Dz: Neuro Disorders

Question 1

(3) Classifications of Nerve Injuries

Answer 1

Depends on length of time damaged
Neuropraxia: temporary, no structural change
Axonotmesis: prolonged pressure = mm atrophy, neuron degeneration
Neurotmesis: no path to follow to grow back

Question 2

Median & Radial Nerve Injury

Answer 2

Median: repetitive stress, pregnancy, narrowing of carpel tunnel (weakness of thenar eminence of hand)
Radial: damaged by pressure
- Saturday Night Palsy
- Crutch Palsy

Question 3

Tests for Neurological System

Answer 3

Posttraumatic Amnesia Scale
Rancho Los Amigos Levels of Cognitive Fxn (problem solve ability & behave appropriately)
Phalen’s wrist flex test (median n injury- tingle)
Reverse Phalen’s (pressure against carpel tunnel- tingle/burn)
Tinel Sign (tap over n)

Question 4

Thoracic Outlet Tests

Answer 4

Allen test: head rotated opposite side, elbow flex - pulse disappears
Adsons maneuver: head rotated on same side, elbow ext - pulse disappears when breathing
Provacative elevation test: arms elevated, open/close hand - cramping, tingling
Vertebral Artery Test: passive neck ext/rotation - dizzy, pupil changes (limit PT to neck area)

Question 5

Seizures

Answer 5

Spontaneous excessive discharge of neurons

Involuntary repetitive movements

Question 6

Increased Intracranial Pressure (ICP)

Answer 6

Skull is rigid, Brain tissue dies
Brain compressed from incr fluid or a mass
First S/S: decreased LOC
- projectile vomit, papilledema, severe HA

Question 7

Guillain-Bare Syndrome

Answer 7

PNS inflammation
Mostly affects motor n
Ascends from legs > cranial n
Can cause paralysis (n>major organs)

Question 8

(3) Chronic Congenital Disorders

Answer 8

Hydrocephalus
Spina Bifida
Cerebral Palsy

Question 9

(3) Chronic Seizure Disorders

Answer 9

Multiple origins (cerebral hemisphere)
Cautions:
- don’t restrain
- put nothing in their mouth
- clear the area
Absence (petit mal): loss of awareness for 5-10sec, eyelid twitch
Tonic-clonic (grand mal): full body movement
Partial: simple (one focal origin- limb), complex (multiple origins - waving/clapping)
Tx: sedatives

Question 10

Hydrocephalus

Answer 10

Excessive CSF within ventricles, water on the brain
Babies: head can expand
Adults: pressure incr rapidly (skull can’t expand)
S/S: Infant - white sclera visible, high cry
Adults - pupils fixedly dilated
Noncommunicating: CSF flow is blocked
Communicating: CSF absorption impaired
MI: shunts (drainage)

Question 11

Spina Bifida - (3) types

Answer 11

Neural tube defects
Vertebral posterior spinous process fail to fuse
Types:
- Spina Bifida Occulta (not seen visually,
hair patch)
- Meningocele (herniation of meninges, sac
formation)
- Myelomeningocele (herniation of spinal
cord & n)
Etiology: multifactorial (genetics/environment, low folic acid/Vit-A)

Question 12

Thoracic Outlet Syndrome

Answer 12

Brachial Plexus compression, subclavian blood vessels compressed

Question 13

Alzheimer’s Dz

Answer 13

Senile plaque/neurofibrillary tangle (brain abnormality)
4 gene mutations
S/S: memory/language decline, late stage- family unrecognizable
Tx: moderate stim, daily ex, routine
Survival 7-20yrs
Can lead to Dimentia

Question 14

Cerebral Palsy - (4)Types

Answer 14

Brain damage (before/during/after birth)
S/S: motor deficits, seizers, poor commun
Types:
- Spastic (hyperflexia)
- Dyskinetic (athetoid- writhing movements)
- Atoxic (loss of balance/coordination)
- Mixed

Question 15

Dimentia

Answer 15

Loss of memory (short-term initially)
Causes: VD, Infxn, Toxins = treatable, Alzheimer’s (not treatable)
Types:
- Vascular (small brain infractions)
- Creutzfeldt-Jakob Dz (alter coding gene, mad cow dz,empty spaces in brain)
- AIDS

Question 16

Schizophrenia

Answer 16

Viral infx from mother to fetus (brain damage)

S/S: delusions, bizarre behavior, flat emotions, hallucinations, persecution

Question 17

Panic Attack/Disorder

Answer 17

Develop many fears
Panic Attack: brief episode of discomfort/anxiety
Panic Disorder: long/freq episodes of panic attacks

Question 18

LMN Disorders

Answer 18

Associated N: cranial n, anterior horn cell of spinal cord, spinal n roots, peripheral n

Question 19

Arnold-Chiari Malformation

Answer 19

Cerebellum protrudes spinal canal = CSF blocked

S/S: impaired skin sensation, paralysis

Question 20

Autistic Spectrum Disorder

Answer 20

Neurodevelopment Disorder
Poor verbal comm/good nonverbal comm
Strict routine
Tx: multidisciplinary- family involved as well

Question 21

Fetal Alcohol Syndrome

Answer 21

Alcoholism during pregnancy
S/S: small eyes, cleft palate/lip, low IQ
Poor attention
PT: ataxia, pron/sup, tremors, posture

Question 22

Spinal Cord Injury (SCI)

Answer 22

Traumatic: MVA, Falls, Gun shot wounds
Nontraumatic: Dz - accounts for 30% of SCI (white males 16-30yrs)
Tetraplegia: all 4 extremities
Paraplegia: comp/partial paralysis trunk/bil LE
Causes:
- Cervical Lesions: 51%
- Compression (burst) fx - C5-7 (common)
- Shearing - fx dislocation at thoracolumbar

Question 23

SCI (Damage, S/S, Classify, Tx)

Answer 23

Damage Sequence:
- Spinal shock (temporary) - n conduction
stops
- LOF < injury site (usually permanent)
S/S: flaccid initially&raquo_space; spastic paralysis (no brain signal - closed reflex loop)
- LOF of body temp/BP/Resp fxn
- Autonomic dysreflexia (no reflex to pain,
unable to determine location)
- Secondary: pneumonia, HO, shoulder inj
- decorticate/decerebrate supine posture
Classification: ASIA impairment scale
Tx: orthotics

Question 24

CVA (TIA/Stroke)

Answer 24

Damage to brain due to lack of Ox
Ischemic: most common, caused by thrombus/embolus, very quick, damage 3-4hrs
Hemorrhagic: rupture of cerebral artery, sever
TIA: neuro sympt 24hrs

Question 25

Stroke

Answer 25

Classified: thrombosis, embolus, hemorrhage
Permanent damage possible >3wks
Most common cause of disability
Males - African American most common
S/S: unilat numbness/weakness (Hemiparesis) opposite of lesion, trouble speaking/seeing, LOC/LOB, severe headache

Question 26

Stroke (damages)

Answer 26

Supratentorial Lesions: within cerebral hemisphere
- L-side: logic, Aphasia (no compreh/express
to language)
- R-side: impulsive, problem solving,
personality, confusion, contralat neglect
(what arm?)
Infratentorial Lesion: within brainstem (widespread impair of sense/motor - RAS)
LOC: coma (Glasgow scale), vegetative state (brain damage, brainstem is fxn)
UMN: hyperreflexia
LMN: flaccid (unilat weakness)

Question 27

Hemianopia (stroke S/S)

Answer 27

Hemianopia: Lose vision on med-half of one eye and lat-half on another eye (if damage is in optic chiasma)