ABIM Neurocritical flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Tenecteplase stroke dose

0.25 mg/kg single IV bolus (max 25 mg) within 4.5 hours of last known well; an alternative to alteplase for eligible acute ischemic stroke, including large-vessel occlusion candidates.

ICH score

GCS 3-4, age >=80 years, ICH volume >=30 mL, infratentorial origin, and intraventricular hemorrhage each score 1 point; total 0-6, with higher scores indicating higher 30-day mortality.

Nimodipine in SAH

60 mg orally or via nasogastric tube every 4 hours for 21 days after aneurysmal subarachnoid hemorrhage; reduces delayed cerebral ischemia and poor outcome, with hypotension as the main adverse effect.

CVT anticoagulation

Start therapeutic low-molecular-weight or unfractionated heparin even with hemorrhagic venous infarction; continue oral anticoagulation for 3-12 months depending on the provoking factor.

Cerebral perfusion pressure formula

Cerebral perfusion pressure equals mean arterial pressure minus intracranial pressure; the typical target after severe traumatic brain injury is 60-70 mmHg in adults.

Hypertonic saline for ICP

3% saline 250 mL IV bolus over 15-30 minutes for elevated intracranial pressure; aim for serum sodium 145-155 mmol/L and monitor for hyperchloremic acidosis and pulmonary edema.

Spinal cord injury MAP target

After acute traumatic spinal cord injury, maintain mean arterial pressure at 85-90 mmHg for 5-7 days to optimize cord perfusion; high-dose methylprednisolone is not routinely recommended.

Posttraumatic seizure prophylaxis

Seven days of phenytoin or levetiracetam after severe traumatic brain injury reduces early posttraumatic seizures; prophylaxis beyond 7 days does not prevent late seizures.

Status epilepticus first-line

IV lorazepam 0.1 mg/kg (max 4 mg) or IM midazolam 10 mg, repeated once; benzodiazepines are first-line, and delay to second-line therapy increases seizure refractoriness.

Refractory status epilepticus

Continuous IV midazolam, propofol, or pentobarbital titrated to EEG burst suppression after failure of two antiseizure drugs; hypotension and propofol infusion syndrome are key risks.

Burst suppression EEG

EEG pattern of high-voltage bursts separated by periods of suppression, typically 1-3 bursts per second; used as a target for pharmacologic coma in refractory status epilepticus.

GBS treatment

IVIG 0.4 g/kg/day for 5 days or plasma exchange (5 exchanges) started within 2-4 weeks of onset; corticosteroids alone are ineffective and may worsen outcome.

GBS intubation criteria

Intubate for forced vital capacity <15-20 mL/kg, negative inspiratory force weaker than -30 cmH2O, or a rapid decline in vital capacity; monitor respiratory function serially.

Myasthenic crisis management

Respiratory failure from myasthenia gravis requiring ventilation; treat with IVIG or plasma exchange, avoid aminoglycosides, fluoroquinolones, magnesium, and beta-blockers, and reduce pyridostigmine if secretions are excessive.

HSV encephalitis treatment

IV acyclovir 10 mg/kg every 8 hours for 14-21 days; start empirically for suspected HSV encephalitis with temporal lobe findings or CSF pleocytosis before PCR results return.

Meningitis dexamethasone

Dexamethasone 10 mg IV given before or with the first antibiotic dose in adults with suspected pneumococcal meningitis, continued for 4 days; reduces hearing loss and neurologic sequelae.

Anti-NMDAR encephalitis

Autoimmune encephalitis with psychiatric symptoms, seizures, dyskinesias, and hypoventilation; treat with IVIG or plasma exchange, then rituximab or cyclophosphamide, and screen for ovarian teratoma.

Brain death apnea test

With core temperature >=36 degrees C, systolic BP >=100 mmHg, and baseline PaCO2 35-45 mmHg, disconnect the ventilator; positive when PaCO2 rises >=20 mmHg above baseline and >=60 mmHg without respiratory effort.

Coma definition

State of unresponsiveness with eyes closed, no command following, no verbal output, and no purposeful movement; GCS <=8; requires an underlying cause and absence of sleep-wake cycles.

Locked-in syndrome

Preserved consciousness with quadriplegia and bulbar paralysis from a ventral pontine lesion; patients communicate with vertical eye movements or blinking, and the EEG is normal.

Hyponatremia correction limit

Correct chronic hyponatremia by no more than 8-10 mmol/L in 24 hours to avoid osmotic demyelination; use hypertonic saline for severe symptomatic hyponatremia with seizures or coma.

Sepsis initial fluids

30 mL/kg IV crystalloid within 3 hours for sepsis-induced hypoperfusion or septic shock, plus broad-spectrum antibiotics within 1 hour of recognition of septic shock.

ARDS lung-protective ventilation

Low tidal volume 6 mL/kg predicted body weight with plateau pressure <=30 cmH2O; permissive hypercapnia is acceptable unless intracranial hypertension is present.

TCD vasospasm

Mean middle cerebral artery flow velocity >120 cm/s suggests vasospasm after subarachnoid hemorrhage; a Lindegaard ratio (MCA to internal carotid) >3 supports vasospasm, and >6 indicates severe vasospasm.

Brain tissue oxygen threshold

Brain tissue oxygen below 15 mmHg indicates cerebral ischemia; a common treatment threshold is 20 mmHg, with interventions including increased FiO2, CPP optimization, and transfusion.

Lundberg plateau waves

Lundberg A waves are plateau waves of 50-100 mmHg lasting 5-20 minutes that indicate critically reduced intracranial compliance and impending herniation.

Propofol infusion syndrome

Occurs with prolonged propofol at >4-5 mg/kg/h; features include metabolic acidosis, rhabdomyolysis, hyperkalemia, renal failure, and cardiac dysfunction; discontinue propofol immediately.

Wernicke encephalopathy treatment

Give IV thiamine 500 mg before glucose in at-risk patients with confusion, ataxia, and ophthalmoplegia; prevents precipitation of Wernicke encephalopathy and Korsakoff syndrome.

Serotonin syndrome

Caused by serotonergic drugs; triad of altered mental status, autonomic hyperactivity, and neuromuscular excitation with clonus and hyperreflexia; stop offending agents and give cyproheptadine or benzodiazepines.

EVD zero point

External ventricular drain is leveled at the foramen of Monro (tragus); an incorrect level causes over- or under-drainage, with risk of herniation or ventricular collapse.

Surrogate decision maker

Person authorized to make healthcare decisions for an incapacitated patient, using substituted judgment (what the patient would have wanted) or best interests when preferences are unknown.

DCD organ donation

Donation after circulatory death: withdrawal of life-sustaining treatment in a controlled setting, followed by rapid organ recovery after a defined no-touch period of usually 2-5 minutes.