Neurology

Sections
 Anatomy & Physiology
 Pathophysiology
 General Assessment Findings
 Management of Nervous System
Emergencies

Anatomy & Physiology
 The Central Nervous System
 The Neuron
 Protective Structures
 The Brain
 The Spinal Cord

Anatomy &
Physiology
 The Neuron

 The Skull

Anatomy &
Physiology
 The Spine

 The Meninges

 The Brain
 Divisions of
the Brain
 Areas of
Specialization

 The Brain
 Vascular
Supply

 The
Spinal
Cord

 The Peripheral Nervous System
 The Autonomic Nervous System
 The Sympathetic Nervous System
“Fight-or-flight”
 The Parasympathetic Nervous System
“Feed-or-breed” or “Rest-and-repair”

Pathophysiology
 Alteration in Cognitive Systems
 CNS Disorders
 Structural Lesions (Tumor, contusions)
 Toxic Metabolic States
 Other Causes
 Cardiovascular
 Respiratory
 Infections
 Drugs

Pathophysiology
 Peripheral Nervous System
Disorders
 Mononeuropathy
 Polyneuropathy

General Assessment
Findings
 Scene Size-up and Initial
Assessment
 AVPU
 General Appearance
 Speech
 Skin & Facial Drooping
 Mood, Thought, Perception, Judgment,
Memory, & Attention

General Assessment
Findings
 Focused History & Physical Exam
 History-Taking
 Trauma-Related
 Underlying Medical Problems
 Environmental Clues
 Physical Exam
 Face, Eyes, Nose, & Mouth

General
Assessment
Findings
 Respiratory Patterns

General Assessment Findings
 Nervous System Status
• Sensorimotor Evaluation
• Motor System & Cranial Nerve Status

General
Assessment
Findings
 Nervous System
Status
• Glasgow Coma
Scale

General Assessment
Findings
 Vital Signs
• Cushing’s Reflex

General Assessment
Findings
 Other Assessment Tools
• End-Tidal CO2 Detector
• Pulse Oximeter
• Blood Glucometer
 Geriatric Considerations in Neurological
Assessment

 Ongoing Assessment

Management of
Neurological Emergencies
 General Principles
 Airway & Breathing
 Circulatory Support
 Pharmacological Intervention
 Psychological Support
 Transport Considerations

Altered Mental Status
 AEIOU-TIPS
 Assessment
 Management
 Initial Assessment
 IV Access
 Treatable Causes
 Hypoglycemia, Narcotic Overdose, Suspected
Alcoholic

Altered Mental Status
 Chronic Alcoholism
 Wernicke’s Syndrome
 Korsakoff’s Psychosis
 Increased Intracranial Pressure
 Hyperventilation
 Mannitol

Stroke & Intracranial
Hemorrhage
 Occlusive Strokes
 Embolic & Thrombotic Strokes
 Hemorrhagic Strokes

Hemorrhage
 Signs  Symptoms
 Facial Drooping  Confusion
 Headache  Agitation
 Aphasia/Dysphasia  Dizziness
 Hemiparesis  Vision Problems
 Hemiplegia
 Paresthesia
 Gait Disturbances
 Incontinence

Hemorrhage
 Transient Ischemic Attacks
 Indicative of carotid artery disease.
 Symptoms of neurological deficit:
 Symptoms resolve in less than 24 hours.
 No long-term effects.
 Evaluate through history taking:
 History of HTN, prior stroke, or TIA.
 Symptoms and their progression.

Hemorrhage
 Management
 Scene safety & BSI
 Maintain the airway.
 Support breathing.
 Obtain a detailed history.
 Position the patient.
 Determine the blood glucose level.
 Establish IV access.
 Monitor the cardiac rhythm.
 Protect paralyzed extremities.

Stroke &
Intracranial
Hemorrhage

Seizures
 Generalized Seizures
 Tonic-Clonic
 Aura
 Loss of Consciousness
 Tonic Phase
 Hypertonic Phase
 Clonic Phase
 Postseizure
 Postictal
 Absence
 Pseudoseizures

Seizures
 Partial Seizures
 Simple Partial Seizures
 Involve one body area.
 Can progress to generalized seizure.
 Complex Partial Seizures
 Characterized by auras.
 Typically 1–2 minutes in length.
 Loss of contact with surroundings.

Seizures
 Assessment
 Differentiating Between Syncope & Seizure
 Bystanders frequently confuse syncope and
seizure.

Seizures
 Patient History
 History of Seizures
 History of Head Trauma
 Any Alcohol or Drug Abuse
 Recent History of Fever, Headache, or Stiff Neck
 History of Heart Disease, Diabetes, or Stroke
 Current Medications
 Phenytoin (Dilantin), phenobarbitol, valproic acid
(Depakote), or carbamazepine (Tegretol)
 Physical Exam
 Signs of head trauma or injury to tongue, alcohol or drug
abuse

Seizures
 Management
 Scene safety & BSI.
 Administer high-flow
oxygen.
 Treat hypoglycemia
if present.
 Do not restrain the
patient.
 Protect the patient
from the
environment.
 Maintain body
temperature.

Seizures
 Management
 Position the
patient.
 Suction if
required.
 Monitor cardiac
rhythm.
 Treat prolonged
seizures.
 Anticonvulsant
medication
 Provide a quiet
atmosphere.
 Transport.

Seizures
 Status Epilepticus
 Two or More Generalized Seizures
 Seizures occur without a return of consciousness.
 Management
 Management of airway and breathing is critical.
 Establish IV access and cardiac monitoring.
 Administer 25g 50% dextrose if hypoglycemia is present.
 Administer 5–10mg diazepam IV.
 Monitor the airway closely.

Syncope
 A Sudden, Temporary Loss of
Consciousness
 Assessment
 Cardiovascular.
 Dysrhythmias or mechanical problems.
 Noncardiovascular.
 Metabolic, neurological, or psychiatric condition.
 Idiopathic.
 The cause remains unknown even after careful assessment.
 Extended unconsciousness is NOT syncope.

Syncope
 Management
 Support breathing.
 Check circulatory status.
 Monitor mental status.
 Determine blood glucose Level.
 Reassure the patient and transport.

Headache
 Types
 Vascular
 Migraines
• Throbbing pain, photosensitivity, nausea, vomiting, and
sweats; more frequent in women
• May last for extended periods of time.
 Cluster
• One-sided with nasal congestion, drooping eyelid, and
irritated or watery eye; more frequent in men
• Typically lasts 1–4 hours.

Headache
 Types
 Tension
 Organic
 Occurs due to tumors, infection, or other diseases
of the brain, eye, or other body system.
 Headaches associated with fever, confusion,
nausea, vomiting, or rash can be indicative of an
infectious disease.

Headache
 Assessment
 What was the patient doing at the onset of
pain?
 Does anything provoke or relieve the pain?
 What is the quality of the pain?
 Does the pain radiate to the neck, arm, back,
or jaw?
 What is the severity of the pain?
 How long has the headache been present?

Headache
 Management
 Scene safety and BSI
 Position the patient.
 Determine blood glucose level.
 Consider medication.
 Antiemetics or analgesics
 Reassure the patient and transport.

“Weak and Dizzy”
 Assessment
 Symptomatic of Many Illnesses
 Focused Assessment
 Include a detailed neurological exam.
 Specific signs and symptoms:
• Nystagmus
• Nausea and vomiting
• Dizziness

“Weak and Dizzy”
 Management
 Maintain airway & administer high-flow oxygen.
 Position of comfort.
 Establish IV access & monitor cardiac rhythm.
 Determine blood glucose level.
 Consider medication.
 Antiemetic
 Transport and reassure patient.

Neoplasms
 Tumors
 Benign
 Malignant
 Assessment
 Signs & Symptoms
 Recurring or severe headaches
 Nausea and vomiting
 Weakness or paralysis
 Lack of coordination or unsteady gait
 Dizziness, double vision
 Seizures without a prior history of seizures

Neoplasms
 History
 Surgery, chemotherapy, radiation therapy, or holistic
therapy
 Experimental treatments

 Management
 Scene size-up and BSI.
 Maintain airway & administer high-flow oxygen.
 Position of comfort.
 Establish IV access and monitor cardiac rhythm.
 Consider medication administration.
 Analgesics, antiseizure meds, anti-inflammatory meds
 Transport and reassure patient.

Brain Abscess
 Abscess
 Collection of Pus
 Assessment
 Signs & Symptoms
 Lethargy, hemiparesis, nuchal rigidity
 Headache, nausea, vomiting, seizures

 Management
 Similar to Neoplasm

Degenerative Neurological
Disorders
 Types of Disorders
 Alzheimer’s Disease
 Most frequent cause of dementia in the elderly.
 Results in atrophy of the brain due to nerve cell death in
the cerebral cortex.
 Muscular Dystrophy
 Characterized by progressive muscle weakness.
 Multiple Sclerosis
 Unpredictable disease resulting from deterioration of the
myelin sheath.
 Dystonias

Disorders
 Parkinson’s Disease
 Tremor, rigidity, bradykinesia, postural instability
 Central Pain Syndrome
 Bell’s Palsy
 Amytrophic Lateral Sclerosis
 Myoclonus
 Spina Bifida
 Poliomyelitis

Disorders
 Assessment
 Obtain history.
 Exacerbation of chronic illness or new problem?
 Management
 Special considerations
 Mobility, communication, respiratory compromise, and
anxiety
 Interventions
 Determine blood glucose level.
 Establish IV access.
 Monitor cardiac rhythm.
 Transport and reassure the patient.

Back Pain & Nontraumatic
Spinal Disorders
 Low Back Pain
 Causes
 Disk Injury
 Vertebral Injury
 Cysts & Tumors
 Other Causes

Back Pain & Nontraumatic
Spinal Disorders
 Assessment
 Evaluate history.
 Speed of onset.
 Risk factors such as vibration or repeated lifting.
 Determine if pain is related to a life-threatening problem.

 Management
 Consider c-spine.
 Immobilize if in doubt.
 Consider analgesics.

Summary
 Anatomy & Physiology
 Pathophysiology
 General Assessment
 Management of Nervous System
Emergencies

Neurology

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Editor's Notes