Chapter 17 Neurologic Emergencies

A seizure affecting a limited portion of the brain.

Partial seizure

A disorder in which abnormal electrical discharges occur in the brain, causing seizures and possible loss of consciousness.

Epilepsy

If a patient complains of a severe migraine, how should she be transported? A) In a brightly lit ambulance so she can see while her vision is impaired B) With loud sirens so she can get to the hospital as soon as possible C) Without lights and sirens D) This patient should not be transported.

Treatment of a migraine headache is supportive; however, you should always assess the patient for other signs and symptoms that might indicate a more serious condition. Applying high-flow oxygen, if tolerated, may help ease the patient's condition. When possible, provide a darkened and quiet environment because patients are sensitive to light and sound. Do not use lights and sirens during transport.

A patient with a suspected stroke presents with slurred speech that is difficult for you to understand. This is referred to as: A) aphasia. B) dysphasia. C) dysphagia. D) dysarthria.

Dysarthria is defined as slurred, poorly articulated speech; it is common in stroke patients. Dysphasia is defined as difficulty speaking; the patient's speech may or may not be slurred. Aphasia is the inability to speak. Dysphagia is defined as difficulty swallowing.

The MOST important reason for promptly transporting a stroke patient to the hospital is: A) a transient ischemic attack can be ruled out. B) medications may be given to reverse the stroke. C) the clot in the coronary artery may be dissolved. D) he or she needs close blood pressure monitoring.

Fibrinolytic medications (clot busters) have been shown to reverse the symptoms of a stroke by dissolving the clot that is blocking the cerebral artery. However, for the patient to be eligible for this therapy, it must be initiated within 3 hours after the onset of symptoms. For this reason, prompt transport of the stroke patient is critical.

A type of seizure that is characterized by severe twitching of all the body's muscles and lasts for several minutes or longer is called a(n): A) partial seizure. B) absence seizure. C) tonic-clonic seizure. D) generalized seizure.

Generalized seizures are characterized by generalized severe twitching of all of the body's muscles; they often last for several minutes or longer. An absence seizure is characterized by a blank stare; generalized muscle twitching is absent.

A condition in which seizures recur every few minutes or last longer than 30 minutes.

Status epilepticus

Your patient opens his eyes when you say his name, is making incomprehensible sounds, and withdraws when you pinch his earlobe. What is his GCS score? A) 9 B) 8 C) 11 D) 12

The Glasgow Coma Scale gives a score of 3 to a patient who opens his or her eyes in response to speech. "Incomprehensible sounds" has a score of 2, and "withdraws to pain" has a score of 4. When added together, this patient's GCS score is 9.

A 41-year-old man presents with slow, irregular breathing; hypotension; and dilated pupils. These signs MOST likely indicate dysfunction of the: A) brain stem. B) hypothalamus. C) cerebrum. D) cerebellum.

The brain stem is responsible for functions such as breathing, blood pressure, and pupil constriction. Brain stem dysfunction would result in abnormal findings with these functions.

An acute ischemic stroke is caused by: A) a ruptured cerebral artery. B) increased intracranial pressure. C) an acute rise in a person's blood pressure. D) a blocked cerebral artery.

There are two types of stroke—hemorrhagic and ischemic. A hemorrhagic stroke is caused by a ruptured cerebral artery (aneurysm), which causes bleeding within the brain and increased intracranial pressure. An ischemic stroke is caused by a blocked cerebral artery—either from a clot that grows locally (thrombus) or that travels to the brain from another part of the body (embolus).

An interruption of blood flow to the brain that results in the loss of brain function; also called a stroke.

cerebrovascular accident

a state of profound unconsciousness from which one cannot be roused

coma

A type of stroke that occurs when blood flow to a particular part of the brain is cut off by a blockage (eg, a blood clot) inside a blood vessel.

ischemic stroke

The inability to understand and/ or produce speech.

Aphasis

A sensation experienced before a seizure; serves as a warning sign that a seizure is about to occur.

Aura

A sudden change in mental status that is generally acute and reversible, characterized by disorientation, inability to focus, inattention, inability to think logically,memory loss, striking changes in personalities and affect, hallucinations, delusions, or a decreased level of consciousness.

Delirium

A 56-year-old man experienced a sudden, severe headache and then became unresponsive. He has a history of high blood pressure. The MOST likely cause of his condition is a(n): A) hemorrhagic stroke. B) acute ischemic stroke. C) severe migraine headache. D)transient ischemic attack.

Hemorrhagic strokes are typically preceded by a sudden, severe headache (signals the rupture of a cerebral artery), after which the patient becomes unresponsive due to bleeding within the brain. Ischemic strokes and transient ischemic attacks generally do not cause a sudden, severe headache, and migraine headaches typically do not cause a loss of consciousness.

A neurologic episode caused by a surge of electrical activity in the brain; can be a convulsion characterized by generalized, uncoordinated muscular activity, and can be associated with loss of consciousness.

Seizure

Unlike an ischemic stroke, a transient ischemic attack is characterized by all of the following, EXCEPT: A) symptoms that resolve within 24 hours. B) symptoms that persist for longer than 24 hours. C) weakness or paralysis to one side of the body. D) an acute onset of confusion and slurred speech.

Signs and symptoms of a transient ischemic attack (TIA) are usually identical to those of an acute ischemic stroke (eg, hemiparesis, slurred speech, confusion, facial droop). Unlike the ischemic stroke, however, the symptoms of a TIA usually resolve within 24 hours.

Which of the following are components of the Cincinnati Prehospital Stroke Scale? A) Arm drift, blood pressure, speech B) Speech, pupil response, arm drift C) Facial symmetry, speech, arm drift D) Pupil response, facial droop, speech

The three components of the Cincinnati Prehospital Stroke Scale are facial symmetry, speech, and arm drift. Both sides of the patient's face should move symmetrically (equally) when he or she smiles. The patient's speech should be easily understandable and without slurring. The patient should be able to hold both arms out in front of his or her body—with eyes closed and palms up—without one arm drifting down to his or her side.

Slurred speech

dysarthria

Seizures that result from sudden high fevers; most often seen in children.

febrile seizures

One of the basic sugars; it is the primary fuel, in conjunction with oxygen, for cellular metabolism.

glucose

Weakness on one side of the body.

hemiparesis

A type of stroke that occurs as a result of bleeding inside the brain.

hemorrhagic stroke

Loss of bowel and/or bladder control; may be the result of a generalized seizure.

incontinence

The period following a seizure that lasts 5 to 30 minutes; characterized by labored respiration and some degree of altered mental status.

postictal state

A blood clot, either in the arterial or venous system. When the clot occurs in a cerebral artery, it may result in the interruption of cerebral blood flow and subsequent stroke.

thrombosis

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

transient ischemic attack