Chapter 17: Neurologic Emergencies

postictal state

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

aphasia

The inability to understand and/or produce speech.

Your patient answers your questions appropriately, although her eyes remain closed the entire time. She moves each extremity on command, although her left side is weaker than the right. You should assign a Glasgow Coma Scale (GCS) score of:

12

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?

9

Which of the following MOST accurately describes the cause of an ischemic stroke? A. Blockage of a cerebral artery B. Acute atherosclerotic disease C. Rupture of a cerebral artery D. Narrowing of a carotid artery

A. Blockage of a cerebral artery

embolus

A blood clot or other substance in the circulatory system that travels to a blood vessel where it causes a blockage.

thrombosis

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.

status epilepticus

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

epilepsy

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

atherosclerosis

A disorder in which cholesterol and calcium build up inside the walls of the blood vessels, forming plaque, which eventually leads to partial or complete blockage of blood flow.

Transient Ischemic Attack (TIA)

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

syncope

A fainting spell or transient loss of consciousness.

ischemia

A lack of oxygen that deprives tissues of necessary nutrients, resulting from partial or complete blockage of blood flow; potentially reversible because permanent injury has not yet occurred.

seizure

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.

parietal (focal) seizure

A seizure affecting a limited portion of the brain

generalized (tonic-clonic) seizure

A seizure characterized by severe twitching of all of the body's muscles that may last several minutes or more; formerly known as a grand mal seizure.

aura

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

coma

A state of profound unconsciousness from which the patient cannot be roused

delirium

A temporary change in mental status characterized by disorganized thoughts, inattention, memory loss, disorientation, striking changes in personality and affect, hallucinations, delusions, or a decreased level of consciousness.

hemorrhagic stroke

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

ischemic stroke

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.

hypoglycemia

An abnormally low blood glucose level.

cerebrovascular accident (CVA)

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

stroke

An interruption of blood flow to the brain that results in the loss of brain function; also called a cerebrovascular accident (CVA).

altered mental status

Any deviation from alert and oriented to person, place, time, and event, or any deviation from a patient's normal baseline mental status.

Which of the following patients would MOST likely demonstrate typical signs of infection, such as a fever? A. A 3-month-old female who was born prematurely B. A 17-year-old male with anxiety C. A 35-year-old female in the later stages of AIDs D. An 88-year-old male with chronic renal problems

B. A 17-year-old male with anxiety

Which of the following conditions is NOT a common cause of seizures? A. poisoning or overdose B. Hypotension C. Acute Hypoglycemia D. Acute alcohol withdrawal

B. Hypotension

Which of the following medications would indicate that a patient has a history of seizures? A. Enalapril (Vasotec) B. Levetiracetam (Keppra) C. Hydromorphone (Dilaudid) D. Metformin (Glucophage)

B. Levetiracetam (Keppra)

Which of the following findings should concern the EMT the MOST when assessing a patient who complains of a headache? A. Sinus congestion B. Neck stiffness or pain C. History of migraines D. Slow onset of symptoms

B. Neck stiffness or pain

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

B. symptoms that persist for longer than 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

C. Facial symmetry, speech, arm drift

incontinence

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

febrile seizures

Seizures that result from sudden high fevers, particularly in children.

Which of the following clinical signs is MOST suggestive of a ruptured aneurysm?

Sudden, severe headache

If a patient complains of a severe migraine, how should she be transported?

Without lights and sirens.

An acute ischemic stroke is caused by:

a blocked cerebral artery.

aneurysm

a swelling or enlargement of the wall of a blood vessel that results from weakening of the vessel wall

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):

acute ischemic stroke.

Components of the Cincinnati Prehospital Stroke Scale include:

arm drift, speech, and facial droop.

A 58-year-old male presents with confusion, right-sided weakness, and slurred speech. His wife is present and is very upset. As your partner is applying oxygen, it is MOST important for you to:

ask his wife when she noticed the symptoms.

Law enforcement has summoned you to a nightclub, where a 22-year-old female was found unconscious in an adjacent alley. Your primary assessment reveals that her respirations are rapid and shallow and her pulse is rapid and weak. She is wearing a medical alert bracelet that identifies her as an epileptic. There is an empty bottle of vodka next to the patient. You should:

assist ventilations, perform a rapid exam, and prepare for immediate transport.

A 41-year-old man presents with slow irregular breathing; hypotension; and dilated pupils. These signs MOST likely indicate dysfunction of the:

brain stem.

Muscle control and body coordination are controlled by the:

cerebellum.

A 29-year-old male complains of a severe headache and nausea that has gradually worsened over the past 12 hours. He is conscious, alert, and oriented and tells you that his physician diagnosed him with migraine headaches. He further tells you that he has taken numerous different medications, but none of them seem to help. His blood pressure is 132/74 mm Hg, his pulse is 110 beats/min and strong, and his respirations are 20 breaths/min. Treatment should include:

dimming the lights in the back of the ambulance and transporting without lights and siren.

A patient with a suspected stroke presents with slurred speech that is difficult for you to understand. This is referred to as:

dysarthria.

The anterior aspect of the cerebrum controls:

emotion

A 40-year-old patient without a history of seizures experiences a generalized (tonic-clonic) seizure. The LEAST likely cause of this seizure is:

epilepsy.

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):

generalized seizure.

The MOST important reason for promptly transporting a stroke patient to the hospital is:

medications may be given to reverse the stroke.

You arrive at a grocery store shortly after a 35-year-old male stopped seizing. Your assessment reveals that he is confused and incontinent of urine. The patient's girlfriend tells you that he has a history of seizures and takes topiramate (Topamax). When obtaining further medical history from the girlfriend, it is MOST important to:

obtain a description of how the seizure developed.

Status epilepticus is characterized by:

prolonged seizures without a return of consciousness.

A generalized (tonic-clonic) seizure is characterized by:

severe twitching of all the body's muscles.

dysarthria

slurred speech

Successful treatment of a stroke depends on whether:

thrombolytic therapy is given within 3 hours of symptoms beginning.

A patient who is experiencing aphasia is:

unable to produce or understand speech.

The principal clinical difference between a stroke and hypoglycemia is that patients with hypoglycemia:

usually have an altered mental status or decreased level or consciousness

hemiparesis

weakness on one side of the body