neuro Flashcards
ischemic stroke
disruption of the blood supply caused by an obstruction, usually a thrombus or embolism that causes an infarction of brain tissue
types: large artery thrombosis, small penetrating artery thrombosis, cardiogenic embolism, cryptogenic
ischemic stroke s&s
depend on the location and size of the area
numbness or weakness of face, arm, leg unilateral
confusion or change in mental status
trouble speaking or understanding speech
difficulty in walking, dizziness, or loss of balance or coordination
sudden severe headache
perceptual disturbances
ischemic stroke treatment
prevention: control of HTN
diagnosis: CT scan, cerebral angiography, lumbar puncture if CT is negative and ICP is not elevated to confirm subarachnoid hemorrhage
care is primarily supportive
bed rest with sedation
O2
treatment of vasospasm, increased ICP, HTN, potential seizures, and prevention of further bleeding
health maintenance measures including a healthy lifestyle, not
smoking, exercise, healthy diet, and weight
carotid endarterectomy for caratoid stenosis anticoagulant therapy for afib
antiplatelet therapy
statins
antihypertensive medication
ischemic stroke rehabilitation strategies
carotid endarterectomy (removal of plaque from carotid artery)
hemorrhagic stroke
spontaneous rupture of small vessels related to hypertension
ruptured aneurysm
intracerebral hemorrhage related to amyloid angiopathy
arterial vein malformations
intracranial aneurysms
anticoag meds
ICP increases caused by blood in the subarachnoid space
hemorrhagic stroke S&S
similar to ischemic stroke
severe headache
early and sudden changes in LOC
vomiting
bleeding
hemorrhagic stroke treatments
drugs that counteract blood thinning drugs
surgery
surgical clipping
coiling
surgical arterial venous malformation removal
stereotactic radiosurgery
right sided stroke symptoms
muscle weakness on the left side of the body
vision problems including seeing from the left side of each eye
hearing problems
sensory changes on the left side of the body
problems with depth perception or directions
problems with balance
a feeling of spinning when a person is still
memory problems
left sided stroke symptoms
right sided weakness or paralysis and sensory impairment
problems with speech and understanding language (aphasia)
visual problems, including ability to do math or organize reason and analyze items
decerebrate
Plantar flexed (feet point OUTWARD)
Arms adducted (toward midline), extended, pronated, and hands flexed outward feet pointed downwards
flaccid
rag doll appearance (risk for foot drop)
decorticate
Plantar flexed
Legs internally rotated
Arms flexed and adducted (towards midline)
Hands flexed
Toes pointed away from the body and turned slightly inward
Glasgow coma scale
numerical rating of eye opening, verbal response, and motor response
9-15 mild to moderate injury
3-8 severe injury
Eye opening
4. Spontaneous
3. Loud voice
2. Pain
1. None
Verbal response
5. Normal conversation
4. Disoriented conversation
3. Non coherent
2. No words, only sounds
1. None
Motor response
6. Normal
5. Localized to pain
4. Withdraws to pain
3. Flexion
2. Extension
1. None
cranial nerve 1
olfactory, sensory, identification of common scents
cranial nerve 2
optic, sensory, snellen chart, color blind test
cranial nerve 3
oculomotor, motor, PERLA (moves eyes up and down), pupil response
cranial nerve 4
trochlear, motor, moves eyes side to side PERLA
cranial nerve 5
trigeminal, both, facial sensation and chewing (sharp or dull, assess chewing)
cranial nerve 6
abducens, motor, eye movement diagonally PERLA
cranial nerve 7
facial, both, facial expression and taste
identifiable tastes, smile puff cheeks out
cranial nerve 8
auditory/vestibulocochlear, sensory, whisper test webber rinne
cranial nerve 9
glossopharyngeal, both, phonation and gag reflex
make them talk watch swallowing
cranial nerve 10
vagus, both, taste and gag reflex, aids in digestion and gag reflex
cranial nerve 11
spinal accessory, motor, shrug shoulders with resistance
cranial nerve 12
hypoglossal, motor, stick tongue out and move it
The first clue of a deteriorating condition
changes in LOC
full conciousness
alert, attentive, follows commands
Lethargic
drowsy, awakens to stimulation
obtunded
difficult to arouse, needs constant stimulation to follow a simple command
stupor
arouses to vigorous, continuous stimulation
coma
does not respond to continuous or painful stimulation
akinetic mutism
unresponsive to enviornment, makes no movement or sound, sometimes opens eyes
persistent vegetative state
devoid of cognitive function but has sleep wake cycles
locked in syndrome
inability to move or respond except for eye movements due to lesion affecting the pons
increased ICP S&S
Normal ICP 1-15
CUSHING’S TRIAD
Increased SBP w widening pulse pressure
Bradycardia
Bradypnea
Present in herniation syndrome
early increased ICP symptoms
change in LOC
any change in condition
restlessness, confusion, increasing drowsiness, increased resp effort, purposeless movements
pupillary changes and impaired ocular movements
weakness in one extremity or one side
headache: constant, increasing in intensity, or aggravated by movement or straining
late increased ICP symptoms
respiratory and vasomotor changes
major vital sign changes (cushings triad: bradypnea, htn with wide pulse pressure, bradycardia )
projectile vomiting
further deterioration of LOC
stupor to coma
hemiplegia, decortication, decerebration, flaccify
cheyne stokes breathing
loss of brainstem reflexes (pupil, gag, corneal, swallowing)
brain tumors S&S
depend based on size and location
localized or generalized neurologic symptoms
symptoms of increased ICP
headache
vomiting
visual disturbances
seizures
hormonal effects with pituitary adenoma
loss of hearing, tinnitus, vertigo with acoustic neuroma
brain tumor diagnostic
neuro exam
ct scan
mri
pet
eeg
cytologic study of csf
biopsy
medical management of brain tumor
dependent on size and location
surgery: remove as much tumor as possible without messing with neurologic symptoms, craniotomy, transsphenoidal surgery, stereotactic procedures
radiation therapy: cornerstone treatment, chemo, pharmacologic therapy
