Neuro

Thrombolysis -> 3.5-4h [BP needs to be <185/110]

R MCA stroke: facial > upper > lower; hemisensory loss, dysarthria, hemineglect

hemorrhagic stroke-> IV nicardipine

Child with elevated ICP: Ultrasound if open fontanelle; MRI if closed
SUNSET EYES

Non–pupil-sparing oculomotor nerve (CN III) palsies are concerning for aneurysmal compression.  MR or CT angiography
should be performed immediately.  Pupil-sparing CN III palsies are most commonly caused by microvascular ischemia
associated with diabetes mellitus, hypertension, and hyperlipidemia.
  Tonsillar herniation: fixed, midposition pupils due to disruption of both sympathetics &
parasympathetics
 Uncal herniation: ipsilateral fixed and dilated pupil due to compression of the ipsilateral CN3 and
accompanying parasympathetic fibers.

ALS->widespread fibrillations and positive sharp waves on EP studies. 

Transverse myelitis -> IVIG, plasmapheresis

Spontaneous cerebellar -> ipsilateral hemiataxia. 

Ischemic stroke patients who are seen within 24 h of symptom onset should have CT angiography of the
head and neck performed to determine whether there is a large vessel occlusion amenable to treatment
with mechanical thrombectomy.  This occurs irrespective of thrombolysis being performed.

Patients may be eligible for mechanical thrombectomy (ie, catheter-assisted mechanical retrieval of a
thrombus) if they meet the following criteria:

 Disabling neurologic symptoms

 Symptom onset <24 hours
 CT scan of the head consistent with an acute ischemic stroke (ie, no evidence of hemorrhage)
 Large vessel occlusion (eg, middle cerebral artery) demonstr

Ischemic stroke
Intervention Blood pressure target
 Prior to administration: lower BP to <185/110 mm Hg
Thrombolytics
 After administration: maintain BP <180/105 mm Hg for 24 hr
administered

 Allow permissive hypertension

Thrombolytics not  Lower extreme hypertension (SBP >220 mm Hg or DBP >120 mm Hg) by 15%
indicated* in first 24 hr   

*If >4.5 hr since symptom onset or contraindication present.

Toxins from scorpion stings-> fasciculations and jerking; awake with intense pain at the site of the bite.

Strychnine blocks inhibitory (glycine) neurotransmission-  ‘awake seizure’