Neurogenic Emergencies

3 major parts of brain + functions

1. Cerebrum (speech, movement, etc)

2. Cerebellum (balance, coordination posture)

3. Brainstem (breathing, HR, BP)

Concerning headache symptoms

1. Sudden, severe headache

2. AMS

3. Vomiting

4. Unequal pupils

5. Seizure

6. Weakness/paralysis

7. Vision changes

8. Slurred speech

Cushing Triad (meaning, 3 signs)

Increased intracranial pressure

• Hypertension (widening pulse pressure)

• Bradycardia

• Irregular respirations

CVA v. TIA

CVA (stroke)

• Blood flow to the brain is interrupted

• Brain cells begin to die

• Symptoms last over 24 hours or become permanent

TIA (mini-stroke)

• Temporary interruption of blood flow

• Symptoms completely resolve within mins to hours

• No permanent brain damage

• Warning of an impending major stroke

Ischemic stroke

Blood clot blocks a vessel

Hemorrhagic stroke

• Blood vessel ruptures

• Bleeding into the brain

Signs and symptoms of stroke

BE FAST

• Balance

• Eyes

• Face droop

• Arm weakness/Asymmetry

• Speech difficulty

• Time to call EMS

Two questions to ask

1. When was the patient last known well?

2. What time did the symptoms begin?

Why rapid transport?

Time = Brain

When you suspect stroke, what should you immediately check?

Blood sugar (hypoglycemia can mimic stroke)

Common causes of seizures

AEIOU-TIPS:

• Alcohol

• Epilepsy

• Insulin (hypo/hyperglycemia)

• Overdose

• Uraemia (renal failure)

• Trauma

• Infection

• Psychiatric conditions

• Shock/Stroke

Generalized seizure

• Entire brain involved

• Loss of consciousness

• Whole body shaking

Focal/partial seizure

• One area of the brain

• May remain conscious

• Only one body part affected

Absence seizure

• Brief staring spell

• Lasts only seconds

• No convulsions

• Common in children

Status Epilepticus

Seizure lasting over 5 mins (or repeated seizures without regaining consciousness)

Postictal State

Period after a seizure where person’s behavior is abnormal

Aura

A warning that a seizure may be coming (smell, lights, tingling)

Febrile Seizure

Triggered by high fever (usually children)

What is the primary concern for AMS patients?

Airway

Glasgow Coma Scale

15 = Normal