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CCRN Review > Neuro > Flashcards

Neuro Flashcards

1
Q

The skull contains the brain in a contiguous enclosure with the exception of these two anatomical features?

A

Transtentorial notch- not an actual hole but sharp outcropping of tentorium cerebelli that separates the…
Foramen magnum –how brain stem and spinal cord get into skull

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2
Q

Which cranial nerves do not originate from the brainstem? Where do they originate from?

A

I, II originate from cerebrum

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3
Q

What does a well developed Circle of Willis provide to the brain?

A

Collateral blood supply

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4
Q

What is the first sign of a neurological problem?

A

A change in LOC

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5
Q

In an exception to the rule of a change in LOC being the first sign of a neuro problem, what type of neuro issue may elicit pupillary changes prior to a change in LOC?

A

Epidural hematoma

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6
Q

Describe the parts of the Reticular Activating system and their function.

A

Upper - Awareness
Lower – sleep-wake cycle

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7
Q

Describe two types of aphasia and their lobe dominance.

A

Expressive (Broca) - frontal lobe
Receptive (wenicke) - temporal lobe

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8
Q

What is the crossing of motor fibers called, where does it take place and what physical manifestation does it create?

A

Decussation
occurs in medulla
motor issues are contralateral to the injury or issue

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9
Q

Describe the association between pupillary response and brain injury or issue?

A

pupillary response occurs ipsilateral to injury

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10
Q

Describe babinksi reflex, what is positive or negative and what is normal?

A

babinski reflex - fanning of toes upward and outward in response to plantar stimulation

upward/outward fanning in adults is a POSITIVE sign and is ABNORMAL

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11
Q

Describe “Doll’s eye reflex”? What is a normal finding?

A

When the head is rapidly rotated side to side, the eyes move opposite the head.
This finding is normal
If the eye move with the head, this is abnormal

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12
Q

What components make up Cushing’s triad?

A

increased SBP, with widening pulse pressure
decreased HR
decreased RR (cheyne-stokes)

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13
Q

What might Cushing’s Triad be caused by?

A

Brain herniation

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14
Q

If a patient has an injury to the midbrain, how may this affect respirations?

A

Hyperventilation

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15
Q

If a patient has an injury to the Potine, how may this affect respirations?

A

Apneustic
“Apneustic respiration (a.k.a. apneusis) is an abnormal pattern of breathing characterized by deep, gasping inspiration with a pause at full inspiration followed by a brief, insufficient release”

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16
Q

If a patient has an injury to the medulla, how may this affect respirations?

A

Ataxic

“Ataxic respiration is an abnormal pattern of breathing characterized by complete irregularity of breathing, with irregular pauses and increasing periods of apnea. As the breathing pattern deteriorates, it merges with agonal respiration”. Sometimes called Biot’s

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17
Q

The difference between obtunded and stuporous

A

obtunded- can speak but mumbles
stuporous - cannot speak, may groan or grimace

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18
Q

Homonymous hemianopsia

A

loss of vision in half of each visual field

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19
Q

Bitemporal hemianopsia

A

loss of visual filed to the outer half of each eye

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20
Q

left hemaniapsia

A

loss of half the visual field to the left half of the eye

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21
Q

In a brain pathology, in which direction will the eyes deviate?

A

towards the pathology

22
Q

In relation to a injury or issue which side will changes occur for the following:

pupil changes
vision changes
motor changes
positive Babinski reflex

A

pupil changes – ipsilateral
vision changes – contralateral
motor changes – contralateral
positive Babinski reflex – contralateral

23
Q

What is Uncal herniation?

A

Displacement of TEMPORAL lobe against brain stem compressing the 3rd/oculomotor nerveleading to pupil dilation

24
Q

What is a very common cause of Uncal herniation?

A

EPIDURAL hematoma

25
Q

Signs and symptoms of Uncal herniation? (3)

A
  1. compression of parasympathetic innervation to AFFECTED side (“which may affect the parasympathetic input to the eye on the side of the affected nerve, causing the pupil of the affected eye to dilate and fail to constrict in response to light as it should.”
  2. Blown pupil on same side, often seen prior to LOC
  3. slight contralateral weakness
26
Q

What often causes central herniation?

A

bilateral swelling and downward displacement of both hemispheres
usually develops slowly

27
Q

In a RIGHT sided stroke, how will the following be affected,
eye deviation
weakness
hemianopsia
Babinski reflex

A

eye deviation – rightward
weakness – left side
hemianopsia – left side
Babinski reflex – left side
labile emotions

28
Q

Left sided stroke, how will the following be affected,
eye deviation
weakness
hemianopsia
Babinski reflex

A

eye deviation –leftward
weakness – right side
hemianopsia– right side
Babinski reflex– right side
aphasia

29
Q

What is a common cause of subdural hematoma

A

middle cerebral artery aneurysm

30
Q

How are Subdural hematoma graded?

A

Hunt & Hess score grades I-V

Documentation of the first Hunt and Hess scale that was done at this hospital. The Hunt and Hess scale is a grading system used to classify the severity of a subarachnoid hemorrhage based on the patient’s clinical condition. The scale ranges from a score of 1 to 5. It is used as a predictor of prognosis/outcome with a higher grade correlating to a lower survival rate.

Grade - Description
1 (I) - Asymptomatic, mild headache, slight nuchal rigidity

2 (II) - Moderate to severe headache, nuchal rigidity, no neurologic deficit other than cranial nerve palsy

3 (III) - Drowsiness / confusion, mild focal neurologic deficit

4 (IV) - Stupor, moderate-severe hemiparesis

5 (V) - Coma, decerebrate posturing

31
Q

What are the signs and symptoms of the Subdural hematoma

A
32
Q

Acidosis has what effect on ICP?

A

Causes vasodilation which causes ICP to increase

33
Q

How does Alkalosis affect affect ICP

A

causes vasoconstriction which decreases cerebral blood flow which deceases ICP

34
Q

GCS/TBI severity grade

A

GCS
0-8 Severe
9-12 Moderate
13-15 Mild

35
Q

Where does epidural bleeding occur?

A

Above the dura matter
which is between the dura and skull

36
Q

What is a major cause of epidural bleeding?

A

tearing of the meningeal artery from temporal bone trauma

37
Q

Where does subdural bleeding occur?

A

Bleeding between the dura matter and arachnoid space

38
Q

Compare and contrast symptoms of epidural and subdural bleeding?

A

SDH is similar to EDH but w/ less vomiting and pupil changes

39
Q

What is a basilar skull fracture?

A

A linear fracture on the floor of the cranial vault. results in meningeal tears, requires more force than other fractures

40
Q

Signs and Symptoms of a basilar skull fracture?(5)

A
  1. racoon eyes
  2. battle sign
  3. cranial nerve I
  4. risk of meningitis
  5. otorrhea / rhinorrhea
41
Q

Seizure versus status epilecticus

A

Sze last more than 5 minutes OR several seizures w/o regaining consciousness

42
Q

Normal CSF measurements

A

60% glucose
25-45 mg/dl protein
opening pressure 80-180 cmH20

43
Q

Viral versus bacterial meningitis

A

VIRAL
opening pressure > 180 cm H20
purulent color
DECREASED glucose

Bacterial
opening pressure normal
clear color
normal glucose
INCREASED protein
INCREASED WBC

44
Q

Meningitis signs and symptoms

A
  1. nuchal rigidity
  2. brudzinski sign - when chin to chest, legs raise
  3. kernigs sign – knee flexion causes leg and neck pain
45
Q

Brain death apnea test

A

PaCO2 > 60mmHg, PaO2 > 20mmHg

46
Q

What is the cause of Gullain - bare syndrome?

A

Autoimmune process
antibodies attack on myelin on lower motor nerves
affects spinal and cranial nerves
ascending paralysis

47
Q

Gullain -bare tx

A

steroids
IVIG for 2-5 d
plasma pheresis exchange – removes circulating antibodies

48
Q

What is Myasthenia gravis?

A

Autoimmune process that attacks neuromuscular junction

49
Q

What is a Myasthenic crises caused by and diagnostic test?

A

caused by Acetocholine deficiency
caused by acute exacerbation or undertreatment
TENSILON 2m g IV causes an improvement of symptoms

50
Q

Cholinergic crises

A

Caused by overtreatment w/ mestinon
too much acetocholine
TENSILON 2 mg IV causes muscle weakness and SLUDGE

Salivation
lacrimation
urination
Defecation
GI upset
Emesis

51
Q
A

CCRN Review (7 decks)

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