Chapter 13

Stroke, seizure, and syncope

Ahterosclerosis

Build up of plaques in the arteries

What is a stroke?

Death to brain tissue due to an interruption in blood flow

Ischemic stroke and its percentage?

Ischemia due to atherosclerosis, compromises blood flow to the brain. About 87% of strokes.

Hemorrhagic stroke

Caused by bleeding within the brain, robbing brain of oxygen delivery. Treatment options are more limited and this stroke is more fatal.

Signs and symptoms

Slurred speech, facial droop, headache, one-sided weakness or paralysis, difficulty walking, vision problems, altered mentation.

Cincinnati prehospital stroke scale CPSS

Facial droop, arm drift, slurred speech

BE-FAST assessment

Balance, eyes, facial droop, arm drift, speech, time

Los angeles prehospital stroke scale

Required ine assessments instead of three.

Conditions that can mimic stroke?

Hypoglycemia, head injury, postictal state

Glasgow coma scale

Eye opening: Spontaneous, to speech, to pain, nothing (1-4)

Verbal response: alert and oriented, confused, inappropriate, incomprehensible, none (1-5)

Motor response: obeys commands, localizes pain, withdraws from pain, abnormal flexion, abnormal extension, none (1-6)

What should stroke documentation include?

Time and onset, GCS score, results of stroke assessment tool used, any changes during care

Transcient ischemic attack

Same presentation as stroke but symptoms self-correct within 24 hours

Types of seizures

Generalized (unresponsive with full body convulsions) and absence (unable to interact with environment, but no convulsions) and partial (simple has no convulsions or change in LOC, complex has altered LOC)

Status epilepticus

Generalized seizure lasting longer than 5 minutes or having more than one within 5 minutes without regaining consciousness between them

What type of seizure is common in pediatric patients?

Febrile (fever) seizures

AEIOU-TIPS

Alcohol, epilepsy/endocrine, insulin, opiates/overdose, uremia/underdose, trauma, increased ICP/infection, poisoning/psychiatric, seizure/syncope/shock/stroke

What is syncope?

Fainting typically caused by temporary loss of blood flow to the brain

Causes of syncope

Irregular heartbeat, hypotension, neurological problems, stress, diabetes, pregnancy

Headache red flags

Severe headache, sudden onset of severe headache, AMS, old, immunocompromised, hypertension, fever, stiff neck, vision changes, neurological impairment, recent trauma.