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Cranial nerves originate where?
What about I and II?
- brain stem
- above brain stem
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Which CN assesses Doll's eyes?
Vestibulocochlear
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Two important arteries of the brain
- basal vertebral- supplies lower brain/brainstem
- bilateral carotid-upper brain
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Part of the brain for speech/language
Broca's area in LEFT hemisphere
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What to mental changes are indicators of issues
memory and personality changes
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what is decortication and prognosis
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What is decerebrate posturing and prognosis?
- extension
- poor due to lesions/infarctions
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What is Babinski reflex
abnormal toe flaring
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What are abnormal eye assessments/reflexes when turning the head side to side
- eyes turn to same side head is turned
- eyes do not move either side when head is turned
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What is cold caloric?
- eyes open with ice water in ear
- good=eyes move toward ear with water
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Sign of brain herniation
- cushings triad
- increase PP, decrease HR, and RR
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What are the 3 brainstem problems that affect breathing?
- midbrain-hypervent
- pontine- apneustic breathing
- medulla-arrest
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Lateral brain herniation causes what
no initial change in LOC
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Central brain herniation causes what?
changes in LOC..death
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basic treatments for encephalopathy
HOB increased and no hypotonic IVF
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What are the 2 kinds of stroke
- ischemic (TIA)
- hemorrhagic
-
what mimics stroke?
hypoglycemia
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parameters to treat, why?
- SBP>220 and DP >120
- sudden drop in BP can reduce blood to brain
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When to treat a CVA with tPA
if onset is < 4 hours, CT - for bleed
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contraindications for tPA
bleed, head trauma within 3 months, sx within 2 weeks, GI bleed
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what is the max for tPA?
90mg
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ss of aneurysm rupture
explosive headache, nuchal rigidity, change in LOC
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treatment for vasospasms
- hypervolemia to keep cvp 10
- hemodilution to keep hct 30%
- hypertension to keep SBP 160-200
- AVOID HYPOTENSION
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what is an AV malformation?
- congenital tight tangle of vessels that shunts
- possible ss are seizures
-
AV malformation tx
sx, radiation, embolization
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ICP normal level
0-10mmHg
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Brain perfusion pressure or CPP range
- 60-80
- less than 30 is brain dead
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how to lower ICP
mannitol, furosemide
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What is Romberg's Test?
- pt standing with eyes closed
- abnormal if pt loses balance
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What is Websters test
- tuning fork at mid skull
- abnormal if hears sounds diff
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