Neurology – Workbook
with correct answers
2025
Stroke sx - what to check? - correct answersAll patients: Noncontrast CT/MRI
Blood glucose
Serum electrolytes/renal function tests
ECG
Cardiac enzymes
CBC w/ platelet count
PT/INR (<4.5 hours)
aPTT
What about on selected patients? - correct answersHepatic function tests
Toxicology screen
blood alcohol level
Pregnancy test
ABG
,CXR
LP (if SAH is suspected and CT scan negative for blood)
EEG
What if noncontrast CT came back normal? - correct answersStill ischemic stroke
Management of ischemic stroke - correct answersSystolic BP 160-200
Statin
ASA
MRI/MRA
Carotid US - cartoid endarectomy within 2 weeks if on the same side if abnormal.
Echo
Telemetry
Speech and swallow eval, MBS
PT eval
Stroke rehab
Contraindications to TPA use - correct answersSustained BP > 185/110 despite treatment
Plt < 100,000; Hct < 25%; Glucose <50 or >400
Use of Heparin within 48 hours and prolonged PTT or elevated INR
Rapidly improving sx
Prior stroke or head injury within 3 months; prior intracranial hemorrhage
Major surgery in preceding 14 days
Minor stroke sx
GI bleeding in preceding 21 days
Recent MI
Coma or Stupor
NIHSS > 25
,New onset A fibb. MRI shows a large infarct in R MCA territory
Dx?
How do you manage this?
Any concerns for starting anticoag with coumadin? - correct answersEmbolic ischemic stroke
Should not put heparin/coumadin for a few days because of fear of converting to hemorrhagic
stroke.
Start ASA first and then 3-4 days later start coumadin
In what common situation is a lumbar puncture contraindicated? - correct answersIn the setting
of acute head trauma, signs of intracranial hypertension (e.g., papilledema), or suspicion for
subarachnoid hemorrhage.
Do a lumbar tap only after you have a negative computed tomography (CT) or magnetic
resonance imaging (MRI) scan of the head in these settings.
Otherwise, you may cause uncal herniation and death.
Normal CSF? - correct answersCells: 0-3
Glucose: 50 - 100
Protein : 20-45
Pressure: 100-200
Bacterial meningitis? - correct answersCells: >1000 (PMN)
Glucose: <50
Protein: Around 100
, Pressure: >200
Viral/aseptic meningitis? - correct answersCells: >100
Glucose: Normal
Protein: Normal/slightly increased
Pressure: Normal/slightly increased
Pseudotumor cerebri - correct answersCells: Normal
Glucose: Normal
Protein: Normal
Pressure: >200
GBS - correct answersCells: 0-100
Glucose: Normal
Protein: >100
Pressure: Normal
Cerebral ehmorrhage - correct answersCells: Bloody RBC
Glucose: Normal
Protein >45
Pressure: >200
MS - correct answersCells: Normal/slightly increased
Glucose: normal
Protein: Normal/slightly increased
Pressure: Normal
with correct answers
2025
Stroke sx - what to check? - correct answersAll patients: Noncontrast CT/MRI
Blood glucose
Serum electrolytes/renal function tests
ECG
Cardiac enzymes
CBC w/ platelet count
PT/INR (<4.5 hours)
aPTT
What about on selected patients? - correct answersHepatic function tests
Toxicology screen
blood alcohol level
Pregnancy test
ABG
,CXR
LP (if SAH is suspected and CT scan negative for blood)
EEG
What if noncontrast CT came back normal? - correct answersStill ischemic stroke
Management of ischemic stroke - correct answersSystolic BP 160-200
Statin
ASA
MRI/MRA
Carotid US - cartoid endarectomy within 2 weeks if on the same side if abnormal.
Echo
Telemetry
Speech and swallow eval, MBS
PT eval
Stroke rehab
Contraindications to TPA use - correct answersSustained BP > 185/110 despite treatment
Plt < 100,000; Hct < 25%; Glucose <50 or >400
Use of Heparin within 48 hours and prolonged PTT or elevated INR
Rapidly improving sx
Prior stroke or head injury within 3 months; prior intracranial hemorrhage
Major surgery in preceding 14 days
Minor stroke sx
GI bleeding in preceding 21 days
Recent MI
Coma or Stupor
NIHSS > 25
,New onset A fibb. MRI shows a large infarct in R MCA territory
Dx?
How do you manage this?
Any concerns for starting anticoag with coumadin? - correct answersEmbolic ischemic stroke
Should not put heparin/coumadin for a few days because of fear of converting to hemorrhagic
stroke.
Start ASA first and then 3-4 days later start coumadin
In what common situation is a lumbar puncture contraindicated? - correct answersIn the setting
of acute head trauma, signs of intracranial hypertension (e.g., papilledema), or suspicion for
subarachnoid hemorrhage.
Do a lumbar tap only after you have a negative computed tomography (CT) or magnetic
resonance imaging (MRI) scan of the head in these settings.
Otherwise, you may cause uncal herniation and death.
Normal CSF? - correct answersCells: 0-3
Glucose: 50 - 100
Protein : 20-45
Pressure: 100-200
Bacterial meningitis? - correct answersCells: >1000 (PMN)
Glucose: <50
Protein: Around 100
, Pressure: >200
Viral/aseptic meningitis? - correct answersCells: >100
Glucose: Normal
Protein: Normal/slightly increased
Pressure: Normal/slightly increased
Pseudotumor cerebri - correct answersCells: Normal
Glucose: Normal
Protein: Normal
Pressure: >200
GBS - correct answersCells: 0-100
Glucose: Normal
Protein: >100
Pressure: Normal
Cerebral ehmorrhage - correct answersCells: Bloody RBC
Glucose: Normal
Protein >45
Pressure: >200
MS - correct answersCells: Normal/slightly increased
Glucose: normal
Protein: Normal/slightly increased
Pressure: Normal
