Neuro 1-7.txt

awake and responsive

drowsy or sleepy but easily awakened

arousable only with vigorous or painful stimulation

Dorsiflexion of the great toe and fanning of the other toes is positive Babinski’s-neuro problems

if lift head then knees go up; meningitis

when knee gets brought up, pain in back occurs-meningitis

10-15 mm Hg

Increased ICP

cerebral perfusion decreases leading to tissue hypoxia, a decrease in serum pH level and increase in CO; these cause cerebral vasodilation, edema and increased ICP

pentobarbital sodium or thiopentone is drug; decrease the metabolic demands of the brain and cerebral blood flow, stabilize cell membranes, decrease the formation of vasogenic edema and produce more uniform blood supply

decreased GI motility, cardiac dysrhythmias and fluctuations in temp

Mannitol (bolus) and Lasix to prevent rebound from mannitol; need to draw it up with filter needle because it can crystallize

cerebral perfusion decreases

MAP-ICP

early: restlessness and irritability; late-decorticate/decerb; cushing’s triad, severe HA, N/V, seizures, papilledema

increased systolic (widening pulse pressure), decreased HR, decreased RR

meds, neuro check, monitor for fever (cooling blankets to protect hypothalamus), hyperventilate before suctioning if on vent

allows accurate measurement of ICP

invasive, infection, CSF leakage around insertion site

Keppra

show circulation to detect blockages in the arteries or veins in the brain, head or neck; NPO 4-6 before, do not move; post op check for bleeding and swelling, keep extremity straight and immobilized, maintain pressure for 2 hours

no metal objects!

provides function of the brain, 2-3 hour procedure, may be blindfolded or have earplugs

uses sound waves to measure blood flow through the arteries; evaluates vasospasm or narrowing of the arteries; safe and can be used repeatedly for the same pt and inexpensive related to angiography.

electrical activity of cerebral hemispheres; must be sleep deprived (wave up at like 2 or 3 a.m.) before procedure and anticonvulsants may be withheld

electromyography that identifies nerve and muscle disorders as well as spinal cord disease

pressure of 20 or less, clear, 0-5 lymphocytes, 15-45 protein, 3-12% of protein, 50-75 glucose, 10-15 lactic acid, 6-15 glutamine, 10% of serum lactate dehydrogenase

a LP is not done for patients with symptoms of severely increased ICP

fetal side-lying to separate vertebrae and move spinal nerve roots away from area to be accessed

are taken and 3-5 test tubes of CSF are usually collected and numbered sequentially

brainstem herniation, infection, CSF leakage and hematoma, headache

may give sedation, assist with cleaning area, hold person still; apply light dressing or bandaid

within 30-60 minutes

blurred vision, blindness, diplopia, tunnel vision, weakness, gait disturbance, numbness, vertigo, aphasia, dysarthria

smoking, booze, drugs, obesity, sedentary lifestyle, oral contraceptive, PPA (in antihistamines)

sudden development

bleeding into subarachnoid space, the ventricles and intracerebral tissue; vasospasm results; blood flow to distal parts of brain is markedly diminished

tangled malformation of veins and arteries during embryonic development; no capillary network; vessels rupture; thin veins can’t handle pressures arteries can

right sided weakness, aphasia, alexia, dyslexia, agraphia, acaculia

left sided weakness, spatial perceptual deficits; unilateral neglect

2 nite stay, monitor VS, neuro, peripheral pulses, incisional bleeding, cerebraral hyperperfusion

give math problem

may have afib

brain attack

Closed

when the skull is fractured or when it is pierced by a penetrating object; integrity of the brain and dura are violated, exposure to environmental contaminants

blunt trauma

simple, clean break, most common

bone is pressed inward into the brain tissue to at least the thickness of the skull

raccoon eyes and battle signs behind ears

at high risk for infection

external force contacting the head

occurs when moving head is suddenly stopped or hits a stationary object

arterial bleed, have lucid intervals

venous bleeding

aneurysm (worst headache ever)

yellowish stain surrounded by bloody drainage

bruising of brain tissue at site of impact (coup) or opposite (contracoup)

shaky movement of the brain and may be mild or more severe

c-spine precautions, ABCs, VS, LOC, fluids and electrolytes, nutrition, meds, be ready for surgical intervention

AVM or aneurysm

chronic, episodic disorder with multiple subtypes; intense pain on one side of the head and occurs with photo or phonophobia

common antiepileptic drug used for migraines (low doses)

caffeine, red wine, stress, MSG

30 minutes to 2 hours, intense unilateral pain in spring or fall

percutaneous stereotactic rhizotomy and deep brain stimulation

for pt with headaches over 50 years old

originates within CNS and rarely metastasize

results from metastisis from other areas of body

located within cerebral hemisphere

area of brainstem structures and cerebellum

to remove pituitary tumors (go through nose)

check that pt has not had alcohol, tobacco, anticoagulants or NSAIDS for at least 5 days pre surgery; NPO for at least 8

early morning headaches, N/V, visual symptoms, seizures, changes in mentation or personality, papilledema

control cerebral edema; check BS with glucocorticoids

are not ususual and cold compresses are used

bed at 30 degrees

flat and on either side for 24-48 hours

h/A, cranial nerve dysfunction and bleeding

within 48 hours in half of patients and 5 days in almost all (bell’s palsy)

bursts of pain (excruciating, sharp, shooting, piercing); bouts of pain for weeks or months and then spontaneous remission

balloon microcompression-compresses the trigeminal nerve root; surgical is crainiotomy with microvascular decompression (surgical relocation of artery which compresses the trigeminal nerve)