Neurological Emergencies Flashcards
Neurons are classified by the direction they travel. What is afferent?
Sensory
Neurons are classified by the direction they travel. What is efferent?
motor
what is brown squared syndrome?
One side of the body has no feeling but full movement and the other half of the body has full feeling but no movement
what are some of your motor neurons?
skeletal muscle, endocrine/exocrine glands (hormones), and smooth muscle.
Do your synapse ever touch? If not how do they work?
Nerves NEVER touch, they have a chemical mediator. it jumps the signal across (neurotransmitter)
What is dopamine?
Neurotransmitter (mood elevator)
What do Benzos stimulate
GABA
what make up the body of the neuron?
cell body (nucleolus)
Dendrites
axon
How does succinylcholine work?
works at the synapse and blocks the signal getting through the synapse.
What makes up Central Nervous System?
brain and spinal cord
what can be causes of neurologic problems?
- Brain Problem
- Spinal Column Problem
- Synapse Problem
What is the myelin Sheath?
Think of it at the insulation on house wire…
- it insulates (so signals don’t cross)
- speeds up conduction.
You have two nervous systems. what are they?
Central Nervous System (CNS)
Peripheral Nervous System (PNS)
When does the spinal cord turn into Cauda Equina?
L2
what is your autonomic nervous system (you dont tell it what to do)
sympathetic
parasympathetic
Why can using the cranial nerves be a good assessment tool?
in figuring out if its peripheral or central
if the assessment finding is one sided weakness, what is it most likely?
brain
if the assessment finding is two sided weakness, what is it most likely?
cord or a toxic thing
What makes up the Cincinnati stroke scale?
smile
raise eyebrows
speech
arm drift
what can patients with stokes can do that some one with bells palsy can not?
raise their eyebrows (bells palsy can not)
If there is paresthesia (tingling) what could it be?
- vague finding (non-specific) brain issue MOST LIKELY
- specific finding, then most likely a nerve issue.
Basillary skull fx mean what?
fx on the floor of the cranial vault.
what can be an issue with bacillary skull fx?
they can pinch the cranial nerves.
what is the dura mater?
outside
fibrous, has potential space between dura and skull.
Epidural bleeds are usually arterial, blood in potential space.
what is the arachnoid mater?
Is an actual space.
Looks like spider webs.
Contains blood vessels and CSF. Arachnoid granulations- sites where CSF enters venous system. Can be a direct portal for infection into brain. CSF comes from ventricles in center of brain.
Bleeds here (WORST HEADACHE EVER)
what is the Pia mater?
membrane that attaches to the brain.
Its like plastic wrap around the brain.
what “material” tissue wraps the brain? making up the dura, arachnoid, and Pia mater?
Meninges
what makes up Cerebral Spinal Fluid?
white blood cells
bathes the brain and spinal cord
how much CSF is produced a day?
150ml
What does your Cerebellum do?
conscious thought processes.
Intellectual functions.
Memory Storage and Processing.
Fine motor skills
What does the Frontal Lobe of the Brain do?
Where your personality is.
This is where lobotomies were
Where having Alzheimers and dementia effect
what does the thalamus do?
relay and processing centers for the sensory information
what does the hypothalamus do?
centers controlling emotions, autonomic functions.
What does the broca’s section of the brain do?
what does the wernekes affect?
what level of CO2 is best for brain perfusion in Cushing triad?
28-29
what is anisocoria?
one blown pupil and one constricted.
Suggest a brain bleed. Know their history too, it could be normal for them
what is conjugate gaze?
both eyes track together.
what is dysconjugate gaze?
looking in different directions.
suggest some sort of lesion.
what can stroke present like?
Hypoglycemia
what are Schwann cells?
cells of the peripheral nervous system which wrap around axons of motor and sensory neurons to form the myelin sheath.
what are the three stages of a seizure?
Preictal
Ictal
Postictal
What is the dose for Mannitol?
0.5-2g/kg
what is a thrombectomy
Its the treatment to break up the clot in a large vessel occlusion (LVO)
Not all hospitals will be able to do this procedure.
what is a mural emboli?
a blood clot (embolus) coming from the heart
what are the two types of strokes?
Hemorrhagic Stroke
Ischemic Stroke
what gives you hemorrhagic stroke?
HTN, that increase the pressure in the head.
Aneurysms will form and not show s/s until they dissect, future, or pressure on something else.
20% strokes
there are three hallmark signs of a LVO
- Gaze toward the effected sides
- aphasia (expresive, receptive, global, sensory [written, see, ect.])
- agnosia (can’t identify objects, or tell you what they do)
what is an ischemic stroke?
caused by an embolus that travels to the brain (clots from the left atria or the carotid bodies)
the thrombus develops at the site of occlusion (atherosclerosis)
clot is plaque
80% of strokes
will peripheral clots give you a stroke?
No, they will reach your lungs (they go to the right side of the heart)
what is the most common ischemic stroke cause?
thrombotic or embolic from the carotid.
what can you treat ischemic strokes with?
Fibrinolytics
TPA, Tissue Plasminogen Activator
can TPA work on all ischemic strokes?
No, it can NOT be a fat embolus
what are some S/s of Subarachnoid
- sudden onset (lots of vasculature)
- photophobia
- “worst headache ever had”
- stiff neck- menages irritation
If you have documented hypoglycemia with neuro deficits (suspected brain bleed) what should you do?
give sugar, brain can not live without sugar.
what is one of the biggest pieces of information that we need to get when we have a suspected stroke?
onset
this is important because there is a 3 hours for TPA, and about 6 hours for a stroke center.
If it happened while pt was “asleep” they can not be a candidate, we dont have accurate time.
is the grey matter on the inside or outside of the brain?
outside
is the grey matter on the inside or outside of the spinal cord?
inside
what will be a big leading difference of a pt that is having a hemorrhagic stroke vs an ischemic stroke?
the hemorrhagic stroke will be associated with pain (can)
be prepared to manage airway
Cushing triad
what does the AHA say about what temp the pt should be at with a stroke pt?
they should be mild hypothermia
what posturing is worse?
Decorticate
Decerebrate
Decerebrate (brain stem damage) WORST
Decorticate is above the brain stem
what is the cause of TIA (transient ischemic attacks)
- indicative of carotid artery disease.
- S/S exact same as a stroke
- resolve in 24 hours.
- Hx: HTN, TIA, or prior stroke.
what is the issue with a TIA and how should we treat them prehospital?
They are at risk for a stroke
not benign, there is damage to the brain.
TIA induced dementia (forgetfulness)
Treat like a stroke, call stroke alert. (inform the facility if the pt is improving)
what is Bells Palsy?
effects cranial nerve 7
stroke mimic
wont be able to raise their eyebrow (total paralysis)
what is one thing a bells palsy pt can’t do that a stoke pt can?
raise their eyebrow.
can stroke cause seizures?
Yes
can seizures cause strokes?
No
what are some stroke mimics?
- Bells Palsy
- hypoglycemia
- Todds paralysis - post seizure (postictal phase)
- migraines- recurent headache with at least 3 other characteristics: abd pain, nausea, aura, vomiting
- Cluster migraine- may look like they have facial droop
what is one thing you can anticipate on seeing with stroke?
hypertension
What are your treatment for stroke?
- IV access
- BGL
- cardiac Monitor
- O2 (94-99%)
get good hx and onset - trend neuro status (better = TIA and get worse = potential bleed)
What are some causes of generalized seizures?
BGL infection hyponutremia (sodium is the main neuro transmitter) head trauma tumor meds CVA dysrhythmias meningitis/encephalitis toxins (tricyclics, ETOH) Stress
VITAMINS*
What is the cause of epilepsy?
disease of exclusion (they use to blanket statement diagnose, dont know the full cause as to why)
what are the stages of a seizure?
- Aura- preictal
- loss of consciousness
- tonic phase (fasciculation, muscle tension and twitching)
- Hypertonic Phase
- Clonic Phase (muscle jerking)
- post seizure (postictal)
what is happening during the postictal phase?
The brain is trying to reset. (Todds Paralysis)
- mimic of a stroke
last for couple of minutes
AMS
If the patient comes out of a seizure and then goes back into a seizure what do we consider that?
Status
what do we treat with a status seizure?
O2 suction protect from trauma Benzo IV BGL 12-lead
What is a breakthrough seizure?
patient that is compliant with medications, and they still have a seizure.
What is the #1 cause of most seizures?
non-compliance of medications.
What is an absence seizure?
Petit Mal
-loss ability to understand what has taken place
have a blank look (look like day dreaming)
can happen many times though out the day (sometimes 100 times)
last for about 20-30 seconds
Will an absent seizure have postictal period?
No
What is the difference with partial and generalized seizures?
partial- part of the brain
generalized- whole brain
Partial can lead into generalized
What is a simple partial seizure?
Isolated, focal motor twitching
DOES NOT CAUSE LOSS OF CONSCIOUSNESS OR AWARENESS, no postictal phase
can have hallucinations
Euphoric (extreme happiness)
Dysphoric (extreme sadness)
60-90 sec last
What is tourrettes?
its a version of simple partial seizure
myoclonus
type of seizure w/ spastic jerking (muscle contraction)
Dysphoric seizures?
sick to stomach/ stomach cramps
euphoric seizure?
experience euphoria multiple times a day
Drop Seizures?
Head drops when comes on, then back up (usually helmet)
Hypertonic seizures?
over stimulation of skeletal muscles?
Giggle Seizures?
over stimulation of skeletal muscles
Complex partial seizure?
Temporal lobe- gives you metallic taste w/ deja vu
Blank stare, lip smacking, isolated muscle movement
lose contact with reality
Erratic movement and can be combative
no postical phase
What are some common Home meds for seizure?
Keppra - newest
Carbamazepine (tegretol)
phenytoin (dilantin)
Sodium blockade and phenothiazine type meds are the ones used for anticonvulsant (can cause arrhythmias)
As an EMS provider who was called to the house for a seizure, and see them seizing what should you consider?
Status Seizure
What is ALS?
Amyotophic lateral sclerosis (Lou Gehrigs disease)
stops the relationship between nerves and muscles (difficulty speaking and respiratory depression)
Poliomyelitis
Virus that causes muscle wasting. Sometimes the muscle can return. Caused by poliovirus hominis. Contracted through direct fecal-oral contact.
What is Bells Palsy?
Virus, Refers to paralysis of the facial muscles due to inflammation of the 7th cranial nerve. Usually one sided and temporary. Usually follows a respiratory infection. Often develops suddenly. Use eyebrow test to differentiate between bell’s palsy and stroke. Bell’s palsy cannot raise eyebrow. Can be some associated pain.
Parkinson’s disease-
Tremor, rigidity, bradykinesia, postural instability- Degenerative neurologic disease effecting the cerebellum
Central pain syndrome- in pain. Commonly become addicted to benzos and narcotics.
Multiple sclerosis
Autoimmune. Unpredictable disease resulting from deterioration of the myelin sheath. Demyelination of Schwann cells. Usually women. Colorado is in the MS belt. Unknown cause. They call it autoimmune but it acts like a virus. Rarely is life threatening.
Muscular dystrophy-
hereditary. characterized by progressive muscle weakness.
Alzheimer’s disease
Organic brain disease. Will start subtle, progress from there. Most frequent cause of dementia in elderly. Results in atrophy of the brain due to nerve cell death in the cerebral cortex. Ballroom dancing is the only physical activity that shows to help slow the progression of Alzheimer’s.
What is a neoplasms
Brain tumors
