotics - Propofol - Tricyclic antidepressants - Zolpidem
List of medications that can cause false-positive BD/DNC exam
|
1) Barbiturates
2) Benzodiazepines
1) Binds to GABA and Increases the duration of chlorine channels opening
2) Binds to GABA and increases the frequency of the chloride ion channel opening |
Oxcarbazepine
Closest by chemical structure to Tegretol, treatment for focal seizures
|
Skull fracture
Acute hemorrhage Calcified lesion Low cost and speed Pacemaker which is not compatible with MRI
Situations when CTH is superior to MRI brain
|
|
What is time t1 in SE?
The time at which seizures usually do not stop spontaneously anymore, and hence, treatment should be initiated; 5 min in bilateral tonic-clonic seizures, 10 min in focal seizure with/without impaired awareness
|
Diagnosis and treatment: aneurysms, acute ischemic stroke, vascular abnormalities, arteriovenous malformation, arteriovenous fistula, caroticocavernous fistula, cerebral vasospasm post subarachnoid hemorrhage, meningioma (preoperative embolization)
investigation of: reversible cerebral vasoconstriction syndrome moya-moya syndrome
Indications for a cerebral angiogram
|
What is the etiology(s) of status epilepticus? Most common? What are rare causes?
Can be caused by cerebrovascular disorders, hypoxia-anoxia, brain trauma, infections, alcohol, drugs, there are also rare genetic/immunological causes
|
ASPECT score
Segmental estimation of the MCA vascular territory is made, and 1 point is deducted from the initial score of 10 for every region involved: caudate, internal capsule, putamen, insular cortex, M1-frontal operculum , M2- ant temporal lobe, M3- post temporal lobe A score less than or equal to 7 predicts a worse functional outcome at 3 months as well as symptomatic hemorrhage
10-point quantitative topographic CT scan score used for middle cerebral artery stroke patients. Clinical significance.
|
Typically occurs in patients with severe carotid stenosis and poor collateral circulation, particularly in those with complete occlusion of the contralateral ICA or patients with an underdeveloped circle of Willis
Clinical manifestations of this complication are varied and include: Ipsilateral headaches, nausea, vomiting Markedly elevated blood pressure Focal seizures and altered mental status Fatal intracranial hemorrhage
Hyperperfusion syndrome
|
|
What is time t2 in SE?
The time at which treatment of SE should be successful to prevent long-term consequences, 30 min in bilateral tonic-clonic seizures, 60 min in focal seizures with/without impaired awareness
|
1st line - lorazepam 2-4mg or diazepam --> 5 min--> another dose
2nd line- a load of AED or a combo (Depakote, Keppra, Lacosomide, Phenytoin, Phenobrabital) 3rd line- Versed or Propofol
Medications that can be used to treat status epilepticus, a step-wise approach.
|
Within 24h of symptoms
NIH>6 LVO Modified Rankin 6 Perfusion mismatch
Criteria for thrombectomy
|
Valproic acid aka Depakote
- ataxia, tremor - GI side effects - transient transaminitis, increased ammonia level
Prolongs sodium channel inactivation, inhibits T-type Ca2+ channels, stimulates GABA synthesis and inhibits breakdown, t1/2 is 15h.
List side effects. |
Peri-procedural minor and major embolic ischemic events ( TIA, stroke, myocardial infarction)
Transient bradycardia and hypotension Carotid artery spasm/dissection Hyperperfusion syndrome After procedure - restenosis
Complications of Carotid Artery Stenting (peri -procedural and post-procedural)
|
|
Conditions that cause irreversible catastrophic brain damage and might warrant evaluation for BD/DNC
Etiologies include hypoxic-ischemic brain injury, hemorrhagic stroke, ischemic stroke, traumatic brain injury, bacterial meningitis, viral encephalitis, hepatic encephalopathy, and obstructive hydrocephalus
|
Phenytoin aka Dilantin
- drowsiness - nausea/vomiting - bradyarrhythmia, hypotension - osteomalacia - gingival hyperplasia - aplastic anemia - cerebellar toxicity long-term
Prolongs sodium channel inactivation, metabolized by CYP 2C9, can be given PO, IV, IM, 90% protein-bound
List side effects |
Carbamazepine aka Tegretol
-Drowsiness, ataxia, double vision, vertigo, aplastic anemia, agranulocytosis, SIADH
Sodium channel blocker, enzyme inducer, PO or IV, treat both generalized seizures and focal seizures, t1/2 20-35h.
List adverse reactions. |
Acute stroke (from 30 min to up to 10-14 days)
CJD (basal ganglia, cortical ribbon) hypercellular lesions (CNS lymphoma, abscess)
Causes of DWI changes
|
small (25mm) 6 % risk/year
Classification of unruptured aneurysms by size and associated risk of rupture
|
Support Us on Ko-fi