Acute Neuro Disorders

Question 1

What is an ischemic stroke?

Answer 1

A sudden loss of function due to disruption of blood supply to that part of the brain

Question 2

What is the cause of an ischemic stroke?

Answer 2

Plaque narrows blood vessels or an embolism

Question 3

What is the patho of an ischemic stroke?

Answer 3

Neurons cannot maintain aerobic metabolism bc of lack of oxygen, so anaerobic metabolism causes waste to build up and neurons are lost every minute and the brain deteriorates

Question 4

What is the clinical presentation of an ischemic stroke?

Answer 4

Numbness/Weakness on one side of the body, confusion, trouble with speech, vision and gait disturbance, sudden and severe headache, short attention span, memory loss, hostile or frustrated

Question 5

What is hemiplegia?

Answer 5

Paralysis on one side of the body

Question 6

What is hemiparesis?

Answer 6

Weakness on one side of the body

Question 7

What is homonymous hemianopsia?

Answer 7

Loss of vision on one side of the vision field

Question 8

What are signs and symptoms of an ischemic stroke on the right side of the brain?

Answer 8

Left sided weakness and vision problems, easily distracted, impulsive, lack of awareness

Question 9

What are signs and symptoms of an ischemic stroke on the left side of the brain?

Answer 9

Right sided weakness and vision problems, aphasia, altered thinking, slow, cautious.

Question 10

How can an ischemic stroke be prevented?

Answer 10

Control hypertension, stop smoking, healthy diet, exercise, control afib, control carotid stenosis, control diabetes, decrease lipids, and alcohol abstinence.

Question 11

What is the treatment of an ischemic stroke?

Answer 11

TPA within three hours, coumadin for a fib, platelet inhibitors, decrease cholesterol, carotid endartectomy

Question 12

What is a hemorrhagic stroke?

Answer 12

Intracranial bleeding into the brain tissue, cerebral aneurysm, bleeding into subarachnoid space, arteriovenous malformation, and irritation of meningies.

Question 13

How does a hemorrhagic stroke clinically present itself?

Answer 13

bad headache, nuchal rigidity, photophobia, vomitting, LOC change, focal seizures

Question 14

What is brudzinski’s sign?

Answer 14

When someone flexes their knees when they flex their neck

Question 15

What is kernig’s sign?

Answer 15

When someone cant straighten their leg; tight hamstring

Question 16

How is a hemorrhagic stroke diagnosed?

Answer 16

CT, MRI, angiography, LP for blood or infection

Question 17

What is the treatment of a hemorrhagic stroke?

Answer 17

Maintain cerebral perfusion, oxygenate, mobility, safety, and nutrition concerns, may clip the aneurysm to prevent further bleeding.

Question 18

What is a concussion?

Answer 18

An acute head injury that is a mild traumatic brain injury and alteration in brain metabolism.

Question 19

What is the primary stage of a concussion?

Answer 19

The initial damage; mild traumatic injury, transiet loss of consciousness, and amnesia.

Question 20

What is the secondary stage of a concussion?

Answer 20

Complications such as infection, bleeding, and edema from increased ICP

Question 21

What is a diffuse axonal injury?

Answer 21

Shearing of axons of neurons that dont regrow; usually from a car accident or rotational injury. There is no connection to the brain and body, there is a poor prognosis.

Question 22

What kind of skull fractures can occur?

Answer 22

Linear, depressed, open, or basilar.

Question 23

What are signs of a skull fracture?

Answer 23

Crepitius of the skull, deformity, and a concern for infection and neurological damage.

Question 24

What are signs of a basilar skull fracture?

Answer 24

Racoon eyes, bruising behind the ears, concern with leaking spinal fluid/running nose… direct opening to environment and brain

Question 25

What can head injuries result in?

Answer 25

cerebral hematoma, subdural bleed, epidural bleed, contusions, coup-contrecoup injury

Question 26

How does a subdural hematoma clinically present?

Answer 26

actue change in LOC, pupillary change, hemiparesis, coma, decrease HR and RR, may mimic a stroke long term

Question 27

How does an epidural hematoma clinically present?

Answer 27

a brief loss of consciousness, then lucid, then restless, acigated, and confused and then coma and death.

Question 28

How should a head injury be assessed?

Answer 28

A full neuro assessment, glascow coma scale, pupil changes may be the first sign of increase ICP

Question 29

How are head injuries diagnosed?

Answer 29

CT scan, MRI, doppler, ultrasound, EEG with stimulation to sound and light, cerebral angiography, MRI and angiography

Question 30

How are hematomas treated?

Answer 30

surgical evacuation, frequent neuro assessments, may need a drain

Question 31

How are contusions treated?

Answer 31

Prevent increase in ICP, may need long term care.

Question 32

What is the normal ICP?

Answer 32

5-15

Question 33

What can cause increased ICP?

Answer 33

increase in brain volume, increase in CSF, (hydrocephalus), cerebral blood volume increase (These 3 things are called the Monro-Kellie Doctorine)

Question 34

How does increased ICP clinically present itself?

Answer 34

A change in LOC and pupil response, wide pulse pressure, decreased HR and RR

Question 35

What can increased ICP cause?

Answer 35

Irreversible brain damage, death and herniation

Question 36

What are some devices to monitor ICP?

Answer 36

Intraventricular catheter, subarachnoid screq, epidural probe, intraparanchymal catheter

Question 37

How can increased ICP be managed?

Answer 37

Maintain oxygenation to maintain cerebral perfusion, elevate HOB, care with suctioning, calm atmosphere, sedation, tylenol for pain, osmotic diuretic, i&o, corticosteroid, dilantin

Question 38

What are some side effects of head injuries?

Answer 38

Diabetes insipidus- ADH deficiency or SIADH- excess ADH

Question 39

What are signs and treatment of diabetes insipidus?

Answer 39

extreme thirst, polyuria, dilute urine, dehydration; replace ADH, fluid volume, and give vasopressin

Question 40

What are signs of SIADH?

Answer 40

Fluid overload, little urine, cerebral swelling

Question 41

What is brain herniation?

Answer 41

When brain tissue moves from an area of high to low pressure and moves through the foramen ovale.

Question 42

What is the classic sign of brain herniation?

Answer 42

Unilateral pupils with sluggish reaction; need an emergency craniotomy

Question 43

What is brain death?

Answer 43

Irreversible cessation of brain function; no brain stem function for 24 hours without sedation and at a normal temperature.

Question 44

How is brain death diagnosed?

Answer 44

Two physicians must diagnose it with an apnea test, look at fixed pupils, angiogram with no cerebral blood flow, flat eeg, cold caloric and doll eyes test

Question 45

What is an apnea test?

Answer 45

When the patient goes off oxygen and arterial blood is drawn at 5 and 10 mins; if it is at 60 it fails the test

Question 46

What is a seizure?

Answer 46

Abnormal motor, sensory, autonomic, or psychic activity from excessive discharge of cerebral neurons; normal functioning is disrupted and parts or all of the brain may be affected.

Question 47

What can be the cause of a seizure?

Answer 47

Cerebrovascular disease, hypoxemia, alcohol, fever, tumor, hypertension, aneurysm, head injury, epilepsy.

Question 48

What are manifestations of a seizure?

Answer 48

loss of consciousness, excessive movement, behaviour, mood, and perception changes.

Question 49

How is a seizure diagnosed?

Answer 49

CT, MRI, EEG, evoked potential

Question 50

What medications can be given for a seizure?

Answer 50

Diazepam, lorazepam to stop the seizure, tegretol and dilantin

Question 51

What are some things to do when a patient is having a seizure?

Answer 51

Turn the patient on their side, protect their head, monitor their airway, give oxygen, suction, IV line

Question 52

What are cerebral lesions?

Answer 52

Space occupying lesions like hematomas, tumors, or gliomas

Question 53

What are manifestations of a cerebral lesion?

Answer 53

Headache, gait disturbance, visual impairment, personality change, altered mentation, weakness, seizure

Question 54

What is the treatment of a cerebral lesion?

Answer 54

Maintain cerebral functioning, monitor ICP, craniotomy to debulk tumor