Chronic Brain Disorders Flashcards
Transient neurologic event of paroxysmal abnormal or excessive cortical electrical discharges
-Manifested by disturbances of skeletal motor function, sensation, autonomic visceral function, behavior, or consciousness
Seizure
Causes: cerebral injury, lesions, metabolic/nutritional disorders, idiopathic (no known cause)
Seizure
Recurrent seizures
epilepsy
May be triggered by specific stimuli such as flashing lights, fever, loud noises
Seizure
Due to an alteration in membrane potential that makes certain neurons abnormally hyperactive and hypersensitive to changes in their environment (epileptogenic focus)
Seizure
What’s the prodrome of a seizure?
subjective sense of impending seizure
whole brain surface is affected during ______seizure
Involvement of thalamus and RAS system results in loss of consciousness
Involvement of thalamus and RAS system results in loss of consciousness
Involvement of thalamus and RAS system results in loss of consciousness
Absence (petite mal): occurs in children, staring spells that last only seconds
•Atypical absence: myoclonic jerks, automatisms with the staring spell
Generalized seizure
Myoclonic: single/several jerks
•Atonic (drop attack): fall down
•Tonic-clonic (grand mal): jerking of many muscles
Generalized seizure
continuing series of seizures without a period of recovery between episodes; can be life-threatening
Status epilepticus
abnormal electrical activity restricted to one brain hemisphere
Partial seizures
No change in level of consciousness; motor, sensory, and/or autonomic symptoms common in ________ seizures
Simple/Partial Seizure
change in consciousness happens in ______ seizures
complex/partial
Starts as simple but advances to generalized in _____ seizures
Partial with secondary generalization
Electroencephalograms: assess electrical patterns of brain regions
Laboratory studies: identify metabolic/nutritional deficits, infections, and exposure to toxins
diagnose _______
Seizure
Lumbar puncture: for CNS infections
CT, MRI: for structural causes
diagnose
Seizure
Maintain airway•Protect from injury•Document course
to treat ____
Seizure
Continued until no seizures for at least 2 years and then gradually withdrawn•Not a cure
Anticonvulsant medications
Avoid triggers
Surgery: removal of foci or neurostimulation to treat ______
seizure
Question 1 A patient has a tonic-clonic seizure. What type of seizure did the patient experience? A. Petite mal B. Grand mal C. Myoclonic D. Drop attack
B. Grand Mal
Syndrome associated with many pathologies; characterized by progressive deterioration and continuing decline of memory and other cognitive changes
dementia
Abrupt onset, may fluctuate often, becoming worse at night; disturbed consciousness, decreased awareness of the environment, incoherence, and hallucinations
delirium
Characterized by degeneration of neurons in temporoparietal and frontal lobes, brain atrophy, amyloid plaques, and neurofibrillary tangles
Alzheimer disease
Deficient synthesis of brain acetylcholine
Alzheimer disease
Cause remains unknown, although genetic factors (family history increases 4x) and environmental triggers suspected
Aging increases risk
Behavioral problems progress from forgetfulness to total inability for self-care
Depression and psychosis may be significant
Alzheimer disease
Results from single cerebrovascular insults
Risk factors: stroke, hypertension, and diabetes
Vascular dementia
Early: memory loss, especially short-term memory, long-term memory may be preserved; thinking ability declines, decreasing ability to function at work and in social settings; anxiety, agitation
dementia
As the disease progresses, increasing difficulty with judgment, abstract thinking, problem solving, and communication; assistance for completing activities of daily living (ADLs); difficulty with eating and swallowing, weight loss; loss of bladder and bowel control and eventual complete loss of the ability to ambulate; personality and behavior changes
dementia
Complete blood cell count, chemistry panel, thyroid function, vitamin B12 levels, and syphilis serology
diagnose
dementia
Chest x-ray, CT, MRILumbar punctureMental status examinations, clock drawing test, and tests of functional status
diagnose
dementia
Early diagnosis and intervention is key in the management of dementia
Early stages may be able to stay at home; later stages may need nursing home or assisted living
dementia
tacrine (Cognex), donepezil (Aricept), rivastigmine (Exelon), and galantamine (Reminyl) are _______ inhibitors. They are indicated for _______. NOT A CURE
Acetylcholinesterase; mild to moderate Alzheimer disease and vascular dementia
Indicated for the treatment of moderate to severe Alzheimer-type dementia
•Blocks stimulation by the neuroexcitatory transmitterglutamate
•Not a cure, but slows progression of the disease
N-methyl-D-aspartate (NMDA) receptor antagonists: memantine (Namenda)
May be idiopathic, acquired or drugs
Dopamine deficiency in the basal ganglia (substantia nigra) associated with motor impairment; Lewy bodies
Parkinson Disease
Difficulty initiating and controlling movements results in akinesia, tremor, and rigidity
Tremor occurs at rest and hand tremors exhibit pill-rolling movements
Attempts to passively move the extremities are met with cogwheel rigidity
Parkinson Disease
General lack of movement, loss of facial expression, drooling, propulsive (shuffling) gait, and absent arm swing
Parkinson Disease
Treatment: no cure; restoring brain dopamine levels or activity by administration of dopamine precursors, dopamine agonists, monoamine oxidase inhibitors, and anticholinergics; antidepressant therapy may be NEEDED
*Ablative surgical procedures may be helpful for motor symptoms
Parkinson Disease
________responsible for smooth, coordinated control of muscle action, excitation and inhibition of postural reflexes, and maintenance of balance
Cerebellum
Causes: abscess, hemorrhage, tumors, trauma, viral infection, chronic alcoholism
Clinical manifestations: ataxia, hypotonia, intention tremors, disturbances in gait and balance
Treatment: identify and eradicate cause
Cerebellum disorders
Chronic demyelinating disease of the CNS that primarily affects young adults
Autoimmune disorder that results in inflammation and scarring (sclerosis) of myelin sheaths covering nerves; slowly progressive
Multiple Sclerosis
Cause unknown, but immunologic abnormalities, genetics, and environmental factors suspected
Demyelination can occur throughout the CNS but often affects the optic and oculomotor nerves and spinal nerve tracts
Multiple Sclerosis
Marked by exacerbations and remissions; exacerbated by heat, infection, trauma, stress
Manifestations: double/blurred vision, weakness, poor coordination, and sensory deficits; bowel and bladder control may be lost; memory impairment common
Multiple Sclerosis
Diagnosis: MRI
Treatment: no cure; short-term steroid therapy may be helpful during acute exacerbations and immune-modifying drugs may slow progression of symptoms
Multiple Sclerosis
Problem of the young
Males 3 to 4x more likely
Usually traumatic, a result of motor vehicle accidents, falls, penetrating wounds (usually gunshot), or sports injuries
Spinal cord injury
Cord may be compressed, transected, or contused
Mechanisms of injury
Hyperflexion, hyperextension, compression
Spinal cord injury
_______injury may result from hemorrhage, swelling, ischemia, inflammation
Secondary spinal cord
________occurs immediately and is characterized by temporary loss of reflexes below the level of injuryMuscles flaccid; skeletal/autonomic reflexes lost
Spinal shock
End of ______: reflexes return and flaccidity replaced by spasticity
spinal shock
______shock may occur after SCI due to peripheral vasodilation
Neurogenic
Hypotension, bradycardia, and circulatory collapse can occur (life-threatening); high spinal cord injuries can affect respiratory muscles, leading to ventilatory failure
results from ________
neurogenic shock
________is an acute reflexive response to sympathetic activation below the level of injury
Autonomic dysreflexia
Visceral stimulation (full bladder or bowel) and activation of pain receptors below the injury are common stimuli
Manifestations: hypertension, headache, bradycardia, flushing above the level of injury, and clammy skin below the level of injury
occur in_______
Autonomic dysreflexia
Prompt removal of the offending stimulus; aggressive blood pressure management may be needed (adrenergic receptor–blocking drug) to amend ____
Autonomic dysreflexia
Appropriate stabilization of spinal vertebrae•May be accomplished surgically with internal fixation or with external fixation and bracing to treat _____
spinal cord injury
intensive care to maintain oxygenation and blood pressure to treat ________ shock
neurogenic
High-dose methylprednisolone may be used to decrease secondary injury
Intensive rehabilitation required to maximize function
spinal cord injury
Inflammatory demyelinating disease of the peripheral nervous system or a lower motor neuron disorder
Segmental demyelination that is T-cell and B-cell mediated
Guillain-Barré Syndrome
Also known as acute idiopathic polyneuropathy or polyradiculoneuropathy
Guillain-Barré Syndrome
Cause unknown; postinfectious immunologic mechanism suspectedSpontaneous recovery usually occurs
Guillain-Barré Syndrome
Muscle weakness that begins in the lower extremities and spreads to the proximal spinal neurons
Progressive ascending weakness or paralysis, may affect respiratory muscles
Diagnosis: patient history, physical examination, and nerve conduction studies, lumbar puncture
Guillain-Barré Syndrome
Treatment: supportive; plasmapheresis; immunoglobulin
Guillain-Barré Syndrome
Idiopathic neuropathy of the facial nerve; paralysis of the muscles on one side of the face
Etiology: virus
Bell Palsy
Clinical manifestations: develop rapidly over 24 to 48 hrs; unilateral facial weakness, facial droop and diminished eye blink, hyperacusis, and decreased lacrimation
Diagnosis: physical findings, MRI, CT, EMG
Bell Palsy
Often self-limiting condition within 3 wks
Lubricating drops, ointments, and nighttime eye patching may be necessary
to treat
Bell Palsy
Corticosteroids improve the likelihood of complete recovery
Antiviral medications: acyclovir or valacyclovir recommended
to treat
Bell Palsy
