CNS CNS Neurocritical Care and Emergency Neurology

Question 1

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?

Accepted Answer

Lumbar puncture for xanthochromia

Answer

Repeat CT in 6 hours

Answer

MRI brain with gadolinium

Answer

Empirical nimodipine administration

Question 2

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

Accepted Answer

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

Answer

<140/90 mmHg immediately

Answer

<160/90 mmHg within 1 hour

Answer

<180/105 mmHg at all times

Question 3

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?

Accepted Answer

Guillain-Barré syndrome

Answer

Myasthenia gravis

Answer

Transverse myelitis

Answer

Multiple sclerosis relapse

Question 4

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

Accepted Answer

Intracranial pressure monitoring with cerebral perfusion pressure targets

Answer

Continuous EEG only

Answer

Hourly pupillary checks alone

Answer

Serial CT scans every 2 hours

Question 5

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?

Accepted Answer

Valproate, fosphenytoin, or levetiracetam IV

Answer

Diazepam rectal gel

Answer

Oral carbamazepine loading

Answer

Ketamine infusion immediately

Question 6

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

Accepted Answer

Impending transtentorial herniation from raised ICP

Answer

Acute ischemic stroke with penumbra

Answer

Severe autonomic dysreflexia

Answer

Hypertensive encephalopathy