Neurological Emergencies

Question 1

What is Ptosis?

Answer 1

Drooping of the eye

Question 2

What is dysphagia?

Answer 2

inability to swallow/eat/drink

Question 3

What is dysarthria?

Answer 3

impairment or clumsiness in the uttering of words

Question 4

What is nystagmus?

Answer 4

involuntary back and forth eye movements; horizontal, vertical or cyclical

Question 5

What is paresthesia?

Answer 5

numbness or tingling; pins and needles

Question 6

What is anesthesia?

Answer 6

complete loss of sensation

Question 7

What is agnosia?

Answer 7

inability to ID simple objects

Question 8

What is apraxia?

Answer 8

Unable to use common objects

Question 9

What is hemiparesis?

Answer 9

One sided weakness

Question 10

What is hemiplegia?

Answer 10

one sided paralysis

Question 11

What does ipsilateral mean?

Answer 11

affecting the same side of the body

Question 12

What does contralateral mean?

Answer 12

affecting the opposite side of the body

Question 13

What are the meninges?

Answer 13

The layers that surround the CNS moving outward in - Dura, arachnoid and pia mater

Question 14

What signs and symptoms indicate neurological compromise?

Answer 14

-Headache
-Visual/auditory abnormalities
-Paralysis
-Paresthesia
-Altered LOA
-Facial droop/ptosis
-Motor function compromise

Question 15

What is Cushing’s Triad?

Answer 15

dec HR and RR, inc. BP w wide PP

Question 16

What is multiple sclerosis?

Answer 16

-Autoimmune disorder where the body attacks the myelin sheath (insulator) in the brain and/or spinal cord resulting in disruption of signal.
-Can result in blindness, motor dysfunctions and/or speech dysfunction.
-Symptoms may persist or come and go (attacks)

Question 17

What is cerebral palsy?

Answer 17

-A group of permanent movement disorders that appear early in childhood generally caused by abnormal development or damage to parts of the brain in utero.
-Will present with poor coordination, muscle stiffness, weak muscles or tremors and can
lead to complications like seizures and intellectual disabilities.

Question 18

What is GBS?

Answer 18

-Sudden bilateral weakness within the PNS usually starting w hands or feet and moving upward.
-Can be fatal if moves into chest and muscles used in respiration.
-Autoimmune in nature where the body attacks the myelin sheath (like MS).
-Pt’s can improve and return to normal life with treatment usually involving IVIG.

Question 19

What are the signs and symptoms of meningitis?

Answer 19

-Fever
-Headache
-Nuccal rigidity
-Photophobia
-Altered LOA
-Sometimes a rash (petechiae)

Question 20

What is Parkinson’s?

Answer 20

-A long-term degenerative disorder of the CNS (cell death within the basil ganglia) mainly affecting motor function.
-S&S worsen over time may include: Tremors, unsteady gait or shuffling, rigidity and difficulty with speech

Question 21

What is Bells Palsy?

Answer 21

-Dysfunction of cranial nerve VII resulting in facial paralysis, twitching or weakness.
-It has a sudden onset and generally lasts around 2 weeks.
-Risk factors are: Diabetes, recent URI, pregnancy

Question 22

What is myasthenia gravis?

Answer 22

-Autoimmune disease that causes breakdown of receptors at the nerve/muscle junction.
-Most commonly affects muscles of the eyes, face and swallowing but can cause motor dysfunction.
S&S may include:
-Unsteady gait
-Ptosis
-Dysarthria
-Muscle weakness

Question 23

What is Wernicke-Korsakoff Encephalopathy?

Answer 23

-Chronic thiamine (vitamin B1) deficiency generally as a result of chronic alcohol abuse.
S&S may include:
-Visual disturbances
-Altered LOA (mood)
-Ataxia (unsteady gait)

Question 24

What are the signs and symptoms of increased ICP?

Answer 24

-Headache
-NV
-Photophobia
-Hemiparesis
-Hemiplegia
-Altered LOA
-Unconsciousness
-Seizure
-Blown pupil
-and/or Cushing’s triad.

Question 25

What are the signs and symptoms of an ischemic stroke?

Answer 25

-Headache -Auditory/visual abnormalities -Facial droop -Ptosis -Speech issues -Unilateral weakness and/or drift

Question 26

What are the signs and symptoms of a hemorrhagic stroke?

Answer 26

The same as an ischemic stroke as well as: -Dizziness -NV -Seizure -Unconsciousness -Irreg resps. -Inc. ICP (Cushing's triad)

Question 27

What is an epidural hematoma?

Answer 27

-Occur between the skull and dura mater and of a arterial or large vein origin. -Develop headache immediately following or a few hours after injury which may disappear and then return even worse. -Will have dec. LOA, sleepiness and coma. -Will sometimes lose consciousness then regain mental function for a period of time and then become unconscious again. -May develop unilateral and other CVA symptoms

Question 28

What is a subdural hematoma?

Answer 28

-Generally caused by bleeding from veins between outer and middle meninges and bc of slower bleed may take hours/days to onset. -Trauma or medical causes. Will c/o: -Persistent headache -Fluctuating drowsiness -Confusion -Memory loss -Unilateral/CVA symptoms

Question 29

What is a intracerebral hematoma?

Answer 29

-Bleeding formed within the brain itself caused by head injury and sometimes from cerebral contusion. May c/o: -Drowsiness -Confusion -Unilateral plus other CVA symptoms.

Question 30

What is a subarachnoid hematoma?

Answer 30

-Bleeding under the arachnoid meningeal layer from ruptured blood vessel (aneurysm). Will c/o: -Severe (thunderclap) headache -Syncope -Confusion -Stiff neck -NV -Seizures

Question 31

What is decorticate posturing?

Answer 31

-flexor -arms are like Cs and are brough in towards the core -Problems with cervical spinal tract or cerebral hemisphere

Question 32

What is decerebrate posturing?

Answer 32

-extensor -arms like es at side -problems with midbrain or pons

Question 33

What are the different levels of GCS for eye response?

Answer 33

4. spontaneous 3. to speech 2. to pain 1. no response

Question 34

What are the different levels of GCS for verbal response?

Answer 34

5. oriented 4. confused 3. inappropriate words 2. incomprehensible sounds 1. no response

Question 35

What are the different levels of GCS for motor response?

Answer 35

6. Obeys commands 5. Moves to localized pain 4. Flex to withdraw from pain 3. Abnormal flexion (decorticate) 2. Abnormal extension (decerebrate) 1. No response

Question 36

What are the 3 main symptoms that a patient must present with at least 1 of to qualify for stroke bypass protocol?

Answer 36

a. unilateral arm/leg weakness or drift b. slurred speech or inappropriate words c. unilateral face droop

Question 37

What are the contraindications for the stroke bypass protocol?

Answer 37

1. CTAS level 1 and/or uncorrected ABC problem 2. Symptoms of stroke resolved prior to paramedic arrival/assessment 3.Blood sugar <3 mmoL 4. Seizure at onset of symptoms or observed by paramedics 5. Glascow coma scale <10 6. Terminally ill or palliative patient 7.Duration of out of hospital transport exceeds 2 hours

Question 38

What is the LAMS used for?

Answer 38

-a tool used to predict the likelihood of a Large Vessel Occlusion (LVO) in the stroke patient -A Patient who has a LAMS >= 4 is a high probability of having an LVO

Question 39

What is the LAMS?

Answer 39

FACE 0-Both sides move normally 1- One side is weak or flaccid ARMS 0- Both sides move normally 1- One side is weak 2- One side is flaccid/does not move GRIP 0- Both sides move normally 1- One side is weak 2- One side is flaccid/does not move