neurologic emergencies

rapidly developing disturbance of cerebral fx lasting longer than 24 h

acute episodes of focal loss of cerebral fx lasting <24 h

• 1. occlusive
• large vessel
• small vessel
• emblic
• inadequate blood flow

• 2. hemorrhagic
• hypertensive
• SAH
• AVM
• henorrhagic metastises
• venous infarction
• arteritis
• bleeding diastheses

• age
• hypertension
• diabetes
• smoking
• afib/cardiomyopathy/valve dz
• cad/hyperlipidemia
• obesity/inactivity
• OCP use

o- when did it start

p- what was pt doing

q- what sxs developed

r-

s- symptoms associated, headache, chest pain, palpitations, vision changes, weakness, numbness, swollowing or speech problems, involuntary movements, loc, incontinence

t-

• pmh- recent surgeries, trauma, infections
• meds
• drug use

• vs- often occur in setting of hypotensiona nd hypertension
• heent- temporal artery tenderness may be present in elderly w temporal arteritis
• neck- nuchal rigidity, caritid bruit
• heart- arrhythmia, murmur
• lung-
• extremities- stigmata of endocarditis(splinter hemorrhages,janeway lesions, osler nodes), hemorrhagic diasthesis, and/or vasculitis
• neuro-
• MS-level of consciousness, orientation, memory, naming, speech, understanding, reading, writing, copying
• CN- including fundiscopic and visual field impairment
• Motor- strength and pronator drift
• DTR-initially hypoactive then hyperactive, babinski
• sensory- pain, temp, light touch, sharp, proprioception(rhomberg)
• cerebellar-balance, heel to shin, finger to nose and gait

blood glucose

cbc, lytes, pt/ptt,

uhcg

cxr- eval for infiltrates, cardiomegaly, signs of malignancy

EKG- arrhythmia,cardiomegaly, ischemia, (both SAH and ischemic stroke can cause peaked t waves, st segment changes, qt interval changes)

NonContrast CT- primarily to r/o hemorrhage or mass effect. ischemia will not usually show up for 24-48 hours. repeat imaging in 7-10 days may furhter define. sensitivity for SAH is 95% if in doubt do LP.

MRI-perferred over CT for brain stem stroke, subacute hematoma, demyelinating diseases, AVMs.

• optional tests
• ESR-manditory in those > 50 w HA or transient vision loss
• LP-if meningitis or SAH suspected
• carotiod doppler
• echocardiography
• angiography
• MRA
• RPR,LYME,toxicology, antithrombinIII, protein c, protein s, anticardiolipin antibody, blood cultures(endocarditis)

ABC- oxygen, IV, Monitor

do not lower bp unless >220 systolic in hemorrhagic stroke or >120 diastolic in in occlusive stroke. >180 systolic in SAH.

get neurology/neurosurgery consult/transfer early

do frequent neuro checks