EXAM 3 STUDY GUIDE
Unit 7: Neurological Disorders
Built from instructor lecture transcript: SP26 Unit 7 Neuro Lecture
EXAM ALERT / IMPORTANT TO REMEMBER
GCS decrease of 2 or more points = significant neuro change / priority.
Any change in level of consciousness is reportable; LOC is usually the first sign of deterioration.
Cushing triad = severe hypertension + bradycardia + widened pulse pressure. This is a late sign of increased ICP.
C3-C5 keeps the diaphragm alive. Cervical injury = respiratory assessment priority.
Fever + chills + nuchal rigidity = droplet precautions immediately until meningitis is ruled out.
For increased ICP, avoid clustering care; keep environment calm/quiet; hyperoxygenate before and after
suctioning.
How to Use This Guide
Red/bold Exam Alerts are points the instructor repeated, emphasized, or linked to priority care.
Focus on recognition cues: GCS changes, pupil changes, Cushing triad, ICP signs, meningitis precautions, spinal
shock vs neurogenic shock.
For exam questions, think: ABCs first, then neuro deterioration, then prevention of secondary injury.
1. Neurologic Assessment and Diagnostic Testing
Neurologic assessment covers the brain, spinal cord, cranial nerves, peripheral nerves, movement, sensation, pupils,
and level of consciousness.
Diagnostic tools mentioned: CT, MRI, X-ray, EEG, blood cultures for infection/sepsis/meningitis, muscle and nerve
biopsies, and physical assessment.
Physical assessment tools: Glasgow Coma Scale (GCS), pupil assessment, motor response, sensation, gait/balance,
and cranial nerve findings.
EXAM ALERT / IMPORTANT TO REMEMBER
Pupil assessment matters because optic nerve findings can show what is happening in the brain.
Do not check only one pupil; compare shape, symmetry, and movement of both pupils.
2. Glasgow Coma Scale (GCS)
Best score = 15. Lowest score = 3. A normal awake/oriented patient should be 15.
Instructor memory tricks: eye opening = 4 points (“glasses = four eyes”); verbal = 5 points; motor = 6 points (“V6
motor”).
GCS Area High Score What High Score Means Low/Concerning Findings
Eye opening 4 Eyes open spontaneously. Opens only to speech, pain,
or not at all.
Verbal response 5 Oriented: knows Confused words,
name/place/situation/time/president- inappropriate words,
type questions. incomprehensible sounds, or
no response.
Motor response 6 Obeys commands: squeeze hands, Localizes pain, withdraws
raise arm, etc. from pain, abnormal flexion,
extension, or no response.
EXAM ALERT / IMPORTANT TO REMEMBER
A drop of 2 or more GCS points is a big neuro difference and needs quick action.
Severe GCS patients are usually not discharge teaching patients; mild/moderate may require education and
Exam 3 Neuro Study Guide - Unit 7 Lecture
, monitoring.
Motor Response to Pain: Know the Difference
Finding Meaning / How to Recognize It Priority Meaning
Localizes pain Apply nail-bed pressure; patient reaches Higher motor response than simple
with the opposite hand to knock your hand withdrawal.
away.
Withdraws from pain Patient pulls back from pain, like pulling Innate reflex; less purposeful than
hand off a hot stove. localizing.
Decorticate posturing Arms/hands flex inward toward the core; Bad brain injury; sign of increased
legs/toes extend. “Core = decorticate.” ICP/herniation risk.
Decerebrate posturing Arms extend outward/external; legs/toes Worse than decorticate; more ominous
extend. “All the E’s = external.” sign of brain herniation.
3. Traumatic Brain Injury (TBI)
TBI can be direct or indirect, open or closed, blunt or penetrating, focal or diffuse, hemorrhagic or non-hemorrhagic,
and primary or secondary.
Brains are different: one person may have severe deficits from an injury while another may not show the same effect.
Falls are a major problem in older adults, especially because of anticoagulants, comorbidities, delayed symptoms,
slower healing, and living alone.
Older adults have brain atrophy/shrinkage, leaving more space in the skull. This allows more bleeding/swelling before
signs appear, so presentation can be delayed and then suddenly severe.
EXAM ALERT / IMPORTANT TO REMEMBER
Geriatric falls with head injury are high risk even if symptoms are delayed.
Anticoagulant use + head trauma = higher risk for brain bleed.
Types of Brain Bleeds/Injuries
Type Instructor Cue / Description Exam Clue
Subdural hematoma Bleeding below the dura; often crescent- Common with falls/elderly; delayed
shaped because it follows the skull. symptoms possible.
Epidural hematoma Bleeding above the dura; swells outward Can worsen quickly.
and does not take the crescent shape.
Subarachnoid hemorrhage Bleeding below arachnoid layer; can look Think “arachnoid = spider-like.”
spider-like on imaging.
Intracerebral hemorrhage Bleeding inside the brain tissue. Neuro deficits depend on location.
Diffuse axonal injury Diffuse damage/shearing of nerve axons. Widespread brain injury; often severe.
Contusion Brain bruise; structural injury visible on May occur with coup-contrecoup and skull
imaging. fracture.
Coup vs Contrecoup
Coup: brain injury occurs at the site of impact.
Contrecoup: brain moves and hits the opposite side of the skull after the initial impact.
Example: car crash - head moves forward and hits the front, then snaps back and injures the opposite side.
Primary vs Secondary Brain Injury
Type When It Happens Examples / Meaning
Primary brain injury At the time of injury. Open head injury, skull fracture, direct
traumatic damage.
Secondary brain injury After the initial injury and worsens Anoxic brain injury, hypoxia, ischemia,
outcome. swelling, post-concussive syndrome.
EXAM ALERT / IMPORTANT TO REMEMBER
Anoxic brain injury = lack of oxygen to the brain and is a classic secondary brain injury.
Exam 3 Neuro Study Guide - Unit 7 Lecture
Unit 7: Neurological Disorders
Built from instructor lecture transcript: SP26 Unit 7 Neuro Lecture
EXAM ALERT / IMPORTANT TO REMEMBER
GCS decrease of 2 or more points = significant neuro change / priority.
Any change in level of consciousness is reportable; LOC is usually the first sign of deterioration.
Cushing triad = severe hypertension + bradycardia + widened pulse pressure. This is a late sign of increased ICP.
C3-C5 keeps the diaphragm alive. Cervical injury = respiratory assessment priority.
Fever + chills + nuchal rigidity = droplet precautions immediately until meningitis is ruled out.
For increased ICP, avoid clustering care; keep environment calm/quiet; hyperoxygenate before and after
suctioning.
How to Use This Guide
Red/bold Exam Alerts are points the instructor repeated, emphasized, or linked to priority care.
Focus on recognition cues: GCS changes, pupil changes, Cushing triad, ICP signs, meningitis precautions, spinal
shock vs neurogenic shock.
For exam questions, think: ABCs first, then neuro deterioration, then prevention of secondary injury.
1. Neurologic Assessment and Diagnostic Testing
Neurologic assessment covers the brain, spinal cord, cranial nerves, peripheral nerves, movement, sensation, pupils,
and level of consciousness.
Diagnostic tools mentioned: CT, MRI, X-ray, EEG, blood cultures for infection/sepsis/meningitis, muscle and nerve
biopsies, and physical assessment.
Physical assessment tools: Glasgow Coma Scale (GCS), pupil assessment, motor response, sensation, gait/balance,
and cranial nerve findings.
EXAM ALERT / IMPORTANT TO REMEMBER
Pupil assessment matters because optic nerve findings can show what is happening in the brain.
Do not check only one pupil; compare shape, symmetry, and movement of both pupils.
2. Glasgow Coma Scale (GCS)
Best score = 15. Lowest score = 3. A normal awake/oriented patient should be 15.
Instructor memory tricks: eye opening = 4 points (“glasses = four eyes”); verbal = 5 points; motor = 6 points (“V6
motor”).
GCS Area High Score What High Score Means Low/Concerning Findings
Eye opening 4 Eyes open spontaneously. Opens only to speech, pain,
or not at all.
Verbal response 5 Oriented: knows Confused words,
name/place/situation/time/president- inappropriate words,
type questions. incomprehensible sounds, or
no response.
Motor response 6 Obeys commands: squeeze hands, Localizes pain, withdraws
raise arm, etc. from pain, abnormal flexion,
extension, or no response.
EXAM ALERT / IMPORTANT TO REMEMBER
A drop of 2 or more GCS points is a big neuro difference and needs quick action.
Severe GCS patients are usually not discharge teaching patients; mild/moderate may require education and
Exam 3 Neuro Study Guide - Unit 7 Lecture
, monitoring.
Motor Response to Pain: Know the Difference
Finding Meaning / How to Recognize It Priority Meaning
Localizes pain Apply nail-bed pressure; patient reaches Higher motor response than simple
with the opposite hand to knock your hand withdrawal.
away.
Withdraws from pain Patient pulls back from pain, like pulling Innate reflex; less purposeful than
hand off a hot stove. localizing.
Decorticate posturing Arms/hands flex inward toward the core; Bad brain injury; sign of increased
legs/toes extend. “Core = decorticate.” ICP/herniation risk.
Decerebrate posturing Arms extend outward/external; legs/toes Worse than decorticate; more ominous
extend. “All the E’s = external.” sign of brain herniation.
3. Traumatic Brain Injury (TBI)
TBI can be direct or indirect, open or closed, blunt or penetrating, focal or diffuse, hemorrhagic or non-hemorrhagic,
and primary or secondary.
Brains are different: one person may have severe deficits from an injury while another may not show the same effect.
Falls are a major problem in older adults, especially because of anticoagulants, comorbidities, delayed symptoms,
slower healing, and living alone.
Older adults have brain atrophy/shrinkage, leaving more space in the skull. This allows more bleeding/swelling before
signs appear, so presentation can be delayed and then suddenly severe.
EXAM ALERT / IMPORTANT TO REMEMBER
Geriatric falls with head injury are high risk even if symptoms are delayed.
Anticoagulant use + head trauma = higher risk for brain bleed.
Types of Brain Bleeds/Injuries
Type Instructor Cue / Description Exam Clue
Subdural hematoma Bleeding below the dura; often crescent- Common with falls/elderly; delayed
shaped because it follows the skull. symptoms possible.
Epidural hematoma Bleeding above the dura; swells outward Can worsen quickly.
and does not take the crescent shape.
Subarachnoid hemorrhage Bleeding below arachnoid layer; can look Think “arachnoid = spider-like.”
spider-like on imaging.
Intracerebral hemorrhage Bleeding inside the brain tissue. Neuro deficits depend on location.
Diffuse axonal injury Diffuse damage/shearing of nerve axons. Widespread brain injury; often severe.
Contusion Brain bruise; structural injury visible on May occur with coup-contrecoup and skull
imaging. fracture.
Coup vs Contrecoup
Coup: brain injury occurs at the site of impact.
Contrecoup: brain moves and hits the opposite side of the skull after the initial impact.
Example: car crash - head moves forward and hits the front, then snaps back and injures the opposite side.
Primary vs Secondary Brain Injury
Type When It Happens Examples / Meaning
Primary brain injury At the time of injury. Open head injury, skull fracture, direct
traumatic damage.
Secondary brain injury After the initial injury and worsens Anoxic brain injury, hypoxia, ischemia,
outcome. swelling, post-concussive syndrome.
EXAM ALERT / IMPORTANT TO REMEMBER
Anoxic brain injury = lack of oxygen to the brain and is a classic secondary brain injury.
Exam 3 Neuro Study Guide - Unit 7 Lecture
