🧠 NEUROLOGY: HIGH-YIELD NURSING STUDY GUIDE ⚡ Your rapid-fire review of the neuro system’s biggest killers and clinical traps. Straight to the point, loaded with red flags 🚨, and built for real-world nursing.

🩸 TRAUMATIC BRAIN INJURY (TBI) & ICP

• Mild TBI: GCS ≥13, LOC <30 min. 90% of all neurotrauma.
• Moderate–Severe TBI: GCS ≤12. Watch for Cushing’s Triad (↑BP, ↓HR, irregular respirations). ➤ ATLS protocol, maintain perfusion, give mannitol or hypertonic saline.
• Epidural Hematoma: ⚠️ Lucid interval, then coma. Ipsilateral dilated pupil → emergency craniectomy.
• Subdural Hematoma: Often venous. Elderly/anticoagulated high risk. Treat with surgical decompression.
• Herniation: Brain shift due to ↑ICP—uncal herniation = blown pupil + contralateral weakness. ➤ Mannitol, hyperventilation, surgical decompression.

🧬 CEREBROVASCULAR DISORDERS

• Ischemic Stroke: 🕒 Time = Brain. Sudden neuro deficit (aphasia, hemiparesis, vision loss). ➤ IV rtPA (alteplase) within 4.5 h if no contraindications. Mechanical thrombectomy up to 24 h.
• Hemorrhagic Stroke: Headache, vomiting, ↓LOC. Often hypertensive or aneurysmal. ➤ Reverse anticoagulation, control BP, consider surgical evacuation.
• NPH (Normal Pressure Hydrocephalus): Hakim’s Triad — gait instability, dementia, incontinence.

🦠 CNS INFECTIONS & SEIZURES

• Bacterial Meningitis: Fever, neck stiffness, photophobia, ↓LOC. Petechial rash = meningococcal sepsis 🚨 ➤ Dexamethasone IV → then ABX, isolate, monitor for sepsis & hydrocephalus.
• Viral Encephalitis (HSV): Hallucinations, confusion → IV Acyclovir STAT.
• Status Epilepticus: Seizure >5 min = neuro emergency. ➤ 1st: Midazolam/Lorazepam IV → 2nd: repeat → 3rd: Phenytoin/Valproic/Levetiracetam.
• Absence Seizures: 5–10 sec “blank stares,” often in kids. Provoked by hyperventilation.
• Todd Paresis: Transient weakness after seizure (mimics stroke).

🧍‍♀️ DIAGNOSTIC & NURSING CRITICALS

• GCS: Eye, Verbal, Motor — use highest side score.
• Pupils: Dilated + unreactive = herniation or EDH ⚡
• Headache Red Flags: Sudden severe onset, fever, neuro deficit, morning vomiting, age >50.
• Lumbar Puncture: Flat 1–4 h post-procedure. ❌Contraindicated w/ ↑ICP (risk of herniation).
• CT/MRI: CT = first-line for TBI/SAH. MRI contraindicated in metal implants or unstable pts.

💉 CRITICAL LABS & DRUG MONITORING

• Bacterial CSF: ↑Pressure, ↑WBC (neutrophils), ↑Protein, ↓Glucose, cloudy.
• Viral CSF: Normal glucose, lymphocytes, clear.
• Post-Thrombolysis Bleed Risk: Major complication of rtPA.
• Anticoag Monitoring:
  • Warfarin → INR
  • Heparin → aPTT
  • LMWH → anti-Xa