Paramedic Test #8 - Chapter 18 - Neurologic Emergencies

Central Nervous System is responsible for thought perception, feeling, and autonomic body functions. 

Peripheral Nervous System is responsible for transmitting commands from the brain to the body and receiving feedback from the body. 

Nerves that leave the brain through the peripheral nervous system and convey commands to other parts of the body.  

Nerves that send information to the brain.  

Controls respiratory pace and depth. Located inferior to the midbrain.    

Blood pressure and pulse controls.  

Emotions.  Rage and anger.  

Part of the diencephalon where pleasure, thirst, and hunger are found.  Links to the endocrine system - pituitary gland, adrenal glands

Manages complex motor skills. Located in the posterior, inferior area of the skull.  

• Nucleus - transmits signals 
• Dentrites - signal the next cell's nucleus
• Axon - pathway
• Myelin sheath - insulating coating along axons that allow neurons to transmit the signal efficiently.  

Caused by increased intercranial pressure - 

• Decreased pulse rate
• Decreased respiratory rate
• Widened pulse pressure (systolic hypertension)

Unequal size of the pupils. 

Drooping, sagging, or prolapse of a part of the body.  

• Mnemonic for assessment of a patient's LOC. 
• Awake and alert to person, place, and day
• Verbal response
• Painful stimuli
• Unresponsive

Patient contracts their arms and toward their chest, and point their toes.  Damage to directly below the cerebral hemispheres.  

Patient extends their arms outward and orate the lower arms in a palms down posture.  More severe.  Damage is near brainstem.  

• Glasgow Coma Scale
• EVM456
• Eye – 4
• Verbal – 5
• Motor – 6

• Eye
• 4 Spontaneous
• 3 Voice
• 2 Pain Stimulation
• 1 None

• Verbal
• 5 Oriented
• 4 Disoriented
• 3 Inappropriate words
• 2 Incomprehensible
• 1 None

• Motor
• 6 Obeys
• 5 Localizes pain
• 4 Withdraws from pain
• 3 Decorticate
• 2 Decerebrate
• 1 None

• 13-15 Mild
• 9-12 Moderate
• 8 or less Critical

Seeing things, hearing voices, feeling things that aren't there.  

Thoughts or perceived abilities not based in reality - superman

Not being able to determine what is real. 

Tapping a patient between the eyes to determine LOC and cough and gag reflex.

Unequal pupil sizes. 

Weakness of the voluntary skeletal muscles. 

Unable to tell you the names of certain items.  Keys

Unable to tell you the use of certain items.  What does the key do?

Unable to understand (receive) speech, but able to speak clearly. 

Unable to speak (express himself) clearly, but is able to understand speech.

Expressive and receptive aphasia.  Cannot follow commands or answer questions.  

Weakness on one side of the body.

Paralysis on one side of the body.  

The crossing of the nerves as they leave the cerebral cortex, move through the brain stem  and arrive at the spinal cord.  

Alteration of a person's ability to perform coordinated motions such as walking.  

Rapid, jerky muscle contractions that occur involuntarily.

Part of the body contracts and remains contracted.

Fine, oscillating movement that occurs when the patient is at rest and not moving.

Fine, oscillating movement when the patient is asked to reach out and grab an object.

Fine, oscillating movement when a patient body part is placed in a particular position and required to maintain that position for a long period of time.  

Rigid, contracted body posture.  Body may shake from severity of the contraction.  

Rhythmic contraction and relaxation of certain muscle groups.  Bizarre, non-purposeful movement of any body part.

Sensation of numbness or tingling.  

Can feel nothing in that body part.  

• Ischemic 75% (AKA occlusive) - 
• Blood vessel is blocked so that tissue distal to the blockage will die. 

Hemorrhagic 25% - slow bleed in the cranium.    Symptoms (headache) will get worse over time. 

Cerebral Perfusion Pressure = Mean Arterial Pressure - Intercranial Pressure.  

• MAP = Average pressure withing the blood vessels at any given time.
• MAP = Dias + 1/3(Sys-Dias)

Transient ischemic attacks - episodes of cerebral ischemia without any permanent damage. 

Mneumonic for remembering the causes for ALOC. 

• Alcohol / Acidosis
• Epilepsy
• Insulin
• Overdose
• Uremia (kidney failure)
• Trauma
• Infection
• Psychosis
• Stroke

Grand mal seizures.  

Rest period of the brain following a seizure, on the way to pre-seizure LOC.  

Petit mal seizures with little or no movement.  Might only be several seconds long, typical in children.  

Generalized neurologic events, similar to tonic/clonic events, but with psychiatric origin.  

Seizure that lasts longer than 4-5 minutes without a return to consciousness between seizures.  20% will die because of high metabolism and no glycogen to the brain.  

Sudden and temporary loss of consciousness with accompanying loss of postural tone.

Signs and symptoms that precede a disease.  

Growths within the body that serve no useful purpose and are caused by errors during cell production.  

When a parent cell divides into two identical duplicates

Buildup of plaque in the brain causing neuron death.  Chronic memory loss. 8-10 years 

Damage to neurons int he frontal and temporal lobe.  Socially inappropriate behavior, such as stealing and obsessive behaviors.  6 years.  

Adult-onset genetic disorder marked by severe loss of neurons.  Fidgetiness, bradykinesia, diff standing, memory loss.  

Prion infection from contaminated beef.  Cognitive deteriorization, always fatal.  

Thiamine Vitamin B deficiency, as in long term alcoholics.  Ataxia, confusion, agitation, general weakness. 

Multiple Sclerosis is an automimmune condition in which the body attacks the myelin of the brain and spinal cord.  

Involuntary, rhythmic eye movement.  

Immune system attacks portions of the nervous system.  May start with respiratory or GI infection or weakness.  

Amyotrophic lateral sclerosis - Lou Gehrig disease.  Strikes the voluntary motor neurons.  

Slowing down of routine motions.  

Error in the movement or absorption of CSF.  Build up.

Neural tube fails to close and part of the nervous system remains outside the body.  

Developmental condition in which damage is done to the brain, hypoxia probable cause.