Neuro A/P and Stroke Flashcards
Point where motor neurons cross causing contralateral impairments
Decussation of pyramids
Important cranial nerves and their functions
2 - detection of light 3 - pupil contraction 5/7 - Corneal reflex 9 - Swallow/gag 10 - Vagus
layers of meninges
inside out PAD - Pia, arachnoid, dura
structure which supports collateral blood flow in the brain
circle of willis
Formula for CPP (cerebral perfusion pressure)
CPP = MAP-ICP mmHg
Normal range 60-100
First sign of neuro degen
LOC change
Cushing’s Triad
Bradycardia, bradypnea, HTN, wide PP
late sign of neurological compromise
Cardinal signs/symptoms of stroke
weakness trouble speaking vision problems headache dizzy
Definition of ischemic stroke
- interruption of blood flow to brain tissue for >24 hrs, less than that is TIA
- Middle cerebral artery most common cause
- 87% of all strokes are ischemic, 80% of those are thrombotic (atherosclerotic like in MI, 20% embolic (came from somewhere else, like clot in heart from afib)
Two types of hemorrhagic stroke
Intracerebral hemorhage - 10% of all strokes
Subarachnoid - 3% of all strokes - occurs in subarachnoid space between arachnoid and pia
Zone of ischemic tissue surrounding an infarcted area
Penumbra
Usual site of brain tissue oxygenation monitoring w/ bolt
The oxygen content of the white matter of the brain.
PbtO2 a directly monitored
Contraindication to thrombolytics in stroke
Art puncture in non-compressible site ~7days
• Major surgery ~14 days
• Recent MI ~ 3 months
• GI or Urinary Tract Hemorrhage ~ 21 days
• Previous stroke or head injury ~ 3 months
• Previous intracranial hemorrhage
BP > 185/110 mmHg
• INR >1.7 (Coumadin?) & high PTT (Heparin?)
• Platelets less than 100,000
• Seizure with post-ictal residual impairments
• Negative CT (no hypo density > 1/3 cerebral
hemisphere identified)
• Pt and/or family does not understand risks vs
benefits
BP goal in hemorrhagic strokes
<180/105
