Neurological Flashcards
Trochlear (4)
Down and inward eye movement;motor
Name the cranial nerves in order
Oh- Olfactor
Oh- Optic
Oh- Oculomotor
To- Trochlear
Touch- Trigenimal
And- Abducens
Feel- Facial
Very- Vestibulocochlear (Assoustic)
Good- Glossopharyneal
Velvet- Vagus
Ah- Accessory (Spinal Accessory)
Ha- Hypoglossal
Olfactory nerve (1)
Smell; Sensory
Optic (2)
Vision;Sensory
Oculomotor (3)
Most extraocular movements, opeing eyelids, pupillary constriction;Motor
Trigenimal (5)
Muscles of mastication, sensation of face, scalp, cornea, mucus membranes and nose;both sensory and motor.
Abducens (6)
Lateral eye movement;motor
Facial (7)
Move face, puff cheeks, close mouth and eyes, taste, saliva, and tear secretion;Both sensory and motor.
Vestibulochoclear (accoustic) (9)
Hearing and equilibrium;sensory
Vagus (10)
Talking, swallowing, general sensation from the carotid body, carotid reflex;both sensory and motor
Accessory (spinal accessory) (11)
Movement of trapezius and sternomastoic muscles (shrug shoulders);motor.
Hypoglossal (12)
Moves the tongue;motor
Type of cranial nerve;motor, sensory or both
Some- 1, sensory
Say- 2, sensory
Marry- 3, motor
Money- 4, motor
But - 5, both
My- 6, motor
Brother- 7, both
Says- 8, sensory
Big- 9, both
Boobs- 10, both
Matter- 11, motor
Most- 12, motor
Mini mental status exam (ORArL 2,3, RWD)
- Orientation to place AND time
- Recognition (repeat three objects ex orange, dog pencil)
- Attention (count back from 100 by 7’s)
- recall (ask to recall three objects 5 minutes later)
- Language
- 2 objects identified (ex clock and chair)
- 3 step command followed (ex take this paper in your right hand, fold it in half and place it on the floor)
- Reading (ex read this statement to yourself, do exactly what it says but do not say it aloud “close your eyes.”)
- Writing (ex write a sentence)
- Drawing (ex copy a design)
Max 30
No cognitive impairment: 24-30
Delirium/dementia: 0-17 (severe impairment), 18-23 (mild impairment)
Seizures
A variety of paroxysmal events occuring as a result of abnormal electrical activity in cerebral neurons.
The international classifiction of seizures is based on mode of seizure onset and spread
Partial seizures (focal or local)
Simple Partial and Complex partial
Simple partial seizure
-Common with cerebral lesions
-NO loss of consciousness
-Rarely lasts more than a minute
-Motor symptoms often start in single muscle group and spread to entire side of body.
-Paresthesia, flashing lights, vocalizations and hallucinations are common.
Complex partial seizure
Any simple partial seizure followed by an impaired level of consciousness
-May have aura, staring, or automatisms such as lip smacking or picking at clothing.
Generalized seizures
Absence (petit mal)
Tonic-clonic (grand mal)
Absence (petit mal) seizures
Sudden arrest of motor activity with blank stare
-Common in children/adolescnce (teachers find it)
-Begins and ends suddenly.
“Absent for awhile”
Tonic-clonic (grand mal) seizures
Begins with tonic contractions (repetitive involuntary contractions of muscle), loss of consiousness, then clonic contractions (maintained involuntary contractions of muscle).
-May have aura
-Usually lasts 2-5 minutes
-Incontinence may occur
-Followed by postictal period
Status epilepticus
A seizure that lasts longer than 5 minutes, or having more than 1 seizure within a 5 minute period without returning to a normal LOC
-Medical emergency
-May occur when the patient is awake or asleep, but the patient never regains consciouness between attacks.
-Most uncommon, but most life threatening.
Autonomic dysreflexia
An emergency clinial condition caused by exaggerated autonomic response to a stimulus.
HTN emergency in pts with injury above T6
Occurs later in the course, days to weeks after injury.
S/S:
-diaphoresis and flushing ABOVE the level of injury.
- Chills and severe vasoconstriction BELOW the level of injury.
- HTN, bradycardia, HA, nausea
TX: Remove stimulus and antihypertensives
Brown sequard syndrome
Caused by damage to one half of the spinal cord.
S/S:
-Same sided (ipsilateral) motor neuron paralysis and loss of prorioception
-Opposite sided (contralateral) loss of pain and temp
TX: MRI and steroids
Phases of seizures
Stabilization phase (0-5min)
Initial therapy phase (5-20min)
Second therapy phase (20-40min)
Third therapy phase (40-60min)
Stabilization phase management (0-5 min)
-Stabilize patient (ABCs)
-Time seizure from onset
-FSBS: <60 treat with 100mg thiamine and amp of D50
Initial therapy phase management (5-20 min)
Choose one:
-IM versed (10mg >40kg; 5mg<40kg) OR
-IV ativan (.1mg/kg; max 4mg may repeat once) OR
-IV diazepam (0.15-0.2mg/kg; max 10mg may repeat once)
If none are available then choose one of these:
-IV phenobarbital (15mg/kg) OR
-Rectal diazepam (.2-.5mg/kg, max 20mg) OR
-Intranasal midazolam, buccal midazolam
Secondary therapy phase management (20-40min)
Choose one of the following as a single dose:
-IV fosphenytoin (20PE/kg; max 1500PR) OR
-IV valporic acid (40mg/kg; max 3000mg) OR
-IV keppra ( 60mg/kg; max 4500mg)
If none are vailable:
-IV phenobarbital (15mg/kg), last ditch effort
NOTE: there is no evidence based prefered choice
Third therapy phase management (40-60min)
Repeat second line therapy OR
Anesthetic dose (with continuous EEG monitoring):
-Thiopental
-Versed
-Pentobarbital
-Propofol
NOTE: there is no evicence based preferred choice
Transient Ischemic Attack (TIA)
Periods of acute cerebral insufficiency lasting <1hour without any residual deficits.
Ischemic strokes are more common (80%) than hemorrhagic strokes.
Causes/geneal concepts:
-Ischemia due to atherosclerosis, thrombus, arterial occlusion, embolus, intracerebral hemorrhage OR
-Cardio-embolic events such as A-fib, MI, endocarditis, valve disease
-TIA is indicative of impending stroke
-Approx 1/3 of pts with TIA experience cerebral infarction within 5 years.
S/S:
-Altered vision: ipsilateral monocular blindness (known as amaurosis fugax); homonymous hemianopia (half vision).
-Altered speech: Transient aphasia
-Motor impairment: Paresthesia of contralateral arm, leg, or face.
-Sensory deficits
-Cognitive and behavioral abnormalities
-Dysphagia
-Vertigo
-Nystagmus
TIA classifications
Vertebrobasilar
Carotid
Vertebrobasilar: Occurs as a result of inadequate blood flow from vertebral arteries (brainstem, cranial nerve impairment)
-Vertigo, ataxia, dizziness, visual field deficits, weakness, confusion.
Carotid: Occurs from carotid stenosis
-Aphasia, dysarthria, altered LOC, weakness, numbness.
Lab/diagnostics of TIA
- CT scan (priority) is best in distinguishing between ischemic, hemorrhage and tumor.
- MRI is better than CT in detecting ischemic infarcts (may be done later)
- Electrocardiogram (workup)
- Echocardiogram (workup)
- Carotid doppler and ultrasonography
- Cerebral angiography (may be done later in ischemic infarcts)