Acute neuro logical injuries Flashcards
what is in the brainstem and its function
- pons
- medulla
- helps with basic breathing and hr and auto regulation of the body
what is frontal in charge of
thought and reasoning
what is occipital in charge of
vision
cerebellum is in charge of
balance
pons and medulla in charge of
breathing and HR
CSF location
-in vents and around brain, sc, and subarachnoid space
what is CSF
- the cushion around the brain and spinal cord
- gives nutrients to brain
normal CSF
- clear
- 20-30 ml/hr
- total volume at any given time: 90-150 ml/hr
- 500 ml/day
why is the circle of willis an area of concern
- bifurcation of the vessels
- are that can have aneurysms and clots that get stuck is bad because big supplier of blood to the brain
anterior circulation
- give brain 02
- middle cerebral: feeds anterior 2/3 of frontal, temporal, parietal lobes and is the most common area for a stroke
poster circulation
- basilar artery which feeds the brain stem. a stroke here can be quickly devastating
- these strokes are hard to get to = tx hard
- can get locked in syndrome where they can only move their eyes
- affect sleep wake cycles
Neuro assessment for anyone with a brain injury
- baseline
- airway respiratory function
- cerebral o2/perfusion
- regain maximal cognitive motor and sensory function
- subtle changes are key (GCS)
what is the conscious exam
- loc
- orientation
- concentration
- affect/behavior, memory, logic
what is the cognitive exam
- reasoning
- expressive aphasia (cant get words out)
- receptive aphasia (dont understand what is being said to them)
- global aphasia (mix of both)
define transient ischemic attack (TIA)
<24 hours symptoms resolve no infarct on scans
define ishcemic attack (stroke)
->24 hours process that leads to destruction of neural tissue and consequent brain damage
define hemorrhagic stroke
leakage of blood or blood vessel into brain tissue
TIA
- Brief episode of neurological dysfunction symptoms
- typically less than 1 hour
- You can have multiple TIAs and no stroke
- Blood flow is re-established before damage brain infarction
- Warning sign of potential stroke
ischemic stroke types
- Thrombotic: injury to the blood vessel wall and the formation of a blood clot
- Embolic: when an embolus occludes a cerebral artery the embolus travels to the circulation (it could be blood or other debris), common cause are due to issues within the heart like atrial fibrillation
types of hemorrhagic strokes
- Intracerebral hemorrhage (ICH): is bleeding in the brain usually the basal ganglia with a poor prognosis, HTN is most common cause
- Subarachnoid hemorrhage (SAH): intracranial bleeding in the cerebrospinal fluid filled space between the arachnoid villa and pia mater, most common cause is ruptured aneurysm
AVM
- arteriovenous malformation
- abnormal dilated blood vessels with an inappropriate capillary network, thin walled, and tortuous and are at risk for clot formation and/or rupture.
manifestations of a stroke
- Weakness/paralysis
- Numbness/tingling
- Speech
- Personality changes
- Blurred vision
- Double vision
- Motor function
- Communication
- Affect
- Intellectual function
- Spatial perceptual alterations
- Elimination (only initially)
DX of stroke
- non contrast CT scan
- MRI: will have greater specificity but may not be done right away if dont know if there is metal in pt body
- be aware of allergies with contrast scans (iodine, seafood, radioactive dyes)
- DSA- has highest resolution for the detection of intracranial aneurysms and is gold standard
other dx if had stroke or TIA
- Cerebral blood flow like an angiograph
- ECG/ 24 hour heart monitor
- Chest x-ray
- Echocardiogram
- Coagulation studies
BP maintenance with someone who is given ateplase
- less than 180 sys
- no heparin, warfarin, aspirin, clopidogrel, or dipyridamole for 24 hours then start as ordered
BP maintenance without ateplase
- allow to auto-regulate and only treat if sys BP is greater than 220
- antithrombotic ordered within 24 hours
ateplase
- Recombinant tissue plasminogen activator
- a protein that is used to break up blood clots
- Given within 3-4.5 hours after onset
- Ischemic only
- Time=brain
things that need to be addressed for stroke pt before discharge (stroke core measures)
- Venous thromboembolism
- Discharge on antithrombotic therapy
- Anticoagulation therapy for atrial fibrillation/flutter
- Thrombolytic therapy (help dissolve clots)
- Antithrombotic therapy by the end of hospital day 2
- Stroke education
- Assess for rehabilitation
antithrombotics for strokes
- not for hemorrhagic
- aspirin, clopidogrel
- prevent a thrombus
ANTICOAGULANTS for strokes
- with atrial fibrillation
- Heparin/lovenox
- Coumadin (INR 2-3)
- Rivaroxaban (xarelto)
- likely be put on coumadin or Xarelto but will initially require lovenox or heparin until the INR levels are therapeutic at 2-3.
cholesterol lowering agents for strokes
- Statins such as atorvastatin , simvastatin
- reduce the risk of fatty plaques breaking off from walls of your arteries
diabetic medications for strokes
-Insulin, metformin
antihypertensive meds for strokes
- Metoprolol: A-fib
- Lisinopril: HTN (think cough)
surgical tx/prevention for strokes
- Carotid endarterectomy (CEA)- remove plaque from artery
- Transluminal angioplasty- balloon to open up stenosed artery
- Stenting- keeps the cerebral artery patent