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Flashcards in Neuro Emergencies Deck (67)
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1
Q

What anatomical structures make up the central nervous system?

A

Brain and spinal cord

2
Q

What anatomical structures make up the peripheral nervous system?

A

Spinal nerves/peripheral nerves

3
Q

The CNS is responsible for ___.

A

thought, perception, feeling, and autonomic body functions.

4
Q

The peripheral nervous system transmits ____.

A

commands from the brain to the body and receives feedback from the body.

5
Q

Largest part of the brain.

A

cerebrum

6
Q

What is the role of the cerebrum?

A

Front part controls emotion and though.
Middle part controls sensation and movement.
Back part processes sight.
Right and left hemispheres of the cerebrum controls the opposite side of the body.

7
Q

Where in the brain is speech controlled?

A

Left side of the brain near the middle of the cerebrum.

8
Q

The brainstem controls basic functions, such as:

A

breathing
BP
swallowing
pupil constriction

9
Q

What is the cerebellum responsible for?

A

Coordinating complex tasks that involve voluntary movement of muscles.

10
Q

Axon

A

projection from the cell body that extends towards another cell carrying signals from the neuron.

11
Q

Role of myelin sheath.

A

Increased speed of conduction and insulates the neuron to allow the cell to transmit its signal efficiently and consistently.

12
Q

Function of the occipital lobe.

A

vision and storage of visual memories

13
Q

Function of the parietal lobe.

A

Sense of touch and texture; storage of tactile memories.

14
Q

Function of temporal lobe.

A

Hearing and smell
Language
Storage of sound and odor memories

15
Q

Function of frontal lobe.

A

Motor cortex: voluntary muscle control and storage of spatial memories.
Prefrontal cortex: judgement and prediction of consequences of a person’s actions; abstract intellectual functions.

16
Q

Function of hypothalamus.

A

Emotions
Temperature control
Interface w/ endocrine system

17
Q

Function of midbrain.

A

Level of consciousness.
Reticular activating system which controls arousal and consciousness.
Muscle tone and posture.

18
Q

Function of pons.

A

Respiratory pattern and depth.

19
Q

Function of medulla oblongota.

A

HR
BP
RR

20
Q

Function of cranial nerves.

A

Special peripheral nerves that connect directly from the brain to body parts to relay information from the brain.

21
Q

Function of peripheral nerves.

A

Brain to spinal cord to body part.
Receive stimulus from body.
Sends commands to body.

22
Q

Two basic types of stroke:

A

hemorrhagic - arterial rupture

ischemic - embolism or thrombus

23
Q

Interruption of cerebral blood low may results from:

A

thrombus
arterial rupture
cerebral embolism

24
Q

Infarcted cells

A

Dead brain cells due to lack of oxygen.

25
Q

Ischemic cells

A

Cells have enough oxygen to stay alive, but not enough to function properly.

26
Q

Severity of hemorrhagic CVA depends on ___ and ____.

A

location; size of ruptured cerebral vessel

27
Q

Which patients are at a higher risk of hemorrhagic CVA?

A

Chronic, poorly controlled HTN

28
Q

Aneurysms occur in the following ways:

A
  1. A small tear or defect occurs w/in wall of artery.
  2. Blood penetrates b/n layers of artery.
  3. Pressure build up causing a small tear.
29
Q

TIA are often signs of:

A

Serious vascular condition that requires medical evaluation.

30
Q

General s/s of CVA.

A
Facial drooping
Sudden weakness or numbness
Decreased or absent movement and sensation of one side of the body.
Ataxia or loss of balance.
Sudden vision loss, blurry vision or double vision.
Dysphagia.
Decrease LOC
Aphasia
Dysarthria
Sudden and severe HA
Confusion
Dizziness
Combativeness
Restlessness
Tongue deviation
Coma
31
Q

Aphasia

A

Expressive : difficulty expressing thoughts or inability to use the right words.
Receptive : difficulty understanding spoken words.

32
Q

Dysarthria.

A

Slurred speech.

33
Q

S/S left hemispheric CVA.

A

Right sided deficit and aphasia.

34
Q

S/S right hemispheric CVA.

A

Left sided deficit, dysarthria, and visual disturbances.

35
Q

Why do s/s of epidural hematoma develop rapid vs. slowly with subdural hematoma?

A

Epidural hematomas are usually caused by arteries where as subdural hematomas are usually veins.

36
Q

What are the two classifications of seicures?

A

Generalized - affecting large portions of the brain.

Partial - affecting limited area of the brain.

37
Q

Steps in tonic-clonic seizures.

A
Aura
Loss of consciousness
Tonic phase
Hypertonic phase
Clonic phase
Post seizure
Postictal phase
38
Q

Describe the tonic and hypertonic phase of a seizure.

A

Tonic : body-wide rigidity

Hypertonic : arched back and rigidity

39
Q

Describe clonic phase of a seizure.

A

Rhythmic contractions of major muscle groups, lip smacking, biting, and teeth clenching.

40
Q

When should you ventilate a patient having an active seizure.

A

Apneic for more than 30 seconds.

41
Q

What is the difference between a seizure and a pseudoseizure?

A

Root cause of usually psychiatric in origin.

42
Q

Absence seziures.

A

Presence w/ little or no movement. Typically occur in children. No postictal period or confusion. Can be caused by flashing lights or hyperventilation.

43
Q

Partial seizure.

A

Involves only a limited portion of the brain.

44
Q

Simple partial seizure.

A

Movement of one part of the body or altered sensations.

45
Q

Complex partial seizures.

A

Subtle changes in LOC; may experience hallucinations, inability to speak; small movement of head or eyes.

46
Q

Status epilepticus.

A

Seizure that lasts longer than 4-5 minutes or consecutive seizures that occur w/o return of consciousness between episodes.

47
Q

Why is status epilepticus life-threatening?

A

Neurons use large amounts of glucose and produce lactic acid - hypermetabolic state. No long-term damage during a short period. Long period can cause damage or death to neurons.

48
Q

List epileptic medications:

A
Phenytoin (Dilantin)
Phenobarbital
Carbamazepine (Tegretol)
Levetiracetam (Keppra)
Gabapentin (Gabarone, Neurontin)
Lamotrigine (Lamictal)
49
Q

FACTS mnemonic

A

Focus (generalozed or focal)
Activity (type of movements)
Color or Cocaine (cyanosis or indication of cocaine use)
Time (length of seizure)
Secondary information (medications, events leading up to seizure, incontinence, tongue biting)

50
Q

Common causes of seizures

A
Abscess
Alcohol
Birth anomaly
Brain infections
Brain trauma
DM
Fever
Eclampsia
Idiopathic
Inappropriate medication dosage
Organic brain syndrome
Recreational drug use
Stroke or TIA
Systemic infection
Tumor
Uremia
51
Q

Why does breathing become labored in a postictal state?

A

The body is attempting to compensate for the buildup of acids.

52
Q

Consider hypoglycemia in a patient who:

A

Had a seizure w/ hx of DM

AMS after MVC

53
Q

Potential causes of syncope:

A
Cardiac rhythm or conduction
Cardiac muscle
MI
Dehydration
Hypoglycemia
Vasovagal episode
54
Q

Tension headache

A

POssible cuases: stress, altered cortisol levels, depression
s/s : residual muscle contractions w/in face and head causing stiffness. May experience stiffness in jaw, neck, or shoulder.
Type of pain: dull, squeezing

55
Q

Migraine headache

A

Causes: minor instability w/ certain cluster of neurons and changes in blood vessel size at the base of the brain.
s/s : unilateral pain, aura, photophobia, n/v
Type of pain: throbbing, pounding, pulsating

56
Q

Cluster headaches

A

Rare vascular headaches occurring in groups and last 30-45 minutes. Minor pain around eye.
Type of pain : sharp and excruciating

57
Q

AEIOU-TIPS

A
A : alcohol, acidosis
E: epilepsy, endocrine, electrolytes
I : insulin
O : opiates
U : uremia
T : trauma, temperature
I : infection
P : poisoning, psychogenic 
S : shock, stroke, syncope, space-occupying lesion, subarachnoid hemorrhage
58
Q

Decorticate posturing

A

Closed hands
Arms adducted and flexed against chest
Legs internally rotated
Feet turned inward

59
Q

Decerebrate posturing

A

Head and neck arched
Arms straight and hands curled
Legs straight
Toes pointed downwards

60
Q

Decorticate and decerebrate posturing are signs of?

A

Substantial ICP

61
Q

Decorticate posturing indicates damage to the area directly below _____

A

Cerebral hemispheres

62
Q

Decerebrate posturing is a sign of damage within or near ____.

A

brainstem

63
Q

“Cat’s eyes and cat’s cries.”

A

Increased ICP in an infant will cause them to shriek similar to a cat. Shape of the pupils can become more oval.

64
Q

Cushing reflex

A
Sign of increased ICP:
BP increases
HR decreases
RR irregular
Systolic hypertension widens
65
Q

Cincinnati Prehospital Stroke Scale

A

Facial droop
Arm drift
Speech
Time

66
Q

LA Prehospital Stroke Screen

A
  1. Age > 45 years
  2. Hx of seizures or epilepsy absent
  3. Symptoms < 24 hours
  4. At baseline, does not use a w/c or is not bedridden
  5. BGS 60-400
  6. Asymmetry in: facial smile/grimace, grip, and arm strength
67
Q

How would the pupils react to bleeding in the brain or ICP?

A

Pupil sizes will change. As pressure increase, pupil on the injured side of the brain becomes larger or fully dilated