CNS Neurocritical Care and Emergency Neurology Flashcards

Which finding on CT angiography is the strongest predictor of hematoma expansion in spontaneous intracerebral hemorrhage?

Answer: The 'spot sign' (contrast extravasation within the hematoma)

The CT angiography spot sign, representing active contrast extravasation into the hematoma, is the strongest independent predictor of subsequent hematoma expansion.

A patient in the neurological ICU develops fever, neck stiffness, photophobia, and CSF showing >1000 WBC with predominantly neutrophils and low glucose. The MOST appropriate immediate intervention is:

Answer: Start empirical IV antibiotics and dexamethasone immediately

Bacterial meningitis is a medical emergency; empirical broad-spectrum antibiotics plus dexamethasone must be started immediately without waiting for cultures.

Which neuroprotective intervention has the STRONGEST evidence for improving neurological outcomes after out-of-hospital cardiac arrest?

Answer: Targeted temperature management (TTM) to 32–36°C

TTM prevents secondary neuronal injury after cardiac arrest by reducing metabolic demand and inflammatory cascades, with the strongest evidence base for post-cardiac arrest neuroprotection.

A patient with myasthenia gravis develops rapidly worsening dysphagia and respiratory distress. The CNS specialist recognizes this as:

Answer: Myasthenic crisis requiring ICU monitoring and possible intubation

Myasthenic crisis is life-threatening deterioration of neuromuscular transmission causing respiratory failure and requires urgent ICU care, plasmapheresis, or IVIG.

In a patient with acute spinal cord injury, neurogenic shock presents with hypotension and which cardiovascular finding that distinguishes it from hemorrhagic shock?

Answer: Bradycardia and warm, vasodilated extremities

Loss of sympathetic tone in neurogenic shock produces bradycardia and peripheral vasodilation, contrasting with the compensatory tachycardia seen in hemorrhagic shock.

Which electroencephalographic pattern is MOST concerning for non-convulsive status epilepticus in a comatose neurocritical care patient?

Answer: Continuous spike-and-wave discharges at 3 Hz

Continuous or near-continuous spike-and-wave activity on cEEG in a comatose patient without overt motor signs is the hallmark of non-convulsive status epilepticus.