Info
🌱 來自: Huppert’s Notes
Other Neurologic Emergencies🚧 施工中
Other Neurologic Emergencies
Elevated intracranial pressure (ICP)
• Definition: Elevation of the pressure in the cranium. ICP is normally 7–15 mmHg; at 20–25 mmHg, treatment to reduce ICP may be needed
• Etiologies: Tumor, infection, trauma, venous sinus thrombosis, surgical complication
• Symptoms: Headache, nausea/vomiting, hypertension, blurry vision, seizures, papilledema, encephalopathy
• Treatment:
- Consult neurosurgery to help guide medical management and to determine if a surgical intervention is needed
- Elevate head of bed 30°, keep head midline, provide sedation (reduced demand)
- Hyperventilate (CO2 washout causes cerebral vasoconstriction, which can be a temporizing measure)
- Mannitol or hypertonic saline (osmotic diuresis)
- Surgical intervention
Status epilepticus
• Definition: A single seizure lasting more than 2–3 minutes or ≥2 seizures back-to-back without the patient returning to their baseline mental status in between them
• Risk factors:
- Acute: Ischemic or hemorrhagic stroke, traumatic brain injury, sympathomimetic intoxication, alcohol withdrawal, CNS infection, metabolic disturbance, paraneoplastic or autoimmune CNS disease
- Chronic: Non-adherence to antiepileptic drugs, prior stroke, prior traumatic brain injury
• Diagnosis: Head imaging, labs (see seizure section), EEG
• Differential diagnosis: Other conditions that may present similarly include hypoglycemia, movement disorders, meningitis, delirium, psychogenic nonepileptic seizures (PNES)
• Treatment: Progress through each treatment tier below until the clinical seizures stop
- 1st tier: Benzodiazepines (lorazepam 0.1 mg/kg [2–4 mg, max 8 mg in two doses], diazepam or midazolam)
- 2nd tier: Fosphenytoin (20 mg PE/kg IV), valproic acid (40 mg/kg IV), OR levetiracetam (30–60 mg/kg IV)
- 3rd tier: Propofol bolus and gtt, midazolam bolus and gtt, pentobarbital. Patients will need to be intubated and undergoing EEG monitoring by this stage.