chapter 45 Flashcards
1
Q
seizure disorder
A
transient neurological event of paroxysmal. abnormal or excessive electrical discharges
2
Q
manifestions of seizure disorder
A
disturbances of
- skeletal motor function
- sensation
- autonomic visceral function
- behavior
- consciousness
3
Q
epilepsy or seizure disorder
A
recurrent seizures
4
Q
seizure disorder acquired by
A
cerebral injury pathologic process -lesion, tumor -blood clots -infection
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
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)
7
Q
absence (petite mal) seizure
A
- children
- sometimes identified in children with poor academics
- brief: 2-10 seconds
- staring spells
- unaware of surrounding
8
Q
atypical absence seizure
A
accompanied by myoclonic jerks and automatisms
- lip smacking, repetitive seemingly voluntary movement.
9
Q
myoclonic seizure
A
extremely brief
single jerk or multiple jerks of one or more muscle groups
10
Q
atonic seizure
A
sudden complete loss of muscle tone
-falls
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
12
Q
status epilepticus
A
continuing seizures without period of recover between
irreversible brain damage, possible death from hypoxia, dysrhythmia, lactic acidosis
13
Q
partial seizures
A
activity in one brain hemisphere
- simple partial
- complex partial
- partial seizures secondarily generalized
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
15
Q
complex partial seizure
A
different combos of cognitive, affective, and psychomotor
- loss or altered LOC
- can be aggressive
- postictal stage
16
Q
partial seizures secondarily generalized
A
begin as simple partial and progress to involve both hemispheres
17
Q
Dx seizures
A
Pt history
neuro exam
EEG
18
Q
seizure tx
A
maintain airway
protect from injury
identify location focus
anticonvulsants
19
Q
dementia
A
syndrome associated with many pathologic processes
progressive deterioration and decrease of memory and other cognitive changes
personality and behavior changes
20
Q
causes/types of dementia
A
alcoholism tumor hydrocephalus parkinsons lewy body huntingtons Multiple sclerosis pick disease
21
Q
hallmark structural changes of dementia
A
intracellular neurofibrillary tangels and extracellular amyloid plaques.
neuroinflammation
22
Q
vascular dementia
A
single cerebrovascular insult multiple lucunar infarcts microvascular pathology - risk: --stroke --HTN --diabetes
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
24
Q
Dx of dementia
A
Hx and physical
CT, MRI
mental status
25
Tx of dementia
```
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
```
26
vascular dementia tx
reduce risk of cerebral damage
| control BP, blood sugar, and lipids
27
Parkinson's
```
mobility disorder
idiopathic or acquired
- infection
- intoxication
- trauma
degeneration of pigmented dopaminergic neurons found in substantia nigra and elsewhere in brain
```
28
parkinsons s/s
```
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
```
29
tx parkinsons
```
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
cerebral palsy
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
cerebral palsy classified based on
```
neuro s/s
- spasticity
- ataxia
- dyskinesia
or combo
```
32
Spastic cerebral palsy s/s
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
dyskinetic/athetoid cerebral palsy s/s
difficulty with purposeful movement and fine motor skills
slow, jerky, uncontrolled, abrupt movements
- injury to basal ganglia or extrapyramidal tracts
34
ataxia cerebral palsy s/s
gait disturbances
instability
hypotonia at birth, stiffness of trunk in infancy
35
pure ataxia cerebral palsy s/s
maldevelopment of the cerebrum or its pathways
| -cognitive impairment
36
common cerebral palsy s/s
```
seizures
intellectual difficulty
visual problems
orthopedic disabilities
hearing impaired
communication disorder
respiratory problems
bowel/bladder problems
```
37
tx of cerebral palsy
```
goal to increase functionality
muscle relaxers
selective dorsal rhizotomy
botox
- reduce pain and increase ROM
anticonvulsants
orthopedic surgery, casts, braces, traction
```
38
selective dorsal rhizotomy
portion of dorsal roots of lumbar spine cut
| - decreases spasticity in cerebral palsy
39
hydrocephalus
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
3 types of hydrocephalus
normal pressure
obstructive/noncommunicating
nonobstructive/communicating
41
normal pressure hydrocephalus
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
s/s of normal pressure hydrocephalus
gait instability
urinary incontinence
dementia
43
obstructive/noncommunicating hydrocephalus
most common in children
abnormal cerebral aqueduct or lesion in 4th ventricle
- congenital
obstruction of CSF flow
44
nonobstructive/communicating hydrocephalus
abnormal capacity to absorb fluid from subarachnoid space
| - infection, trauma, tumors
45
tx of hydrocephalus
surgical correction with shunting
46
cerebellar disorders myriad causes
```
abscess
hemorrhage
tumor
trauma
viral infection
chronic alcoholsim
```
47
cerebellar disorder s/s
```
ataxia
hypotonia
intention tremors
gait disturbances
balance disturbance
staggering/lurching
clumsy
```
48
multiple sclerosis
chronic demyelinating disease of CNS
significant disability in young adults
autoimmune: inflammation and scarring of myelin sheaths covering nerves
49
multiple sclerosis s/s
```
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
relapsing-remitting MS
most common form
defined exacerbations with acute decline in neuro function
followed by periods of partial/complete recovery and remissions
51
primary progressive MS
slow but continuous decline in neuro function
plateaus may occur
severe disability develops
52
secondary progressive MS
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
progressive relapsing MS
progressive from outset, but with clear exacerbations with or without recovery.
54
tx of MS
managing symptoms
| minimize damage inflicted by autoimmune attack
55
spina bifida
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
spina bifida occulta
anomaly not visible
57
spina bifida cystica
external protrusion
58
spina bifida environmental and genetic factors
vitamin deficiency: folate
anticonvulsants
chromosomal abnormalities
maternal obesity and diabetes
59
spina bifida occulta s/s
```
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
spina bifida cystica (meninogocele)
saclike cyst filled with CSF protrudes through spinal defect, does not involve spinal cord
61
spina bifida cystica (myelomeningocele or meningomyelocele)
deformity contains meninges, CSF, and portion of spinal cord
62
spina bifida cystica s/s
```
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
spina bifida tx
severity of defect and neuro dysfunction
| supplement folic acid: prevent
64
amyotrophic lateral sclerosis (ALS)
- 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
hallmark of ALS
misfolded protein aggregate inclusions in affected motor neurons and glial cells
66
ALS s/s
```
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
ALS tx
glutamate inhibitor
| -prolongs life
68
bell palsy
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
bell palsy risk factors
diabetes
hypothyroidism
pregnancy
70
bell palsy s/s
rapid over 24-48 hours
| unilateral facial weakness with facial droop and diminished eye blink
71
bell palsy tx
spontaneous recovery approx. 3 weeks
prevention of corneal damage (unable to blink)
- drops, ointment, eye patch
corticosteroids
