CNS Neurocritical Care and Emergency Neurology Flashcards

A patient arrives with sudden onset worst headache of life. CT head is negative. What is the NEXT priority step to rule out subarachnoid hemorrhage?

Answer: Lumbar puncture for xanthochromia

When CT is negative but SAH is clinically suspected, lumbar puncture to detect xanthochromia (yellow CSF discoloration) is mandatory to rule out subarachnoid hemorrhage.

Which blood pressure target is recommended during the acute phase of ischemic stroke in a patient NOT receiving thrombolysis?

Answer: Allow up to 220/120 mmHg unless end-organ damage is present

For non-thrombolyzed acute ischemic stroke, permissive hypertension up to 220/120 is recommended to maintain penumbral perfusion unless end-organ damage is present.

A 45-year-old presents with ascending weakness beginning in the legs over 3 days, areflexia, and albuminocytologic dissociation on LP. Which diagnosis is MOST likely?

Answer: Guillain-Barré syndrome

GBS classically presents with ascending flaccid paralysis, areflexia, and elevated CSF protein with normal cell count (albuminocytologic dissociation).

Which monitoring parameter is MOST critical in a neurocritical care patient with severe traumatic brain injury to guide management?

Answer: Intracranial pressure monitoring with cerebral perfusion pressure targets

ICP monitoring with CPP targets (typically 60–70 mmHg) is the standard of care in severe TBI to prevent secondary brain injury from herniation or ischemia.

A patient with known epilepsy presents with continuous seizure activity lasting 30 minutes. After benzodiazepines fail, which second-line agent is preferred per US guidelines?

Answer: Valproate, fosphenytoin, or levetiracetam IV

After benzodiazepine failure in status epilepticus, IV valproate, fosphenytoin, or levetiracetam are recommended second-line agents per AES/NCS guidelines.

Cushing's triad—hypertension, bradycardia, and irregular respirations—signals which life-threatening neurological emergency?

Answer: Impending transtentorial herniation from raised ICP

Cushing's triad is a late sign of severely elevated intracranial pressure threatening brainstem compression and herniation, requiring immediate intervention.