Chapter 17- Neurologic Emergencies Flashcards
Coma
A state of profound unconsciousness where the patient can’t be awoken
What is a tension headache
Caused by muscle contractions in the head and neck and are attributed to stress
What is a migraine headache
Thought to be caused by changes in blood vessel size in the base of the brain. Children and adults can experience migraines. Women are three times more likely. Pain includes pounding, throbbing, or pulsating.
What is a sinus headache?
A headache caused by pressure that is the result of fluid accumulation in the sinus cavities. Patient me Trece pain when I bend over or when their heads or move forwards.
What are headache red flags?
- sudden onset of symptoms
- explosive/thunderclap pain
- altered mental status
- > 50
- depressed immune system
- neurologic deficit’s
- neck stiffness/pain
- fever
- changes in vision
- One sided paralysis or weakness
Cerebrovascular accident (CVA) OR stroke
Interruption of blood flow to an area within the brain that results in the loss of brain function
Ischemia
A lack of oxygen that deprives tissues of necessary nutrients, resulting from partial or complete blockage of blood flow
Ischemic stroke
When the blood flow through the cerebral arteries is blocked. Accounts for more than 80% of all strokes
Thrombosis
When a clot forms at the site of blockage
Embolus
Where the blood clot forms in a remote area (such as a diseased heart) and then travels to the site of the blockage
What are the two ways that it ischemic stroke can happen?
Thrombosis, or embolus
Atherosclerosis
A disorder in which calcium and cholesterol buildup, forming plaque inside the walls of the blood vessels
Hemorrhagic stroke
Occurs as a result of bleeding inside the brain. A blood vessel rupture’s in the accumulated blood and forms a blood clot, which compresses the brain tissue next to it. Accounts for 13% of all strokes
Aneurism
The swelling or enlargement of the wall of a blood vessel that results from weakening of the vessel wall.
Berry aneurysm
Resembles a tiny balloon (or berry) that juts out from the artery. We near here is an ruptures, blood spurts into the subarachnoid space. The strokes are called subarachnoid hemorrhages
Transient ischemic attack (TIA)
A disorder of the brain in which the brain cells temporarily stop functioning because of insufficient oxygen, causing stroke like symptoms that resolve completely within 24 hours
Signs and symptoms of stroke
- facial drooping
- sudden weakness or numbness in the face, arm, leg, or one side of the body
- decreased or absent movement and sensation on one side of the body
- lack of muscle coordination or loss of balance
- sudden loss of vision in one eye, blurred or double vision
- difficulty swallowing
- decreased level of responsiveness
- speech disorders
- Aphasia; difficulty expressing thoughts or inability to use the right words
- slurred speech (dysarthria)
- sudden and severe headache
- dizziness, confusion, weakness, combativeness, restlessness, tongue deviation, coma
Dysarthria
Slurred speech
Aphasia
The inability to produce or understand speech. This happens if the left cerebral hemisphere has been affected by a stroke
Postictal state
Period following a seizure that lasts between five and 30 minutes, characterized by labored respirations and some degree of altered mental status
Seizure
A neurologic episode caused by surge of electrical activity in the brain
Epilepsy
A common cause of seizures. A disorder in which abnormal electrical discharges occur in the brain, causing seizure and possible loss of consciousness
Generalized (tonic-clonic) seizure
Result from abnormal electrical discharges from large areas of the brain, usually involving both hemispheres.
What are the characteristics of generalized seizure?
Characterized by unconsciousness and a general severe twitching of the body’s muscles the last several minutes or longer
Partial (focal) seizure
A Seizure affecting a limited part of the brain
What are the two classifications of partial seizures?
Simple or complex
What is a simple partial seizure?
No change occurs in the patient’s LOC. Patient may report numbness, weakness, or dizziness. The seizure may cause twitching of the muscles in the extremities that spreads slowly from one part of the body to another, but it is not severe twitching. The patient may also experience brief paralysis
What is a complex partial seizure?
The patient has an altered mental status and does not interact normally with his or her environment. This type of seizure results from abnormal discharges from the temporal lobe of the brain. Signs may include lipsmacking, I blinking, and isolated conversions or jerking of the body or in one part of the body such as the arm. The patient may experience weird smells and visual hallucinations, uncontrollable fear
Aura
A warning sign prior to having a seizure. This can include visual changes like flashing lights or blind spots in the field of vision, or hallucinations.
Status epilepticus
Describe seizures they continue every few minutes without the person regaining consciousness or lasts longer than 30 minutes
Hypoglycemia
A low blood glucose level
Common causes of epileptic seizures
Congenital origin
Causes of structural seizures
Tumor, infection, scar tissue from injury, head trauma, stroke
Causes of metabolic seizures
Hypoxia, abnormal blood chemical values, hypoglycemia, poisoning, drug overdose, sudden withdrawals from alcohol or medications
Causes for febrile seizures
Sudden high fever
Febrile seizures
Seizures that result from sudden high fever’s, particularly in children
Incontinence
A loss of bowel or bladder control
Hemiparesis
Weakness on one side of the body, resembling a stroke
Syncope
Fainting
Altered mental status
The patient is not thinking clearly or is in capable of being aroused
What is a helpful pneumonic to use when reviewing the possible causes of altered mental status?
AEIOU TIPS
What does AEIOU TIPS stand for?
Alcohol Epilepsy, endocrine, electrolytes Insulin Opiates and other drugs Uremia (kidney failure)
Trauma, temp
Infection
Poisoning, psychogenic causes
Shock, syncope, seizure, stroke, Space occupying lesion, sub arachnoid hemorrhage
Delirium
A temporary change in mental status characterized by disorganized thoughts, in attention, memory loss, disorientation, striking changes in personality and affect, hallucinations, delusions, or a DLOC
Three items stroke severity scale
Level of consciousness: normal=0, mild dysfunction= 1 severe dysfunction (unconscious)=2
Arm drift: normal=0. Mild =1. Severe=2
Gaze (same)
List the key information needed to document for a patient who has had a stroke
- Time of onset of the signs and symptoms
- score on the GCS
- result of the stroke assessment tool
- changes noted on reassessment
