CEN7_Neurological Endocrine

NEUROLOGICAL EMERGENCIES
Objectives:
At the completion of this section, the learner will be able to:
 Differentiate between early and late signs of increased intracranial pressure
 Discuss care of the patient with a basilar skull fracture
 Define autonomic dysreflexia
 Recognize medications used in the treatment of seizures
 Verbalize discharge instructions that should be provided to patients with Myasthenia Gravis
The CEN exam contains fifteen questions on neurological emergencies which involve the following topics:
 Alzheimer’s Disease/Dementia
 Chronic Neurological Disorders (e.g. Multiple Sclerosis, Myasthenia Gravis)
 Guillain-Barre Syndrome
 Headache (including temporal arteritis, migraine)
 Increased intracranial pressure
 Meningitis
 Seizure disorders
 Shunt Dysfunctions
 Spinal cord injuries
 Stroke (e.g. Ischemic or hemorrhagic)
 Transient Ischemic attack (TIA)
 Trauma
 Increased intracranial pressure (ICP)
 Cranial Vault consists of three constituents: brain, cerebral spinal fluid (CSF) and blood.
 Normal ICP: 0 - 15 mm Hg
 Elevated ICP: > 20 mm Hg
 Extremely high ICP may lead to herniation of the brain.
 Clinical Manifestations of increased intracranial pressure: EARLY SIGNS (Increased ICP) LATE SIGNS (Herniation) Level of Consciousness
More stimulation required to get same response
Arousable only with deep pain or unarousable Pupils
Sluggish response to light
Fixed or dilated Motor Function
Loss of one or more grades on the strength scale
Posturing or no response Vital Signs
Tachycardia, hypertensive swings
Cushing’s response
 Treatment
 Reduce ICP by reducing the constituents of the skull: Brain Blood CSF Fluid
 Diuretics
 Hypertonic solutions
 Patient position
 Maintain normothermia
 Prevent/ treat seizures
 Reduce noxious stimuli
 Suctioning
 Surgical decompression
 CSF drainage catheter