Exam 4-Neuro Flashcards
STROKE
Etiology: blood supply to part of the brain is suddenly interrupted or when a blood vessel in the brain bursts, spilling blood in the spaces surrounding brain cells.
Manifestations:
- Sudden onset of weakness or numbness on one side of the body.
- Sudden speech difficulty or confusion.
- Sudden difficulty seeing in one or both eyes.
- Sudden onset of dizziness, trouble walking or loss of balance.
- Sudden, severe headache with no known cause.
Pathophysiology: brain cells die because they don’t get enough oxygen and nutrients;
HYPERNATERMIA
occurs when serum sodium levels exceed 145mEq/L.
Risk Factors: advanced age, AMS, fever, diarrhea, vomiting, uncontrolled DM.
Infants with severe diarrhea are at risk for?
hypernatermia
HYPONATREMIA
occurs when serum sodium levels are less than 135 mEq/L.
-usually due to inappropriate secretion of ADH leading to SIADH or cerebral salt wasting syndrome ( CSWS).
**most common electrolyte d/o with increased morbidity and mortality
When sodium is too low in blood, extra water goes into body cells and causes swelling which can be dangerous to brain cells because
it can results in neurological symptoms such as headache, confusion, irritability, seizures, or coma
PARTIAL (aka focal) SEIZURES
- can impair consciousness or not impair it
- may or may not include motor activity
- -aura: ex: lip smacking, chewing, smells, rapid eye blinking
- clinical finding may be subtle
GENERALIZED SEIZURES
- can be motor or nonmotor (absence seizures; can happen multiple times a day)
- sudden LOC
- tonic clonic, clonic (twitching), tonic (stiff), atonic (no muscle tone-just fall to ground), or myoclonic (sudden rapid muscle contractions-very fast; happen in morning and usually d/t no sleep)
- mental status impairment
- possible focal neurological deficits
TENSION TYPE HEADACHE (TTP)
- BILATERAL pain distribution (band, pressure); gradual onset; more common in WOMEN
- genetic disposition; may be episodic or chronic
- more localized pain and tenderness of pericranial muscles; last 30 min-week
cause: trigeminal hypersensitivity (central); myofacial afferent sensitivity (peripheral); usually exacerrabated by stress and fatigue - most common type of headache
Txt: caffeine and relaxation ; NSAIDs and chronic pain can be treated with amitriptyline and tricyclic antidepressants
CLUSTER HEADACHE
- group of disorders-headache for several days followed by remission
- usually in MALES 20-50 YR OLD
- EXCRUCIATING, STABBING PAIN UNILATERALLY BEHIND ONE EYE
- LAST 8-10 WEEKS PER YEAR; SAME TIME EVERY DAY 15 MIN TO 3 HOURS
- usually associated with autonomic symptoms on affected side: PTOSIS, MIOSIS, LACRIMATION, NASAL CONGESTION
-nasoactive peptides, neurogenic inflammation, pain activation
TXT: inhaled oxygen and sumatriptans
Ischemic stroke
blockage of a blood vessel supplying the brain
-can be caused by thrombus from atherosclerosis or can be embolic
Pathophysiology etiologies of AMS
- arousal (RAS) vs awareness
- structural changes
- trauma
- infection
- toxic substances
- metabolic (sodium, glucose, oxygen)
- dementia vs. delerium
Hemorrhagic stroke
bleeding into or around the brain
Which type of stroke is most common in the US?
ischemic
Frontal stroke deficits
problem solving, perseveration, expressive aphasia, personality changes
Temporal stroke deficits
- receptive aphasia
- recognizing faces
- short term memory loss
- aggressive behavior
Parietal stroke deficits
- object naming
- confusion
- difficulty with tactile senses
Occipital stroke deficits
- visual field and color identification
2. word blindness
Cerebellum stroke deficits
- gross and fine motor movement
- posture
- tremor
- speech
Brainstem stroke deficits
- temperature
- heart rate
- respiratory rate
- swallaow
- balance
Which common artery is the most commonly effected?
MCA - middle cerebral artery
Contralateral
symptoms occur on opposite side of the stroke
Ipsiliateral
symptoms occur on same side as stroke
Symptoms of MCA injury
- contralateral face and arm weakness and sensory loss
- mild or no leg weakness
- head and eyes deviated towards side of stroke
- if left sided may produce aphasia
- if right sided, may cause deficits of spatial perception, hemineglect, and apraxia (trouble completing movements)
Symptoms of Posterior Cerebral Artery injury (PCA)
- visual problems
- prosopagnosia (can’t recognize faces)
- alexia (inability to read)
- aphasia (can’t comprehend spoken words)
Symptoms of Anterior Cerebral Artery injury (ACA)
-contralateral leg weakness and sensory loss -mild or no upper extremity involvement -balance problems -may produce aphasia if left sided
Right brain injury symptoms
- paralyzed left side
- special perceptual deficits
- quick impulsive behavior
- memory deficits
Left brain injury symptoms
- paralyzed right side
- speech language deficits
- slow, cautious behavioral style
- memory deficits
How does high repetition help after a stroke?
helps create and reinforce new pathways in the brain
What is meningitis
inflammation of the meninges surrounding the brain and spinal cord usually due to a bacterial or viral infection
what are the 3 membranes in the brain and spinal cord
- dura mater
- arachnoid
- pia mater
Bacterial meningitis
can be cause by strep. pneumoniae, H. influenza, neisseria meningitiis, group B strep
Viral meningitis
- most common type of mengiitis
- less severe than bacterial
- most get better without txt
- echovirus most common cause of viral meningitis
BACTERIAL MENINGITIS CSF FLUID
Opening pressure: increased WBCS: >1000 Glucose: greater than or = 40 Protein: >100 Cells: PMNs
VIRAL MENINGITIS CSF FLUID
Opening pressure: normal WBCs: <1000 Glucose: normal Protein: normal or <100 Cells: neutrophils (early lymphocytes (late)
Encephalitis
inflammation of brain itself that can be caused by virus, bacteria, fungus, parasites
- inflammation of the active tissues of the brain caused by an infection or an autoimmune response. The inflammation causes the brain to swell, which can lead to headache, stiff neck, sensitivity to light, mental confusion and seizures.
Common symptoms of encephalitis
fever headache stiff neck sensitivity to bright light vomiting changes in behavior seizures LOC
What is a symptom in infants of who have meningitis or encephalitis?
bulging fontanel
Common viruses that cause encephalitis
herpes, varicella zoster, measles, mumps, and rubella viruses
Encephalitis autoimmune evaluation
rapid onset of on or more cognitive symptoms, seizures, psychiatric disturbances, particularly in patients who have background of autoimmunity, cancer, or smoking hx
Which has more neurological deficits
encephalitis
Seizures
- transient disruption in electrical function with excessive discharges of cortical neurons
- balance between excitation and inhibition of impulses disrupted
- uncontrolled shaking that is rapid, rhythmic, with muscles contracting an relaxing repeatedly
What are seizures normally associated with
cerebral lesions (tumor), biochemical alterations, trauma, epilepsy
S/S of seizures
- blackout with period of confusion
- changes in behavior
- drooling
- loss bladder or bowel
- mood changes
- shaking of entire body
- sudden falling
- teeth clenching
- uncontrolled muscle spasms
- temporary stop in breathing
Path of seizure
can be conceptualized as occurring when there is distortion of the normal balance between excitation and inhibition in the brain which can alter brain function. Can be genetic or acquired
How to control seizures
control abnormal neuronal activity by elevated threshold of neuron responsible to electrical or chemical stimuli. Stabilize neuron membrane, reducing neuron conduction.
Cause of seizures:
- drugs
- epilepsy
- fever
- head injury
- stroke
- heart disease
- brain tumor
- brain infections
- congenital brain defects
- brain injury to baby during delivery
- abnormal levels of sodium or glucose in blood
- poisoning
- phenylketonuria (PKU)