Neuro Flashcards
***First Aid for Seizures: what are the steps?
- cushion head
- loosen clothing
- turn on side (so no aspiration of vomit)
- time seizure (if > 4 min, then mb status epilepticus)
- don’t put anything in mouth
- look for ID
- don’t hold down
offer help
Why time the seizure?
If > 5 min OR 2nd seizure wo regaining consciousness in between, then “Status Epilepticus”
***If pt is in their 50’s/60’s and has a seizure for their first time, you must R/O?
space occupying lesion
if younger pt w seizure, think…
febrile seizure
if 10-30 yo w seizure, think…
vascular malformations
if a pt is experiencing SYNCOPE, make sure to ask…
fever?
hx of trauma?
***3 types of Cerebrovascular Dz (stroke) … most prevalent neuro disorders that lead to morbidity and mortality
- thrombotic
- embolic
- hemorrhagic
If pt presents w acute neuro deficit or w altered level of consciousness, what should be in the DDx?
STROKE
- time of onset is important
Focal cerebral ischemia is usu dt…
- embolus or thrombus in large vessel OR
- vasculitis
Global cerebral ischemia is usu dt…
- cardiac arrest
- shock
- severe hypotension
Focal cerebral ischemia causes a _________ area of necrosis.
well circumscribed
- looks pie-shaped
Global cerebral ischemia causes ______ necrosis.
laminar necrosis
- and border zone infarcts
Ischemic vs Hemorrhagic Stroke:
- which is MC?
- which is more deadly?
- MC is ischemic
- more deadly is hemorrhagic
- **TIA (transient ischemic attacks)
- Sxs
- how long does it last?
- defining characteristics
- milder sxs than stroke
- aphasia, think very well, mb LOC, weakness of limb(s)
- lasts seconds to min
- back to normal after 24 hrs
***CVA (cerebrovascular accident) or Stroke defining characteristic (vs TIA)
neuro deficits for 48-72 hrs it’s considered a stroke
- (remember contralateral sxs to artery affected)
*MC cause of Ischemic Stroke dt THROMBOTIC OCCLUSION
atherosclerosis
- occurs mc at carotid bifurcation or in vertebrobasilar system
- Posterior stroke sx
- Cerebellar, Brain Stem stroke sxs
- dysphagia
- dysphagia, coordination, eventually breathing affect bc close to medulla
- usu dt VERTEBRAL or BASILAR ARTERIES
what is uncal herniation?
- edema can cause the brain to herniate downwards into foramen magnum
bleeding in the CNS can be caused by?
- berry aneurysm (it can leak too!)
- AV malformations (lots of little bleeding sites, see white clouds on CT)
Vessel w greatest degree of compromise in an ischemic stroke
Middle Cerebral A.
- usu dt thrombotic occlusion
Hemorrhagic stroke usu dt
- *HTN….
- *intracerebral hemorrhage, subarachnoid hemorrhage, subdural hemorrhage, or epidural hemorrhage
MC cause of Subarachnoid Hemorrhage
Berry Aneurysm
- other causes: AV malform., disorders of BV in spinal cord, tumor, cocaine, sickle cell anemia, trauma
***BASAL SKULL FRACTURE is a
- *linear fracture through petrus portion of temporal bone that leaks spinal fluid from an ear
- base of the skull, typically involving the temporal bone, occipital bone, sphenoid bone, and/or ethmoid bone
- assoc sxs: hearing loss, instability of gait, vertigo
***What is Battle’s Sign?
mastoid ecchymosis
- think BASILAR SKULL FRACTURE
***What is Raccoon’s Eyes?
bilat. periorbital ecchymosis
- think BASILAR SKULL FRACTURE
Linear vs Displaced skull fracture…
- Linear bends inward making area around it buckle outward….
- Displaced = bone is displaced into cranial cavity by distance greater than thickness of bone
***Trauma to temporal region can result in laceration to ______ and cause an ______ hematoma.
- MIDDLE MENINGEAL ARTERY
- EPIDURAL HEMATOMA (blood bet dura and skull)
- can also be caused by laceration to dural venous sinus
- *ARTERIAL BLEED
Epidural Hematomas do not cross….
cranial sutures
- so most unilat. and above tentorium
***Trauma to fronto-parietal region can result in laceration to ______ and cause an _______ hematoma.
- BRIDGING VEINS bet. brain and superior sagittal sinus
- SUBDURAL HEMATOMA accum. of blood bet dura and arachnoid
- *VENOUS BLEED
- slower in develop. vs epidural hematoma
Meningitis pertinent negatives:
- it is a medical emergency and does not usu present classically
- MC sxs: HA!!, F, nuchal rigidity… altered mental status
- other sxs: photophobia, sensitivity to sound, N/V
If see petechial rash, think what type of meningitis?
Neisseria Meningitidis
**Other causes of Meningitis other than bacteria and viruses.
- carcinomatous, drugs, hemochromatosis, wilson’s dz
Bacterial Meningitis MC in:
- premature babies, newborns
- after 3/4 yo
- older
- recent skull trauma (from nasal cavity)
- group B strep, e. coli, listeria monocytogenes
- neisseria meningitidis
- strep penumoniae, mb h flu
- staph, pseudomonas, other gram (-)
*CT scans are done immediately to see what in strokes?
blood… esp if on anticoags. cerebral edema will take 10-12 hrs to see.
