Neurology Flashcards
How would an obtundated patient present themselves?
lethargic, somnolent, responsive to verbal or tactile stimulation, but quickly drifts back to sleep
What kind of patient would present generally unresponsive; may be briefly aroused by vigorous, repeated, or painful stimuli; may withdraw (shrink away from) or localize (grab at) the source of stimuli?
a patient presenting with stupor
What scale is used to assess changes in arousal?
glascow coma scale
What are the three categories assessed in the Glascow Coma Scale?
Eye opening, verbal response, and best motor response
What are three examples of central stimulation? What does this address?
Trapezius pinch, sternal rub, supraorbital pressure
This will assess if the brain stem is still intact/functioning
What does peripheral stimulation assess?
spinal cord function
If a patient is presenting with decorticate posturing, what may this indicate?
cerebral hemispheric dysfunction
If a patient is presenting with decerebrate posturing, what may this indicate?
brainstem dysfunction
Is decorticate or decerebrate posturing more concerning? Why?
decerebrate, as this means there is brainstem dysfunction
What is the inability to understand written or spoken words?
wernicke’s (receptive) aphasia
What is the inability to express language through speech or writing?
broca’s (expressive) aphasia
What can pupillary reaction provide information on?
the location of the lesions or mass effect from cerebral edema
If both pupils are nonreactive, where is damage indicated?
the midbrain
If pupils are dilated on a patient, what is important to assess before getting too concerned?
medications.. atropine and epinephrine can cause pupil dilation
If a patient has pinpoint pupils, what can this be an indicator of?
pons lesion or opiate drug overdose
What are the two oculomotor responses that determine brainstem integrity?
oculovestibular (caloric) and oculocephalic (doll’s eyes) reflexes
What kind of drugs can depress oculocephalic/oculovestibular reflexes?
ototoxic drugs, neuromuscular blockers, and ethyl alcohol
What kind of respirations are seen in a bilateral lesion in the cerebral hemispheres, cerebellum, midbrain, or, in rare circumstances, upper pons, and it may be caused by cerebral infarction or metabolic disease?
Cheyne-stokes
What type of respirations indicate a lesion in the low midbrain or upper pons and may be caused by infarction or ischemia of the midbrain or pons, anoxia, or tumors of the midbrain?
central neurogenic hyperventilation
What may an increased pulse be indicative of?
poor cerebral oxygenation
In the late stages of ICP, there will be a ____ in heart rate?
decrease
What is the reason that widening pulse pressure may occur?
ICP exceeds MAP
What do cranial nerve reflexes indicate?
brainstem functioning
What are the 4 protective reflexes?
(1) corneal reflex (blink), (2) gag reflex, (3) swallow reflex, and (4) cough reflex
What is the gold standard for measuring ICP?
intraventricular monitoring
What are the major disadvantages of having an intraventricular drain?
it is very invasive and carries a high risk for hemorrhage and infection
Why is a subarachnoid pressure monitoring device not ideal for someone with an increased ICP?
they are unable to drain CSF
What is the anatomic landmark for the lateral ventricle?
foramen of Monroe (tragus)
Why is the waveform of a subarachnoid bolt/screw easily dampened?
fragments of bone or brain tissue may obstruct the bolt
What is the p1 waveform on an ICP monitor?
pulse pressure
What does the p2 waveform represent on an ICP monitor?
compliance of brain tissue
What is the p3 waveform on an ICP monitor?
dicrotic wave
When do A waves typically occur? What do they look like?
When there is an increase in ICP. They are sharp increases that plateau
What kind of neurological changes typically accompany A waves?
decreased level of consciousness, pupillary changes, and posturing
What are the two types of cerebral oxygenation monitoring?
jugular bulb oximetry and brain tissue oxygen monitoring
What does a transcranial doppler measure?
cerebral blood velocity
Three primary types of TBIs
Accelerational/decelerational, Rotational, Penetrating
What are the 5 trademark signs of a basilar skull fracture?
Battle sign, raccoon eyes, otorrhea, rhinorrhea, positive halo sign.
What are three circumstances that may cause an increase in cerebral blood volume?
hypoxemia and/or hypercapnia, cerebral venous outflow obstruction, or loss of cerebral autoregulation
Why does hypoxemia/hypercapnia result in an increased CBV?
it causes vasodilation
What term describes the process whereby cerebral vessels have the capacity to dilate or constrict in response to changes in perfusion pressures?
Autoregulation
A brief loss of consciousness followed by a period of being alert and oriented and then a loss of consciousness again is a typical presentation for which condition?
epidural hematoma
What is the term used to describe an accumulation of blood between the dura and the arachnoid layers of the meninges?
Subdural hematoma
What should the MAP be maintained at for management of an intraparenchymal hematoma?
70mmHg or less
Presence of dizziness, headache, and confusion for long periods of time after concussion is _______.
postconcussive syndrome
What are the components of the beside neurological assessment?
LOC, motor function, pupillary response, respiratory function, and VS
What interventions are used to manage cerebral metabolism?
sedation, anticonvulsants, antipyretic therapies
