Neurological emergencies Flashcards
What are some things you can do if you see someone having a seizure (general knowledge)?
- do not restrain extremities
- cushion head, remove glasses
- loosen tight clothing
- do not stick you fingers or anything in person’s mouth
- turn pt on side (don’t vomit and aspirate the vomit)
- time the seizure
- look for id
Don’t hold them down
offer help as the seizure ends.
What do you need to rule out when someone under 40 comes in with seizure?
brain mass
what is status epilepticus?
potentially life-threatening condition in which the brain is in a state of persistent seizure.
one continuous, unremitting seizure lasting longer than 5 minutes or recurrent seizures without regaining consciousness
what is syncope? would you send to ER?
a transient loss of consciousness and postural tone, characterized by rapid onset, short duration, and spontaneous recovery, due to global cerebral hypoperfusion to the brain [that most often results from hypotension.]
- if there is a concerning underlying cause then send to ER (i.e. trauma)
what are the 3 major categories of cerebrovascular disease/accident
Ischemic (embolus)
Hemorrhagic
Transient ischemic attack
what is the survival of ischemic tissue dependent on?
availability of collateral circulation, duration, magnitude of reduction, and rapidity of reduction.
What is a focal cerebral ischemia generally due to?
embolus or thrombus in a large vessel or vasculitis in medium or small sized vessel
- may result in cerebral infarct in a well circumscribed area of necrosis
TIA can last how long?
a few seconds or up to 24 hours (max range)
can return to full neurological condition (also a Rind)
what are some risk factors for cerebral infarct (stroke)?
advanced age, hypertension, DM, high cholesterol, tobacco use, and A. Fib. (irreg- greater chance of embolization, esp left atrium)
what are some sxs that are more common in hemorrhage stroke vs. ischemic?
N/V, HA, and change in level of consciousness.
[no PE finding, Hx,
what population has a greater risk of hemorrhagic stroke in the US?
African Americans
what is the most common cause of thrombotic stroke?
Thrombotic occlusion –usually at carotid bifurcation or in vertebrobasilar system ( mc vessel: middle cerebral artery)
What is the most common type of stroke?
Ischemic
what type of stoke is the most deadly?
hemorrhagic
for all stokes, increased mortality rate in the first month post stroke, need to monitor
what are some common sxs of stroke?
abrupt onset of mono/hemi/quadriparesis, mono/binocular visual loss, visual field deficits, diplopia, dysarthria, ataxia, vertigo, aphasia or a sudden change in the patient’s level of consciousness.
Dominant hemisphere stroke
(usually left) is involved, a classic syndrome consisting of right hemiparesis, right hemisensory loss, left gaze preference, right visual field cut and aphasia may result.
non dominant hemisphere stroke
(usually right sided) hemisphere is involved, a syndrome of left hemiparesis, left hemisensory loss, right gaze preference and left visual field cut may result.
what is a key factor when considering thrombolytic therapy?
The time since the stroke has occurred [also location–get a CT scan]
The biggest offender of cerebral embolism?
middle cerebral artery (MCA)
hemorrhagic stroke is generally due to…?
intracerebral hemorrhage, subarachnoid hemorrhage, subdural hemorrhage, or epidural hemorrhage.
what is the primary underlying cause of intracerebral hemorrhage?
Hypertension
Hemorrhagic stroke risk is increased with:
Advanced age Hypertension (up to 60% of cases) Previous history of stroke Alcohol abuse Use of illicit drugs (i.e. cocaine, other sympathomimetic drugs) - anticoagulant pts
What happens to the brainstem with a stroke in that area?
Edema- which increases risk for brainstem herneation and compression –> decrease LOC, apnea, and risk of death.
Signs of brainstem involvement?
Gait or limb ataxia Vertigo or tinnitus Nausea and vomiting Hemiparesis or quadriparesis Eye movement abnormalities resulting in diplopia or nystagmus Oropharyngeal weakness or dysphagia
what is the most clinically significant cause of subarachnoid hemorrhage?
rupture of berry (saccular) aneurysm
[an out pouching on the circle of Willis]
most clinically significant vascular malformation?
Arteriovenous (AV) malformations
What are some symptoms of acute hypertensive encephalopathy?
characterized by diffuse cerebral dysfunction including: headaches, confusion, vomiting, convulsions and possible coma.
what someone has a trauma what do you need to document?
Take a good history, did they lose consciousness, palpate scalp for step off phenomena, make sure you do a good neurological exam, check papillary size, document pertinent neg/pos (don’t just list WNL)
anisocoria
unequal pupil size, can be a sign of brain injury that is more serious than a concussion (can also be benign- congenital, previous injury, response to lateral light)
Where is the location of impact when an individual falls while awake?
occipital portion
Where is the location of impact when an individual falls from a syncopal event?
frontal impact
Basal skull fracture
linear fractures extending through the petrus portion of the temporal bone that leak spinal fluid from an ear. (associated with hearing loss, instability of gait and vertigo)
**what is battle’s sign?
mastoid ecchymosis. Suspect basilar skull fracture (know for final!)
**What are raccoon’s eyes?
bilateral periorbital ecchymosis. If the patient is unconscious or has a hx of head trauma, suspect basilar skull fracture. (final)
which is venous bleed?
subdural
most common symptoms of meningitis
most common symptoms are fever, headache and neck stiffness (nuchal rigidity). severe HA, confusion or altered consciousness, vomiting, and an inability to tolerate light or loud noises.
what tests would you do for meningitis?
Kernigs, Brudzinskis’ signs… do CT (cerebral edema),
what differentiates bacterial meningitis caused by Neisseria meningitidis?
a petechial rash that frequently develops with meningococcal meningitis. (does not blanch when you press on it) , dangerous bc it can cause death within 48 hours dt vascular disruption
in premature babies and newbornes what is the most common bacterial cause of bacterial meningitis?
group B streptococci which normally inhabit the vagina and Escherichia coli that normally inhabit the digestive tract. Listeria monocytogenes is a bacteria that may be transmitted by the mother before birth and may cause meningitis in the newborn
In older children: what is the most common bacterial cause of bacterial meningitis?
Neisseria meningitidis and Streptococcus pneumoniae and in countries that do not offer vaccination, Haemophilus influenzae, type B.
In adults: what is the most common bacterial cause of bacterial meningitis?
Neisseria meningitidis and Strep pneumoniae together cause approximately 80% of all bacterial meningitis cases.
Risk of infection with Listeria monocytogenes is increased in individuals over 50 years of age
what are some non-infectious causes of meningitis?
spread of cancer to the meninges and certain drugs (mainly non-steroidal anti-inflammatory drugs, antibiotics and intravenous immunoglobulins). sarcoidosis, connective tissue disorders such as SLE and certain forms of vasculitis.
