Neurologic Emergency Management (knowt)

what are the layers of the brain? starting with the outer most layer first.

dura mater, subdural space, arachnoid, subarachnoid space(contains cerebrospinal fluid), Pia mater

what is the name of the layer of that adheres to the surface of the brain?

pia mater

what is the main purpose of cerebrospinal fluid?

to provide cushion for the brain.

what are important properties of the blood-brain barrier?

limits the materials passing through to the brain, controls the balance of electrolytes, glucose and proteins in the brain.

define the cortex of the brain

also known as "grey matter", nerve cell bodies

Define corpus callosum

a broad band of nerve fibers joining the two hemispheres of the brain. also known and "white matter"

what are the 5 major lobes of the brain?

prefrontal, frontal, parietal, temporal, and occipital lobes

What is Broca's area?

motor and speech area

What's Wernicke's area?

comprehension of speech

What does the prefrontal cortex do?

Controls elaboration of thought, cognitive behaviour, and components for expression of personality

What does the basal nuclei do?

Allow movements to occur -> balancing motor input and postural support

What does the limbic system do?

controls emotions

Define Thalamus

the part of the brain located in the middle of the central core that acts primarily to relay information about the senses

Define hypothalamus

it is the key role in maintaining homeostasis of the body, controls the autonomic nervous system and the endocrine system, and also regulates body temp, fluid, food intake, regulates sleep cycles, stress responses, emotional responses and sex drive ;)

What are the 3 parts between the brain and the spinal cord?

midbrain, pons, medulla oblongata

what is the function of the cerebellum?

fine motor control/voluntary movement. proprioception

How many cranial nerves are there?

12

How many spinal nerves are there?

31 pairs

whats the difference between axons and dendrites?

axons- conduct impulses AWAY from the cell body
Dendrites- conduct impulses TOWARD the cell body, also they are the receptor site

What are glial cells?

cells in the nervous system that support, nourish, and protect neurons

Where does the fight-or-flight response occur?

sympathetic nervous system

What happens if damage happens to the left hemisphere of the brain?

Loss of logical thinking, analytical skills and other intellectual communication skills

What happens if damage happens to the right hemisphere of the brain?

causes behavioural problems, spatial orientation and recognition of relationships may be deficient, self-care deficits are common

What is hemianopia caused by?

damage to the visual cortex/occipital lobe

What is aphasia?

loss of ability to understand or express speech, caused by brain damage.

What is dysarthria?

motor inability to speak (movement deficit)

What is global aphasia?

combination of expressive and receptive aphasia. Major brain damage to Broca area, Wernicke area and in communication fibres

What is agraphia?

inability to write

What is alexia?

loss of reading skills due to recent brain damage. writing and other language skills are intact.

What is agnoisa?

Loss of recognition or association

What are the criteria of the Glasgow Coma Scale?

Eye opening: spontaneous-4 response to speech-3 response to pain-2 none-1
Motor response: obeys commands-6 localizes pain-5 normal flexion to pain-4 abnormal flexion decorticate-3 abnormal flexion decerebrate-2 none-1
Verbal response: orientated to time and place-5 confused-4 inappropriate words-3 incomprehensible-2 none-1

Define decorticate

arms curl toward body

define decerebrate

arms extend outward, lower arms rotated palms-down/wrists flexed

Whats the difference between hemiparesis and hemiplegia?

Hemiparesis- weakness
Hemiplegia- paralysis

Define syncope

Temporary loss of consciousness due to a lack of blood flow to the brain (fainting)

Describe Primary brain injuries

Direct injuries. Such as lacerations, rupture or compression of cerebral blood vessels or brain tissues, etc.

Describe Secondary brain injuries

Results from additional effects of cerebral edema, hemorrhage, hematoma, cerebral vasospasm, infection, ischemia related to systemic factors

What is a extradural/epidural hematoma?

Blood will fill space between dura and bone

What is a subdural hematoma?

blood fills space between dura and arachnoid

What is a intracerebral hematoma?

bleeding within the brain tissue

What are some signs and symptoms to look out for with a hematoma?

seizures, cranial nerve impairment, otorrhea or rhinorrhea(leaking of csf from ear or nose), and fever

What are the 3 main phases of a seizure and describe them?

Tonic phase- straightening of body and limbs, cyanosis, may wet themselves
Clonic phase- Clonic jerks of body, limbs and head, salivation, cyanosis and eyes blinking
Postictal phase- limbs and body will go limp, no movement occurs after a seizure has finished

What is an absence seizure?

Sudden lapse in consciousness and staring blankly into space. episodes will last usually 15 seconds or less

Define pseudoseizures

non-epileptic seizures

How do you manage a seizure?

Determine is trauma is a concern(did the patient fall?), protect from injury, maintain airway patency, and provide oxygen and ventilation assistance, start IV access, Emotional support and transport

What are the 2 types of stroke?

ischemic and hemorrhagic

Define ischemic stroke

Sudden neurologic deficits from focal cerebral ischemia associated with permanent brain infarction

Define hemorrhagic stroke

ruptured artery increased pressure
focal bleeding from a blood vessel in the brain parenchyma
chronic HTN weakens small artery and it ruptures, bleed increased pressure and the brain stem is compressed

T or F. Females have more strokes than men

True

What age is more likely to have a stroke?

30x for ages 60-79, 63x for ages over 80

Clinical feature to watch out for with stroke patients

weakness or numbness in the face, arm, or leg, especially on one side of the body
Sudden confusion
Trouble speaking or understanding
Trouble seeing
Dizziness or loss of balance or coordination
Sudden severe headache

What percentage of strokes are hemorrhagic?

20%

What is the most common type of hemorrhagic stroke?

Intracerebral

What is a TIA (transient ischemic attack)?

stroke like symptoms, resolve in 24 hours. increases risk of stroke 10x

Describe encephalitis

infection of brain tissue and connective tissue , can cause permanent brain damage

What is an early indicator of increased intracranial pressure?
A) Papilledema
B) Bilateral fixed dilated pupils
C) Decreasing responsiveness
D) Rapid heart rate

C) Decreasing responsiveness

What is the typical change in blood pressure in a patient who has increased intracranial pressure?
A) Erratic diastolic pressure
B) Decreasing systolic pressure
C) Systolic and diastolic pressures decreasing proportionately
D) Increasing pulse pressure

D) Increasing pulse pressure

Signs and symptoms of a stroke depend upon:
A) location of obstruction, size of artery, and area affected.
B) duration of the blockage, distance from the heart, and type of obstruction.
C) health of the victim, area affected, and collateral circulation.
D) size of the obstruction, condition of the heart, and duration of blockage.

A) location of obstruction, size of artery, and area affected.

Which of the following is a TRUE statement about transient ischemic attacks (TIAs)?
A) They usually cause necrosis and permanent brain damage.
B) They may be caused by rupture of an aneurysm or a damaged artery.
C) They usually indicate systemic hypertension.
D) They can warn of potential cerebrovascular accidents.

D) They can warn of potential cerebrovascular accidents.

In the weeks following CVA, why might some neurological function return?
1. Presence of collateral circulation
2. Immediate therapy to dissolve thrombi and maintain perfusion
3. Reduced inflammation in the area
4. Development of alternative neuronal pathways
A) 1 only
B) 2 only
C) 1, 3
D) 2, 3, 4
E) 1, 2, 3, 4

E) 1, 2, 3, 4

An epidural hematoma is located between the:
A) dura mater and the arachnoid mater.
B) dura mater and the skull.
C) arachnoid mater and the pia mater.
D) pia mater and the brain.

B) dura mater and the skull.

How does the heart rate change as intracranial pressure increases?
A) Rate decreases
B) Rate increases
C) No change in rate
D) Irregular heart rate

A) Rate decreases

Which of the following factors predispose(s) an individual to a CVA?
1. Hypertension
2. Smoking cigarettes
3. History of coronary artery disease
4. Diabetes mellitus
A) 1, 3
B) 1, 2, 4
C) 2, 4
D) 1, 2, 3, 4

D) 1, 2, 3, 4

What are the significant early signs of a ruptured cerebral aneurysm?
A) Impaired speech and muscle weakness
B) Severe headache, nuchal rigidity, and photophobia
C) Abnormal sensations and tremors
D) Vomiting and visual abnormalities

B) Severe headache, nuchal rigidity, and photophobia

The stroke scale used to rapidly diagnose a stroke includes:
A) capacity for speech, level of consciousness, motor skills, eye movements.
B) motor skills, spatial awareness, time awareness, facial recognition.
C) short-term memory, cognitive skills, speech, name recognition.
D) hand-eye coordination, problem solving, ability to stand or walk, consciousness.

A)capacity for speech, level of consciousness, motor skills, eye movements

Typical signs of a TIA include:
A) rapidly increasing intracranial pressure.
B) loss of consciousness.
C) transient muscle weakness in a hand or leg.
D) headache, photophobia, and nuchal rigidity.

C) transient muscle weakness in a hand or leg.

Which of the following is characteristic of generalized seizures?
A) The localization of the seizure activity
B) The uncontrolled discharge of neurons in both hemispheres
C) Seizures that persist for several hours
D) Loss of consciousness and all motor function

B) The uncontrolled discharge of neurons in both hemispheres

From the following, choose the two events (in correct sequence) that immediately follow the aura during a tonic-clonic event:
A) Prodromal signs, then the clonic stage
B) Clonic stage, then the tonic stage
C) Loss of consciousness, then the tonic stage
D) Loss of consciousness and cessation of respiration

C) Loss of consciousness, then the tonic stage

What does the clonic stage of a seizure consist of?
A) A sudden strong skeletal muscle contraction and rigidity of trunk and limbs
B) A cry and contraction of abdominal and thoracic muscles
C) Alternating contractions and relaxation of skeletal muscles
D) Cessation of all skeletal muscle activity

C) Alternating contractions and relaxation of skeletal muscles

How would a seizure consisting of bizarre or inappropriate activity be classified?
A) Absence seizure
B) Psychomotor seizure
C) Focal seizure
D) Jacksonian seizure

B) Psychomotor seizure

Which of the following is used to confirm the diagnosis of, and classify, seizures?
A) Characteristics of the aura
B) Presence of precipitating factors
C) Electroencephalogram
D) Changes in the characteristics of cerebrospinal fluid

C) Electroencephalogram

Which statement does NOT apply to status epilepticus?
A) Seizures are recurrent or continuous without full recovery between episodes.
B) Severe hypoxia and acidosis develop.
C) Person does not lose consciousness during seizure
D) If the episode persists, there may be additional brain damage.

C) Person does not lose consciousness during seizure

Which type of seizure commonly occurs in children?
A) Absence
B) Tonic-clonic
C) Focal
D) Complex partial

A) Absence

All of the following may precipitate a seizure EXCEPT:
A) hypoglycemia.
B) hypoventilation.
C) brain abscess.
D) high fever in young child.

B) hypoventilation.

A 35-year-old athletic man experiences a stroke that completely incapacitates him, while a 55-year-old man who does not exercise and is sedentary gets a clean bill of health from his physician. The 35-year-old man MOST likely had a/an:
A) neoplastic condition.
B) autoimmune disorder.
C) intracerebral infection.
D) genetic predisposition.

D) genetic predisposition.

The MOST immediate and significant complication associated with a hemorrhagic stroke is:
A) acute hypovolemic shock.
B) hypertension and bradycardia.
C) mean arterial pressure increase.
D) increased intracranial pressure.

D) increased intracranial pressure.

As intracranial pressure rises:
A) the heart rate acutely increases.
B) the brain becomes hypocarbic.
C) cerebral herniation may occur.
D) mean arterial pressure decreases.

C) cerebral herniation may occur.

Which of the following would MOST likely cause a sustained increase in intracranial pressure?
A) Bearing down
B) Frequent coughing
C) Projectile vomiting
D) Intracranial tumor

D) Intracranial tumor

Hyperventilating a patient who has increased intracranial pressure (ICP) will:
A) dilate the cerebral vasculature and cause further increases in ICP.
B) constrict the cerebral vasculature and decrease cerebral perfusion.
C) increase the carbon dioxide levels in the brain through vasodilation.
D) decrease ICP and maintain adequate cerebral perfusion.

B) constrict the cerebral vasculature and decrease cerebral perfusion.

Management for a patient with a neurologic emergency begins by:
A) ensuring that the patient's airway remains patent.
B) taking deliberate actions to ensure personal safety.
C) determining the degree of neurologic impairment.
D) protecting the patient from further injury or harm.

B) taking deliberate actions to ensure personal safety.

Decerebrate posturing:
A) is characterized by abnormal flexion of the arms and extension of the lower extremities.
B) is considered less severe than decorticate posturing, because it indicates that the brain stem is intact.
C) is an early clinical finding, because it occurs with minimal increases in intracranial pressure.
D) is a more severe finding than decorticate posturing, as it indicates damage in or near the brain stem.

D) is a more severe finding than decorticate posturing, as it indicates damage in or near the brain stem.

An adult who opens her eyes in response to verbal stimuli, is disoriented, and localizes pain, has a Glasgow Coma Scale score of:
A) 9
B) 10
C) 11
D) 12

D) 12

An acutely frustrated, angry, or aggressive patient should be assumed to be:
A) hypoxic or hypoglycemic.
B) under the influence of alcohol.
C) intoxicated with a narcotic drug.
D) experiencing a psychiatric crisis.

A) hypoxic or hypoglycemic.

A patient with a Glasgow Coma Scale (GCS) score of 8 or less:
A) will most likely require intubation.
B) has moderate neurologic dysfunction.
C) is often able to localize his or her pain.
D) is likely experiencing brain herniation.

A) will most likely require intubation.

The involuntary, rhythmic movement of the eyes is called:
A) nystagmus.
B) hyperopia.
C) anisocoria.
D) dysphagia.

A) nystagmus.

How do people get encephalitis west nile?

spread of mosquito bites

Signs and symptoms of encephalitis west nile

fever, chills, headache, body aches, may become confused, lethargy, and death(1-2 days potentially)

How do people get encephalitis lyme disease?

bacterial infection due to tick bite

Signs and symptoms of encephalitis lyme disease

vary from person to person but normally include fever, headache, nausea, jaw pain, photophobia, red eyes, body aches, neck stiffness

Define encephalitis herpes simplex virus

caused by virus travelling from peripheral site to brain by trigeminal or olfactory nerve

Signs and symptoms of encephalitis herpes simplex virus

fever, headache, nausea, weakness, lethargy, confusion, delirium, seizures

How do people develop encephalitis tetanus(lock jaw)?

spore-forming bacteria in soil dust and aminal feces

Signs and symptoms of encephalitis tetanus (lock jaw)

muscle spasms, neck stiffness, difficulty swallowing, fever, sweating, hypertension, tachycardia

Define meningitis

an inflammation of the meninges due to bacteria, viruses, yeast, fungus, toxins, or meningeal irritation resulting from other causations; bacterial from used to be the most common; however, with the advent of HIB and pneumococcal vaccines, the viral form may now be the most prevalent form

What are the 6 different forms of meningitis?

bacterial, viral, fungal, parasitic, amebic, and non-infectious

describe how meningitis in bacterial form results

death can occur in hours, most survive with deafness or learning disability

describe how meningitis in viral form results

most common, recovery over 7-10 days, less severe symptoms

describe how meningitis in fungal form results

spread from fungal infection within the body, fungal spores are inhaled from bird droppings or soil

describe how meningitis in parasitic form results

from eating raw or undercooked snails, slugs, chicken, fresh water fish, eels, frogs, snakes or raccoon feces

describe how meningitis in amebic form results

a rare parasitic infection that is fatal, water containing ameba enters through the nose, found in untreated warm water