Neuro

Question 1

What areas are assessed in the NIHSS

Answer 1

• LOC
• orientation
• ability to follow commands
• horizontal eye movement
• visual fields
• facial paralysis
• arm movement
• leg movement
• ataxia
• sensation
• aphasia
• dysarthria
• extinction and inattention

Question 2

What areas are assessed in the GCS

Answer 2

• eye opening
• verbal
• motor

Question 3

neuro assessment

Answer 3

• LOC and cognition
• posture and movements
• facial expression
• cranial nerves
• strength, coordination, balance
• ability to perform ADLs
• clonus and reflexes
• gag and swallow
• sensation

Question 4

lumbar puncture

Answer 4

• needle inserted into subarachnoid space btwn 3/4 or 4/5th vertebrae
• should be clear and colorless, no RBCs, WBCs < 0.5 mL
• Queckenstedt’s test

Question 5

avoiding complications after LP

Answer 5

• pt should remain in prone position for at least 3 hrs
• relieving intracranial pressure by withdrawing CSF may cause herniation of the brain – should be done w/ care in presence of increased ICP
• most common complaint is spinal headache
• tx w/ fluids, analgesics, and bed rest
• if severe or persistent, an epidural blood patch may be done

Question 6

metabolic encephalopathy

Answer 6

• damage to the brain resulting from a metabolic disturbance

* as a result of ingestion of drugs or toxins, liver disease

Question 7

s/s metabolic encephalopathy

Answer 7

• irritability and agitation
• altered LOC
• dysphonia
• lack of coordination, spasticity
• SEIZURES are common and may be the presenting symptom
• disorientation that may progress to coma

Question 8

complications of head trauma

Answer 8

• pts often suffer initial HTN which increases ICP, decreasing perfusion
• primary problem is swelling, which also interferes w/ perfusion –> hypoxia and hypercapnia
• if pressure continues to rise, may result in herniation

Question 9

tx for head trauma

Answer 9

• monitor ICP and CCP
• provide O2
• elevate HOB and maintain proper body alignment
• meds: analgesics, anticonvulsants, anesthetics
• provide blood/fluids to stabilize hemodynamics
• manage airway
• provide osmotic agents such as mannitol and hypertonic saline to reduce cerebral edema

Question 10

concussion

Answer 10

• most common head injury
• usually relatively transient
• confusion, disorientation, and mild amnesia
• no permanent neuro damage unless multiple

Question 11

contusion/laceration

Answer 11

• bruising and tears of cerebral tissue
• areas most impacted are occipital, temporal, and frontal lobes
• symptoms persist and may progress
• laceration are often caused by fractures

Question 12

myasthenia gravis

Answer 12

Autoimmune disorder of the neuromuscular system in which acetylcholine receptors are damaged at neural synapses, preventing transmission of impusles to contract muscles

• weakness of voluntary muscles
• initially muscles of eye, face, and neck are affected
• dangerous complication is respiratory distress and airway compromise

Question 13

Guillain Barre

Answer 13

Autoimmune disorder of the myelinated motor peripheral nervous system, often by viral gastroenteritis or Campylobacter jejuni infection
* dx by hx or LP which shows increased protein

Question 14

s/s and tx of Guillain Barre

Answer 14

s/s
* ascending numbness and tingling w/ increasing weakness –> may result in complete paralysis and inability to breathe w/o ventilatory support
* DTR typically absent
* some people experience facial weakness and opthalmoplegia
tx
* supportive
* plasma exchange or IVIG shorten duration of symptoms

Question 15

status epilepticus

Answer 15

Usually generalized tonic-clonic seizures that are characterized by a series of seizures w/ intervening time too short to regain consciousness. Can lead to exhaustion, resp failure, cardiac failure, and death

Question 16

causes and tx of status epilepticus

Answer 16

causes
* uncontrolled epilepsy
* infections such as encephalitis
* drug toxicity (isoniazid)
* brain trauma
* neoplasms
* metabolic disorders
tx:
* anticonvulsants (keppra, ativan)
* if cause is undetermined, acyclovir and ceftriaxone may be added
* phenytoin and phenobarbital

Question 17

ischemic stroke

Answer 17

• interruption of blood flow to an area of the brain, account for 80%
• thrombosis: usu from atherosclerosis
• lacunar infarct: penetrating thrombosis in a small artery
• embolism: travels

Question 18

thrombotic stroke

Answer 18

thrombosis in a large artery, usu resulting from atherosclerosis
* most common in elderly

Question 19

lacunar infarct

Answer 19

penetrating thrombosis in a small artery

* most common in those w/ HTN or DM

Question 20

embolitic stroke

Answer 20

travels through the arterial system and lodges in the brain, most commonly in MCA

• may be cardiogenic
• usu occurs rapidly w/ no warning signs

Question 21

cryptogenic stroke

Answer 21

no ID cause

Question 22

hemorrhagic stroke

Answer 22

results from a ruptured cerebral artery

• causes lack of oxygen and nutrients
• edema that causes widespread pressure and damage

Question 23

intracerebral stroke

Answer 23

bleeding into the substance of the brain from an artery in the central lobes, basal ganglia, pons, or cerebellum.

• usu results from atherosclerotic degenerative changes, HTN, brain tumors, anticoag therapy, or come illicit drugs
• onset often sudden and may cause death

Question 24

intracranial aneurysm

Answer 24

occurs w/ ballooning cerebral artery ruptures, most commonly at the Circle of Willis

Question 25

arteriovenous malformation (AVM)

Answer 25

tangle of dilated arteries and veins w/o a capillary bed. * congenital abnormality * rupture is a cause of stroke in young adults

Question 26

subarachnoid hemorrhage

Answer 26

bleeding in the space between the meninges and brain, resulting from aneurysm, AVM, or trauma * compresses the brain tissue