The Acute Neurology Survival Guide: A Practical Resource for Inpatient and ICU Neurology

Foreword
Preface
Contents
Contributors
Part I: A Comprehensive “How-To” Guide
	Chapter 1: Pre-rounding on and Presenting Neurology Floor Patients
		Pre-rounding on Neurology Patients
		Presenting Neuro Floor Patients
	Chapter 2: Pre-rounding and Presenting NeuroICU Patients
		Pre-rounding on ICU Patients
		Commonly Used Drips in the NeuroICU
		Presenting NeuroICU Patients
	Chapter 3: The Coma Exam
		Glasgow Coma Scale
		Mental Status
		Herniation Syndromes
	Chapter 4: Cranial Nerve Testing in Acute Neurology
		Anisocoria
		Localizing Extraocular Eye Movement Abnormalities
		Caloric Testing
		Testing the Gag Reflex (Pharyngeal Reflex)
		Testing Cough Reflex
		Reference
	Chapter 5: Stroke and Vascular Anatomy
		Anterior Circulation Anatomy
			Classic Syndromes
		Anterior Circulation – Major Branches
		Posterior Circulation
			Lacunar Syndromes
		Reference
	Chapter 6: Basics of Computed Tomography (CT)
		Examples of Acute Hemorrhage
		Features Concerning for Hydrocephalus
		Examples of Herniation Syndromes on CT Scan
		Use of Computed Tomography in Stroke
	Chapter 7: Basics of Magnetic Resonance Imaging (MRI) Ordering and Assessment
		MRI Sequences
		MRI in Stroke
		MRI in Hemorrhage
		MRI in Infectious/Inflammatory/Neoplastic Conditions
		Examples of Diffusion Restriction Patterns
		Examples of Contrast Enhancement
		Reference
	Chapter 8: Understanding Transcranial Dopplers (TCDS)
		Basic Principles [1]
		Examples of Arteries on TCD
		Common Application of TCDs
		Monitoring
		Application in SAH
		Overview of Other TCD Applications
		References
	Chapter 9: Tips and Tricks for EEG Interpretation
		Electrodes
		Optimizing EEG Data
		Getting the Big Picture (The Spectrogram and Seizure Detection)
Part II: Vascular Neurology
	Chapter 10: Acute Ischemic Stroke – First Encounter Assessment and Management
		Emergency Department Management
		TPA (TNK) SCREENING
		Endovascular Treatment and Screening
		A Summary of Who is Likely to Benefit from Thrombectomy in Anterior Circulation Large Vessel Occlusion [5]
		TPA+Mechanical Thrombectomy (MT) vs. only MT
		Posterior Circulation Occlusions
		MAJOR SCORING METRICS FOR ACUTE STROKE
		References
	Chapter 11: Perfusion Imaging
		Techniques [1]
		Two Acute Stroke Cases That Distinguish a Completed Infarct from Penumbra
		References
	Chapter 12: Ischemic Stroke: Admission Checklist
		Review
		Confirm Patient Ordered For
		Special Considerations
		References
	Chapter 13: Stroke Workup – Beyond the Basics
		Ischemia Due to Arterial Hypercoagulable State
		Ischemia Due to Venous Hypercoagable State (Requires R → L Shunt)
		Ischemia Due to Less Common Causes of Thromboembolic Disease [8]
		Ischemia Due to Vasculopathy
		Other Etiologies of Ischemia
		References
	Chapter 14: Ischemic Stroke: Dissection
		Historical Points, Signs, and Symptoms That Should Raise Concern for Dissection [1]
			Both
			Internal Carotid
			Vertebral Artery
		Pathophysiology
		Admission Checklist
		Determining When a Vessel Is Extracranial Vs. Intracranial
			Carotids
			Vertebrals
		Aspirin Vs. Anticoagulation
		References
	Chapter 15: Ischemic Stroke: Symptomatic Carotid Stenosis (“Hot Carotid”)
		“Symptomatic” Definition
		Interventional Vs. Medical Treatment
		Carotid Endarterectomy (CEA) Vs. Carotid Stenting (CAS)
		Takeaway
		Treatment Prior to Surgery
		Factors That Demonstrate Plaque Instability
		Timing of Surgery
		Treatment After Surgery or Stenting
		References
	Chapter 16: Ischemic Stroke – Post Stroke Management of Anticoagulation
		Data About the Effectiveness of Anticoagulation in Atrial Fibrillation in the Long Term
		PART 1: RISK AND BENEFIT OF ANTICOAGULATION BY POPULATION SUBGROUP:
			Atrial Fibrillation
			Mechanical Valves
			Symptomatic Carotid Stenosis
		PART 2: UNDERSTANDING THE PATIENT’S PERSONAL RISK OF BLEEDING
			Grading Hemorrhagic Conversion
		PART 3: WEIGHING RISK/BENEFIT OF EARLY ANTICOGAULATION
		References
	Chapter 17: Selected Anti-platelets and Anticoagulation in Stroke Prevention
		References
	Chapter 18: Acute Management Strategies: tPA and Mechanical Thrombectomy Trials
		Dual Antiplatelet for Minor Stroke/Transient Ischemic Attack
		Extracranial Disease
		Severe Intracranial Stenosis
		PFO Closure Trials
		References
	Chapter 19: Venous Sinus Thrombosis
		Anatomy of the Venous Sinuses
		Historical Points and Neuroimaging Findings That Raise Concern for VST
			Risk Factors
			Symptoms
			Neuroimaging Findings That Should Raise Concern for VST
		Workup and Treatment
			Workup [5]
			Acute Treatment
			Chronic Treatment
		References
	Chapter 20: Posterior Reversible Vasoconstriction Syndrome (PRES) and Reversible Cerebral Vasoconstriction Syndrome (RCVS)
		Core Clinical Features
		Associated Conditions and Medications
		Imaging Characteristics
		Management Principles Important in Both Conditions
		Management Principles for PRES
		Management Principles for RCVS
		References
Part III: Nonvascular Inpatient Neurology
	Chapter 21: Altered Mental Status
		Workup of AMS
			Consider the Time Course
		Review Chart/History Especially
		High Yield Exam
		Testing to Consider [1]
		Management
			For Delirium
			Agitation
		References
	Chapter 22: Framework for Workup of Unknown Brain “Lesion”
		Important Factors to Gain from H&P
		Advanced Neuroimaging Techniques
		Further Testing to Consider 
	Chapter 23: Approach to First-Time Seizure
		Categories of First-Time Seizures [1]
		Workup
		Who Needs an Anti-epileptic Drug?
			Based on AAN Practice Guidelines [6]
		References
	Chapter 24: Pharmacology Tips for Commonly Used AEDS
		Valproate
		Lacosamide
		Phenytoin
			Notes on the Dosing of Phenytoin
		References
	Chapter 25: Approach to Infectious Encephalitis and Meningitis
		Workup [1]
		Typical CSF Findings in Infectious Meningitis
		Treatment
		Empiric Treatment for Community-Acquired Meningitis/Encephalitis
		CNS Penetration of Commonly Used Antibiotics
		References
	Chapter 26: Non-Infectious Meningitis
		References
	Chapter 27: Inflammatory and Autoimmune Encephalitis
		Major Categories of Inflammatory/Autoimmune Encephalitis
		Workup [1, 3]
		Treatment [3]
		Induction Immunosuppression [2]
		References
	Chapter 28: Infectious Workup by Neuroanatomical Location: An Ordering Guide
	Chapter 29: Autoimmune Encephalitis Testing
		Reference
	Chapter 30: Approach to New Onset Weakness
		Evaluation
		Selected Screening Evaluation for Infratentorial Causes of Acute Weakness by Anatomical Syndrome
			Selected Variants of Guilain-Barré [7]
		References
	Chapter 31: Workup of New Demyelinating Lesion
		Overview
		Diagnostic Workup
		Acute Management
		Demyelinating Syndromes
		References
	Chapter 32: Approach to the “Dizzy” Patient
		Step 1: Define the Dizziness
		Step 2: Examining the Dizziness: The TiTraTE Method [1]
		Step 3: Diagnosing, Localizing, and Treating the Cause [3]
		Step 4: Further Management Details
		References
Part IV: Neuroicu
	Chapter 33: Intracranial Pressure: Theory and Management Strategies
		Theory and Formulas Central to Neurocritical Care
		Strategies for Monitoring ICP
			Noninvasive ICP Monitoring
			Invasive ICP Monitoring
			When to Monitor
		Waveform Interpretation
			Lundberg A Waves
			Lundberg B Waves
			Lundberg C Waves
		Management of Increased Intracranial Pressure
			Tier Zero
			Tier One
			Tier Two
			Tier Three
			Practical Tips for Fever/Shivering Management
		References
	Chapter 34: Management of External Ventricular Catheters
		EVD Setup
		For Patients with EVDS, Things to Monitor and Report
		Selected Complications
	Chapter 35: Malignant Middle Cerebral Artery Infarction
		Major Trials Evaluating Surgical Decompression and Duraplasty Vs Conservative Treatment
		References
	Chapter 36: Intraparenchymal Hemorrhage
		Common Etiologies of Non-traumatic Intraparenchymal Hemorrhage by Location
		Early Management [1]
		Labs to Review or Order
		Admission Checklist: Confirm Patient Ordered For
		Ongoing Management
		Scoring Systems [3–5]
		Notes on Scoring Systems
		References
	Chapter 37: Intracranial Hemorrhage – Landmark Trials
		References
	Chapter 38: Reversal of Selected Antithrombotics
		References
	Chapter 39: An In-Depth Review of Reversing Direct Factor XA-Inhibitor-Related Hemorrhages
		Background
		Factor-Xa Inhibitor Reversal Therapy Used in Clinical Practice
			Andexanet Alfa (FDA-Approved for Rivaroxaban and Apixaban Reversal)
			PCC (Off-Label Use)
		References
	Chapter 40: Intracranial Hemorrhage – Management of Anticoagulation
		Early Management
		Subacute and Late Management
		Data about Risk of Recurrent ICH with Different Antithrombotics
		Timing of Resumption
		References
	Chapter 41: Subarachnoid Hemorrhage – Differential
		EXAMPLES OF ANGIO-NEGATIVE SUBARACHNOID HEMORRHAGE
		Management and Workup of Angionegative SAH
		Reference
	Chapter 42: Aneurysmal SAH – Admission and Early Management
		References
	Chapter 43: Subarachnoid Hemorrhage – Scoring Systems
		Hunt and Hess Grade [1]
		Modified Fisher Scale (Imaging Appearance) [2]
		World Federation of Neurosurgeons (WFNS) Classification [3]
		References
	Chapter 44: Aneurysmal SAH – Daily Management Principles
		Daily Management Principles
		Monitoring for and Treatment of Hydrocephalus
		Monitoring for Delayed Cerebral Ischemia (DCI)
		Treatment and Prevention of Delayed Cerebral Ischemia
		Cerebral Edema
		Systemic Complication
			Fever
			SIADH/Cerebral Salt Wasting
			Other Complications
		References
	Chapter 45: Subarachnoid Hemorrhage – Notable Trials
		References
	Chapter 46: Traumatic Brain Injury
		Framework for Traumatic Brain Injury
			The Glasgow Coma Scale (GCS)
		Emergent Management
		When to Monitor ICP [1]
		Principles of ICU Management
		Surgical Management in TBI
			Focal Lesions
		Further Management Guidance for Chronic Subdural Hematomas
		References
	Chapter 47: Trials in TBI
		References
	Chapter 48: Neuroprognosis and Induced Normothermia after Cardiac Arrest
		HISTORY IMPORTANT IN NEUROPROGNOSIS:
		Perspective in Neuroprognostication
		FOR PATIENT IN WHOM HYPOTHERMIA IS PURSUED
		Findings Associated with Poor Prognosis
		References
	Chapter 49: Status Epilepticus
		Definitions
		A Guide to Status Epilepticus Treatment
		Notes on Medications for Status Epilepticus
		Adjunctive Workup in Status
		References
	Chapter 50: Continuous EEG Monitoring, Electrographic Seizures, and the Ictal-Interictal Continuum
		Indications for Continuous EEG Monitoring
		Terms
		Examples of Commonly Encountered Continuous EEG Findings
		2HELPS2B Score [3]
		Management of the Ictal-Interictal Continuum Findings
		A Proposed Algorithm for the Treatment of IIC Patterns
		References
	Chapter 51: Neuromuscular Crises: ICU Management of Guillain-Barré Syndrome and Myasthenia Gravis
		Guillain-Barré Syndrome
		Myasthenia Gravis
			Workup
			ICU Management
			Treatment
		References
	Chapter 52: Evaluation of C-Spine Trauma
		Overview of the C-Spine Anatomy
		C-Spine Injuries
		Important and Named Injuries
		Canadian Rules for C-Spine Clearance in the Adult Patient [1]
		NEXUS Rule for C-Spine Imaging [2]
		C-Spine Collar Removal in an Awake (GCS 15) Patient
		C-Spine Clearance in the Obtunded Trauma Patient
		Should an MRI C-Spine Be Obtained?
		References
	Chapter 53: ICU Management of Spinal Cord Injuries
		Terms
		Admission Checklist
			Steroids and Spinal Injury
		Classic Syndromes
		Prognostication in Spinal Cord Injuries
		Subacute to Late Complications
		References
	Chapter 54: Management of the Postoperative Craniotomy Patient
		Craniotomy
		Craniectomy
		Checklist for Admission
		General Craniotomy Admission Orders
		Things That Affect How a Patient Wakes Up from Surgery
		Unexpected Change in the Neurological Exam
		References
	Chapter 55: Postoperative Management of Cerebrovascular Patients
		Commonly Treated Neurovascular Pathologies
		References
	Chapter 56: Preparation for Brain Death Testing
		VENTILATOR AUTOTRIGGERING & BRAIN DEATH
		PREPARATION FOR BRAIN DEATH TESTING
		Ancillary Testing
		Notes on Organ Donation
		References
	Chapter 57: Nutrition in the Neuroicu
		Goals
		Starting Tube Feeds
		Tips
		References
	Chapter 58: Hypernatremia in the Neuroicu
		Hypernatremia
		Treatment of Hypernatremia Not Due to Diabetes Insipidus
		Management and Treatment of Diabetes Insipidus
	Chapter 59: Hyponatremia in the Neuroicu
		Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)
			Treatment
		Cerebral Salt Wasting
			Treatment
		References
	Chapter 60: Pressors and Inotropes Commonly Used in the Neuroicu
		Brief Overview of the Physiology [1, 2]
		References
	Chapter 61: Seizure Prophylaxis in the Neuroicu
		References
	Chapter 62: Venous Thromboembolism Prophylaxis in the Neuroicu
		Pharmacologic Agents
		Indications for VTE Prophylaxis [1, 4, 5]
		References
Part V: Important References
	Chapter 63: Brainstem Anatomy
	Chapter 64: NeuroICU Intravenous Fluid Compositions
		Preferred NeuroICU Solutions
		Other Available Intravenous Fluids
	Chapter 65: Anti-Seizure Medication Chart for Use in Adults
		ANESTHETIC INFUSIONS FOR REFRACTORY STATUS:
	Chapter 66: Drug-Drug Interactions Common in Neurology Patients
		Definitions [1]
		Major Drug-Drug Interactions Common in Neurology Patients
		References
	Chapter 67: Myasthenia Gravis: Medications to Avoid
		References
	Chapter 68: Parkinson’s Disease: Medications to Avoid
		References
NIH Stroke Scale [1, 2]
	References
Index