CNS Neurocritical Care and Emergency Neurology Flashcards

A patient is brought to the ED with suspected opioid-induced altered consciousness and miosis. Before administering naloxone, which assessment is MOST important for a CNS specialist to perform?

Answer: Airway, breathing, and circulatory status

ABC assessment takes priority in any emergency; establishing airway and ventilatory support is critical before administering reversal agents.

Which clinical feature BEST distinguishes a simple partial seizure from a transient ischemic attack (TIA)?

Answer: Symptoms spread or march across adjacent body regions (Jacksonian march)

The spreading or 'march' of focal motor or sensory symptoms across contiguous body parts reflects ictal excitation spreading across cortex, which is characteristic of partial seizures, not TIAs.

A patient develops sudden painless monocular vision loss lasting 10 minutes and then fully resolves. This presentation is MOST consistent with:

Answer: Amaurosis fugax from carotid artery embolism

Amaurosis fugax is transient monocular blindness classically caused by cholesterol emboli from an ipsilateral carotid plaque temporarily occluding the ophthalmic artery.

In the management of elevated ICP, hyperosmolar therapy with mannitol works by which primary mechanism?

Answer: Creating an osmotic gradient that draws water from brain parenchyma into the bloodstream

Mannitol creates an osmotic gradient across the intact blood-brain barrier, drawing interstitial and intracellular water into the circulation and reducing brain volume.

A patient in the neurological ICU develops a new unilateral dilated, non-reactive pupil after worsening headache. The MOST urgent concern is:

Answer: Uncal herniation compressing CN III

An ipsilateral blown pupil signals uncal herniation compressing the oculomotor nerve (CN III) against the tentorium—a neurosurgical emergency.

Which scale is the standard tool used in the US to communicate neurological status and guide management decisions in acute stroke patients across care teams?

Answer: NIH Stroke Scale (NIHSS)

The NIHSS is the standardized, validated tool used to quantify stroke severity across neurological domains and guides tPA eligibility and treatment decisions.