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Signs of neurological badness

I will be giving high-impact, rapid-fire talks on assessing stroke symptoms, using EEG after acute brain injury, and advanced multimodality monitoring

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Signs of neurological badness

  1. 1. Neurological badness By Brandon foreman md @neurollama
  2. 2. Signs of Herniation or Increasing Mass Effect warranting ICP reduction measures Changes in pupillary exam Extensor Posturing or No Motor Response Decrease of > 2 in GCS
  3. 3. *Neurological badness is defined broadly as any of the following in the absence of reasonable alternative cause: • Decline in the total GCS ≥ 2 or motor GCS ≥ 1 (Fan 2013, Morris 1998) • Decline in the NIHSS > 2 (Kwan 2006) • New focal neurological deficit lasting > 1 hour (Zafar 2016) >neurodeterioration/neuroworsenin g
  4. 4. >Top 10 Signs of neurological badness 10. Lateral Gaze
  5. 5. >10 lateral GAZE Stroke! Seizure!
  6. 6. >Top 10 Signs of neurological badness 9. Inattention 10. Lateral Gaze
  7. 7. >9 inAttention Yadav 2007 1) Is my patient infected or experiencing a new organ failure? 2) Is something happening to BOTH my patients frontal lobes?
  8. 8. >Top 10 Signs of neurological badness 9. Inattention 10. Lateral Gaze 8. Crazy talk
  9. 9. >8 crazy talk Hagoort 2013
  10. 10. >Top 10 Signs of neurological badness 7. Painless leg weakness 9. Inattention 10. Lateral Gaze 8. Crazy talk
  11. 11. >7 Painless leg weakness https://radiopaedia.org/articles/cauda-equina-syndrome?lang=us • Sphincter tone, straight cath • Pulses • Count forwards in one breath or associated respiratory symptoms https://radiopaedia.org/articles/cauda-equina-syndrome?lang=ushttps://en.wikipedia.org/wiki/File:Aortic_dissection_-_Echocardiogram_-_Longitudinal_view.jpghttps://media.giphy.com/media/krP2NRkLqnKEg/giphy.gif
  12. 12. >Top 10 Signs of neurological badness 7. Painless leg weakness 9. Inattention 10. Lateral Gaze 8. Crazy talk 6. The Tense Flap
  13. 13. >6 The TENSE flap
  14. 14. >Top 10 Signs of neurological badness 5. Stiff legs
  15. 15. >5 stiff legs Rafa 2017
  16. 16. >Top 10 Signs of neurological badness 4. Downward gaze and skew 5. Stiff legs
  17. 17. >4 vertical gaze
  18. 18. >Top 10 Signs of neurological badness 4. Downward gaze and skew 3. Talk and die 5. Stiff legs
  19. 19. >3 talk and die
  20. 20. PTD1>Day 1: GCS 13
  21. 21. PTD2>Day 2: GCS 12
  22. 22. PTD2>Day 4: GCS 3
  23. 23. >Top 10 Signs of neurological badness 4. Downward gaze and skew 2. Herniation rigors 3. Talk and die 5. Stiff legs
  24. 24. >2 Shivering Wijdicks 2009
  25. 25. >2 Shivering Rodriguez-Luna 2011
  26. 26. >Top 10 Signs of neurological badness 4. Downward gaze and skew 1. Seizures 2. Herniation rigors 3. Talk and die 5. Stiff legs
  27. 27. >end

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