FA Wards - Neuro
Terms
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- Reflexes - grading scale
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0 = areflexia
1 = weak reflex (hypoactive)
2 = normal
3 = hyperactive with spread across joint. "spread" of reflex to other muscle groups
4 = hyperactive with clonus - Strength - grading scale
-
0 = no movement
1 = flicker of contraction
2 = full range of motion with gravity eliminated
3 = full range of motion against gravity
4 = full range of motion against gravity and some resistance
5 = full power - "inability to recognize object by feeling"
- graphesthesia
- "ability to localize sensory input"
- point localization
- "inability to recognize dual, bilateral stimuli"
- extinction
- When is a CT better than an MRI
-
skull fracture - (bone cannot be imaged by MRI)
Intracranial bleeds - Acute bleeds appear white on CT within 20 minutes of onset.
Blood takes hours to appear on MRI
Trauma - CT is safer than MRI in trauma setting b/c pt may have metallic implants, fragments, or pacemakers. It's also faster when time is of the essence.
Monitoring hydrocephalus - CT is cheaper and large ventricles are easier to image. - increased WBC in CSF think:
-
Bacterial meningitis (inc PMNs)
Viral meningitis (inc leukocytes)
Subarachnoid hemorrhage - Bacterial meningitis labs:
-
inc WBCs (PMNs)
dec glucose
inc PROTEIN
inc Opening Pressure - Viral Meningitis labs;
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inc WBCs (leukocytes)
normal glucose - RBCs in CSF think
- Subarachnoid Hemorrhage
- Increased protein in CSF but normal WBCs
- Guillain Barre GBS
- Significantly Increased gamma globulin (% protein) in CSF
- Multiple Sclerosis
- clear or yellow CSF
- GBS (high protein)
- Significantly increased Opening Pressure
- Pseudotumor Cerebri (all other levels are normal)
- decreased glucuse
- bacterial meningitis