Neurologic Emergencies Flashcards
1
Q
Three major parts of the brain
A
- Brainstem
- Cerebellum
- Cerebrum
2
Q
Controls basic functions of the body, such as breathing, BP, swallowing, and pupil constriction
A
Brainstem
3
Q
Located just behind the brainstem
A
Cerebellum
4
Q
Controls muscle and body coordination
A
Cerebellum
5
Q
Responsible for coordinating complex tasks that involve many muscles, such as standing on one foot without falling, walking, writing, picking something up, and playing piano
A
Cerebrum
6
Q
Largest part of the brain
A
Cerebrum
7
Q
The front part of the cerebrum controls ___
A
Emotion and thought
8
Q
The middle part of the cerebrum controls ___
A
Sensation and movement
9
Q
The back part of the cerebrum processes ___
A
Sight
10
Q
In most people, speech is controlled on the ___
A
Left side of the brain, near the middle of the cerebrum
11
Q
How many pairs of cranial nerves run from the brain to parts of the body?
A
12
12
Q
The brain is most sensitive to changes in ___
A
Oxygen, glucose, and temperature levels
13
Q
A state of profound unconsciousness
A
Coma
14
Q
The pain from a headache is felt from ___
A
The surrounding areas of the face; scalp; meninges; larger blood vessels; and muscles of the head, neck and face
15
Q
Caused by muscle contractions in the head and neck and are attributed to stress
A
Tension headaches
16
Q
Type of pain with a tension headache
A
Squeezing, dull, or an ache
17
Q
Thought to be caused by changes in blood vessel size in the base of the brain
A
Migraine headaches
18
Q
Type of pain with a migraine headache
A
Pounding, throbbing, or pulsating
19
Q
Migraines are usually associated with ___
A
Nausea and vomiting, and may be preceded by visual warning signs such as flashing lights or partial vision loss
20
Q
Caused by pressure that is the result of fluid accumulation in the sinus cavities
A
Sinus headaches
21
Q
ICP
A
Intracranial pressure
22
Q
You should suspect a hemorrhagic stroke in patients with a ___
A
Severe headache, seizures, and altered mental status
23
Q
Early signs of increased ICP
A
Headache, vomiting, altered mental status, and seizures
24
Q
An inflammation of the meninges caused by a bacterial infection
A
Bacterial meningitis
25
Bacterial meningitis is a ___
Central nervous system infection in which the patient may complain of a headache, stiff neck, fever, and sensitivity to light
26
Cerebrovascual accident
Stroke
27
CVA
Cereobrovascular accident
28
An interruption of blood flow to an area within the brain that results in the loss of brain function
Stroke
29
Two main types of stroke
1. Ischemic
2. Hemorrhagic
30
Occurs when blood flow through the cerebral arteries is blocked
Ischemic stroke
31
A blood vessel ruptures and the accumulated blood causes increased pressure in the brain
Hemorrhagic stroke
32
Most common type of stroke
Ischemic stroke
33
Ischemic stroke may be due to a ___
Thrombosis or an embolus
34
A clot forms at the site of the blockage
Thrombosis
35
A clot forms in a remote area and then travels to the site of the blockage
Embolus
36
Patients with atrial fibrillation are prone to ischemic strokes caused by ___
An embolus
37
A blood vessel ruptures, and the accumulated blood then forms into a clot, which compresses the brain tissue next to it. The compression prevents oxygenated blood from getting into the area
Hemorrhagic stroke
38
Hemorrhagic stroke commonly occurs in people experiencing ___
Stress or exertion
39
The people at the highest risk of a hemorrhagic stroke
With extremely high BP, or long-term untreated elevated BP
40
A swelling or enlargement of the wall of an artery resulting from a defect or weakening of the arterial wall
Aneurysm
41
Most notable symptom of a ruptured aneurysm
A sudden-onset, severe headache, typically described as the worst headache the patient has ever had
42
The headache from an aneurysm is caused by ___
The irritation of blood on the brain tissue after the artery swells and ruptures
43
A hemorrhagic stroke in an otherwise healthy young person is often caused by a ___
Berry aneurysm
44
This type of aneurysm resembles a tiny balloon (or berry) that juts out from the artery
Berry aneurysm
45
When the aneurysm is overstretched and ruptures, blood spurts into ___
An area between two of the coverings of the brain called the subarachnoid space
46
Blood spurts into the subarachnoid space
Subarachnoid hemorrhages
47
When stroke-like symptoms resolve on their own in less than 24 hours
Transient ischemic attack
48
TIA
Transient ischemic attack
49
Signs and symptoms of a stroke
1. Facial drooping
2. Sudden weakness or numbness in the face, arm, leg, or one side of the body
3. Decreased or absent movement and sensation on one side of the body
4. Lack of muscle coordination (ataxia) or loss of balance
5. Sudden vision loss in one eye; blurred or double vision or abnormal eye movements
6. Difficulty swallowing
7. Decreased level of responsiveness
8. Speech disorders
9. Aphasia
10. Dysarthria
11. Sudden and severe headache
12. Confusion
13. Dizziness
14. Weakness
15. Combativeness
16. Restlessness
17. Tongue deviation
18. Coma
50
Dysarthria
Slurred speech
51
Inability to produce or understand speech
Aphasia
52
If the ___ has been affected by a stroke, the patient may exhibit aphasia
Left cerebral hemisphere
53
If the ___ is not getting enough blood, the patient will have trouble moving the muscles on the left side of the body
Right cerebral hemisphere
54
Patients involuntarily ignore symptoms
Neglect
55
Patients with conditions affecting the back part of the cerebrum may neglect ___
Certain parts of their vision
56
Patients with bleeding in the brain may have ___ BP
Very high
57
Conditions that may appear to be a stroke
1. Hypoglycemia
2. A postictal state
3. Subdural or epidural bleeding
58
Period following a seizure that lasts between 5 and 30 minutes, characterized by labored respirations and some degree of altered mental status
Postictal state
59
A collection of blood near the skull that presses on the brain
Subdural or epidural bleeding
60
The leathery covering of the brain that lies next to the skull
Dura
61
Subdural bleeding is ___ than epidural bleeding
Slower
62
The period between injury and deterioration from a epidural hemorrhage is called a ___
Lucid interval
63
A neurologic episode caused by a surge of electrical activity in the brain
Seizure
64
A disorder in which abnormal electrical discharges occur in the brain, causing seizures and possible loss of consciousness
Epilepsy
65
Seizures are classified as either ___
Generalized or focal, and their underlying cause either known or unknown
66
Results from abnormal electrical discharges from large areas of the brain, involving both hemispheres
Generalized seizure
67
Two types of generalized seizures
1. Generalized motor seizure (tonic-clonic)
2. Generalized-onset absence seizure
68
A focal seizure begins ___
In one part of the brain
69
Classifications of focal-onset seizures
Aware or impaired-awareness, and can be motor or absence
70
In a focal-onset aware seizure, no change occurs in ___
The patient's LOC
71
Focal-onset impaired awareness seizures result form ___
Abnormal discharges from the temporal lobe of the brain
72
Patient's often experience this warning sign prior to a seizure
Aura
73
Phase of a seizure with extreme muscle rigidity
Tonic phase
74
Phase of a seizure with constant muscle contraction and tumbling, tongue biting, bladder incontinence, or bowel incontinence
Clonic phase
75
Generalized motor seizures typically last less than ___
5 minutes
76
The period after a generalized motor seizure
Postictal state
77
How long does the postictal state last?
5 to 30 min or more
78
The postictal state is over when ___
The patient regains a complete return of their normal LOC
79
A generalized absence seizure may last for ___
Just a few seconds, after which the patient fully recovers with only a brief lapse of memory of the event
80
Seizures lasting more than 5 minutes are at risk for progressing to ___
Status epilepticus
81
Seizures that continue every few minutes without the person regaining consciousness or that last longer than 30 minutes
Status epilepticus
82
How to care for status epilepticus
1. Protect from self-harm
2. Call for ALS backup
3. Will need advanced airway management and medication to stop the seizure
83
Cause cannot be determined
Idiopathic
84
Most common medications to treat seizures
1. Levetiracetam (Keppra)
2. Phenytoin (Dilantin)
3. Phenobarbital
4. Carbamazepine (Tegretol)
5. Valproate (Depakote)
6. Topiramate (Topamax)
7. Clonazepam (Klonopin)
85
Cause of epileptic seizures
Congenital origin
86
Cause of structural seizures
1. Tumor
2. Infection (brain abscess)
3. Scar tissue from injury (within the skull)
4. Head trauma
5. Stroke
87
Cause of metabolic seizures
1. Hypoxia
2. Abnormal blood chemical values
3. Hypoglycemia
4. Poisoning
5. Drug overdose
6. Sudden withdrawal from alcohol or medications
88
Cause of febrile seizures
Sudden high fever (primarily in children)
89
During the postictal state, the patient's breathing becomes fast and deep to compensate for ___
The buildup of acids in the bloodstream
90
Weakness on one side of the body
Hemiparesis
91
In some situations, the postictal state may be characterized by ___
Hemiparesis
92
Unlike a stroke, hypoxic hemiparesis ___
Soon resolves
93
Most commonly the postictal state is characterized by ___
Lethargy and confusion to the point that the patient may be combative
94
Geriatric patients with status epileptics are at a higher risk of ___
Hypoxia, hypotension, and/or cardiac dysrhythmias
95
Difference between syncope and seizures
Fainting typically occurs while standing up, seizures may happen in any position
96
The patient is not thinking clearly or is incapable of being awakened
Altered mental status
97
How to tell the difference between hemiparesis from stroke or hypoglycemia
Person experiencing stroke typically alter and attempting to communicate normally. Hypoglycemia will have altered mental status
98
Possible causes of altered mental status
AEIOU TIPS
A: Alcohol
E: Epilepsy, endocrine, electrolytes
I: Insulin
O: Opiates and other drugs
U: Uremia (kidney failure)
T: Trauma, temperature
I: Infection
P: Poisoning, psychogenic causes
S: Shock, stroke, seizure, syncope, space-occupying elision, subarachnoid hemorrhage
99
A temporary change in mental status characterized by disorganized thoughts, inattention, memory loss, disorientation, striking changes in personality and affect, hallucinations, delusions, or a decreased LOC
Delirium
100
BE-FAST stroke assessment
Balance
Eyes
Facial droop
Arm drift
Speech
Time
101
Cincinnati Prehospital Stroke Scale
Facial droop
Arm drift
Speech
102
Los Angeles Prehospital Stroke Screen
Items 1-6 yes, 97% chance of stroke
1. Older than 45
2. History of seizures or epilepsy absent
3. Symptoms <24 h
4. At baseline, not wheelchair bound or bedridden
5. Blood glucose between 60 and 400 mg/dL
6. Obvious asymmetry if any of the following 3 categories:
- Facial smile/grimace
- Grip
- Arm strength
103
Most commonly used stroke assessment in the hospital setting
11-step numerical grading system with the NIH Stroke Scale
104
LAG scale
3-item Stroke Severity Scale
105
3-item Stroke Severity Scale
LOC:
0 - Normal
1 - Mild dysfunction
2 - Severe dysfunction (unconscious)
Arm drift (hemiparesis):
0 - Normal function
1 - Mild dysfunction
2 - Severe dysfunction (flaccid)
Gaze:
0 - Normal gaze (follows pen/finger to left and right sides)
1 - Mild dysfunction
2 - Severe dysfunction (fixed gaze)
106
LAG Scale scores
>4 stroke likely
5-6 high probability
107
LVO stroke
Large vessel occlusion stroke, subtype of ischemic stroke. Caused by an occlusion of a large blood vessel in the brain
108
LVO strokes respond well to ___
Fibrinolytics or mechanical thrombectomy
109
Los Angeles Motor Scale (LAMS) was developed to identify ___
LVO strokes
110
Los Angeles Motor Scale
Facial droop:
0 - absent
1 - present
Arm drift:
0 - absent
1 - slow drift
2 - rapid fall
Grip strength:
0 - Normal
1 - weak grip
2 - no grip
Score of 4+ strong indication of LVO stroke
111
Key info to document for a patient with a suspected stroke
1. Time of onset of signs and symptoms
2. Score on the GCS
3. Results of the stroke assessment tool
4. Changes noted on reassessment
