Neurology (Crash Course)

ataxia
difficulty w/coordinated movement

decerebrate posturing
arms and legs extended

decorticate posturing
arms flexed and legs extended

dysphagia
difficulty swallowing

hemiparesis
unilateral weakness

hemiplegia
unilateral paralysis

nustagmus
involuntary eye movement

Wernicke's encephalopathy
brain damage due to a lack of vitamin B1

cerebrum
largest part of the brain; controls thought, learning, memory, sense. two hemispheres joined by corpus callosum

Cerebellum
coordinates voluntary movement, fine motor function, balance

Diencephalon
includes thalamus, hypothalamus, limbic system. controls thermoregulation, sleep, emotions, much of autonomic nervous system

brain stem
midbrains, pons, medulla. controls essential functions.

Central Nervous System (CNS)
brain
spinal cord
meninges

Peripheral Nervous System (PNS)
all systems outside of CNS

somatic
voluntary portion of PNS

autonomic
involuntary portion of PNS

parasympathetic nervous system
'feed or breed' or 'rest and digest'

sympathetic nervous system
'fight or flight'

s/s of nervous system emergencies
altered mentation
abnormal vitals(irreg. respirations)
cognitive, speech, motor or sensory deficits
posturing(sign of ICP)

management of neurologic emergencies
manage ABCs
monitor SpO2
do not hyperventilate
aggressively correct and avoid even transient episodes of hpoxia or hypotension
monitor ECG
assess blood glucose and manage as indicated
provide supplemental o2
support ventilations as needed to maintain ETCO2 of 35-45mmHg
IV access
consider causes
rapid transport

common causes of altered mental status
Acidosis, alcohol
Epilepsy
Infection
Overdose
Uremia(blood infection, often kidney related)
Trauma, toxins, tumor
Insulin
Psychological, poison
Stroke, seizures, shock

causes of stroke
ischemia(occlusion, embolus, thrombus) and hemorrhage

s/s of stroke
altered mentation
slurred speech
dysphagia
aphasia
facial droop
unilateral weakness or paralysis
ataxia

Los Angeles Prehospital Stroke Screen
assesses blood glucose, facial droop, grip strength and arm drift

Cincinnati Prehospital Stroke Scale
assesses speech, facial droop and arm drift

management of suspected stroke
preform stroke assessment
protect paralyzed pt from further harm
rapid transport to stoke center

Transient Ischemic Attack (TIA)
caused by temporary impaired blood flow to brain
mimics stroke, but can resolve w/in 24hrs w/no permanent damage
may indicate elevated risk of impending stroke
tx as possible stroke

types of seizures
generalized and partial

Types of generalized seizures
tonic-clonic(grand mal)
status epilepticus
absence
pseudoseizures

Types of partial seizures
simple partial(focal motor)
complex partial(temporal lobe or psychomotor)

management of seizure pt
protect airway
do not restrain pt
o2 and ventilatory support
spinal precautions
assess blood glucose
IV access
consider anticonvulsant meds

syncope
fainting caused by temporary lack of blood flow to the brain

common causes of syncope
cardiovascular conditions
hypovolemia
orthostatic hypotension
diabetic problem
TIA
head injury

management of syncope
spinal precautions as indicated
supplemental o2 as needed
assess vitals, ECG, blood glucose
IV access
transport as indicated

common cause of headache
vascular headaches, such as migraines and cluster headaches
tension headaches
organic headaches, such as infections and tumors

indications for possible serious condition headache
headache w/fever and nuchal rigidity
headache in pt over 50 or under 5 YOA
c/c of 'worst headache ever experienced'
headache w/s/s of stroke
headache w/exertion, coughing, sneezing, sex

management of headache
supplemental o2
IV access
assess blood glucose
monitor ECG, vitals
be prepared for possible vomiting, loss of consciousness
transport as indicated

cranial nerve related conditions
bell's pasy
trigeminal neuralgia

degenerative neurological disorders
alzheimer's disease(dementia)
muscular dystrophy(muscle weakness and degeneration)
multiple sclerosis(CNS disease, weakness, sensory loss, paresthesia, vision changes)
guillain-barre syndrome(immune system attacks peripheral nerves causing muscle weakness)
parkinson's disease(chronic and progressive disorder causing tremors, rigidity, bradykinesia)
spina bifida(fetal vertebrae does not close properly during pregnancy, leaving part of spine exposed.)