Neurologic Emergencies Flashcards
Three major parts of the brain
- Brainstem
- Cerebellum
- Cerebrum
Controls basic functions of the body, such as breathing, BP, swallowing, and pupil constriction
Brainstem
Located just behind the brainstem
Cerebellum
Controls muscle and body coordination
Cerebellum
Responsible for coordinating complex tasks that involve many muscles, such as standing on one foot without falling, walking, writing, picking something up, and playing piano
Cerebrum
Largest part of the brain
Cerebrum
The front part of the cerebrum controls ___
Emotion and thought
The middle part of the cerebrum controls ___
Sensation and movement
The back part of the cerebrum processes ___
Sight
In most people, speech is controlled on the ___
Left side of the brain, near the middle of the cerebrum
How many pairs of cranial nerves run from the brain to parts of the body?
12
The brain is most sensitive to changes in ___
Oxygen, glucose, and temperature levels
A state of profound unconsciousness
Coma
The pain from a headache is felt from ___
The surrounding areas of the face; scalp; meninges; larger blood vessels; and muscles of the head, neck and face
Caused by muscle contractions in the head and neck and are attributed to stress
Tension headaches
Type of pain with a tension headache
Squeezing, dull, or an ache
Thought to be caused by changes in blood vessel size in the base of the brain
Migraine headaches
Type of pain with a migraine headache
Pounding, throbbing, or pulsating
Migraines are usually associated with ___
Nausea and vomiting, and may be preceded by visual warning signs such as flashing lights or partial vision loss
Caused by pressure that is the result of fluid accumulation in the sinus cavities
Sinus headaches
ICP
Intracranial pressure
You should suspect a hemorrhagic stroke in patients with a ___
Severe headache, seizures, and altered mental status
Early signs of increased ICP
Headache, vomiting, altered mental status, and seizures
An inflammation of the meninges caused by a bacterial infection
Bacterial meningitis
Bacterial meningitis is a ___
Central nervous system infection in which the patient may complain of a headache, stiff neck, fever, and sensitivity to light
Cerebrovascual accident
Stroke
CVA
Cereobrovascular accident
An interruption of blood flow to an area within the brain that results in the loss of brain function
Stroke
Two main types of stroke
- Ischemic
- Hemorrhagic
Occurs when blood flow through the cerebral arteries is blocked
Ischemic stroke
A blood vessel ruptures and the accumulated blood causes increased pressure in the brain
Hemorrhagic stroke
Most common type of stroke
Ischemic stroke
Ischemic stroke may be due to a ___
Thrombosis or an embolus
A clot forms at the site of the blockage
Thrombosis
A clot forms in a remote area and then travels to the site of the blockage
Embolus
Patients with atrial fibrillation are prone to ischemic strokes caused by ___
An embolus
A blood vessel ruptures, and the accumulated blood then forms into a clot, which compresses the brain tissue next to it. The compression prevents oxygenated blood from getting into the area
Hemorrhagic stroke
Hemorrhagic stroke commonly occurs in people experiencing ___
Stress or exertion
The people at the highest risk of a hemorrhagic stroke
With extremely high BP, or long-term untreated elevated BP
A swelling or enlargement of the wall of an artery resulting from a defect or weakening of the arterial wall
Aneurysm
Most notable symptom of a ruptured aneurysm
A sudden-onset, severe headache, typically described as the worst headache the patient has ever had
The headache from an aneurysm is caused by ___
The irritation of blood on the brain tissue after the artery swells and ruptures
A hemorrhagic stroke in an otherwise healthy young person is often caused by a ___
Berry aneurysm
This type of aneurysm resembles a tiny balloon (or berry) that juts out from the artery
Berry aneurysm
When the aneurysm is overstretched and ruptures, blood spurts into ___
An area between two of the coverings of the brain called the subarachnoid space
Blood spurts into the subarachnoid space
Subarachnoid hemorrhages
When stroke-like symptoms resolve on their own in less than 24 hours
Transient ischemic attack
TIA
Transient ischemic attack
Signs and symptoms of a stroke
- Facial drooping
- Sudden weakness or numbness in the face, arm, leg, or one side of the body
- Decreased or absent movement and sensation on one side of the body
- Lack of muscle coordination (ataxia) or loss of balance
- Sudden vision loss in one eye; blurred or double vision or abnormal eye movements
- Difficulty swallowing
- Decreased level of responsiveness
- Speech disorders
- Aphasia
- Dysarthria
- Sudden and severe headache
- Confusion
- Dizziness
- Weakness
- Combativeness
- Restlessness
- Tongue deviation
- Coma
Dysarthria
Slurred speech
Inability to produce or understand speech
Aphasia
If the ___ has been affected by a stroke, the patient may exhibit aphasia
Left cerebral hemisphere
If the ___ is not getting enough blood, the patient will have trouble moving the muscles on the left side of the body
Right cerebral hemisphere
Patients involuntarily ignore symptoms
Neglect
Patients with conditions affecting the back part of the cerebrum may neglect ___
Certain parts of their vision
Patients with bleeding in the brain may have ___ BP
Very high
Conditions that may appear to be a stroke
- Hypoglycemia
- A postictal state
- Subdural or epidural bleeding
Period following a seizure that lasts between 5 and 30 minutes, characterized by labored respirations and some degree of altered mental status
Postictal state
A collection of blood near the skull that presses on the brain
Subdural or epidural bleeding
The leathery covering of the brain that lies next to the skull
Dura
Subdural bleeding is ___ than epidural bleeding
Slower
The period between injury and deterioration from a epidural hemorrhage is called a ___
Lucid interval
A neurologic episode caused by a surge of electrical activity in the brain
Seizure
A disorder in which abnormal electrical discharges occur in the brain, causing seizures and possible loss of consciousness
Epilepsy
Seizures are classified as either ___
Generalized or focal, and their underlying cause either known or unknown
Results from abnormal electrical discharges from large areas of the brain, involving both hemispheres
Generalized seizure
Two types of generalized seizures
- Generalized motor seizure (tonic-clonic)
- Generalized-onset absence seizure
A focal seizure begins ___
In one part of the brain
Classifications of focal-onset seizures
Aware or impaired-awareness, and can be motor or absence
In a focal-onset aware seizure, no change occurs in ___
The patient’s LOC
Focal-onset impaired awareness seizures result form ___
Abnormal discharges from the temporal lobe of the brain
Patient’s often experience this warning sign prior to a seizure
Aura
Phase of a seizure with extreme muscle rigidity
Tonic phase
Phase of a seizure with constant muscle contraction and tumbling, tongue biting, bladder incontinence, or bowel incontinence
Clonic phase
Generalized motor seizures typically last less than ___
5 minutes
The period after a generalized motor seizure
Postictal state
How long does the postictal state last?
5 to 30 min or more
The postictal state is over when ___
The patient regains a complete return of their normal LOC
A generalized absence seizure may last for ___
Just a few seconds, after which the patient fully recovers with only a brief lapse of memory of the event
Seizures lasting more than 5 minutes are at risk for progressing to ___
Status epilepticus
Seizures that continue every few minutes without the person regaining consciousness or that last longer than 30 minutes
Status epilepticus
How to care for status epilepticus
- Protect from self-harm
- Call for ALS backup
- Will need advanced airway management and medication to stop the seizure
Cause cannot be determined
Idiopathic
Most common medications to treat seizures
- Levetiracetam (Keppra)
- Phenytoin (Dilantin)
- Phenobarbital
- Carbamazepine (Tegretol)
- Valproate (Depakote)
- Topiramate (Topamax)
- Clonazepam (Klonopin)
Cause of epileptic seizures
Congenital origin
Cause of structural seizures
- Tumor
- Infection (brain abscess)
- Scar tissue from injury (within the skull)
- Head trauma
- Stroke
Cause of metabolic seizures
- Hypoxia
- Abnormal blood chemical values
- Hypoglycemia
- Poisoning
- Drug overdose
- Sudden withdrawal from alcohol or medications
Cause of febrile seizures
Sudden high fever (primarily in children)
During the postictal state, the patient’s breathing becomes fast and deep to compensate for ___
The buildup of acids in the bloodstream
Weakness on one side of the body
Hemiparesis
In some situations, the postictal state may be characterized by ___
Hemiparesis
Unlike a stroke, hypoxic hemiparesis ___
Soon resolves
Most commonly the postictal state is characterized by ___
Lethargy and confusion to the point that the patient may be combative
Geriatric patients with status epileptics are at a higher risk of ___
Hypoxia, hypotension, and/or cardiac dysrhythmias
Difference between syncope and seizures
Fainting typically occurs while standing up, seizures may happen in any position
The patient is not thinking clearly or is incapable of being awakened
Altered mental status
How to tell the difference between hemiparesis from stroke or hypoglycemia
Person experiencing stroke typically alter and attempting to communicate normally. Hypoglycemia will have altered mental status
Possible causes of altered mental status
AEIOU TIPS
A: Alcohol
E: Epilepsy, endocrine, electrolytes
I: Insulin
O: Opiates and other drugs
U: Uremia (kidney failure)
T: Trauma, temperature
I: Infection
P: Poisoning, psychogenic causes
S: Shock, stroke, seizure, syncope, space-occupying elision, subarachnoid hemorrhage
A temporary change in mental status characterized by disorganized thoughts, inattention, memory loss, disorientation, striking changes in personality and affect, hallucinations, delusions, or a decreased LOC
Delirium
BE-FAST stroke assessment
Balance
Eyes
Facial droop
Arm drift
Speech
Time
Cincinnati Prehospital Stroke Scale
Facial droop
Arm drift
Speech
Los Angeles Prehospital Stroke Screen
Items 1-6 yes, 97% chance of stroke
1. Older than 45
2. History of seizures or epilepsy absent
3. Symptoms <24 h
4. At baseline, not wheelchair bound or bedridden
5. Blood glucose between 60 and 400 mg/dL
6. Obvious asymmetry if any of the following 3 categories:
- Facial smile/grimace
- Grip
- Arm strength
Most commonly used stroke assessment in the hospital setting
11-step numerical grading system with the NIH Stroke Scale
LAG scale
3-item Stroke Severity Scale
3-item Stroke Severity Scale
LOC:
0 - Normal
1 - Mild dysfunction
2 - Severe dysfunction (unconscious)
Arm drift (hemiparesis):
0 - Normal function
1 - Mild dysfunction
2 - Severe dysfunction (flaccid)
Gaze:
0 - Normal gaze (follows pen/finger to left and right sides)
1 - Mild dysfunction
2 - Severe dysfunction (fixed gaze)
LAG Scale scores
> 4 stroke likely
5-6 high probability
LVO stroke
Large vessel occlusion stroke, subtype of ischemic stroke. Caused by an occlusion of a large blood vessel in the brain
LVO strokes respond well to ___
Fibrinolytics or mechanical thrombectomy
Los Angeles Motor Scale (LAMS) was developed to identify ___
LVO strokes
Los Angeles Motor Scale
Facial droop:
0 - absent
1 - present
Arm drift:
0 - absent
1 - slow drift
2 - rapid fall
Grip strength:
0 - Normal
1 - weak grip
2 - no grip
Score of 4+ strong indication of LVO stroke
Key info to document for a patient with a suspected stroke
- Time of onset of signs and symptoms
- Score on the GCS
- Results of the stroke assessment tool
- Changes noted on reassessment
