Neuro Flashcards
(153 cards)
1
Q
What condition is characterized by an acute onset of neurological deficits that gradually improve over time?
A
- Transient Ischemic Attack
- Bell’s Palsy (face only)
2
Q
Which conditions can mimic stroke like symtoms? (9)
A
- BG < 60mg/dl
- Bells Palsy
- Todd’s paralysis
- migraines
- psych disorders
- infections
- seizures
- metabolic/toxic disorders
- structural brain lesions
3
Q
How long do TIA symptoms usually last?
A
< 1hr
4
Q
What is the gold standard test for both TIA’s and stroke?
A
rapid assessment
5
Q
What imaging studies are done when a stroke is suspected?
A
- CT head w/out contrast
- CT angiography brain and neck
- MRI brain (see changes w/in 30min)
- TEE (aortic arch, LA, PFO)
- CXR (evaluate cardiomyopath)
- ekg
- Echo
6
Q
When should an MRA brain and neck be done on a suspected stroke patient?
A
when CTA is contraindicated, MRA does not need contrast
7
Q
When should a carotid US de done for a patient with a suspected stroke?
A
if MRA and CTA are contraindicated
8
Q
What labs should be drawn on a suspected stroke patient?
A
- BG
- troponin
- E-lytes (to see if Na, K are low)
- CBC (anemia, polycythemia)
- PT/INR (hypercoagulopathy)
- BUN/Creatinine (renal sufficiency)
- lipid panel
- toxicology screen
9
Q
What are the 2 main types of strokes?
A
- Ischemic
- Hemorrhagic
10
Q
What are the types of the ischemic strokes?
A
- thrombotic
- embolic
- cryptogenic
- lacuner
11
Q
What are the types/causes of hemorrhagic strokes?
A
- intracranial hemorrhage (ICH)
- subarachnoid hemorrhage (SAH)
12
Q
Which type of stroke is associated with “a severe HA that radiates down the neck?
- worst headache of a patients life
A
subarachnoid hemorrhage
13
Q
What is the most commonly occluded vessel and cause of ischemic stroke?
A
middle cerebral artery (MCA)
14
Q
What should the BP in a patient prior to and during administration of tPA thrombolytic?
A
1) Prior:
- SBP < 185 and DBP < 110
2) During:
- SBP <180 and DBP < 105
15
Q
Which medications are recommended for BP control prior to and during administration of tPA?
A
- labetolol 10-20mg IV push
- nicardipine gtt 2.5-15 mg/hr
16
Q
What timeframe after symptom onset should alteplase be started in a stroke patient?
A
< 4.5 hrs
17
Q
What are contraindications for thrombolytic therapy in stroke patients?
A
- current ICH/SAH
- active bleeding
- head trauma/surgery < 3 months
- uncontrolled Systolic BP >180 mmHg
- uncontrolled diastolic BP > 110 mmHg
- aortic dissection
18
Q
What is the dosing for Alteplase?
A
-0.9mg/kg (max 90mg) admin over 1hr
- 10% given as bolus with other 90% given over an hr
19
Q
Why are nitroprusside or nitrogylcerin not given to a patient with a hemorrhagic stroke?
A
- both cause vasodilation, which can increase the intracranial pressure
20
Q
What is the reversal agent for heparin?
A
protamine
21
Q
What are/is the reversal agent(s) for warfarin (coumadin)?
A
- Vitamin K
- 4- Factor Prothrombin Complex Concentrate (4FPCC)
22
Q
What is Apixaban brand name?
A
Eliquis
23
Q
What class of medication is apixaban (eliquis)?
A
Factor Xa inhibitor
- rapid onset (mins) with peak of 1-2 hrs
- half-life of 12hrs
- metabolized by liver
- excreted mostly in feces, little in urine
24
Q
What class of medication is rivaroxaban (xarelto)
A
Factor Xa inhibitor
25
What is the brand name for rivaroxaban?
Xarelto
26
What is hydrocephalus?
blockage of CSF flow resulting in dilation of the brain ventricles
27
How much CSF does the brain produce?
500ml/day
28
What are the s/s of hydrocephalus in an adult?
- cognitive decline
- HA (initially in am)
- neck pain
- vomitting (bad in the am)
- blurred or double vision
- upward gaze
- drowsiness
- unsteady gai
29
Why is a CT scan of the brain done in a suspected stroke patient?
to rule out structural causes
- Subdural Hematoma
- Intracranial Hemorrhage
- brain tumor
29
In a suspected stroke patient, whey is an brain MRI better than a CT scan?
- MRI is more sensitive in detecting early pathological changes
- MRI shows changes seen < 30min
- CT shows changes 6-8hrs
29
An MRI is the preferred imaging study for which type of strokes?
lacunar stroke and TIA
29
What is a lacunar stroke?
a type of ischemic stroke that occurs when blood flow to one of the small arteries deep within the brain becomes blocked
29
What is the term for a type of ischemic stroke that occurs when blood flow to one of the small arteries deep within the brain becomes blocked?
Lacunar stroke
29
How long does it take for pathological changes following or during a stroke in the brain to appear on an CT scan?
6-8 hrs
29
In a stroke patient with A-Fib or Flutter lasting > 48hrs , which anticoagulant should be administered and for what timeframe when planning for a cardioversion?
- Warfarin
- factor Xa inhibitor
- direct thrombin inhibitor
- given for at least 3 weeks prior to and 4 weeks following a cardioversion
29
What is the other name for aspirin?
acetylsalicylic acid
29
What is the 1st line therapy medication to reduce the risk of stroke in patients with TIA?
aspirin (acetylsalicylic acid)
29
How long does it take for pathological changes following or during a stroke in the brain to appear on an MRI?
< 30 min
30
What is the dosing for aspirin when used to prevent strokes in patients with TIA?
180mg x 5 days then 81mg QD
30
What medication is recommended for patients with LDL > 100 and < 75 y/o for stroke prevention?
- high intensity statin therapy
- 80mg atorvastatin
30
Why is a non-contrast CT scan of the brain done on a suspected TIA patient?
to r/o structural causes for the symptoms such as subdural hematoma, intracranial hemorrhage or tumor
30
What imaging study is done to r/o structural causes in a suspected TIA patient?
Non-contrast CT scan
30
What imaging study is done to evaluate the vessels of the neck and brain for patency/occlusions?
CT angiography (CTA)
- requires contrast
31
An MRI is the preferred image study to detect which type of TIA?
lacuner or vertebrobasilar
32
What labs should be done for a patient with suspected TIA?
- CBC to r/o:
- anemia/polycythemia
- BG
- CMP to r/o e-lyte imbalances
- coag panel to r/o:
- hypercoagulopathy
- lipid panel
- hyperlipidemia/dyslipidemia
- BUN/Creatine to r/o:
- renal insufficiency
- troponins to r/o:
- MI
33
What is the difference between the NIHSS and ABCD2s score?
- NIHSS is used to assess the initial severity of the symptoms r/t a TIA or stroke
- ABCD2 tool predicts risk of future stroke
34
What vessel is the most commonly occluded and cause of ischemic stroke?
Middle Cerebral Artery (MCA)
35
Why should a repeat CT scan be completed 24 hrs following a suspected stroke?
infarct my not be visible for up to 24hrs
36
According to the AHA, the BP should initially lowered by how much in a suspected/confirmed stroke patient?
lower BP by 15%
37
Which medications are recommended for lowering BP in suspected stroke patient?
- Labetolol 10-20mg IV push
- may repeat once
- Nicardipine 2.5-15 mg/hr gtt
- titratable to goal
38
What is the dose of Labetalol used to treat HTN in a suspected stroke patient?
10-20mg IV push, may repeat once
39
What is the dose of Nicardipine used to treat HTN in a suspected stroke patient?
1.5-15 mg/hr, titratable to goal
40
What are the contraindications to thrombolytic therapy with altepase?
- Intracranial Hemorrhage
- Sub-Arachnoid Hemorrage
- any active internal bleeding
- head/spinal trauma in last 3 months
- severe uncontrolled HTN
- arterial-venous malformations in brain
41
What is the maximum dose of Alteplase that can be given?
90 mg
42
What is the dose of alteplase dose and how is it administered?
- 0.9mg/kg
- 10% given as bolus over 1 min
- 90% given over 1 hr
43
Why is succinylcholine contraindicated in patients with an ICH/SAH?
it causes transient increase in intracranial pressure (ICP)
44
What is the systolic BP goal in a patient with an ICP/SAH?
less than 140 mmHg
45
What medications are recommended in the treatment of HTN in a patient with an ICH/SAH?
- Nicardipine 5-15 mg/hr gtt
- Labetolol 10 mg IV PRN
- Hydralazine 10 mg IV PRN
46
What is the normal range for intracranial pressure (ICP)?
4-13 mmHg or 7-18 cm H2O
47
What is the normal Cerebral Perfusion Pressure?
60-80 mmHg
48
At a serum sodium of _____, there is an increased risk of seizures, renal failure, pulmonary edema and HF?
Na > 160 mEq/L
49
Which electrolyte abnormality is common among patients with a Sub-Acute Hemorrhage?
hyponatremia
- cerebral vasospasm injures hypothalamus and stimulates ADH release from the anterior pituitary
50
What is the treatment of choice and goal of therapy for when treating cerebral salt wasting r/t a SAH?
- 3% Na soln 30-60 mL/hr
- goal = 320 mOmol/L
- cerebral salt wasting is where excess Na is excreted via the kidneys due to an impairment following a brain injury
51
What are the types of aneurysms?
- berry (aka saccular)
- fusiform
- mycotic
- pseudo-aneurysm
52
Type of aneurysm that balloons or bulges out on all sides of the artery and takes on bizarre shapes?
fusiform
53
What class of medication is recommended for use in the e treatment of a vasospasm following an acute SAH?
- Calcium Channel Blocker
- Nimodipine PO 60 mg q4 x 21 days
54
What are causes of hydrocephalus?
- CSF over secretion/production
- obstruction of CSF flow (lesion/tumor)
- impaired absorption
55
What is communicating hydrocephalus?
- when the flow CSF is obstructed after it leaves the ventricles
- CSF can still flow between the ventricles
56
What is non-communicating/obstructive hydrocephalus?
- obstruction occurs within or next to the ventricular system which prevents CSF from circulating normally
57
Specific S/S of hydrocephalus in an infant?
- poor feeding
- irritability
- reduced activity
- vomitting
58
What are the classic symptoms of hydrocephalus?
- cognitive deterioration
- neck pain
- vomitting (more often in am)
- blurred vision
- double vision
- drowsiness
- papilledema
- can’t look up
- unsteady gait
- larger head
- uni or bilateral 6th nerve palsy
59
What imaging study is done to assess for potential/suspected hydrocephalus?
- CT scan of brain for size of ventricles
- MRI to detect flow voids
- Transcranial doppler
60
Autoimmune disease characterized by rapid progression of ascending paralysis and areflexia that begins in the lower extremities and is preceded by an infection?
Guillain-Barre Syndrome (GBS)
- affects motor neurons more than sensory
61
In patient with Guillain-Barre Syndrome (GBS), when can they expect the max deficit to occur from time of onset?
usually by week 4
62
What is the cause of Guillain-Barre Syndrome?
- autoimmune disease where the pts immune system attacks peripheral nerves causing ascending paralysis that begins in the lower extremeties
- usually preceded by an infection
63
Are symptoms of Guillain-Barre Syndrome permanent?
- Not permanent
- most fully recovery, but can take months or years
64
What are the S/S of Guillain-Barre syndrome?
- usually symmetric rapid progression of muscle weakness and paresthesia that begin in the legs and moves up body
- reduced/absent deep tendon reflexes
- can cause total motor paralysis leading to respiratory failure
65
What tests are done to confirm Guillain-Barre Syndrome?
- LP for CSF: will see
- elevated CSF protein, esp IGG
- > 1000 mg/dl
- CBC:
- leukocytosis with a shift to
the left that resolves during
the course of illness
- Motor/Sensory nerve
- conduction studies and
needle electromyography
- slow conduction r/t
demyelination
66
What is the treatment for Guillain Barre Syndrome?
- there is no known cure
- admit to ICU and monitor cardiovascular and respiratory status
- Consult neurologist
- IVIG or plasmapharesis/plasma exchange (PLEX) are 1st line therapies
67
What is the term for the group of muscles that control swallowing, chewing, speaking, and keeping the jaw in place?
Bulbar Muscles
68
Which receptor is affected in patients with Myasthenia Gravis?
Acetylcholine receptors (AChR) at the postsynaptic membrane of the neuromuscular junction are attacked by the patients immune system
69
S/S of Myasthenia Gravis?
- ptosis (eye droopage)
- diplopia
- facial weakness
- dysphagia
- dysarthria
- dysphonia
- respiratory weakness
- no loss of deep tendon reflexes
70
What are common precipitating factors that cause a Myasthenic Crisis?
- infections
- stress (trauma, surgery)
- rapid start, stop, tapering of steroids
- withdrawal of cholinesterase inhibitors
- drugs
71
What tests should be run on a patient with suspected Myasthenia Gravis?
- Antibody testing
- AChR: + in 80-85% of pts
- MuSK: + in 50% of pts that
test AChR AB +
- antinuclear antibodies +
- antithyroid AB +
- rheumatoid arthritis factor
- Repetitive nerve stimulation
- single fiber electromyography
- MRI/CT of anterior mediastinum may find thymoma
- thyroid function test: MA pts have higher incidence of thyroid disease
- B12: may be low
72
How is Myasthenia Gravis managed?
- consult neurologist
- Cholinesterase inhibitors
- pyridostigmine bromide
- prednisone: if don’t respond well to cholinesterase inhibitors
- Azathioprine: immunosuppressant
- used to prevent organ rejection
and to tux rheumatoid arthritis
73
Why is hyperventilation (PaCO2 25-30%) used in the treatment of a patient with a TBI?
- used when herniation symptoms are present
- it causes cerebral vasoconstriction, which lowers ICP
- careful not to cause cerebral ischemia
74
What is the term meaning periorbital ecchymosis/bruising caused by an anterior skull base fracture?
Raccoon eyes
75
What is the term for mastoid (behind the ear) ecchymosis related to a posterior skull fracture?
Battle sign
76
An epidural hematoma is a bleed between which layers of the brain?
in the epidural space between the skull and dura mater
77
A subdural hematoma is a bleed between which layers of the brain?
caused by tearing of bridging veins between the dura mater and arachnoid or pial layers
78
A patient with a penetrating head wound should be started on which antibiotics?
- ceftriaxone
- metronidazole
- vancomycin
- for minimum of 6 weeks
79
What are the components of Cushings Triad?
Signs of increased ICP:
- Systolic HTN with widening pulse pressure
- Irregular respiratory rate
- Bradycardia
80
What are the treatment strategies to manage increased ICP?
- elevated HOB >30 deg
- promote venous drainage
- sedation and opioids
- reduces metabolic demand
and relieves anxiety
- Code Cool
- reduces metabolic demand
- Possibly paralysis
- hyperosmolar therapy (mannitol, hypertonic Na- 2,3%)
- pulls excess H2O across BBB
from CNS to intravascular
space
- Surgery: decompressive craniotomy
- anticonvulsants
- DVT prophylaxis
- BG control
81
When should ICP monitoring be started in an patient with a TBI?
- comatose (GCS 3-8) with abnormal CT scan
- comatose with normal CT and 2 of:
1) > 40 y/o
2) uni/bilateral posturing
3) hypotension
82
Treatment to lower ICP should be initiated when the ICP is?
> 22 mmHg for > 5 min
- normal range is 5-15 mmHg
83
Cerebral perfusion pressure (CPP) should be maintained at what value in a patient with a TBI?
- minimum of 60 mmHg
- CPP = MAP - ICP
84
What type of medication is Phenytoin?
Anticonvulsant
- aka: Dilantin
85
Dilantin is the brandname for which medication?
Phenytoin
86
What are the causes of both TIA and strokes?
- atherosclerosis
- cardiac emboli
- vasculitis
- anemia (low RBC)
- polycythemia (high RBC)
- thrombocytosis (high PLT)
- thrombocytopenia (low PLT)
- hypercoagulable states
- orthostatic hypotension
87
What are risk factors for TIA? (9)
- HTN > 140/90
- cardiac disease
- smoking
- obesity
- HLD
- high homocysteine levels
- age > 60
- DM
- alcohol/drug abuse
88
What diagnostic test should be done on a suspected TIA patient? (13)
- NIHSS (high score = bad)
- ABCD2 score (risk of stroke)
- continuous telemetry (afib)
- BG
- troponins
- CBC w/ plt count
- coag panel (pt, INR)
- CMP
- lipid panel
- tox screen
- Brain imaging (CT,MRI brain, CTA)
- TEE
- CXR (cardiomegaly)
89
What coagulation studies should be drawn on a patient with a suspected TIA or stroke?
- prothrombin time (PT)
- INR
- fibrinogen
- D-dimer
- anticardiolipin (aCL) AB, inc clotting
- Factor VII
- Von Willebrand Factor
90
Which medication(s) should be considered for patient with the following:
- Afib/flutter lasting < 48hrs
- CHADS2VASC2:
- men > 2
- women > 3
- anticoagulation with:
- heparin
- warfarin (factor Xa inhibitor)
- Direct-acting Oral AntiCoag
91
What is the first line medication and dose when starting antiplatelet therapy in a TIA patient to reduce risk of stroker?
- Aspirin (acetylsalicyclic acid)
- 160 mg x 5 days, then 81mg QD
92
What is the difference between a TIA and stroke?
- TIA is a transient neurological condition with no infarct
- stroke involves destruction of a portion of brain parenchyma due to an infarct
93
Low cholesterol increases the risk for which type of stroke?
hemorrhagic stroke
94
A CT scan of the head w/out contrast should be done within what timeframe of arrival to the hospital in a suspected stroke patient?
within 20 min
- done to r/o cerebral hemorrhage
95
What is the treatment for orolingual angioedema associated with IV alteplase administration?
- discontinue infusion
- airway management
- IV methylprednisolone 125mg
- IV benadryl 50 mg
- ranitidine 50mg or famotidine 20 mg
96
Aspirin administration is delayed for how long in patients treated with IV altepase following an acute ischemic stroke?
delayed for 24hrs
97
If the left side of the brain is affected by stroke, what symptoms might the patient be expected to present with?
- expressive and/or receptive aphasia
- small percentage of left handed patients have right sided dominance and may present with left sided weakness and aphasia
98
If the right side of the brain is affected by stroke, what symptoms might the patient be expected to present with?
- unilateral/left sided neglect
99
What are the common presenting symptoms of hemorrhagic stroke?
- seizures
- vomiting
- headache
- diminished LOC
100
What antihypertensives are recommended to lower BP in a patient with an ICH or SAH?
- CCB
- nicardipine 5-15mg/hr
- clevidipine
- labetolol 10mg PRN
- hydralazine 10mg PRN
101
How do you calculated cerebral perfusion pressure (CPP)?
MAP - ICP
102
What are the treatment options for the management of an aneurysm?
- surgical clipping
- endovascular coiling
103
What are the general management steps for an ICH/SAH?
- ABCs
- BP control
- anticoagulation reversal
- external ventricular drain
- strict bedrest
- minimize stimuli
- seizure prophylaxis
- craniectomy for hematoma evacuation
104
What is the cause of the hyponatremia associated with a SAH?
- stroke causes cardiac dysfunction and release of B-Type Natiuretic peptide (BNP) from the myocardial ventricular cells causing excess secretion for sodium and water in the urine
- BNP will be high following a stroke
105
What is the most common cause of non-traumatic subarachnoid hemorrhages?
rupture of a berry/saccular aneurysm
106
How big does an aneurysm need to be for treatment to be started?
5mm or bigger
107
When should treatment be considered or started for a patient with an aneurysm?
- size is 5mm or greater
- prior hx of aneurysm rupture
- changes in shape/size in between interval imaging
- daughter domes present: odd, non-smooth morphology
108
What are the cranial nerves?
I - olfactory nerve (smell)
II - optic nerve (sight)
III - oculomotor nerve (move/blink eyes)
IV - trochlear nerve
V - trigeminal nerve
VI - abducens nerve
VII - facial nerve
VIII - vestibulocochlear nerve
IX - glossopharyngeal
X - vagus
XI - accessory nerve
XII -hypoglossal
109
When should intubation be considered in a patient with Guillain-Barre Syndrome (GBS)?
- vital capacity < 12-15 mL/kg
- PaO2 < 70
- difficulty clearing secretions
- concerns for aspiration
110
What is the leading cause of death in a patient with Guillain Barre Syndrome (GBS)?
autonomic dysfunction
- brady/tachy arryhthmias
- hyper/hypotension
111
What is/are considered first line therapies for the treatment of Guillain-Barre Syndrome?
- PLEX (plasmapheresis)
- IVIG (intravenous immunoglobulin)
112
When is intubation and mechanical ventilation indicated for a patient with Guillain Barre Syndrome (GBS)?
- vital capacity < 12-15 ml/kg
- PaO2 < 70
- difficulty clearing secretions
- concerns with aspiration
113
Patients with which antibody are most likely to experience a Myasthenic Crisis?
Muscle-specific kinase (MUSK) antibody
114
Which antibiotics are risk factors for developing myasthenia gravis?
- aminoglycosides
- gentamicin, tobramycin
- fluoroquinolones
- ciprofloxacin, levofloxacin
- macrolides
- erythromycin, azithromycin
115
Pyridostigmine bromide (Mestinon) is what class of medication?
Cholinesterase inhibitor
- used to tx myasthenia gravis
- reverse effects of nondepolarizing muscle relaxants
116
What is the scoring range for the Glascow Coma Scale?
Range is 3-15:
- 3 = worst score
- 15 = best score
117
A patient with a Glascow Coma Scale score of _?__ is considered to be in a coma?
8 or less
118
A sluggish, unequal, or enlarged pupil w/o response or “blown pupil” is indicative of what?
- increased ICP or brain herniation
119
Layers of the head from bone to brain?
- skull
- epidural space
- dura mater
- subdural space
- arachnoid mater
- subarachnoid space (vessels in this layer)
- pia mater
- brain
120
What are the meningeal layers (meninges)?
- dura mater
- arachnoid mater
- pia mater
121
What is the term for the inflammation of the meninges caused by a viral, bacterial, or fungal infection?
Meningititis
122
What is the most common organism that causes bacterial meningitis?
Streptococcus Pneumonia called Pneumococcal meningitis
123
What organism is the most common cause of viral meningitis?
Enterovirus
124
What are the signs/symptoms of meningitis?
1) Classic Triad:
- stiff neck (nuchal rigidity)
- fever
- altered mental status
2) Other S/S:
- severe HA
- photophobia
- seizures
- chills
- N/V
- pos Brudzinski’s sign
- pos Kernig’s sign
125
What are the classic signs of meningitis?
- fever
- nuchal rigidity
- altered mental status
126
What is considered a positive Brudzinski’s sign?
if the patient flexes/bends their hips and knees when the provider lifts their head
- sign of meningitis
127
What is considered a positive Kernig’s sign?
if the patient reports/experiences spasms/pain in the hamstring when the provider extends the leg towards the sky after flexing the patients knee, then hip to a 90 degree angle
128
What is the gold standard test to diagnose meningitis?
Lumbar Puncture (LP)
129
Compare the following LP CSF sample characteristics for bacterial vs viral meningitis?
1) Appearance
2) Cells
3) Total Protein
4) Glucose
5) Culture q
Bacterial:
1) Cloudy appearane
2) increased WBCs, most are polymorphonuclear
3) total protein: 100-500/mm
4) low glucose: 5-40 mg/dl
5) bacteria on gram stain
Viral:
1) clear (occasionally cloudy) appearance
2) increased WBC’s, most are mononuclear
3) total protein: < 200 mg/dl
4) normal glucose (> 45 mg/dl)
5) no bacteria on culture
130
What is the term for fast, painful sensations that travels from the neck down the spine and can radiated to the arms and legs?
Lhermitte’s sign
- seen in MS and pts with cervical nerve damage
- aka barber chair phenomenon
131
What is the term for an increased rigidity of the muscles due to brain or spinal cord injury?
Spasticity
132
What are the diagnostic tests for multiple sclerosis?
- full neuro exam
- MRI of head/neck
- cerebrospinal fluid analysis '
133
What are white mater lesions in the brain?
areas of abnormal myelination in the brain that appear as bright spots on MRI
134
What would be seen in the CSF of a patient with multiple sclerosis?
- elevated IgG and oligoclonal bands in CSF, but not in serum
- bands are indicative of MS
135
What is the treatment of choice for a patient experiencing an relapse of symptoms related to multiple sclerosis?
- high dose glucocorticoids
- IV or oral
- methylprednisolone 500-1000mg/day
136
Prednisolone is what type of medication?
glucocorticoid
137
Methylprednisolone is what type of medication?
glucocorticoid
138
Dexamethasone is what type of medication?
glucocorticoid
139
Glucocorticoids are used to treat what conditions?
- allergies
- asthma
- autoimmune diseases
- sepsis
140
What is cranial nerve number one?
olfactory
- sense of smell
-
