Neuro 5 Flashcards
s/s of Anterior Cerebral Artery stroke
- *frontal lobe problems: personality changes
- Confusion
- Weakness
- Numbness on the affected side
- Paralysis of the contralateral foot and leg
- Incontinence
- Poor coordination
- Impaired motor and sensory function
- Personality changes, such as flat affect and distractibility
s/s of Vertebral Basilar Artery stroke
- *back of head
- Mouth and lip numbness
- Dizziness
- Weakness on the affected side
- Visual changes, color blindness, lack of depth perception and diplopia
- Poor coordination
- Slurred speech
- Amnesia
- ataxia
s/s of posterior cerebral artery stroke
Visual field cuts Sensory impairment Dyslexia Coma Blindness from ischemia in the occipital area
what is neglect
*middle cerebral stroke
pt doesn’t know they have a L or R side of their body (will not brush hair or get dressed on that side)
what is Hemianopsia
- *lose peripheral vision on that side (HALF VISION)
- cannot see L peripheral on each eye: may walk into walls, see food on that side
- CANNOT drive, do not show up on left side, come from the front
where should you put their food/utensils, if true hemianopsia
- *put IN FRONT of them so they learn to scan environment and turn head
- get them dressed on unaffected side first
if ischemic stroke what should be given immediately
Thrombolytics within 3 hours
if thrombosis or embolism what should be given
TPA IV (up to 8 hrs since stroke)
treatment of CVA
-CT or MRI immediately
-meds:
ASA or Plavix: antiplatelets
Anticonvulsants
Antihypertensives and Antiarrhythmics
Stool Softeners
what is a Cerebrovascular accident
aka stroke or CVA
protocol for brain attack
1) Neuro consult,
2) CT in 20 min,
3) swallowing study (choke…)
initial stroke algorithm
Identify signs- Stroke Assessment
Assess oxygenation, IV access, obtain BG and VS
Contact Stroke Team for Assessment and order CT
after CT if NO hemorrhage…
- *thrombolytics
- If thrombolytics, no ASA or antiplatelets for 24 hours
- Monitor BP and neurologic assessment
after CT if hemorrhage…
consult neurosurgeon Give ASA (aspirin)
FAST stroke assessment
1) Facial dropping (ask them to smile)
2) Arm drooping (one arm weak/numb?, raise arms are any downward?)
3) Speech difficulties (slurred? can they repeat sentence?)
4) Time (call 911 immediately if have these s/s)
Cincinnati Pre-Hospital Stroke Scale
-Facial Droop- patient shows teeth or smiles (both sides should be equal)
-Arm drift- closes eyes and extends both arms straight out for 10 seconds (Both arms move the same or both don’t move)
-Speech- patient repeats, “the sky is blue in Cincinnati”
(no slurring of words)
describe spinal shock
- flaccid paralysis, loss of DTR and loss of motor and sensory function
- spinal cord not working, flacid paralysis
describe neurogenic shock
-bradycardia, orthostatic hypotension, inability to sweat below the level of injury
what should you assess if spinal cord injury suspected
Assess level of damage- what level is respiratory compromise?
types of spinal cord injuries
spinal shock and neurogenic shock
what to remember about spinal cord injuries
- Remember the damage can extend due to swelling- ASSESS respiratory and cardiac status every hour
- Stabilize the spine and treat the symptoms with ventilator and vasopressor support
hyperflexion
Sudden deceleration of the head and neck- MCA
type of spinal cord injury
hyperextension
Most common type, fall, read-end MVC or hit in the head
type of spinal cord injury
axial loading
compression of vertebral column
type of spinal cord injury
rotational injuries
Extreme twisting or lateral flexion
type of spinal cord injury
because spinal cord injuries cause a lot of swelling…
do not know extent of injury until it decreases
what are the most common causes of spinal injuries
45% road accidents
34% domestic or industrial accidents
15% sports injuries
6% self harm and assault
spinal cord injury causes what
causes microscopic hemorrhages in the gray matter and pia-arachnoid
hemorrhages in spinal cord increase until what
increase until all of the gray matter is filled with blood. THEN necrosis occurs
describe bleeding in spinal cord
- blood enters spinal column, edema causes compression and decreased blood supply
- clot formation and damage to cell in spinal cord
- may get function back but not level that it once was
injuries about 6th thoracic may have what
- may have bradycardia, hypotension and hypothermia
- may still have some involuntary changes, NOT cushings triad
complete, but temporary loss of motor, sensory, reflex and autonomic function that lasts less than 48 hours, but may continue or weeks r/t swelling
spinal shock
treatment of spinal cord injuries
- Immobilization and keep STABLE
- High dose IV methylprednisolone (Solu-Medrol)
- Assess respiratory status, GI distress from Solu-medrol, renal status
- Monitor improvement or progression of spinal damage
how should the BP be maintained if spinal cord injury
BP above 90 systolic to keep perfusion to the spinal cord
syndrome to watch for in spinal cord pt (if above T6)
- *autonomic dysreflexia
- sudden onset of excessively high blood pressure
- BP increased dramatically and HR increases d/t epi stimulation
- often d/t full bladder or some kind of stimuli which the pt cannot control (pain, full bowel)
how to prevent AD
may need to cath, give enema to get rid of stool
what is important to consider when dealing with a TBI
where did the injury occur in the brain
