Neuro Flashcards
CN I
Olfactory; smell
CN II
Optic; sight
CN III
Occulomotor; eye movement
CN IV
Trochlear; eye movement
CN V
Trigeminal; facial sensation; chewing
CN VI
Abducens; eye movement
CN VII
Facial; facial movement
CN VIII
Auditory/Acoustic; hearing and balance
CN IX
Glossopharyngeal; swallowing
CN X
Vagus; swallowing and heart rate
CN XI
Spinal Accessory; shrugging shoulders
CN XII
Hypoglossal; tongue movement
TIA is also known as a
mini stroke, warning stroke
A BRIEF interruption in cerebral flow due to a clot…
TIA
2 types of stroke
Ischemic and hemorrhagic
Thrombotic strokes…
gradual blockage of an artery, onset is slower
Embolic strokes…
more sudden and severe onset
Intracerebral hemorrhage causes
severe HTN; cocaine abuse
Subarachnoid hemorrhage…
most common; caused from ruptured aneurysm or AVM
S/S of an aneurysm
“exploding” headache, N/V, decreased LOC, seizures
Romberg test
Stand up with feet together and arms at sides, no swaying should happen
Babinksi test
Should not result in the splaying of toes, toes should curl
Glasgow coma scale is testing for
Level of consciousness
Highest score in GCS
15
Lowest score in GCS
3
3 categories of GCS
Eye opening, best verbal response, best motor response
Scores for each category of GCS
Eye opening-4
Best verbal response-5
Best motor response-6
Left cerebral hemisphere of the brain…
“artsy” word formation/reception; writing; math
Right cerebral hemisphere of the brain…
“spatial awareness” proprioception; vision
Broca’s area is located where and does what
frontal lobe; formation of words (expressive aphasia)
Werniche’s area is located where and does what
temporal lobe; processing of words (receptive aphasia)
Agnosia
unable to recognize familiar objects
Agraphia
difficulty with writing
Acalculia
difficulty with mathematic calculations
Apraxia
inability to perform previously learned action
Ataxia
gait disturbance; inability to walk properly
Stroke in the cerebellum…
inability to walk; problems with coordination/balance
Stroke in the brainstem…
problems with the vital signs; breathing, heartrate, temperature, vertigo, hearing
No contrast with CT because…
the dye can irritate the brain tissue if the stroke is hemorrhagic.
TPA can only be used if the stroke is NOT
hemorrhagic
TPA has to be used within _____ of patient’s Last Known Well.
4.5 hours
TPA contraindications…
over 80, INR over 1.7, 3 mo. history of stroke/head injury/trauma, over 1/3 brain affected
With any procedure, the major concern is…
post op bleeding
hemorrhagic stroke S/S…
severe headache, nausea, vomiting, changes in LOC, seizures
Vasospams can occur…
within 7-10 days of initial hemorrhage
only FDA approved calcium channel blocker used for vasospasms/aneursym
nimodipine
Hydrocephalus sign…
downward deviated eyes
Medication used for increased ICP
mannitol
antidote for warfarin
FFP and vitamin K
medication for seizures
phenytoin
With a traumatic brain injury, the damage is most likely to occure in the…
frontal and temporal lobes
Increased cranial pressure S/S:
change in LOC; HTN; bradycardia; bradypnea (cushings triad)
S/S of typical shock…
hypotension, tachycardia, tachypnea
The greatest priority with any brain injury/stroke/trauma…
maintaining patient’s airway (ABCs)
if the cerebral perfusion pressure is under 50, the patient is….
retaining too much CO2
If the cerebral perfusion pressure is too high, the patient’s blood vessels…
vasoconstricts
3 cardinal signs of brain death..
coma, apnea, absent brainstem reflexes
Number of cervical, thoracic and lumbar vert…
8, 12, 5
Damage at c4 and above is at greatest risk for…
respiratory problems.
Halo care/precautions
No driving, no pulling patient up by halo, daily pin care
Neurogenic shock S/S:
decreased C.O.; bradycardia; hypotension (life threatening)
Neurogenic shock can occur
within 24 hours of SCI and last for several days-weeks
Spinal shock occurs
immediately following injury
Spinal shock S/S…
bradycardia, hypotension, bladder paralysis/distention
Autonomic Dysreflexia can occur..
anytime after injury, even years later
Autonomic Dysreflexia causes
restrictive clothing, stool impaction, full bladder, pressure areas
S/S of AD above the level of injury…
“hot”–HTN, flushed faced, headache, sweating, bradycardia
S/S of AD below the level of injury…
“cold”– pale, cool, no sweating
AD is triggered by sustained stimuli below the level of
T6
Increased Intracranial Pressure can cause..
decreased cerebral blood flow; cerebral edema
Supratentorial surgery patients must be kept…
HOB up 30 degrees; head midline and neutral; no extreme neck/hip flexion
Infratentorial surgery patients must be kept…
flat and positioned on side for 24-48 post op; NPO for 24 hrs while awake
Absence seizure..
brief, sudden lapse in attention. Most common in children
Tonic-Clonic seizure…
moments of rigidity, followed by jerking. Grand Mal seizure
Tonic seizure…
stiffening of muscles
Clonic seizure…
jerking of muscles
Myoclonic seizure…
very short lasting clonic seizure…
Atonic seizure..
“drop” seizure.
instructions for phenytoin
take them on time; avoid oral contraceptives; cannot take with coumadin; no grapefruit; can build up sensitivity to it
Tension headache…
“stress” HA; most common type; bandlike headahce; dull pressure
MIgraines…
sensitivity to stress and sounds; triggered by specific things
Diet modifications for headaches and migraines
No red wine; no caffeine; no alcohol; no cold foods; no artificial sweeteners; no tyramine
Mild medications for headaches…
acetaminophen; NSAIDS
Triptan is used for…
severe migraine headaches
Triptans have the effect of…
vasoconstriction
Most common antiepileptic…
Topomax
Cluster headaches…
usually occur at the same time each day; throbbing; excruciating; unilateral
When bacterial meningitis is suspected, the number 1 treatement is…
antibiotics
CSF obtained from a lumbar puncture when patient is suspected of meningitis…
cloudy—bacterial; clear–viral
Kernig’s sign…
when hips flexed, cannot extend knee
Brudzinksi sign…
supine position; when neck if flexed, lower extremities flex
Treatment for brain abscesses…
antibiotics
Brain abscesses have similar S/S to stroke True or False
True
Multiple Sclerosis…
caused by factors that affect the myelin and nerve fibers of the brain and spinal cord.
Lumbar puncture is to be avoided if suspected IICP because…
the sudden release of pressure may cause brain herniation.
Those with MS need…
risked for falls; adequate rest, avoid stress/crowds
MS medications…
immunosuppresive agents; corticosteroids; antispasmodics
Immunosuppressive agents..
cyclosporine; Cytoxan
Corticosteroids…
prednisone; Solu-medrol
Antispasmodics..
Dantrolene; baclofen; diazepam
Myasthenia Gravis (MG) attacks the
acetylcholine receptors
Test for MG
tensilon test
MG causes the patient to feel
extreme fatigue, gets worse throughout the day
Tensilon crisis causes
a severe bradycardia
Tensilon crisis medication
atropine
Cholinergic crisis..
too much acetylcholine drugs; inability to clear secretions, swallow or breathe
Myasthenic crisis…
not enough anticholinesterease drugs; maintain respiratory function
Guillain-Barre Syndrome causes
ascending paralysis, usually temporary
Guillain-Barre Syndrome does NOT have a
neurotransmitter disorder
Guillain-Barre Syndrome is usually triggered by..
prior GI or respiratory infection
Treatments for GBS..
Plasmapheresis; IVIG; cerebrospinal fluid filtration
Trigeminal Neuralgia affects CN
V…Trigeminal
Bell’s Palsy affects CN
7…Facial
Bell’s Palsy treatment..
corticosteroids; antivirals
Peripheral Nerve Trauma priority assessment…
neurovascular checks
Parkinson’s is caused by a decreased level of..
dopamine
Parkinson’s S/S:
tremors; ataxia; rigidity
Parkinson’s medications..
dopamine agonists; levodopa/carbidopa
Dopamine agonists…
Bromocriptine; pergolide; ropinirole
Dopamine agonists may cause..
orthostatic hypotension; sleepiness; hallucinations
Patients with dementia Do’s and Dont’s
Do talk calmy; dont raise your voice
Cholintesterase inhibitors help to
“keep the pathways clear” for dementia patients
Amyotrophic Lateral Sclerosis (ALS)…
muscle wasting, no sensory involvement
Greatest concern with ALS
Respiratory function
