CH 15 Neurologic Emergencies

A period following a seizure that typically includes labored respirations and altered mental status

Postictal state

Low blood glucose levels

Hypoglycemia

A temporary alteration in consciousness, classified as a generalized, partial, or status epilepticus

Seizure

Experiencing a warning sense prior to an event

Aura

Part of the brain located above the cerebellum, divided into R and L hemispheres

Cerebrum

Loss of bowel or bladder control

Incontinence

Aphasia

An inability to produce or understand speech

Aneurism

A swelling or enlargement of part of an artery resulting from weakness of the arterial wall

Brain stem

Controls basic functions of the body, such as breathing and blood pressure

Cerebellum

Controls basic functions of the body, such as breathing and blood pressure

Hemiparesis

Weakness of one side of the body

Ischemia

A lack of oxygen

Status epilepticus

A seizure lasting longer then 30 minutes

Stroke

An interruption of blood flow to the brain that results in a loss of brain function

Transient ischemic attack

Stroke symptoms that go away in less than 24 hours

A _________ is typically characterized by unconsciousness and a generalized severe twitching of all of the bodies muscles that lasts several minutes or longer

generalized seizure

The _________ controls the most basic functions of the body, such as breathing, blood pressure, swallowing, and pupil constriction

brain stem

At each vertebrae in the neck and back, _________ nerves, called spinal nerves, branch out from, the spinal cord and carry signals to and from the body

two

All of the following are associated with altered mantel status EXCEPT __________
coma
seizure
incontinence
intoxication

incontinence

When blood flow to a particular part of the brain is cut off by a blockage inside a blood vessel, the result is

an ischemic stroke

Patients who are at the highest risk of hemorrhagic stroke are those who have

untreated hypertension

Patients with a subarachnoid hemorrhage typically complain of sudden severe

headache

The plaque that builds up in atherosclerosis obstructs blood flow and interferes with the vessel's ability to

dilate

A TIA, or mini-stroke, is the name given to a stroke when symptoms go away on their own in less then

24 hours

Patients with a decreased LOC

should not be given anything by mouth

Hypoglycemia can mimic conditions such as

stroke

When assessing a patient with a history of seizure activity, it is important to

determine whether this episode differs from any previous ones

Signs and symptoms of possible seizure activity include all of the following EXCEPT
altered mental status
incontinence
muscle rigidity and twitching
petechiae

petechiae

Common causes of altered mental status include all of the following EXCEPT
body temperature abnormalities
hypoxia
unequal pupils
hypoglycemia

unequal pupils

The principal difference between a patient who has had a stroke and a patient with hypoglycemia almost always has to do with

mental status

Consider the possibility of __________ is a patient who has had a seizure

hypoglycemia

__________ are the second most common type of headache and are thought to be caused by changes in blood vessel size in the base of the brain

Tension headaches

Headache. altered mental status, and seizures and all considered early signs of

increased intracranial pressure

People within __________ have a higher risk of hemorrhagic stroke

uncontrolled hypertension

Headaches caused by muscle contractions in the head and neck are typically associated with

tension headaches

The following conditions may simulate a stroke EXCEPT
hyperglycemia
a postictal state
hypoglycemia
subdural bleeding

hyperclycemia

When assessing a patient with a possible CVA (cerebrovascular accident) , you should check the __________ first

airway

A _________ is usually a warning sign that larger, significant stroke may occur in the future

TIA transient ischemic attack

Which mnemonic is used to check a patients mental status

AVPU alert, voice, pain, unresponsive

There are ____ cranial nerves

12

Playing the piano is coordinated through the cerebellum

cerebellum

The two main types of strokes are

ischemic and hemorrhagic

The brain is most sensitive to _______, _________, and, _______ levels

oxygen, glucose, temp

An incident in which you have more than one patient complaining of a headache may indicate

carbon monoxide poisoning

A _______ _______ seizure may cause twitching of the extremity muscles that may spread slowly to another body part

simple partial

Each hemisphere of the cerebrum activates on the ______ side of the body

opposite

Complex partial seizures result from abnormal discharges from the ______ lobe of the brain

temporal

Dilantin and Tegretol are medications used to control ______ __________

epileptic seizures

A period following a seizure in which the muscles relax and the breathing becomes labored is called a

postictal state

Weakness of one side of the body is known as

hemiparesis

All patients with an altered mental status should have an ______ ______ ______ score calculated

Glasgow coma scale

______ ______ may reverse stroke symptoms and even stop the stroke if given within 2-3 hours of onset of symptoms

Thrombolytic therapy

A _______ seizure feathers rhythmic back-and-forth motion of an extremity and body stiffness

Tonic-clonic

Slurred speech

Dysarthria

The inability to understand and/or produce speech

Aphasia

The sensation that serves as a warning sign that a seizure is about to occur

Aura

An interruption of blood flow to the brain that results in the loss of brain function

Stroke

A stroke

CVA cerebrovascular accident

Clotting that forms in a remote area and travels to the site of blockage

Embolus

A ______ seizure affects a limited portion of the brain

partial

A disorder of the brain in which brain cells temporarily stop working because of insufficient oxygen, causing stroke like symptoms that resolve within 24 hours on onset

TIA

A state of profound unconsciousness from which one cannot be roused

Coma

A ______ seizure is characterized by severe twitching of all of the body's muscles that may last several minutes or more

generalized

Clotting of the cerebral arteries that may result in the interruption of cerebral blood flow and subsequent stroke

Thrombosis

Generalized, uncoordinated muscular activity associated with loss of consciousness

seizure

A swelling or enlargement of part of a blood vessel, resulting from weakening of the vessel wall

Aneurism

A lack on oxygen in the cells of the brain that causes them not to function properly

Ischemia

__________ seizures result from sudden high fevers, particularly in children

Febrile

Cincinnati Prehospital Stroke Scale: Facial Droop

Ask patient to show teeth or smile

Cincinnati Prehospital Stroke Scale: Arm Drift

Ask patient to close eyes and hold both arms out with palms up

Cincinnati Prehospital Stroke Scale: Speech

Ask patient to say, "the sky is blue in Cincinnati.

Why is prompt transport of stoke patients critical?

New thrombolytic therapies may help in reversing some of the damage but must be started within 3 hours on onset

Describe the characeristics of a postictal state

After seizure, duration 5-30 min, AMS, labored resp. muscles relax or hemiparesis

What is the difference between a simple partial and a complex partial seizure?

SPS: no AMS, numbness, weakness, dizziness, twitching
CPS: AMS, lips smacking, eye blinking, isolated convulsions

List three conditions that may simulate stroke

hypoglycemia, postictal state, subdural or epidermal bleeding

The patients wife tells you the patient has a history of hypertension, myocardial infarction, renal failure, diabetes, and GERD. Based on the patients history, what are possible conditions that could explain his symptoms?

Hypoglycemia

While transporting the pt to the hospital, his left-sided weakness and speech improve. By the time you reach the hospital, the pt appears almost normal. What is most likely his underlying condition.

Transient ischemic attack