Medical Block Study Guide
Neurological Emergencies
Stroke Symptoms
Ischemic Stroke- ischemic stroke (occlusive stroke) caused by an occlusion or blockage in a blood vessel due to thrombus or
embolus.
➢ Blood vessel becomes blocked, lack of blood flow beyond the blockage.
➢ Tissue will eventually die, becoming ischemic.
➢ Severity depends on the artery involved and the portion of the brain deprived of oxygen.
➢ Typically, a more gradual onset.
➢ 87% of strokes.
Hemorrhagic Stroke- caused by bleeding within the cranium, leading to increased ICP and brainstem herniation.
➢ “Worst headache of my life”.
➢ Presents with severe headache and signs of increased ICP.
➢ Skull contains three substances exerting pressure: brain tissue, blood and CSF.
➢ When ICP rises and remains high, the brain can become ischemic as cerebral perfusion pressure falls.
➢ Herniation may occur, intracranial contents toward the foremen magnum, compressing the brainstem and loss of
autonomic functions.
➢ Large vessel occlusion from blockages in major brain arteries can lead to significant brain function disruptions.
Stoke Assessment
➢ Stoke causes sudden-onset changes in neurological status. S/S include:
o Slurred speech, aphasia (inability to speak), agnosia (inability to recognize objects), apraxia (inability to
perform movement or tasks).
o Hemiparesis (weakness), hemiplegia (paralysis), arm drift, facial droop, ptosis.
o Headache, sudden blindness, weakness on side.
o Decreased LOC, seizures, coma.
o Hypertension.
➢ BE-FAST
o B- Balance (loss of balance/coordination)
o E- Eyesight (loss of vision in one/both eyes)
o F- Face (facial droop)
o A- Arms (arm drift or weakness)
o S- Speech (impairment or inability)
o T- Time (Time last known well)
Head Bleeds and Increased ICP
➢ Evidence of Herniation:
➢ Cushing Triad (bradycardia, high systolic pressure, irregular respiration)
OR
➢ Unresponsive Patient with bilateral dilated pupils and decebrate posturing with no motor response to painful stimuli
Management
➢ Patient who are unresponsive and demonstrate other signs of increased ICP, administer fluids to maintain SBP of 110.
Ventilate to an ETCO2 of 30-35.
➢ A high CO2 level causes vasodilation of the cerebral arteries, this allows more blood into the skull, increasing ICP.
➢ Ensure the airway is clear but do not vigorously suction to stimulate gagging which may increase ICP.
➢ Atropine and pacing are not indicated in patients that have systolic hypertension that accompanies bradycardia.
➢ Supplemental oxygen is not recommended for no hypoxia patients experiencing an acute ischemic stroke. If needed,
94% or greater.
, ➢ Fibrinolytic given 3-4.5hrs from onset of ischemic stroke.
TIA (Transient Ischemic Attack)- temporary interference with blood supply to the brain (mini stroke)
➢ No evidence of residual brain or neurological damage.
➢ Lasts for minutes to hours, but symptoms fully resolve in 24 hours.
Head Bleeds
Intracerebral Hemorrhage
➢ Location: Bleeding occurs within the brain tissue.
➢ Causes: Often due to hypertension, trauma, or vascular malformations.
➢ Symptoms: Similar to other types of strokes but may include focal neurological deficits depending on the bleed’s
location.
Subarachnoid Hemorrhage
➢ Location: Bleeding occurs in the subarachnoid space, which is the area between the brain and the tissues covering
the brain.
➢ Causes: Commonly caused by the rupture of an aneurysm.
➢ Symptoms: Sudden, severe headache, neck pain or stiffness, photophobia (sensitivity to light), and loss of
consciousness.
Epidural Hematoma
➢ Location: Blood accumulates between the dura mater and the skull.
➢ Causes: Typically associated with trauma.
➢ Symptoms: Patients may experience a “lucid interval” followed by a rapid decline in mental status.
Subdural Hematoma
➢ Location: Blood gathers between the dura mater and the brain.
➢ Causes: Often result from head injury, especially in elderly patients who may experience a slow bleed.
➢ Symptoms: Symptoms can develop slowly over days or weeks and include headache, confusion, and varying degrees
of neurological impairment
Cranial Nerves
“On Occasion Our Trusty Truck Acts Funny Very Good Vehicle Any How”
➢ 1/I- Olfactory- Smell
➢ 2/II- Optic- vision
➢ 3/III- Oculomotor- Movement of the eye, pupil and eyelid
➢ 4/IV- Trochlear- Movement of eye
➢ 5/V- Trigeminal- Chewing, pain, temperature, touch of the mouth and face
➢ 6/VI- Abducens- Movement of the eye
➢ 7/VII- Facial- Movement of the face, tears, salivation and taste
➢ 8/VIII- Vestibulocohlear- Hearing and balance
➢ 9/IX- Glossopharyngeal- Swallowing, taste, and sensations in the mouth/pharynx
➢ 10/X- Vagus- Sensation and movement of the pharynx, larynx, thorax, and GI system (PNS)
➢ 11/XI- Accessory- Movement of the head and shoulders
➢ 12/XII- Hypoglossal- Movement of the tongue
Cranial Nerve Disorder
➢ Acoustic Neuroma- tumor at the base of the brain
o Cranial Nerve Affected: VIII/8 (Vestibulocochlear) or VII/7 (Facial Nerve)
, o Symptoms: Hearing loss, Tinnitus, Balance, Vertigo, Headache, Facial Numbness.
➢ Bell Palsy- often follows viral infections, sudden and temporary paralysis of one side of the face.
o Cranial Nerve Affected: VII/7 (Facial Nerve)
o Symptoms: Facial muscle paralysis, drooping, inability to close the eye, decreased tearing, loss of taste,
hyperacusis.
➢ Glossopharyngeal Neuralgia- Severe pain on one side of the throat, stabbing, sharp, electric like pain.
o Cranial Nerve Affected: IX/9 (Glossopharyngeal nerve)
o Symptoms: Feeling of something stuck in throat, pain radiates around mouth or is spontaneous.
➢ Hemifacial Spasm- Involuntary, irregular, and recurring contractions of the muscles on one side of the face. Usually
caused by irritation of the facial nerve, often due to blood vessels pressing on the nerve.
o Cranial Nerve Affected: VII/7 (Facial Nerve)
o Symptoms: Muscle twitches, continuous muscle contractions, facial tightness, eye closure.
➢ Meniere Disease- Abnormal fluid buildup in the ear that affects balance and hearing.
o Cranial Nerve Affected: VIII/8 (Vestibulocochlear Nerve)
o Symptoms: Vertigo, hearing loss, Tinnitus, Pressure in the ear.
➢ Trigeminal Neuralgia (Tic Douloureux)- Chronic pain condition on one side of the face.
o Cranial Nerve Affected: V/5 (Trigeminal Nerve)
o Symptoms: Severe facial pain, often triggered by light touch, chewing, or speaking.
➢ Guillain-Barré Syndrome (GBS): Immune System attacks portions of the nervous system.
o Cranial Nerves Affected: Often VII (Facial Nerve), IX (Glossopharyngeal Nerve), X (Vagus Nerve)
o Symptoms: Weakness moves from legs to thorax resulting in paralysis, manage with ETCO2 readings, fluid to
maintain BP and bradycardia using AHA guidelines.
➢ Myasthenia Gravis:
o Cranial Nerves Affected: III (Oculomotor Nerve), IV (Trochlear Nerve), VI (Abducens Nerve), VII (Facial Nerve)
o Symptoms: Ptosis, diplopia, facial weakness, difficulty swallowing.
➢ Parkinson's Disease: neurological condition in which the environmental and genetic factors can place patients at
risk for damage to strain neurons.
o Cranial Nerves Affected: Indirectly affects III (Oculomotor Nerve), VII (Facial Nerve)
o Symptoms: Resting tremor, bradykinesia, rigidity, decreased facial expressions.
➢ Amyotrophic Lateral Sclerosis (ALS) (Lou Gehrig’s Disease): progressive neurodegenerative disorder that affects
the nerve cells in the brain and spinal cord controlling voluntary muscle movement.
o Cranial Nerves Affected: V (Trigeminal Nerve), VII (Facial Nerve), IX (Glossopharyngeal Nerve), X (Vagus
Nerve), XII (Hypoglossal Nerve)
o Symptoms: Progressive muscle weakness, difficulty speaking, swallowing, and breathing.
➢ Multiple Sclerosis (MS): autoimmune condition in which the body attacks the myelin of the brain and spinal cord,
immune system is no longer able to distinguish friend from foe.
o Cranial Nerves Affected: Often II (Optic Nerve), V (Trigeminal Nerve)
o Symptoms: Visual disturbances, sensory and motor impairments.
, Cerebral Inflammation/Infection
Encephalitis:
➢ Definition: Encephalitis is an inflammation of the brain tissue, often due to an infection or an autoimmune process.
➢ Causes: Most commonly caused by viral infections (such as herpes simplex virus, enteroviruses, or arboviruses), but
can also be due to bacterial infections, autoimmune diseases, or post-infectious immune responses.
➢ S/S:
➢ Fever, headache, N/V, general malaise.
➢ Progress into ALOC, including behavioral and personality, stiff neck, lethargy, confusion and seizure.
Bacterial Meningitis
➢ Definition: Bacterial meningitis is a serious and potentially life-threatening infection of the meninges caused by
bacteria.
➢ Causes: Common pathogens include Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae,
and Listeria monocytogenes.
➢ S/S
➢ Upper respiratory infection (runny nose, cough and malaise).
➢ Progress into headache, nuchal rigidity (stiff neck), fever. Classic triad of symptoms.
➢ Chills, vomiting, seizure, confusion, Kernig sign, brudzinski sign and increased ICP.
Viral Meningitis
➢ Definition: Viral meningitis, also known as aseptic meningitis, is an inflammation of the membranes (meninges)
covering the brain and spinal cord caused by viral infections.
➢ Causes: Common viruses include enteroviruses, herpes simplex virus, varicella-zoster virus, and mumps virus.
➢ S/S
➢ Fever, headache, stiff neck, photophobia (sensitivity to light), and sometimes mild confusion or lethargy. It is usually
less severe than bacterial meningitis.
➢ Viral meningitis does not cause increased ICP.
Decreased LOC
AEIOUTIPS
➢ Any time there is a decreased LOC use this mnemonic:
➢ A-Alcohol
➢ A-Acidosis (tachypnea/hyperpnea) (ventilation/Sodium Bicarbonate)
➢ E-Epilepsy
➢ E- Endocrine (thyroid, increased/decreased metabolism)
➢ E- Electrolytes (dehydration, renal/liver failure, ECG changes) (volume)
➢ I- Insulin (diaphoresis, tachy) (dextrose or glucagon)
➢ O- Opiates (pinpoint pupils, decrease LOC, bradypnea, cyanosis) (Narcan)
➢ U- Uremia (N/V, uremic frost, cramping, pulmonary edema, dysrhythmias) (O2, BGL, Temp)
➢ T- Trauma (ALOC, head injury, hypotension) (c-spine, fluid)
➢ T- Temperature (Exertional, environmental or endocrine)
➢ I- Infection (fever, rash, malaise) (fluids)
➢ P- Poisoning (pills, chemicals, pesticides)
➢ P- Psychogenic Causes (delusions, hallucinations, bizarre behavior) (restraints/sedation)
➢ S- Shock (decreased BP, signs of hypoperfusion) (volume/vasopressors)
➢ S- Stroke (FAST)
➢ S- Syncope (weakness, loss of vision, LOC) (volume, cardiac rhythm, trauma)
➢ S- Subarachnoid Hemorrhage (thunderclap headache, S/S of stroke or seizure)
Neurological Emergencies
Stroke Symptoms
Ischemic Stroke- ischemic stroke (occlusive stroke) caused by an occlusion or blockage in a blood vessel due to thrombus or
embolus.
➢ Blood vessel becomes blocked, lack of blood flow beyond the blockage.
➢ Tissue will eventually die, becoming ischemic.
➢ Severity depends on the artery involved and the portion of the brain deprived of oxygen.
➢ Typically, a more gradual onset.
➢ 87% of strokes.
Hemorrhagic Stroke- caused by bleeding within the cranium, leading to increased ICP and brainstem herniation.
➢ “Worst headache of my life”.
➢ Presents with severe headache and signs of increased ICP.
➢ Skull contains three substances exerting pressure: brain tissue, blood and CSF.
➢ When ICP rises and remains high, the brain can become ischemic as cerebral perfusion pressure falls.
➢ Herniation may occur, intracranial contents toward the foremen magnum, compressing the brainstem and loss of
autonomic functions.
➢ Large vessel occlusion from blockages in major brain arteries can lead to significant brain function disruptions.
Stoke Assessment
➢ Stoke causes sudden-onset changes in neurological status. S/S include:
o Slurred speech, aphasia (inability to speak), agnosia (inability to recognize objects), apraxia (inability to
perform movement or tasks).
o Hemiparesis (weakness), hemiplegia (paralysis), arm drift, facial droop, ptosis.
o Headache, sudden blindness, weakness on side.
o Decreased LOC, seizures, coma.
o Hypertension.
➢ BE-FAST
o B- Balance (loss of balance/coordination)
o E- Eyesight (loss of vision in one/both eyes)
o F- Face (facial droop)
o A- Arms (arm drift or weakness)
o S- Speech (impairment or inability)
o T- Time (Time last known well)
Head Bleeds and Increased ICP
➢ Evidence of Herniation:
➢ Cushing Triad (bradycardia, high systolic pressure, irregular respiration)
OR
➢ Unresponsive Patient with bilateral dilated pupils and decebrate posturing with no motor response to painful stimuli
Management
➢ Patient who are unresponsive and demonstrate other signs of increased ICP, administer fluids to maintain SBP of 110.
Ventilate to an ETCO2 of 30-35.
➢ A high CO2 level causes vasodilation of the cerebral arteries, this allows more blood into the skull, increasing ICP.
➢ Ensure the airway is clear but do not vigorously suction to stimulate gagging which may increase ICP.
➢ Atropine and pacing are not indicated in patients that have systolic hypertension that accompanies bradycardia.
➢ Supplemental oxygen is not recommended for no hypoxia patients experiencing an acute ischemic stroke. If needed,
94% or greater.
, ➢ Fibrinolytic given 3-4.5hrs from onset of ischemic stroke.
TIA (Transient Ischemic Attack)- temporary interference with blood supply to the brain (mini stroke)
➢ No evidence of residual brain or neurological damage.
➢ Lasts for minutes to hours, but symptoms fully resolve in 24 hours.
Head Bleeds
Intracerebral Hemorrhage
➢ Location: Bleeding occurs within the brain tissue.
➢ Causes: Often due to hypertension, trauma, or vascular malformations.
➢ Symptoms: Similar to other types of strokes but may include focal neurological deficits depending on the bleed’s
location.
Subarachnoid Hemorrhage
➢ Location: Bleeding occurs in the subarachnoid space, which is the area between the brain and the tissues covering
the brain.
➢ Causes: Commonly caused by the rupture of an aneurysm.
➢ Symptoms: Sudden, severe headache, neck pain or stiffness, photophobia (sensitivity to light), and loss of
consciousness.
Epidural Hematoma
➢ Location: Blood accumulates between the dura mater and the skull.
➢ Causes: Typically associated with trauma.
➢ Symptoms: Patients may experience a “lucid interval” followed by a rapid decline in mental status.
Subdural Hematoma
➢ Location: Blood gathers between the dura mater and the brain.
➢ Causes: Often result from head injury, especially in elderly patients who may experience a slow bleed.
➢ Symptoms: Symptoms can develop slowly over days or weeks and include headache, confusion, and varying degrees
of neurological impairment
Cranial Nerves
“On Occasion Our Trusty Truck Acts Funny Very Good Vehicle Any How”
➢ 1/I- Olfactory- Smell
➢ 2/II- Optic- vision
➢ 3/III- Oculomotor- Movement of the eye, pupil and eyelid
➢ 4/IV- Trochlear- Movement of eye
➢ 5/V- Trigeminal- Chewing, pain, temperature, touch of the mouth and face
➢ 6/VI- Abducens- Movement of the eye
➢ 7/VII- Facial- Movement of the face, tears, salivation and taste
➢ 8/VIII- Vestibulocohlear- Hearing and balance
➢ 9/IX- Glossopharyngeal- Swallowing, taste, and sensations in the mouth/pharynx
➢ 10/X- Vagus- Sensation and movement of the pharynx, larynx, thorax, and GI system (PNS)
➢ 11/XI- Accessory- Movement of the head and shoulders
➢ 12/XII- Hypoglossal- Movement of the tongue
Cranial Nerve Disorder
➢ Acoustic Neuroma- tumor at the base of the brain
o Cranial Nerve Affected: VIII/8 (Vestibulocochlear) or VII/7 (Facial Nerve)
, o Symptoms: Hearing loss, Tinnitus, Balance, Vertigo, Headache, Facial Numbness.
➢ Bell Palsy- often follows viral infections, sudden and temporary paralysis of one side of the face.
o Cranial Nerve Affected: VII/7 (Facial Nerve)
o Symptoms: Facial muscle paralysis, drooping, inability to close the eye, decreased tearing, loss of taste,
hyperacusis.
➢ Glossopharyngeal Neuralgia- Severe pain on one side of the throat, stabbing, sharp, electric like pain.
o Cranial Nerve Affected: IX/9 (Glossopharyngeal nerve)
o Symptoms: Feeling of something stuck in throat, pain radiates around mouth or is spontaneous.
➢ Hemifacial Spasm- Involuntary, irregular, and recurring contractions of the muscles on one side of the face. Usually
caused by irritation of the facial nerve, often due to blood vessels pressing on the nerve.
o Cranial Nerve Affected: VII/7 (Facial Nerve)
o Symptoms: Muscle twitches, continuous muscle contractions, facial tightness, eye closure.
➢ Meniere Disease- Abnormal fluid buildup in the ear that affects balance and hearing.
o Cranial Nerve Affected: VIII/8 (Vestibulocochlear Nerve)
o Symptoms: Vertigo, hearing loss, Tinnitus, Pressure in the ear.
➢ Trigeminal Neuralgia (Tic Douloureux)- Chronic pain condition on one side of the face.
o Cranial Nerve Affected: V/5 (Trigeminal Nerve)
o Symptoms: Severe facial pain, often triggered by light touch, chewing, or speaking.
➢ Guillain-Barré Syndrome (GBS): Immune System attacks portions of the nervous system.
o Cranial Nerves Affected: Often VII (Facial Nerve), IX (Glossopharyngeal Nerve), X (Vagus Nerve)
o Symptoms: Weakness moves from legs to thorax resulting in paralysis, manage with ETCO2 readings, fluid to
maintain BP and bradycardia using AHA guidelines.
➢ Myasthenia Gravis:
o Cranial Nerves Affected: III (Oculomotor Nerve), IV (Trochlear Nerve), VI (Abducens Nerve), VII (Facial Nerve)
o Symptoms: Ptosis, diplopia, facial weakness, difficulty swallowing.
➢ Parkinson's Disease: neurological condition in which the environmental and genetic factors can place patients at
risk for damage to strain neurons.
o Cranial Nerves Affected: Indirectly affects III (Oculomotor Nerve), VII (Facial Nerve)
o Symptoms: Resting tremor, bradykinesia, rigidity, decreased facial expressions.
➢ Amyotrophic Lateral Sclerosis (ALS) (Lou Gehrig’s Disease): progressive neurodegenerative disorder that affects
the nerve cells in the brain and spinal cord controlling voluntary muscle movement.
o Cranial Nerves Affected: V (Trigeminal Nerve), VII (Facial Nerve), IX (Glossopharyngeal Nerve), X (Vagus
Nerve), XII (Hypoglossal Nerve)
o Symptoms: Progressive muscle weakness, difficulty speaking, swallowing, and breathing.
➢ Multiple Sclerosis (MS): autoimmune condition in which the body attacks the myelin of the brain and spinal cord,
immune system is no longer able to distinguish friend from foe.
o Cranial Nerves Affected: Often II (Optic Nerve), V (Trigeminal Nerve)
o Symptoms: Visual disturbances, sensory and motor impairments.
, Cerebral Inflammation/Infection
Encephalitis:
➢ Definition: Encephalitis is an inflammation of the brain tissue, often due to an infection or an autoimmune process.
➢ Causes: Most commonly caused by viral infections (such as herpes simplex virus, enteroviruses, or arboviruses), but
can also be due to bacterial infections, autoimmune diseases, or post-infectious immune responses.
➢ S/S:
➢ Fever, headache, N/V, general malaise.
➢ Progress into ALOC, including behavioral and personality, stiff neck, lethargy, confusion and seizure.
Bacterial Meningitis
➢ Definition: Bacterial meningitis is a serious and potentially life-threatening infection of the meninges caused by
bacteria.
➢ Causes: Common pathogens include Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae,
and Listeria monocytogenes.
➢ S/S
➢ Upper respiratory infection (runny nose, cough and malaise).
➢ Progress into headache, nuchal rigidity (stiff neck), fever. Classic triad of symptoms.
➢ Chills, vomiting, seizure, confusion, Kernig sign, brudzinski sign and increased ICP.
Viral Meningitis
➢ Definition: Viral meningitis, also known as aseptic meningitis, is an inflammation of the membranes (meninges)
covering the brain and spinal cord caused by viral infections.
➢ Causes: Common viruses include enteroviruses, herpes simplex virus, varicella-zoster virus, and mumps virus.
➢ S/S
➢ Fever, headache, stiff neck, photophobia (sensitivity to light), and sometimes mild confusion or lethargy. It is usually
less severe than bacterial meningitis.
➢ Viral meningitis does not cause increased ICP.
Decreased LOC
AEIOUTIPS
➢ Any time there is a decreased LOC use this mnemonic:
➢ A-Alcohol
➢ A-Acidosis (tachypnea/hyperpnea) (ventilation/Sodium Bicarbonate)
➢ E-Epilepsy
➢ E- Endocrine (thyroid, increased/decreased metabolism)
➢ E- Electrolytes (dehydration, renal/liver failure, ECG changes) (volume)
➢ I- Insulin (diaphoresis, tachy) (dextrose or glucagon)
➢ O- Opiates (pinpoint pupils, decrease LOC, bradypnea, cyanosis) (Narcan)
➢ U- Uremia (N/V, uremic frost, cramping, pulmonary edema, dysrhythmias) (O2, BGL, Temp)
➢ T- Trauma (ALOC, head injury, hypotension) (c-spine, fluid)
➢ T- Temperature (Exertional, environmental or endocrine)
➢ I- Infection (fever, rash, malaise) (fluids)
➢ P- Poisoning (pills, chemicals, pesticides)
➢ P- Psychogenic Causes (delusions, hallucinations, bizarre behavior) (restraints/sedation)
➢ S- Shock (decreased BP, signs of hypoperfusion) (volume/vasopressors)
➢ S- Stroke (FAST)
➢ S- Syncope (weakness, loss of vision, LOC) (volume, cardiac rhythm, trauma)
➢ S- Subarachnoid Hemorrhage (thunderclap headache, S/S of stroke or seizure)
