Alterations of Neurologic Function Flashcards
What GCS ratings indicate mild, moderate and severe brain injury?
Mild= 13-15 Moderate= 9-12 Severe= 3-8
What are the physical symptoms of a severe concussion?
Increased ICP, LOC that can be >24 hours, spastic paralysis, peripheral nerve injury
What are the cognitive symptoms of a severe concussion?
disorientation, confusion, dysphagia, poor judgement
What are the behavioural symptoms of a severe concussion?
agitation, blunted affect, impulsiveness, social withdrawal, depression
What is post concussive syndrome?
Persistent concussive symptoms that last from weeks to months: headache, nervousness/anxiety, irritability, insomnia, depression, inability to concentrate, fatigue
Which TBI is usually caused by bleeding from an artery and 90% of patients also have a skull fracture?
Epidural hematoma
What are the signs and symptoms of an epidural hematoma?
LOC, period of lucidity including headache, vomiting, drowsiness, seizure, hemiparesis and possibly ipsilateral pupillary dilation
How long can it take for subacute subdural hematoma to develop?
From 48 hours to 2 weeks
What is usually the source of bleeding in a subdural hematoma?
A vein
What is an intracerebral hematoma?
Hematoma formed within brain parenchyma with or without blood distention into ventricles
Define “coup” and “contrecoup”
Coup: brain damage that occurs directly under point of impact
Contrcoup: brain damage occurs on the opposite side of the brain from site of impact
Where do spinal cord traumas usually occur?
C1-2, C4-7 or T1-L2
What is the treatment for spinal cord injuries?
Immobilize spine to prevent further injury. Surgical decompression and stabilization necessary, corticosteroids to decrease risk of secondary injury
What is the cause of over 40% of spinal cord injuries
Motor vehicle collisions
Define hypereflexia
uncompensated cardiovascular response to stimulation of SNS. Occurs any time after spinal shock ceases. Hypertension, headache, blurred vision, sweating above level of lesion, nasal congestion, nausea, bradycardia. Most common cause is distended bladder or rectum
List the 3 types of primary intracerebral tumors and their preceding cell types
Astrocystoma-astrocytes-slow growing
Glioblastoma multoforme-glial cells-rapidly growing
Pituitary adenoma-pituitary cells-secreting tumor
List the 2 types of primary extracerebral tumors and their preceding cell types
Meningioma-arachnoid cells
Neurofibroma-schwann cells
Which parts of the body is brain cancer most commonly metastasized from?
Lung, breast, skin or kidney cancer
What are the risk factors for strokes?
Arterial hypertension, impaired cardiac function, atrial fibrillation
Smoking
Diabetes/insulin resistance
Polycythemia and thrombocythemia
What is the difference between a thrombotic and an embolic stroke
Thrombotic- caused by a blood clot in an artery going to the brain
Embolic- fragments of clots formed elsewhere (heart or neck) that occludes a blood vessel leading to, or in the brain
Define a completed stroke
CVA has reached max destructiveness in producing neurological deficits
Define a transient ischemic attack
intermittent blockage-all neurological deficits completely clear within 24 hours
Usually an indicator of future stroke
What causes a hemorrhagic stroke?
hypertension, ruptured aneurysms, bleeding in a tumor, bleeding disorders or anticoagulants, head trauma or illicit drug use
Define hemorrhagic infarcts
can happen with reperfusion as resumption of blood flow may compromise recovery by accelerating the sequence of metabolically damaging events
Primary cause of cerebral hemorrhage is hypertension, aneurysms in smaller vessels or arteriolar necrosis
What are treatment interventions for strokes?
Treatment within 6 hours minimum
Drug therapy prevents further thrombotic events, augments blood flow and repurfuses tissues
Controlling cerebral edema anf increased ICP
Preventing further emboli
What is a seizure?
Sudden disorderly discharge of neurons characterized by sudden, transient alteration in brain function
What are contributing factors to epilepsy?
metabolic defects, congenital malformation, perinatal injury, postnatal trauma, infection, brain tumor, vascular disease, drug or alcohol abuse
What are possible seizure triggers?
Hypoglycemia, fatigue, emotional/physical stress, febrile illness, excess H20 ingestion, constipation, use of stimulants, withdrawal from depressant drugs, hyperventilation, environmental stimuli
What defines a general seizure?
bilateral neuron involvement, general onset, originates from subcortical or deeper. Impaired or LOC
What defines a partial seizure?
Unilateral neuron involvement, originate from cortical brain tissue, maintains conciousness but may become generalized
Define: status elipeticus
multiple seizures without regaining conciousness or one seizure lasting >30min
Define: post-ictal state
time period immediately following a seizure
Define: epileptogenic focus
group of neurons with more permeable membranes that are hypersensitive to stimuli (like hypoxia, hypoglycemia or hyperthermia)
Define: aura
A partial seizure immediately preceding a generalized seizure
Define: prodromal (as it relates to seizures)
An early manifestation that can occur hours before a seizure
What are the signs and symptoms of meningitis?
Fever, chills, petechial rash and neck stiffness
What are the most common bacteria causing meningitis?
Meningococcal and streptococcus bacteria
What is relapsing-remitting MS?
most common. MS that relapses for at least 24 hours where symptoms worsen followed by a remission where symptoms go away
What is primary MS?
worsening neurologic function (accumulation of disability) from the onset of symptoms, without early relapses or remissions.
What pharmacological interventions are used for MS?
Steroids (acutely) and interferon (chronically)
What is myasthenia gravis?
Chronic autoimmune disorder mediated by anti-acetylcholine receptor antibodies. Insidious onset with progressive muscle weakening
How is myasthenia gravis diagnosed?
Tensilon test, antibody assay and electromyography
What is electromyography?
A test measuring muscle response to nerve stimulation via electrodes
What pharmacological interventions are used for myasthenia gravis?
steroids, anticholinterase drugs, immunosuppresants
What is Gullian-Barre syndrome?
Inflammatory disease resulting in demyelination of peripheral nerves. Almost always preceded by a viral illness. First sign is weakening of leg muscles
What pharmacological intervention is commonly used for alzheimer’s?
Anticholinergics- cholinterase inhibitors
What are the symptoms of parkinsons disease?
resting tremor, rigidity, bradykinesia and postural instability
