Slides CH. 18 Neurologic Emergencies – Practice Flashcards

100 Question-and-Answer style flashcards covering anatomy, pathophysiology, signs, assessment, and emergency care of neurologic emergencies based on the lecture notes.

What are the three major parts of the brain?

Brainstem, cerebellum, and cerebrum.

Which part of the brain controls the most basic life functions such as breathing and blood pressure?

The brainstem.

Which brain region is primarily responsible for muscle and body coordination?

The cerebellum.

What is the largest part of the brain?

The cerebrum.

Each cerebral hemisphere controls activities on which side of the body?

The opposite (contralateral) side.

In most people, where in the brain is speech controlled?

On the left side of the cerebrum near the middle.

How many cranial nerves run directly from the brain to the head?

Twelve cranial nerves.

What is the name of the large opening at the base of the skull through which the spinal cord exits?

The foramen magnum.

The brain is especially sensitive to changes in which three factors?

Oxygen, glucose, and temperature.

Which three types of headaches are most common?

Tension, migraine, and sinus headaches.

What typically causes a tension headache?

Muscle contractions in the head and neck, often related to stress.

What physiologic change is thought to trigger migraine headaches?

Changes in blood vessel size at the base of the brain.

What causes sinus headaches?

Pressure from fluid accumulation in the sinus cavities.

List three serious conditions in which headache is a key symptom.

Hemorrhagic stroke, brain tumor, and meningitis.

How is stroke defined?

An interruption of blood flow to an area of the brain causing loss of function.

Name the two main types of stroke.

Ischemic stroke and hemorrhagic stroke.

Approximately what percentage of strokes are ischemic?

About 87%.

Ischemic strokes are usually caused by what two processes?

Thrombosis or an embolus blocking a cerebral artery.

What percentage of strokes are hemorrhagic?

About 13%.

Which risk factor places a person at the highest risk for a hemorrhagic stroke?

Very high blood pressure (hypertension).

Define an aneurysm.

A swelling or enlargement of an arterial wall due to a defect or weakness.

What is a transient ischemic attack (TIA)?

Stroke-like symptoms that resolve on their own in less than 24 hours.

Roughly what fraction of TIA patients will later experience a full stroke?

About one-third.

What facial sign commonly indicates stroke?

Facial drooping on one side.

Sudden weakness or numbness on one side of the body is known as what?

Hemiparesis or unilateral paralysis indicating possible stroke.

What is ataxia?

Lack of muscle coordination or balance.

Name two visual symptoms that may accompany a stroke.

Sudden loss of vision in one eye or double/blurred vision.

What does the term aphasia mean?

Inability to produce or understand speech.

Define dysarthria.

Slurred or poorly articulated speech.

A stroke in the left cerebral hemisphere typically causes what speech problem?

Aphasia—difficulty producing or understanding speech.

Right hemisphere strokes often result in what behavioral phenomenon?

Neglect—unawareness of deficits on the left side of the body.

Why is rising blood pressure important in intracranial bleeding?

It indicates increasing intracranial pressure; a sudden drop may signal deterioration.

Name three conditions that can mimic stroke.

Hypoglycemia, postictal state after seizure, and subdural or epidural bleeding.

How is a seizure defined?

A surge of electrical activity in the brain causing convulsions or altered consciousness.

What are the two broad categories of seizures?

Generalized and partial (focal) seizures.

Describe a generalized (tonic-clonic) seizure.

Unconsciousness with generalized severe muscle twitching lasting minutes.

What characterizes an absence (petit mal) seizure?

Brief lapse of consciousness with a blank stare and no motor changes.

List two features of a focal-onset aware seizure.

No LOC change; may have localized numbness, weakness, or twitching.

What are common signs of a focal-onset impaired awareness seizure?

Altered LOC, lip smacking, eye blinking, isolated jerking, or repetitive behaviors.

What is an aura?

A sensory warning (visual change, smell, etc.) that precedes some seizures.

How long do generalized tonic-clonic seizures usually last?

Typically less than 5 minutes followed by a postictal state.

Define status epilepticus.

Seizures lasting more than 5 min or recurring without regaining consciousness (>30 min).

Name three antiepileptic medications.

Examples: Levetiracetam (Keppra), Phenytoin (Dilantin), Valproate (Depakote).

List two hallmark features of the postictal state.

Lethargy/confusion and possible hemiparesis with labored breathing.

Give one key difference between syncope and a seizure.

Syncope lacks a postictal state and usually occurs while standing.

What is meant by altered mental status (AMS)?

A patient who is not thinking clearly or cannot be aroused appropriately.

List four possible causes of AMS.

Hypoglycemia, hypoxia, intoxication, brain infection (among others).

Why is scene size-up crucial in neurologic emergencies?

To determine if the cause is medical or trauma and ensure rescuer safety.

During primary assessment, what takes priority?

Identifying and treating life-threatening conditions affecting XABCs.

Why is obtaining a SAMPLE history important in neurologic patients?

It helps determine events leading up to the incident and possible causes.

Slow pulse, erratic respirations, and high BP after head injury suggest what?

Significant intracranial bleeding and rising intracranial pressure.

Stroke assessment scales primarily evaluate which three functions?

Face, arm, and speech.

What does the BE-FAST mnemonic stand for?

Balance, Eyes, Face, Arm, Speech, Time.

List the three components of the Cincinnati Prehospital Stroke Scale.

Facial droop, arm drift, and speech abnormalities.

What minimum age criterion is used in the Los Angeles Prehospital Stroke Screen?

Older than 45 years.

On the LAG scale, a total score of 4 or more indicates what?

A stroke is likely.

What GCS score range indicates severe neurologic dysfunction?

8 or less.

Why do ED physicians order a CT scan for suspected stroke?

To determine whether intracranial bleeding is present.

Why is the last known well (symptom-free) time critical in stroke care?

Eligibility for clot-dissolving therapy depends on symptom onset time.

What SpO2 level should be maintained in stroke patients?

At least 94%.

List three immediate care steps for an actively seizing patient.

Protect from injury, maintain airway with suction, and provide oxygen.

How should status epilepticus be managed pre-hospital?

Suction, PPV, rapid transport, and rendezvous with ALS if possible.

Name two headache red flags that warrant concern.

Sudden severe onset or headache with fever, seizures, AMS, or trauma.

How should a migraine patient be transported?

In a dark, quiet ambulance without lights or siren.

What is the recommended destination for suspected stroke patients?

A designated stroke center if feasible.

What does the acronym XABCs stand for?

Exsanguination, Airway, Breathing, Circulation (plus disability).

When is spinal motion restriction indicated in neuro emergencies?

If head or neck trauma is suspected.

Which type of stroke is generally more fatal, ischemic or hemorrhagic?

Hemorrhagic stroke.

Stroke is the fifth-leading cause of death and the leading cause of what?

Adult disability in the United States.

Stroke incidence is especially high in which age group?

Geriatric patients.

Name two non-modifiable risk factors for stroke.

Family history and race.

What percentage of strokes are hemorrhagic in nature?

Approximately 13%.

Within how many hours must fibrinolytic therapy be started to be effective for stroke?

Within 3 hours of symptom onset.

Which part of the brain controls pupil constriction?

The brainstem.

List two functions governed by the cerebellum besides coordination.

Maintaining posture and fine-tuning voluntary movements (e.g., writing).

Why should lights and siren be avoided when transporting migraines?

Patients are sensitive to light and sound, which can worsen their pain.

Why is supplemental oxygen strongly advised for seizure patients?

Seizures can cause apnea and hypoxia; oxygen helps prevent hypoxemia.

Differentiate subdural from epidural bleeding.

Epidural is outside the dura; subdural is beneath the dura but outside the brain.

What was the former name for an absence seizure?

Petit mal seizure.

Give one example of an aura a patient might report.

Seeing flashing lights or experiencing a strange smell before a seizure.

Is intoxication a possible cause of altered mental status?

Yes, intoxication is a common AMS cause.

Status epilepticus is defined as seizures lasting longer than how many minutes?

More than 5 minutes, or recurring without regaining consciousness for 30 minutes.

In BE-FAST, what does the "Time" component emphasize?

Documenting symptom onset and not delaying transport to a stroke facility.

Describe how to perform the arm-drift test.

Patient closes eyes, holds both arms out palms up; observe for one arm drifting down.

Why might right-hemisphere stroke patients delay seeking help?

Neglect and lack of pain make them unaware of their deficits.

During the postictal state, breathing usually becomes what?

Labored but gradually normalizes as muscle tone relaxes.

What is the minimum SpO2 level to maintain in stroke or seizure emergencies?

At least 94% saturation.

At each vertebra, how many spinal nerves branch out from the spinal cord?

Two spinal nerves (one on each side).

Define ataxia.

Lack of voluntary coordination of muscle movements.

What common factor triggers tension headaches?

Stress leading to head and neck muscle contractions.

Why is fainting not associated with a postictal state?

Syncope involves transient global hypoperfusion without prolonged cortical excitation.