Pt. arrives at the ER with her daught after having a fall. Daughter expressed concern b/c her mother has been misidentifying objects for the last 3 day, she has also been experiencing sudden blindness. What part of the brain has MOST LIKELY been affected?
Occipital lobe. BLINDNESS would be the key identifier.
What does cerebral blood flow depend on?
Gravity and Blood pressure. - Aging patients will have decreased blood flow.
An abnormal movement marked by alternating contraction and relaxation of a muscle occuring in rapid succession is BEST described as what?
Clonus- be able to recognize "foot bouncing" occurs
After a CVA involving the parietal-occipital area of the brain, what might a patient have trouble with?
Copying a letter would be difficult- APHASIA
The innermost layer of the brain meniges, which extends into the brain folds like saran wrap
Pia mater- know that it "hugs" the brain
What can result from stroke or spinal cord injury which can cause a loss of voluntary control with increased muscle tone, hyperactive muscle reflexes, and no muscle atrophy?
Upper motor neuron lesion
Patient is having difficulty swallowing, slurred speech, and no gag reflex. Which nerve has MOST LIKELY been affected?
Cranial nerve X- Vagus
Patient is having problems d/t impairment of cranial nerve VIII. Which tests would have helped to determine this diagnosis?
Weber, Romberg, and the whisper test
When having a patient move his tongue from side to side against a tongue depressor, what cranial nerve are you assessing?
Cranial Nerve XII- Glossopharyngeal
Pt. has been in a coma for 48 hours following an automobile accident. What test would the doctor order to evaluate brain function?
When assessing a patients response to stimuli, what test would you most likely use?
Glasgow coma scale. LOC-3=unresponsive/15=normal
After a seizure a pt. might be confused and hard to aroue after sleeping for hours. What might the pt be suffering from?
What test is used to diagnose Meningitis?
What is the earliest sign of increased cranial pressure? (ICP)
A change in LOC; ex- Drowsiness, confusion, restlessness
When doing an assessment of altered LOC, what are you assessing for?
Mental status, cranial nerve function, cerebellar function, reflexes, and motor and sensory function. (associate an assessment of LOC with Glasgow Coma Scale)
You have a pt hemorrhaging from the nose and blood under the conjunctiva. The pt also has ecchymosis over the mastoid and drainage of CSF from the ears. What head injury is suspected?
Basilar skull fx
a T1 spinal cord injury could cause what life-threatening complication?
People living in close quarters are more susceptible to this and having a stiff neck or red "rash spots" on the chest or extremities are the two main symptoms
Bacterial Meningitis-Assessment tests used are the Kernig and Brudzinski
A patient has a history of fatigue, depression, weakness, numbness, difficulty with coordination, loss of balance, and pain. What condition might the patient be suffering from?
Multiple Sclerosis- Associate MS with intention Tremors
What is the treatment window for thromolytic therapy administration for a pt suffering an ischemic stroke?
What is the treatment for viral encephalitis?
A pt who has spinal cord injury presents symptoms of a pounding headache, profuse sweating, nasal congestion, goose-bumps, and bradycardia. What might the patient be experiencing?
What is the most common cause of death in SCI?
Secondary conditions such as pneumonia or pulmonary emboli
Which test is used to detect hypoxia in secondary TBI?
Reflexive activity is affected BELOW the level of injury- Flaccid extremities
Guillain Barre Syndrome clinical manifestations
ASCENDING- begins in the lower extremities, patent may not be able to take a deep breath
How do you detect expressive aphasia?
Ask the pt to smile and look for facial drooping on either side. Patients often understand what they are told but cannot speak
How long does a reoccuring migrain last?
48-72 hours- associate Aura, visual changes, and nausea are symptoms
What is the most common cause of subarachnoid hemorrhage?
A leaking aneurism- Signs are a severe headache and vomiting
What nerve is affected by Bell's palsy?
Cranial nerve VII- Unilateral
You can diagnose this by performing a CT scan which will show blood in the brain
3 things to include in your ROUTINE NEUROLOGIC ASSESSMENT
Glascow Coma Scale, Pupil Reaction and Vital Signs?
Which of these is NOT a function of the frontal lobe?
Name the lobe of the brain that is essential to a person's awareness of body positioning in space, size, shape discrimination, and left- right orientation
Parietal lobe- The awareness of your body without having to look is called proprioception
After a pt's accident, his only complaint is that he is unable to understand his favorite classical music composer. What area of the brain has most likely been affected?
Temporal lobe- Arterial bleed
Which portion of the brain acts primarily as a relay station for all sensation EXCEPT smell?
What part of the autonomic nervous system controls body temp and sleep cycle
What mixed cranial nerve controls facial sensation?
Cranial nerve V
What forms the Blood Brain Barrier?
Which of the following tests would NOT be used to assess neurologic function?
Pt has flexion of the upper extremities, internal rotation of the lower extremities, and plantar flexion of the feet. What posture response is this?
Cushing's respnse is seen when there is significant
Reduced blood flow
A neurologic deficit that deprives the brain of glucose and oxygen that typically lasts less than one hour and is manifested by a sudden loss of motor, sensory, or visual function is what?
A collection of blood between the dura and the brain, most often caused by trauma or a rupture of an aneurysm is known as what?
Pt was taken to the ER after sustaining a head injury. During the pts examination he briefly loss conciousness followed by a lucid interval in which the pt was awake and conversing with the nursing staff pt then became increasingly restless, agitated, and vonfused as the condition progressed to a coma. What type of hematoma would this be?
Epidural hematoma- epidural hematoma= getting hit in the head
Clear, colorless fluid that is produced in the choroid plexus of the ventricles and circulates around the surface of the brain and spinal cord
A pt comes in with S/S of immediate coma, no lucid interval, decortiate and decerbrate posturing and global cerebral edema. What did the pt most likely come in with?
Diffuse Axonal Injury- Severe head trauma
What vertebrae's are most frequently involved with a spinal injury? Why?
Vervical 5,6 7
Because there is a greater range of mobility in the vertebral column. car accidents are the number one cause of spinal injury
What is the most common cause of a traumatic brain injury?
Parkinson's Disease- 3 things in normal assessment
Pill rolling tremor
CVA- presenting symptoms
Early manifestations of ICP?
Restlessness and confusion
A lumbar puncture is risky if there is a presence of what?
Intracranial mass lesion
Primary risk factor for a hemorrhagic stroke?
How do you assess the Hypoglossal cranial nerve?
People with SCI are at increased risk for what complication? What do they die from?
Population with higest death rates for TBI?
What are intention tremors
Decreased cerebral flow is normal in the aging process, True or false?
The frontal love is responsible for
concentration, thought, information, memory and motor
sensory lobe, sense position in space
Auditory, sound, language, music
visual interpretation and memory
CNS is in accessible to many substances that circulate in the blood. This barrier is formed by endothelial cells of the brain's capillaries that make tight junctions. Acts as a "filter" and a protective function
Perfusion study that captures cerebral blood flow, tissue composition and oxygen metabolism; evaluating brain function- used to detect Alzheimer's disease, brain tumors, epileptic lesions...
SPECT single proton emission computed tomography
Computer based nuclear imaging
Patient either inhales a radioactive gas, or is injected with a radioactive substance taht emits positively charged partices- provides 2 dimensional views
Produces images of actual organ functioning
Permits measurment of blood flow
PET scan- Positron Emission Tomography
In a lumbar puncture, the needle is usually inserted into the subarchnoid space, between the __ and __ or the __ and __ vertebrae
3rd and 4th or 4th and 5th
Unresponsive to the environment, no voluntary movements
Persistent Vegetative state
Unresponsive, with sleep-wake cycles, devoid of cognitive mental function