Neurological Emergencies Flashcards
Which lobe scans through images?
Occipital lobe
Which lobe attaches a name to an image?
Temporal lobe
Which lobe controls voluntary motion?
Frontal lobe
Which lobe perceives touch and pain?
Parietal lobe
Which neurological cause is the 5th leading cause of death in the US in 2019?
Stroke
Which neurological cause is the 6th leading cause of death in the US in 2019?
Alzheimer Disease
What section of the nervous system do thoughts, perceptions, feelings and autonomic body functions fall under?
Central Nervous System
What section of the nervous system do transmitting commands between the brain and body and receiving feedback fall under?
Peripheral Nervous System
What part of the brain filters out unneeded information and conscious vs. unconscious management of information?
Diencephalon
What part of the brain regulates level of consciousness?
Midbrain
What part of the brain frees cerebral cortex for higher activities?
Brainstem
What does the hypothalamus control?
controls pleasure, thirst, hunger
What part of the brain mediates all emotions?
prefrontal cortex
What part of the brain generates rage and anger?
limbic system
What part of the brain manages complex motor activity and transfers learned behaviors from the frontal lobe?
Cerebellum
Which nerves are responsible for airway control?
Trigeminal, glossopharyngeal, vagus, hypoglossal (allow for swallowing, tongue control, hypopharynx)
What does trismus mean?
clenched teeth
What could trismus indicate?
seizure in progress, severe head injury, cerebral hypoxia
What are the three major parts of the brain?
cerebrum, cerebellum, brainstem
What is the most significant risk for hemorrhagic stroke?
hypertension
What patient with an altered mental status is thought to be?
Is not thinking clearly or is incapable of being aroused
What is a simple partial seizure?
a seizure that begins in one extremity
When caring for a pt with documented hypoglycemia, you should be most alert for?
a seizure
What is aphasia?
unable to produce or understand speech
What is a contraindication for thrombolytic (fibrinolytic) therapy?
brain bleed
Components of the Cincinnati Stroke Scale include?
arm drift, speech, facial droop
What type of seizures are benign but should still be evaluated?
febrile seizures
What are individuals with chronic alcoholism predisposed to?
Intracranial bleeding and hypoglycemia
muscle control and body coordination are controlled by?
cerebellum
What type of seizure is prolonged in nature without a return of consciousness?
status epilepticus
What part of the brain controls basic body functions like breathing, BP and swallowing?
brain stem
The spinal cord exits the cranium through the…
foramen magnum
What is the most suggestive sign of ruptured aneurysm?
sudden, severe headache
What is a characteristic of a focal-onset aware seizure?
normal level of conscious
What is a cause of an ischemic stroke?
blockage of a cerebral artery
What is one metabolic cause of a seizure?
poisoning
Which type of posturing has abnormal flexion, curls arms toward chest, point their toes and flex their wrists (indicative of damage to the area below the cerebral hemispheres)
Decorticate
What is one characteristic of focal onset aware seizure?
a seizure that causes the pt to stare blankly
In most people, speech is controlled by which hemisphere?
Left hemisphere
What disorder of the brain is caused by the disruption of blood flow resulting in brain cell death?
cerebral infarction
What is the largest part of the brain?
Cerebrum
What type of posturing is abnormal extension, points their toes, extends their arms outward and palms down(pronation) [indicative of damage near or in the brainstem]
decerebrate
What sign lets you suspect ischemic stroke vs. hypoglycemia?
If the pt attempts to communicate with you
When is hyperventilation indicated for neuro emergencies?
those with documented signs of intracranial pressure (ICP) and impending herniation
What is anisocoria?
unresponsive and dilated pupils
What happens to blood flow and systolic pressure when ICP rises?
Blood flow diminishes, medulla oblongata signals heart to increase force of contractions causing systolic to rise
What is cushing’s reflex for ICP?
BRadycardia, irregular breathing, hypertension and widened pulse pressure
What is ptosis?
Drooping or sagging of the eyelids
What can ptosis indicate?
Bell palsy
What happens with a breakthrough seizure?
the seizure occurs despite a therapeutic medication blood level
What are thoughts, ideas, perceived abilities that are not based in common reality?
delusions
What are sensory stimulations that cannot be verified by others?
hallucinations
What is a protective movement that results in blinking. moving the head posteriorly and pupil constriction called?
corneal reflex
If you tap between a patient’s eye and the pt does not blink or twitch it is safe to assume what?
The the pt does not have an intact cough or gag reflex
What type of pupil response does cocaine, methamphetamines and hallucinogens tend to cause?
pupil dilation
What do depressants tent to the do the pupils?
constrict the pupils
What are unequal pupils a sign of?
increased ICP
What is weakness of one side of the body called?
hemiparesis
Paralysis of one side of the body is called?
hemiplegia
Uncontrolled hypertension, sudden severe headache and rapidly deteriorating level of consciousness is most suggestive of?
ruptured cerebral artery
A degenerative cerebral disease is an example of a _______ cause of a seizure?
structural
A hemorrhagic stroke occurs as a result of?
a ruptured cerebral artery
What is status epilepticus?
prolonged generalized motor seizure
A transient ischemic attack occurs when?
body’s normal processes destroy a cerebral thrombus
What is an idiopathic seizure?
a seizure without an identifiable etiology
What does hypermetabolic state mean?
they are using large amounts of glucose and produce lactic acid
Following a head injury, a pt who is verbally abusive and combative most likely had an injury to what part of the brain?
frontal
What controls muscle and body coordination?
cerebellum
Pt with hemorrhagic strole experience rapidly declinging LOC because?
of increasing ICP
Migraines are thought to be caused by
changes in blood vessel size within the base of the brain
The clonic phase of a generalized motor seizure is characterized by?
muscle contraction and relaxations in rapid succession
Which condition can mimic the signs and symptoms of an acute ischemic stroke?
low bgl
Where is the 12th cranial nerve located?
arises from the brain and innervates the head and face
What is the alteration of a person’s ability to perform coordinated motions such as walking?
ataxia
A sensation of numbness or tingling is called?
parasthesia
If a pt does not feel anything within that body part, it is called?
anesthesia
What is the minimum systolic BP for a pt with ICP?
110 to 120 mm Hg
Sensations commonly experienced before a seizure or migraine headache like visual changes and hallucinations
aura
What is the onset time of glucagon?
20 minutes
What can increase the morbidity of pts who have had a stroke?
hyperglycemia
Pts with hyperglycemic are often _____ and require volume support.
dehydrated
What is a normal range for CPP?
70 to 90 mm Hg
What is the target systolic BP of a pt with ICP?
110 mmHg
What interventions should you consider with someone who has signs of ICP?
IV access and NS or Lactated Ringer
An aneurysm can happen due to the following:
-tear in the arterial wall
-blood entering one of more of the three layers of the artery
-pressure build up and initial tear increases
What is another name for an ischemic stroke?
occlusive stroke (bc it’s caused by an occlusion- blockage)
What is a hallmark symptom of a hemorrhagic stroke?
“worst headache of my life”
How do you calculate CPP?
MAP -ICP
What serious conditions include headache as a symptom?
brain tumor, meningitis, stroke
What are the three substances in the skull?
brain, blood and CHF
What is the normal ICP in adults?
less than 10-15mm Hg
What is the normal ICP in young children?
less than 3-7mm Hg
What does MAP signify?
The mean arterial pressure is the average pressure within the blood vessel at any given time
What are the four signs of increase ICP?
-Shock
-posturing
-irregular respiratory
-unequal pupils
True or False: Pt with strokes will also exhibit cardiac dysrhythmias.
True
Unless cervical spine injury, what how should you position a pt with stroke?
supine and elevate the head 30 degrees
What can cause vasodilation of the cerebral arteries which allows more blood into the skull?
high CO2 level
What is the ETCO2 goal for pt’s with stroke
30-35mm HG
For ischemic strokes, fibrinolytics needs to be administered with how many hours of onset?
3-4.5 hrs
What are episodes of cerebral ischemia without permanent damage?
TIAs - transient ischemic attacks
What are mini-strokes(TIAs) a sign of?
serious vascular conditions that require medical evaluation
According to AHA/ASA, TIAs resolve within what time frame?
1 hour
What is the #1 preventable cause of strokes and TIAs?
hypertension
What happens if a seizure occurs for a long period of time?
-cerebral glucose
-oxygen is depleted
-hypoxia
-hypercarbia
-hyperthermia
what is another name for tonic-clonic seizures?
grand mal seizures
What happens during the tonic phase of a tonic-clonic seizure?
systemic rigidity
What happens during the hypertonic phase of the tonic-clonic seizure?
arched back and rigidity
what happens during the clonic phase of the tonic-clonic seizure?
intermittent contractions of major muscle groups - contractions are chaotic
What are some signs of postseixures?
major muscles relax, nystagmus, eyes on back of the head
What are some signs of the postictal phase?
aphasic (unable to speak), confused, emotional, tired, headache, gradual return of normal brain function
What do you do if a pt is apneic for more than 30 seconds during a seizure?
begin ventilation assistance
What type of seizure might happen with hyperventilation and flashing lights?
absence seizures
What is another name for an absence seizure?
petit mal seizure
What type of seizure has little to no movement, typically experience by children,last a few seconds and have no postictal period?
absence (nonmotor) seizures
Causes of hemorrhagic stroke
hypertension, ruptured aneurysm, arteriovenous malformations, bleeding disorders
If a pt’s awareness is affected or impaired at any time during a focal seizure, it is called?
focal impaired-awareness seizure
What type of seizure affects an area on one side of the brain?
focal seizure
If a pt had a focal seizure in the temporal lobe, what type signs and symptoms might you see?
snapping fingers, repeating phrases, walking in circles
A focal seizure in the frontal lobe might have signs and symptoms of?
gesturing, cycling, kicking movements, loud cry and scream
What is another name for psychogenic nonepileptic seizures?
pseudoseizures
What is the root cause for pseudoseizures?
psychiatric
What type of medications can be given for seizures?
diazepam(Valium), Lorazepam (Ativan), Midazolam (versed)
What type of seizure last longer than 4-5 minutes or consecutive seizures without a return to consciousness between seizures?
status epilepticus
During a seizure, the neurons are in what state?
hypermetabolic state
Why must be prepared to control the airway and ventilations when administering benzo because?
Benzos can cause respiratory depression or arrest
Pregnant patients experiencing eclampsia can be managed with?
magnesium
Syncope can be a sign of what?
life-threatening cardiac dysrhythmias, stroke
Conditions that may mimic stroke
hypoglycemia, postictal state, subdural/epidural bleeding, bells palsy
Common causes of syncope
vagal stimulation, lack of oxygen, hypoglycemia, seizure activity
Pt with syncope usually experience , ______________, signs and symptoms that precede a disease; dizziness, weakness, SOB, chest pain, headache, black vision
prodrome
What causes muscle tension headaches?
stress, cortisol levels, depression
What type of headache had pain on both sides of the head, travel from back to front, dull ache, squeezing pain?
muscle tension headache
What type of headache reports seeing an aura, unilateral and focuses, throbbing, pounding, pulsating, nausea, vomiting, lasts several days?
migraine headaches
What type of headache is a rare vascular headache that begins in the face as a minor pain around the eye, lasts 30-45minutes, sharp and excruiating pain on one side of the face?
cluster headache
What plays a role in cluster headaches?
erotonin, histamine and anxiety
What type of headache is caused by inflammation or infection within the sinus cavity of the face, worse when waking, postnasal drip, sore throat?
sinus headache
What is a chronic deterioration of memory, personality, language skills, reasoning, judgement?
Dementia
What can present as dementia and is caused by vitamin B1 deficiency, typically found in pt who are malnourished ro alcoholic?
Wernicke encephalopathy
What is the most common form of dementia?
Alzheimer disease
What type of disease is a progressive, organic condition where neurons die?
Alzheimer disease
What type of disease has a genetic aspect, damage in the neurons in the frontal and temporal lobes, occurs between 55-65yrs, socially inappropriate behavior.
Pick disease
What type of disease is fatal, myoclonic jerking, ataxia (unstable gait), where prions (proteins) clump together with resultant death of neurons.
Creutzfeldt-Jakob diease
What type of disease is an adult-onset genetic disorder marked by a severe loss of neurons, fidgetiness, abnormal eye movement, memory loss, irritability?
Huntington disease (Huntington chorea)
What is a medical term for growths within the body that serve no useful purpose and are caused by errors during cellular reproduction - cancer of the brain or spinal cord?
neoplasm
Primary CNS tumors are usually caused by errors in what?
mitosis
The process by which cancerous cells move to sites distant from their site of origin
metastasis
What common type of cancers metastasize to the CNS?
lung and breast cancer
An autoimmune condition in which the body attacks the myelin of the brain and spinal cord, destruction of myelin, demyelination, resulting in areas of scarring?
multiple sclerosis
What are some symptoms during the pattern of episodes with Multiple sclerosis?
double, blurred vision, nystagmus, muscle weakness, loss of pain or temperature, ataxia, euphoria, electric sensation down the spine
What type of sign is a strange electric sensation down the spine or extremities when the head is flexed forward
Lhermitte sign
What is a rare disease in which the immune system attack portions of the nervous system with minor respiratory or gastrointestinal infection?
Guillain-Barre Syndrome
Around 1/3 of Guillain Barre patients will need what type of support?
respiratory
How is Guillain Barre described?
weakness, tingling sensations in the legs, which moves up to the thorax and arms. weakness can lead to paralysis.
What part of the brain is responsible for production of dopamine and if injured, can cause Parkinson?
substantia nigra
What neurologic condition have environmental and genetic factors place pts at risk for damage to certain neurons
parkinson disease
What is another name for Amyotrophic lateral sclerosis that strikes the voluntary motor neurons?
Lou Gehrig disease
What condition is subtle and progresses without being noticed, have generalized weakness of muscle groups, fasciculations, difficulty speaking.
ALS- Lou Gehrig
True or False: Someone with severe facial pain or sudden-onset facial paralysis is not necessarily having a stroke.
True
If a pt has vertigo, look at the pt’s eyes and you should see?
nystagmus
What medications may provide relief for vertigo?
Benzodiazepines
What medication may be helpful for nausea and vomiting present with cranial nerve disorders?
Phenergan (promethazine) or ondansetron (Zofran)
What are severe abnormal muscle spasms that cause bizarre contortions, repetitive motions or postures?
Dystonias
Do dystonias impact a pt’s LOC?
no
What is a common dystonia that causes neck muscles to contract?
spasmodic torticollis
Patients who take what type of medication can have sudden onset of dystonias?
antipsychotic medications
