Neuro Exam
Cerebral Aneurysms - Answer intracranial aneurysm is when a saccular outpouching of
a cerebral artery occurs at the site of a weakened vessel wall. This weakened vessel
wall is thought to be caused by a congenital defect in a cerebral vessel wall. A ruptured
cerebral aneurysm is the most common cause of a hemorrhagic stroke.
Hemorrhagic strokes are most commonly seen in patients over the age of
_______________________ - Answer 50 and a ruptured intracranial aneurysm often
results in death or a severe disability in those who survive.
Intracranial aneurysms usually occur at the ____________________ - Answer
bifurcations in the circle of Willis
Intracranial aneurysms usually ________________________ - Answer enlarge over
time, making the vessel wall thinner and thinner and increasing the probability of
rupture.
There are many different types of cerebral aneurysms , but the most common are called
_________________________ - Answer berry aneurysms because they form small
berry like projections off of the vessel.
Cerebral Aneurysms Manifestations - Answer -"Worst headache of my life"
-Neck pain, stiff neck - nuchal rigidity
-Photophobia
-Nausea and vomiting
-Symptoms similar to a CVA
-Death
Cerebral Aneurysms complications - Answer -Seizures
-Risk for re-bleeding
-Cerebral vasospasm
The biggest risk are of re-bleeding (typically occurs 2 weeks after initial event) and
vasospasms. Vasospasms narrows the lumen of the vessel, causing infarction and
ischemia to that area of the brain. It normally occurs in blood vessels surrounded by
thick blood clots. If patient has re-bleeding, around 70% of them will die. Seizures,
Hypothalamic dysfunction (helps control pituitary gland and also regulates body
temperature, growth, sleep, weight, emotions etc.), and hydrocephalus ("water on the
brain" or edema) are other complications that can arise.
Cerebral Aneurysms diagnostics - Answer -CT/MRI is used to initially detect the
hemorrhage
,-Angiogram can rapidly identify the arterial abnormality
Lumbar Puncture - will reveal blood-tinged cerebral spinal fluid
Cerebral Aneurysms treatments - Answer -Medications
-Calcium channel blockers
-Anticonvulsants
-Analgesics
-Surgery
-ASAP
-Balloon embolization
-Platinum coil electrothrombosis
-Metal clip
Calcium channel blockers for cerebral aneurysms - Answer these are used to improve
neurological deficits relating to the vasospasm that follows a hemorrhage. CCBs They
have been found to enhance blood flow collaterally and improve patient outcomes.
(Amlodipine/Norvasc, Nifedipine/Procardia)
Anticonvulsants for cerebral aneurysms - Answer are used to prevent seizures.
Surgeries for cerebral aneurysms - Answer are done to either prevent rupture if it is
caught in time or to isolate the vessel to prevent further bleeding. Surgery may be
delayed d/t critical status, but the trend is to get them to the OR ASAP to prevent further
bleeding and vasospasm.
Balloon Embolization (cerebral aneurysms) - Answer In the balloon remodeling
technique, a balloon is placed across the site where the aneurysm originates from the
cerebral blood vessel. Through a second catheter in the aneurysm coils or liquid
embolic material are inserted. The balloon is temporarily inflated during coil or liquid
embolic placement and keeps the treatment material in the aneurysm and away from
the normal artery
Cerebral Aneurysms nursing management - Answer -FAMILY HISTORY
-Neuro checks paramount
-Airway management
-Safety - seizure precautions
-Accurate I&O
-PT/OT/Speech
cerebral aneurysm nursing considerations - Answer -Airway - suctioning, provide O2
-Frequent monitoring of neuro status is necessary to detect any changes in status -
could indicate IICP if there are changes.
-Provide safety, at increased risk for seizures so place in seizure precautions.
, -Accurate I&Os - Possibility to develop DI
-PT/OT/Speech for rehabilitation post aneurysm.
Cerebral Aneurysms precautions - Answer -Bed rest, semi-Fowler's or side lying
-Darkened, private, quiet room
-Limit visitors
-Maintain fluid restrictions
-Avoid dietary stimulants
-Prevent Valsalva maneuver (straining, coughing),
provide stool softeners
-Gentle care
-Limit invasive procedure
-Maintain normothermia
-Provide sedation and pain control if needed, prophylactic antiseizure medications, DVT
prophylaxis
AV malformation - Answer AV malformations are present at birth, and are congenital
intracranial lesions. It is believed to arise from failure of the development of the capillary
network in the embryo, displace, rather than encompass normal brain tissue. They are
essentially a tangled mass of dilated cerebral blood vessels that allows blood to flow
directly from the arterial into the venous system bypassing the normal capillary system.
About 90% of AV malformations are found in the cerebral hemisphere. The remainder
are found in the cerebellum and the brainstem.
Arteriovenous Malformation - Answer -Tangled mass of dilated cerebral blood vessels
-Blood flows directly from arterial to venous system
-Can easily rupture = hemorrhagic stroke
AV Malformation manifestations - Answer -Large - seizures initially
-Small - neurologic deficits d/t hemorrhage
-Both can cause recurrent headaches
With large AV malformations the patients will _________________ - Answer have
seizure activity to the disruption in the electrical activity relating to the bleeding
With small AV malformations ____________________ - Answer they will usually see
neurological deficits relating to the hemorrhaging
Both large and small AV malformations ____________________ - Answer can cause
recurring headaches that will not respond to treatment.
AV Malformation diagnostics - Answer -CT / MRI
-Cerebral angiogram
-Lumbar puncture
Cerebral Aneurysms - Answer intracranial aneurysm is when a saccular outpouching of
a cerebral artery occurs at the site of a weakened vessel wall. This weakened vessel
wall is thought to be caused by a congenital defect in a cerebral vessel wall. A ruptured
cerebral aneurysm is the most common cause of a hemorrhagic stroke.
Hemorrhagic strokes are most commonly seen in patients over the age of
_______________________ - Answer 50 and a ruptured intracranial aneurysm often
results in death or a severe disability in those who survive.
Intracranial aneurysms usually occur at the ____________________ - Answer
bifurcations in the circle of Willis
Intracranial aneurysms usually ________________________ - Answer enlarge over
time, making the vessel wall thinner and thinner and increasing the probability of
rupture.
There are many different types of cerebral aneurysms , but the most common are called
_________________________ - Answer berry aneurysms because they form small
berry like projections off of the vessel.
Cerebral Aneurysms Manifestations - Answer -"Worst headache of my life"
-Neck pain, stiff neck - nuchal rigidity
-Photophobia
-Nausea and vomiting
-Symptoms similar to a CVA
-Death
Cerebral Aneurysms complications - Answer -Seizures
-Risk for re-bleeding
-Cerebral vasospasm
The biggest risk are of re-bleeding (typically occurs 2 weeks after initial event) and
vasospasms. Vasospasms narrows the lumen of the vessel, causing infarction and
ischemia to that area of the brain. It normally occurs in blood vessels surrounded by
thick blood clots. If patient has re-bleeding, around 70% of them will die. Seizures,
Hypothalamic dysfunction (helps control pituitary gland and also regulates body
temperature, growth, sleep, weight, emotions etc.), and hydrocephalus ("water on the
brain" or edema) are other complications that can arise.
Cerebral Aneurysms diagnostics - Answer -CT/MRI is used to initially detect the
hemorrhage
,-Angiogram can rapidly identify the arterial abnormality
Lumbar Puncture - will reveal blood-tinged cerebral spinal fluid
Cerebral Aneurysms treatments - Answer -Medications
-Calcium channel blockers
-Anticonvulsants
-Analgesics
-Surgery
-ASAP
-Balloon embolization
-Platinum coil electrothrombosis
-Metal clip
Calcium channel blockers for cerebral aneurysms - Answer these are used to improve
neurological deficits relating to the vasospasm that follows a hemorrhage. CCBs They
have been found to enhance blood flow collaterally and improve patient outcomes.
(Amlodipine/Norvasc, Nifedipine/Procardia)
Anticonvulsants for cerebral aneurysms - Answer are used to prevent seizures.
Surgeries for cerebral aneurysms - Answer are done to either prevent rupture if it is
caught in time or to isolate the vessel to prevent further bleeding. Surgery may be
delayed d/t critical status, but the trend is to get them to the OR ASAP to prevent further
bleeding and vasospasm.
Balloon Embolization (cerebral aneurysms) - Answer In the balloon remodeling
technique, a balloon is placed across the site where the aneurysm originates from the
cerebral blood vessel. Through a second catheter in the aneurysm coils or liquid
embolic material are inserted. The balloon is temporarily inflated during coil or liquid
embolic placement and keeps the treatment material in the aneurysm and away from
the normal artery
Cerebral Aneurysms nursing management - Answer -FAMILY HISTORY
-Neuro checks paramount
-Airway management
-Safety - seizure precautions
-Accurate I&O
-PT/OT/Speech
cerebral aneurysm nursing considerations - Answer -Airway - suctioning, provide O2
-Frequent monitoring of neuro status is necessary to detect any changes in status -
could indicate IICP if there are changes.
-Provide safety, at increased risk for seizures so place in seizure precautions.
, -Accurate I&Os - Possibility to develop DI
-PT/OT/Speech for rehabilitation post aneurysm.
Cerebral Aneurysms precautions - Answer -Bed rest, semi-Fowler's or side lying
-Darkened, private, quiet room
-Limit visitors
-Maintain fluid restrictions
-Avoid dietary stimulants
-Prevent Valsalva maneuver (straining, coughing),
provide stool softeners
-Gentle care
-Limit invasive procedure
-Maintain normothermia
-Provide sedation and pain control if needed, prophylactic antiseizure medications, DVT
prophylaxis
AV malformation - Answer AV malformations are present at birth, and are congenital
intracranial lesions. It is believed to arise from failure of the development of the capillary
network in the embryo, displace, rather than encompass normal brain tissue. They are
essentially a tangled mass of dilated cerebral blood vessels that allows blood to flow
directly from the arterial into the venous system bypassing the normal capillary system.
About 90% of AV malformations are found in the cerebral hemisphere. The remainder
are found in the cerebellum and the brainstem.
Arteriovenous Malformation - Answer -Tangled mass of dilated cerebral blood vessels
-Blood flows directly from arterial to venous system
-Can easily rupture = hemorrhagic stroke
AV Malformation manifestations - Answer -Large - seizures initially
-Small - neurologic deficits d/t hemorrhage
-Both can cause recurrent headaches
With large AV malformations the patients will _________________ - Answer have
seizure activity to the disruption in the electrical activity relating to the bleeding
With small AV malformations ____________________ - Answer they will usually see
neurological deficits relating to the hemorrhaging
Both large and small AV malformations ____________________ - Answer can cause
recurring headaches that will not respond to treatment.
AV Malformation diagnostics - Answer -CT / MRI
-Cerebral angiogram
-Lumbar puncture
