Neurological Emergencies Flashcards
1
Q
Which lobe scans through images?
A
Occipital lobe
2
Q
Which lobe attaches a name to an image?
A
Temporal lobe
3
Q
Which lobe controls voluntary motion?
A
Frontal lobe
4
Q
Which lobe perceives touch and pain?
A
Parietal lobe
5
Q
Which neurological cause is the 5th leading cause of death in the US in 2019?
A
Stroke
6
Q
Which neurological cause is the 6th leading cause of death in the US in 2019?
A
Alzheimer Disease
7
Q
What section of the nervous system do thoughts, perceptions, feelings and autonomic body functions fall under?
A
Central Nervous System
8
Q
What section of the nervous system do transmitting commands between the brain and body and receiving feedback fall under?
A
Peripheral Nervous System
9
Q
What part of the brain filters out unneeded information and conscious vs. unconscious management of information?
A
Diencephalon
10
Q
What part of the brain regulates level of consciousness?
A
Midbrain
11
Q
What part of the brain frees cerebral cortex for higher activities?
A
Brainstem
12
Q
What does the hypothalamus control?
A
controls pleasure, thirst, hunger
13
Q
What part of the brain mediates all emotions?
A
prefrontal cortex
14
Q
What part of the brain generates rage and anger?
A
limbic system
15
Q
What part of the brain manages complex motor activity and transfers learned behaviors from the frontal lobe?
A
Cerebellum
16
Q
Which nerves are responsible for airway control?
A
Trigeminal, glossopharyngeal, vagus, hypoglossal (allow for swallowing, tongue control, hypopharynx)
17
Q
What does trismus mean?
A
clenched teeth
18
Q
What could trismus indicate?
A
seizure in progress, severe head injury, cerebral hypoxia
19
Q
What are the three major parts of the brain?
A
cerebrum, cerebellum, brainstem
20
Q
What is the most significant risk for hemorrhagic stroke?
A
hypertension
21
Q
What patient with an altered mental status is thought to be?
A
Is not thinking clearly or is incapable of being aroused
22
Q
What is a simple partial seizure?
A
a seizure that begins in one extremity
23
Q
When caring for a pt with documented hypoglycemia, you should be most alert for?
A
a seizure
24
Q
What is aphasia?
A
unable to produce or understand speech
25
What is a contraindication for thrombolytic (fibrinolytic) therapy?
brain bleed
26
Components of the Cincinnati Stroke Scale include?
arm drift, speech, facial droop
27
What type of seizures are benign but should still be evaluated?
febrile seizures
28
What are individuals with chronic alcoholism predisposed to?
Intracranial bleeding and hypoglycemia
29
muscle control and body coordination are controlled by?
cerebellum
30
What type of seizure is prolonged in nature without a return of consciousness?
status epilepticus
31
What part of the brain controls basic body functions like breathing, BP and swallowing?
brain stem
32
The spinal cord exits the cranium through the...
foramen magnum
33
What is the most suggestive sign of ruptured aneurysm?
sudden, severe headache
34
What is a characteristic of a focal-onset aware seizure?
normal level of conscious
35
What is a cause of an ischemic stroke?
blockage of a cerebral artery
36
What is one metabolic cause of a seizure?
poisoning
37
Which type of posturing has abnormal flexion, curls arms toward chest, point their toes and flex their wrists (indicative of damage to the area below the cerebral hemispheres)
Decorticate
38
What is one characteristic of focal onset aware seizure?
a seizure that causes the pt to stare blankly
39
In most people, speech is controlled by which hemisphere?
Left hemisphere
40
What disorder of the brain is caused by the disruption of blood flow resulting in brain cell death?
cerebral infarction
41
What is the largest part of the brain?
Cerebrum
42
What type of posturing is abnormal extension, points their toes, extends their arms outward and palms down(pronation) [indicative of damage near or in the brainstem]
decerebrate
43
What sign lets you suspect ischemic stroke vs. hypoglycemia?
If the pt attempts to communicate with you
44
When is hyperventilation indicated for neuro emergencies?
those with documented signs of intracranial pressure (ICP) and impending herniation
45
What is anisocoria?
unresponsive and dilated pupils
46
What happens to blood flow and systolic pressure when ICP rises?
Blood flow diminishes, medulla oblongata signals heart to increase force of contractions causing systolic to rise
47
What is cushing's reflex for ICP?
BRadycardia, irregular breathing, hypertension and widened pulse pressure
48
What is ptosis?
Drooping or sagging of the eyelids
49
What can ptosis indicate?
Bell palsy
50
What happens with a breakthrough seizure?
the seizure occurs despite a therapeutic medication blood level
51
What are thoughts, ideas, perceived abilities that are not based in common reality?
delusions
52
What are sensory stimulations that cannot be verified by others?
hallucinations
53
What is a protective movement that results in blinking. moving the head posteriorly and pupil constriction called?
corneal reflex
54
If you tap between a patient's eye and the pt does not blink or twitch it is safe to assume what?
The the pt does not have an intact cough or gag reflex
55
What type of pupil response does cocaine, methamphetamines and hallucinogens tend to cause?
pupil dilation
56
What do depressants tent to the do the pupils?
constrict the pupils
57
What are unequal pupils a sign of?
increased ICP
58
What is weakness of one side of the body called?
hemiparesis
59
Paralysis of one side of the body is called?
hemiplegia
60
Uncontrolled hypertension, sudden severe headache and rapidly deteriorating level of consciousness is most suggestive of?
ruptured cerebral artery
61
A degenerative cerebral disease is an example of a _______ cause of a seizure?
structural
62
A hemorrhagic stroke occurs as a result of?
a ruptured cerebral artery
63
What is status epilepticus?
prolonged generalized motor seizure
64
A transient ischemic attack occurs when?
body's normal processes destroy a cerebral thrombus
65
What is an idiopathic seizure?
a seizure without an identifiable etiology
66
What does hypermetabolic state mean?
they are using large amounts of glucose and produce lactic acid
67
Following a head injury, a pt who is verbally abusive and combative most likely had an injury to what part of the brain?
frontal
68
What controls muscle and body coordination?
cerebellum
69
Pt with hemorrhagic strole experience rapidly declinging LOC because?
of increasing ICP
70
Migraines are thought to be caused by
changes in blood vessel size within the base of the brain
71
The clonic phase of a generalized motor seizure is characterized by?
muscle contraction and relaxations in rapid succession
72
Which condition can mimic the signs and symptoms of an acute ischemic stroke?
low bgl
73
Where is the 12th cranial nerve located?
arises from the brain and innervates the head and face
74
What is the alteration of a person's ability to perform coordinated motions such as walking?
ataxia
75
A sensation of numbness or tingling is called?
parasthesia
76
If a pt does not feel anything within that body part, it is called?
anesthesia
77
What is the minimum systolic BP for a pt with ICP?
110 to 120 mm Hg
78
Sensations commonly experienced before a seizure or migraine headache like visual changes and hallucinations
aura
79
What is the onset time of glucagon?
20 minutes
80
What can increase the morbidity of pts who have had a stroke?
hyperglycemia
81
Pts with hyperglycemic are often _____ and require volume support.
dehydrated
82
What is a normal range for CPP?
70 to 90 mm Hg
83
What is the target systolic BP of a pt with ICP?
110 mmHg
84
What interventions should you consider with someone who has signs of ICP?
IV access and NS or Lactated Ringer
85
An aneurysm can happen due to the following:
-tear in the arterial wall
-blood entering one of more of the three layers of the artery
-pressure build up and initial tear increases
86
What is another name for an ischemic stroke?
occlusive stroke (bc it's caused by an occlusion- blockage)
87
What is a hallmark symptom of a hemorrhagic stroke?
"worst headache of my life"
88
How do you calculate CPP?
MAP -ICP
89
What serious conditions include headache as a symptom?
brain tumor, meningitis, stroke
90
What are the three substances in the skull?
brain, blood and CHF
91
What is the normal ICP in adults?
less than 10-15mm Hg
92
What is the normal ICP in young children?
less than 3-7mm Hg
93
What does MAP signify?
The mean arterial pressure is the average pressure within the blood vessel at any given time
94
What are the four signs of increase ICP?
-Shock
-posturing
-irregular respiratory
-unequal pupils
95
True or False: Pt with strokes will also exhibit cardiac dysrhythmias.
True
96
Unless cervical spine injury, what how should you position a pt with stroke?
supine and elevate the head 30 degrees
97
What can cause vasodilation of the cerebral arteries which allows more blood into the skull?
high CO2 level
98
What is the ETCO2 goal for pt's with stroke
30-35mm HG
99
For ischemic strokes, fibrinolytics needs to be administered with how many hours of onset?
3-4.5 hrs
100
What are episodes of cerebral ischemia without permanent damage?
TIAs - transient ischemic attacks
101
What are mini-strokes(TIAs) a sign of?
serious vascular conditions that require medical evaluation
102
According to AHA/ASA, TIAs resolve within what time frame?
1 hour
103
What is the #1 preventable cause of strokes and TIAs?
hypertension
104
What happens if a seizure occurs for a long period of time?
-cerebral glucose
-oxygen is depleted
-hypoxia
-hypercarbia
-hyperthermia
105
what is another name for tonic-clonic seizures?
grand mal seizures
106
What happens during the tonic phase of a tonic-clonic seizure?
systemic rigidity
107
What happens during the hypertonic phase of the tonic-clonic seizure?
arched back and rigidity
108
what happens during the clonic phase of the tonic-clonic seizure?
intermittent contractions of major muscle groups - contractions are chaotic
109
What are some signs of postseixures?
major muscles relax, nystagmus, eyes on back of the head
110
What are some signs of the postictal phase?
aphasic (unable to speak), confused, emotional, tired, headache, gradual return of normal brain function
111
What do you do if a pt is apneic for more than 30 seconds during a seizure?
begin ventilation assistance
112
What type of seizure might happen with hyperventilation and flashing lights?
absence seizures
113
What is another name for an absence seizure?
petit mal seizure
114
115
What type of seizure has little to no movement, typically experience by children,last a few seconds and have no postictal period?
absence (nonmotor) seizures
116
Causes of hemorrhagic stroke
hypertension, ruptured aneurysm, arteriovenous malformations, bleeding disorders
117
If a pt's awareness is affected or impaired at any time during a focal seizure, it is called?
focal impaired-awareness seizure
118
What type of seizure affects an area on one side of the brain?
focal seizure
119
If a pt had a focal seizure in the temporal lobe, what type signs and symptoms might you see?
snapping fingers, repeating phrases, walking in circles
120
A focal seizure in the frontal lobe might have signs and symptoms of?
gesturing, cycling, kicking movements, loud cry and scream
121
What is another name for psychogenic nonepileptic seizures?
pseudoseizures
122
What is the root cause for pseudoseizures?
psychiatric
123
What type of medications can be given for seizures?
diazepam(Valium), Lorazepam (Ativan), Midazolam (versed)
124
What type of seizure last longer than 4-5 minutes or consecutive seizures without a return to consciousness between seizures?
status epilepticus
125
During a seizure, the neurons are in what state?
hypermetabolic state
126
Why must be prepared to control the airway and ventilations when administering benzo because?
Benzos can cause respiratory depression or arrest
127
Pregnant patients experiencing eclampsia can be managed with?
magnesium
128
Syncope can be a sign of what?
life-threatening cardiac dysrhythmias, stroke
129
Conditions that may mimic stroke
hypoglycemia, postictal state, subdural/epidural bleeding, bells palsy
130
Common causes of syncope
vagal stimulation, lack of oxygen, hypoglycemia, seizure activity
131
Pt with syncope usually experience , ______________, signs and symptoms that precede a disease; dizziness, weakness, SOB, chest pain, headache, black vision
prodrome
132
What causes muscle tension headaches?
stress, cortisol levels, depression
133
What type of headache had pain on both sides of the head, travel from back to front, dull ache, squeezing pain?
muscle tension headache
134
What type of headache reports seeing an aura, unilateral and focuses, throbbing, pounding, pulsating, nausea, vomiting, lasts several days?
migraine headaches
135
What type of headache is a rare vascular headache that begins in the face as a minor pain around the eye, lasts 30-45minutes, sharp and excruiating pain on one side of the face?
cluster headache
136
What plays a role in cluster headaches?
erotonin, histamine and anxiety
137
What type of headache is caused by inflammation or infection within the sinus cavity of the face, worse when waking, postnasal drip, sore throat?
sinus headache
138
What is a chronic deterioration of memory, personality, language skills, reasoning, judgement?
Dementia
139
What can present as dementia and is caused by vitamin B1 deficiency, typically found in pt who are malnourished ro alcoholic?
Wernicke encephalopathy
140
What is the most common form of dementia?
Alzheimer disease
141
What type of disease is a progressive, organic condition where neurons die?
Alzheimer disease
142
What type of disease has a genetic aspect, damage in the neurons in the frontal and temporal lobes, occurs between 55-65yrs, socially inappropriate behavior.
Pick disease
143
What type of disease is fatal, myoclonic jerking, ataxia (unstable gait), where prions (proteins) clump together with resultant death of neurons.
Creutzfeldt-Jakob diease
144
What type of disease is an adult-onset genetic disorder marked by a severe loss of neurons, fidgetiness, abnormal eye movement, memory loss, irritability?
Huntington disease (Huntington chorea)
145
What is a medical term for growths within the body that serve no useful purpose and are caused by errors during cellular reproduction - cancer of the brain or spinal cord?
neoplasm
146
Primary CNS tumors are usually caused by errors in what?
mitosis
147
The process by which cancerous cells move to sites distant from their site of origin
metastasis
148
What common type of cancers metastasize to the CNS?
lung and breast cancer
149
An autoimmune condition in which the body attacks the myelin of the brain and spinal cord, destruction of myelin, demyelination, resulting in areas of scarring?
multiple sclerosis
150
What are some symptoms during the pattern of episodes with Multiple sclerosis?
double, blurred vision, nystagmus, muscle weakness, loss of pain or temperature, ataxia, euphoria, electric sensation down the spine
151
What type of sign is a strange electric sensation down the spine or extremities when the head is flexed forward
Lhermitte sign
152
What is a rare disease in which the immune system attack portions of the nervous system with minor respiratory or gastrointestinal infection?
Guillain-Barre Syndrome
153
Around 1/3 of Guillain Barre patients will need what type of support?
respiratory
154
How is Guillain Barre described?
weakness, tingling sensations in the legs, which moves up to the thorax and arms. weakness can lead to paralysis.
155
What part of the brain is responsible for production of dopamine and if injured, can cause Parkinson?
substantia nigra
156
What neurologic condition have environmental and genetic factors place pts at risk for damage to certain neurons
parkinson disease
157
What is another name for Amyotrophic lateral sclerosis that strikes the voluntary motor neurons?
Lou Gehrig disease
158
What condition is subtle and progresses without being noticed, have generalized weakness of muscle groups, fasciculations, difficulty speaking.
ALS- Lou Gehrig
159
True or False: Someone with severe facial pain or sudden-onset facial paralysis is not necessarily having a stroke.
True
160
If a pt has vertigo, look at the pt's eyes and you should see?
nystagmus
161
What medications may provide relief for vertigo?
Benzodiazepines
162
What medication may be helpful for nausea and vomiting present with cranial nerve disorders?
Phenergan (promethazine) or ondansetron (Zofran)
163
What are severe abnormal muscle spasms that cause bizarre contortions, repetitive motions or postures?
Dystonias
164
Do dystonias impact a pt's LOC?
no
165
What is a common dystonia that causes neck muscles to contract?
spasmodic torticollis
166
Patients who take what type of medication can have sudden onset of dystonias?
antipsychotic medications
167
