neuro Flashcards
Hemorrhagic stroke is due to
poorly controlled HTN
Adult female patient complains of episodic visual loss or diplopia (double vision), problems with balance and walking, and numbness and paresthesia on one side of the face. Accompanied by urinary incontinence (75%) and/or bowel dysfunction (50%). Reports that when bending neck forward/flexion, an electric shock-like sensation runs down the back (Lhermitte sign). Not emergent, but recognition of presenting signs and symptoms is important for diagnosis and treatment.
MS
Sudden and rapid onset of severe headache described as “the worst headache of my life” accompanied by nausea/vomiting, neck pain or stiffness (positive Brudzinski and/or Kernig signs), photophobia, and visual changes (diplopia, visual loss) with a rapid decline in LOC. The headache may be nonlocalized or localized in the occipital area and neck. May have seizures during the acute phase. Vital signs reveal blood pressure (BP) elevation, temperature elevation, and tachycardia. Depending on the source of the bleed, may have focal neurologic signs or no signs. Usually caused by ruptured cerebral aneurysm or AVM. A “sentinel headache” (sudden intense headache) can precede a spontaneous SAH by days to weeks. An non-contrast CT scan can detect an SAH in approximately 95% of patients within first 24 hours. Associated with a high early mortality rate; some patients die suddenly before hospital evaluation. A medical emergency. Call 911
subarachnoid hemorrhage
Place a familiar object (e.g., coin, key, pen) on the patient’s palm and tell the patient to identify the object with eyes closed.
Stereognosis (Ability to Recognize Familiar Object Through Sense of Touch Only)
Write” a large letter or number on the patient’s palms using fingers (patient’s eyes are closed).
Graphesthesia
Grading Reflexes
0 No response
1+ Low response
2+ Normal or average response
3+ Brisker than average response
4+ Very brisk response (sustained clonus)
Innervates movement of soft palate (ask patient to yawn or say “aah” to check voice clarity).
IX
X1
shoulder shrug
Herpes zoster infection is what CN
V
f rash at tip of nose and the temple area, rule out
shingles
achilles tendon reflex is
L5 - S2
quadriceps reflex is
L2 to L4
Plantar reflex (babinski) is
L4 - S2
achilles is
S1
Tell patient to touch chest with the chin. Inability to touch the chest secondary to pain is a positive finding.
nuchal rigidity
