20. Diagnostic Tool
Indications of use of CT
`Hounsfield number(Bone>>> lipid>air)
`fisrt line in evaluation of a change in mental status
`Test of choice for those with implantable devices
`shows acute and sub acute blood(ICH/SAH,SDH)
`Bony abnormalities,i.e Trauma or Fracture
`Edema/mass effect
`Abnormalities in size and shape of structures
(brain atrophy,gyri effacement with swelling)
`Hydrocephalus
`Ischemic stroke
21. Diagnostic Tool
Indications of use of MRI
`Use with caution with people with claustrophobia,implantable
devices or programmable shunts
`Provide better soft tissue differentiation than CT
`Tumor
`Abscess
`Edema/mass effect
`Stroke
`Hydrocephalus
`Stereotactic surgical planning
26. How things appear on a CT
Acute blood/Calcifications -White
Chronic blood collection -Low density
black to gray as increasing density
CSF/Air-Black
White matter- Less dense than gray matter
Ischemia-lower density and therefore will be
darker and may not appear for 12hours
27.
28. Types of MRI
Gadilinium enhancement(tumor/infection)
T1/T2
Diffusion- can assess an acute infarct within the last 2 weeks
MRV-Assess patency,stenosis or occlusion of the venous system
MRA
Flair/Echo gradient-Similar studies(Echo gradient may see a smaller
bleed clearer
Functional MRI-Asked to do sensory,motor and cognitive tasks.
Shows increasing signals with cerebral activity
29. MRI overview (T1/T2)
T1
CSF appears black
White matter brighter than gray matter
T2
CSF apperars white
60. Spinal cord injury
Methylprednisolone(Within 8hrs)
1.concentration:62.5mg/ml
2.bolus:30mg/kg initial bolus over
15minutes
3.followed by a 45 minutes pause
4.maintenance:then 5.4 mg/kg/hr
if<3hrs:23hrs, >3~8hrs:47hrs
61. Spinal cord injury
(Frankel Scale)
Grade Description
1(A) complete motor and sensory paralysis below lesion
2(B) Complete motor paralysis,but some residual sensory
perception below lesion
3(C) Residual motor function,but of no practical use
4(D) Useful but subnormal motor function below lesion
5(E) normal
62. Glasgow coma scale(≥4yrs)
Points Eye opening verbal motor
6 - - obeys
5 - oriented Localizes pain
4 Spontaneou Confused Withdrawals to pain
s
3 To speech Inappropriate Flexion
2 To pain Incomprehesible Extenson
1 None None none
63. Glasgow coma scale(≤4yrs)
Points Eye opening verbal motor
6 - - obeys
5 - Smile,interact Localizes pain
s
4 Spontaneous Consolable , Withdrawals to
inappropriate pain
3 To speech moaning Flexion
2 To pain Inconsolable, Extenson
restless
1 None None none
66. Vegetative state
Preservation of autonomic function and
primitive reflex.
No meaingful interaction for external
stimuli.
67. Locked in syndrome
A state quadriplegia with preservation of
cognition
Consciousness,vertical eye
movements,eyelid blinking
Destructive lesions in the ventral pons or
ventral midbrain
Reemergence of horizontal movement
(within 4weeks):Predictive of improved
recovery
69. Muscle strength
Grade Strength
0 No contraction
1 Flickering
2 Movement with gravity eliminated
3 Movement against gravity
4 Against resistance(4-,4 ,4+)
5 normal
79. Facial weakness
H-B(House-Brackmann grade)
Grade Description
1 Normal function in all areas
2 Slight weakness on close inspection
3 Obvious but not disfiguring
4 Obvious weakness and/or disfiguring
asymmetry
5 Barely perceptible motion
6 No movement
85. Acute medical management of
ischemic stroke
Effective therapy for stroke
-Reduce degree of ischemic change
-Minimize effect of reperfusion injury
*penumbra:
Target of
neuroprotective therapy
86. Thrombolytic agents
Plasminogen to plasmin
Degradation of fibrin
Canal recanalization
* t-PA:only drug approved by FDA
87. t- PA administration
Inclusion
-18yr older
-Signs of measurable neurological deficit
-Onset≤3hrs
88. t- PA administration
Exclusion
-Hemorrhage
ICH,SAH,active internal bleeding
Platelet count<100,000/mm 3
Heparin within48hrs,PT>15sec
Recent lumbar or arterial puncture
GI bleeding within 21 days
89. t- PA administration
Exclusion
-Minor or rapidly improving symptoms
-Uncontrolled HTN (SBP>180,DBP<110)
-abnormal blood glucose(<50 or >400)
-Post myocardial infarction
-Seizure at time stroke onset
90. t- PA administration
Monitor BP every 15min for 2hrs
Recommneded goal of BP
-less than 185/100
Aggressive blood pressure reduction
might precipitate further ischemic injury
91. Pain-sensitive structure
Venous sinuses
Cortical veins
Artery
Dura mater
Scalp vessels and muscle
92. Classfication(Headache)
Sinusits
Migrane
Cluster headache
Post traumatic
Drug-induced HA
Menigitis
Hydrocephalus
Tension HA
Cervicalgia
Hemorrhage
93. History taking
Character,site,mode of onset
Frequently duration
Timing
Associated symptoms
Precipitating factors