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Pathophysiology > chapter 45 > Flashcards

chapter 45 Flashcards

1
Q

seizure disorder

A

transient neurological event of paroxysmal. abnormal or excessive electrical discharges

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2
Q

manifestions of seizure disorder

A

disturbances of

  • skeletal motor function
  • sensation
  • autonomic visceral function
  • behavior
  • consciousness
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3
Q

epilepsy or seizure disorder

A

recurrent seizures

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4
Q

seizure disorder acquired by

A 
cerebral injury
pathologic process
-lesion, tumor
-blood clots
-infection
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5
Q

seizures are classified by

A

s/s and EEG features

manifestations determined by area of brain involved, area of origin, and areas to which seizure spreads

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6
Q

generalized seizure

A 
whole brain affected
metabolic or toxin induced
thalamus and reticular activating system: LOC
includes
- absence (petite mal)
- atypical absence
- myoclonic
- atonic (drop attack)
- tonic-clonic (grand mal)
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7
Q

absence (petite mal) seizure

A
  • children
  • sometimes identified in children with poor academics
  • brief: 2-10 seconds
  • staring spells
  • unaware of surrounding
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8
Q

atypical absence seizure

A

accompanied by myoclonic jerks and automatisms

- lip smacking, repetitive seemingly voluntary movement.

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9
Q

myoclonic seizure

A

extremely brief

single jerk or multiple jerks of one or more muscle groups

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10
Q

atonic seizure

A

sudden complete loss of muscle tone

-falls

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11
Q

tonic-clonic (grand mal) seizure

A 
sudden LOC
muscle rigidity (tonic phase)
- lasts 10-15 seconds
clonic activity
- voilent rhythmic contractions
- 1-2 minutes
- apnic
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12
Q

status epilepticus

A

continuing seizures without period of recover between

irreversible brain damage, possible death from hypoxia, dysrhythmia, lactic acidosis

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13
Q

partial seizures

A

activity in one brain hemisphere

  • simple partial
  • complex partial
  • partial seizures secondarily generalized
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14
Q

simple partial seizure

A 
no change in LOC 
s/s: motor, sensory, autonomic, or combined
- motor: may be limited to one body part
- sensory: tingling or numbness
---auditory sounds
---olfactory
---visual manifestation
-autonomic: pupil dilation
---sweating, flushing
---respiratory changes
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15
Q

complex partial seizure

A

different combos of cognitive, affective, and psychomotor

  • loss or altered LOC
  • can be aggressive
  • postictal stage
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16
Q

partial seizures secondarily generalized

A

begin as simple partial and progress to involve both hemispheres

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17
Q

Dx seizures

A

Pt history
neuro exam
EEG

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18
Q

seizure tx

A

maintain airway
protect from injury
identify location focus
anticonvulsants

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19
Q

dementia

A

syndrome associated with many pathologic processes
progressive deterioration and decrease of memory and other cognitive changes
personality and behavior changes

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20
Q

causes/types of dementia

A 
alcoholism
tumor
hydrocephalus
parkinsons
lewy body
huntingtons
Multiple sclerosis
pick disease
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21
Q

hallmark structural changes of dementia

A

intracellular neurofibrillary tangels and extracellular amyloid plaques.
neuroinflammation

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22
Q

vascular dementia

A 
single cerebrovascular insult
multiple lucunar infarcts 
microvascular pathology
- risk: 
--stroke
--HTN
--diabetes
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23
Q

manifestations of dementia

A
  • gradual onset with chronic decline in cognitive function
  • memory loss, especially ST memory
  • thinking ability decline
  • decrease function at work/social settings
  • anxiety, agitation
  • difficulty with judgement, problem-solving, communication
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24
Q

Dx of dementia

A

Hx and physical
CT, MRI
mental status

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25
Q

Tx of dementia

A 
2 drug classes
acetylcholinesterase inhibitors
- mild to moderate alzheimers
-stabilize cognitive function
-slow progression
N-methyl-D-asparate (NMDA) receptor antagonist
- moderate to severe alzheimers
-blocks stimulation by glutamate
-slows progression
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26
Q

vascular dementia tx

A

reduce risk of cerebral damage

control BP, blood sugar, and lipids

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27
Q

Parkinson’s

A 
mobility disorder
idiopathic or acquired
- infection
- intoxication 
- trauma
degeneration of pigmented dopaminergic neurons found in substantia nigra and elsewhere in brain
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28
Q

parkinsons s/s

A 
early signs
- loss of flexibility
- aching
- fatigue
initally worse on one side of body
tremor-generallly at rest, unilaterally affecting distal extremity
bradykinesia
regidity
loss of facial expression
later stage
- small handwriting, evidence of tremor
-low volume speech, monotonous, mumble
-bradykinesia effects swallowing, and level of mobility
-drooling, aspiration risk
-falls
-dementia
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29
Q

tx parkinsons

A 
no cures
slow progression
- increase dopamine in CNS
--dopamine does not cross BBB
---levodopa and carbidopa combined will cross BBB and then convert to dopamine
30
Q

cerebral palsy

A

diverse group of crippling syndromes that appear in childhood and involve permanent, non-progressive damage to brain.
damage to upper motor neurons
-voluntary and involuntary movement

31
Q

cerebral palsy classified based on

A 
neuro s/s
- spasticity
- ataxia
- dyskinesia
or combo
32
Q

Spastic cerebral palsy s/s

A

most common

  • hypertonia
  • prolonged reflexes
  • increased deep tendon reflexes
  • clonus
  • rigidity of limbs
  • scoliosis
  • contractures
  • scissors gait, toe walking
  • spastic paralysis
    • hemipegia, paraplegia, triplegia, quadriplegia
33
Q

dyskinetic/athetoid cerebral palsy s/s

A

difficulty with purposeful movement and fine motor skills
slow, jerky, uncontrolled, abrupt movements
- injury to basal ganglia or extrapyramidal tracts

34
Q

ataxia cerebral palsy s/s

A

gait disturbances
instability
hypotonia at birth, stiffness of trunk in infancy

35
Q

pure ataxia cerebral palsy s/s

A

maldevelopment of the cerebrum or its pathways

-cognitive impairment

36
Q

common cerebral palsy s/s

A 
seizures
intellectual difficulty
visual problems
orthopedic disabilities
hearing impaired
communication disorder
respiratory problems
bowel/bladder problems
37
Q

tx of cerebral palsy

A 
goal to increase functionality
muscle relaxers
selective dorsal rhizotomy
botox
- reduce pain and increase ROM
anticonvulsants
orthopedic surgery, casts, braces, traction
38
Q

selective dorsal rhizotomy

A

portion of dorsal roots of lumbar spine cut

- decreases spasticity in cerebral palsy

39
Q

hydrocephalus

A

abnormal accumulation of CSF in cerebral ventricular system
associated with congenital defect, usually neural tube
-viral infections of neruotoxic agent during pregnany
-occasionally in adults from
lesions, trauma, hemorrhage, infections: meningitis

40
Q

3 types of hydrocephalus

A

normal pressure
obstructive/noncommunicating
nonobstructive/communicating

41
Q

normal pressure hydrocephalus

A

increased CF volume without change in intracranial pressure because brain tissue has been lost

  • abnormal absorption of CSF
  • -ventricles distend, compressing brain tissue and vessels
42
Q

s/s of normal pressure hydrocephalus

A

gait instability
urinary incontinence
dementia

43
Q

obstructive/noncommunicating hydrocephalus

A

most common in children
abnormal cerebral aqueduct or lesion in 4th ventricle
- congenital
obstruction of CSF flow

44
Q

nonobstructive/communicating hydrocephalus

A

abnormal capacity to absorb fluid from subarachnoid space

- infection, trauma, tumors

45
Q

tx of hydrocephalus

A

surgical correction with shunting

46
Q

cerebellar disorders myriad causes

A 
abscess
hemorrhage
tumor
trauma
viral infection
chronic alcoholsim
47
Q

cerebellar disorder s/s

A 
ataxia
hypotonia
intention tremors
gait disturbances
balance disturbance
staggering/lurching
clumsy
48
Q

multiple sclerosis

A

chronic demyelinating disease of CNS
significant disability in young adults
autoimmune: inflammation and scarring of myelin sheaths covering nerves

49
Q

multiple sclerosis s/s

A 
vary daily can be mild or extreme
slow or interrupt conduction of nerve impulses
-imparied vision
-weakness/numbness
-spasticity
-gait disturbance
-bowel/bladder maybe
-tingling
-fatigue
-imbalance
-movement disorders
50
Q

relapsing-remitting MS

A

most common form
defined exacerbations with acute decline in neuro function
followed by periods of partial/complete recovery and remissions

51
Q

primary progressive MS

A

slow but continuous decline in neuro function
plateaus may occur
severe disability develops

52
Q

secondary progressive MS

A

approx. 50% of relapsing-remitting pt develop this form
- begins as relapsing-remitting; followed by steady decline in neuro function with or without occasional relapses, remission, or plateaus

53
Q

progressive relapsing MS

A

progressive from outset, but with clear exacerbations with or without recovery.

54
Q

tx of MS

A

managing symptoms

minimize damage inflicted by autoimmune attack

55
Q

spina bifida

A

defective closure of the bony encasement of spinal cord (neural tube)
-spinal cord and meninges may or may not protrude
further classified by neural involvement

56
Q

spina bifida occulta

A

anomaly not visible

57
Q

spina bifida cystica

A

external protrusion

58
Q

spina bifida environmental and genetic factors

A

vitamin deficiency: folate
anticonvulsants
chromosomal abnormalities
maternal obesity and diabetes

59
Q

spina bifida occulta s/s

A 
change in skin and body hair
- coarse or silky hair along spine 
midline dimple
cutaneous port-wine angioma
subcutaneous mass- lipoma or demoid cyst
usually no serious neuro problems
gait disturbances 
positional deformity of feet 
bowel/bladder dysfunction
60
Q

spina bifida cystica (meninogocele)

A

saclike cyst filled with CSF protrudes through spinal defect, does not involve spinal cord

61
Q

spina bifida cystica (myelomeningocele or meningomyelocele)

A

deformity contains meninges, CSF, and portion of spinal cord

62
Q

spina bifida cystica s/s

A 
permanent neuro dysfunction
motor weakness or paralysis
sensory deficit below defect
bowel/bladder dysfunction
scoliosis
hydrocephalus
seizures worsen as child grows and cord ascends
-pulling at scar tissue and tethering cord.
63
Q

spina bifida tx

A

severity of defect and neuro dysfunction

supplement folic acid: prevent

64
Q

amyotrophic lateral sclerosis (ALS)

A
  • progressive degenerative disease affecting upper and lower motor neurons
  • characterized by muscle wasting and atrophy of hands, arms, and legs
  • some cases cognitive changes and dementia
  • progressive paralysis and death
65
Q

hallmark of ALS

A

misfolded protein aggregate inclusions in affected motor neurons and glial cells

66
Q

ALS s/s

A 
muscle weakness and atrophy
muscle twitching, cramping, stiffness
hands/upper limbs affected first
hyperreflexia in a weak atrophied extremity 
die of respiratory failure
maintain sensory and cognitive function
67
Q

ALS tx

A

glutamate inhibitor

-prolongs life

68
Q

bell palsy

A

acute idopathic paresis or paralysis of facial nerve with inflammatory reaction at or near stylomastoid foramen or in boney facial canal
-compression, ischemia, demylination

69
Q

bell palsy risk factors

A

diabetes
hypothyroidism
pregnancy

70
Q

bell palsy s/s

A

rapid over 24-48 hours

unilateral facial weakness with facial droop and diminished eye blink

71
Q

bell palsy tx

A

spontaneous recovery approx. 3 weeks
prevention of corneal damage (unable to blink)
- drops, ointment, eye patch
corticosteroids

Pathophysiology (80 decks)

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