CEN7 Neurological & Endocrine Guide: Symptoms, Diagnosis & Treatment

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

 Pupil                                        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

Vital signs                                Tachycardia, hypertensive swings                                                  Cushing’s response