Exam 5 - Neuro Flashcards
What are the pain sensitive areas of the brain?
What is a migraine?
An episodic vascular disorder manifested by pain in the head & often accompanied by anorexia, photophobia, nausea with or without vomiting.
What are the 3 phases of a migraine?
- Early (prodromal) phase cerebral arterial constriction and a rise in serotonin levels.
- Second phase - dilation, stretching, & swelling of intracranial & extracranial vessels & fall in level of serotonin. Congestion of nasal mucus & conjunctiva.
- Final phase - neck & scalp muscles may contract.
What can trigger migraines?
Migraine in women tend to occur during periods of premenstrual tension & fluid retention.
–Estrogen & progesterone levels are not changed
–onset in premenstrual period is related to estrogen rather than progesterone.
–Stress
–Missing meals
–Tyramine-rich foods
Describe the phases of a migraine with aura
1st phase - an aura typically develops over several minutes and does not last longer than one hour.
- Prodromal phase consists of transient focal neurological dysfunction often visual such as spots, lines, zigzags
- May have confusion, vertigo, numbness, tingling of lips
2nd phase - HA, N/V. Pain begins in one area and spreads
3rd phase - pain changes from throbbing to dull
Describe a migraine without aura
- Not present or not recognized
- If early warning - mood change such as irritability, euphoria, or depression
- Begins in one area & spreads to entire side. May be bilateral.
- May have N/V.
- May start in early AM, during periods of stress, premenstrual tension
What drugs are used as preventive therapy for migraines?
- Beta-adrenergic blockers (propranolol, nadolol, or atenolol)
- Anticonvulsant such as gabapentin (neurontin), topiramate (Topamax), valproate (Depacon)
- Lamotrigine (Lamictal)- migraines with auras
- Antidepressants - tricyclic’s such as amitriptyline (Elavil) or nortriptyline (pamelor)
- Not first line - has S/E such as hypotension, drowsiness
What are some treatments for migraines after the headache has started?
- Ergotamine derivatives – useful for migraines lasting longer than 48 hours; D.H.E. available in an injectable & nasal spray
- NSAIDs or combination drugs of tylenol, ASA, and caffeine
- Antiemetic - compazine
- Triptans (zomig, imitrx, axert, etc) - PO or SC.
- Stimulates 5-HT1 (serotonin) receptors causing cranial vasoconstriction, and also widespread vasoconstriction
- contraindicated in pt. With ischemic heart disease or Prinzmetal’s angina because of the potential for coronary vasospasms.
What are some alternative treatment measures for pain releif from migraines?
- Beginning of migraine - pt. Lay down in a quiet, darkened room.
- Modify potential triggering factors
- foods such as MSG, mature cheese, sausage, sauerkraut, dark chocolate, citrus fruit, red wine
- odors - cigarettes, cigar, paint, perfumes, gasoline
- Decrease stress in life - biofeedback, etc
- Exercise helps
What are some characteristics of cluster headaches?
- Pain is unilateral
- oculofrontal or oculotemporal
- Pain described as boring, excruciating, nonthrobbing
- HA usually occur every 8-12 up to 24 h daily at the same time for about 6-8 weeks, usually start in the morning
- Then period of remission (9 mo to 1 yr), to return
- Average duration of the HA is 10-45 min.
What are some signs and symptoms of cluster headaches?
- Other S/S- ipsilateral tearing of eye, rhinorrhea, congestion, ptosis, miosis. Bradycardia, flushing, pallor, inc. intraocular pressure, inc. skin temp.
- Pain may radiate to forehead, temple, or cheek
- Temporal artery may be tender & prominent.
- Pt. Will generally pace, walk, or rock –> Patient can’t sit still, they are trying to block the pain.
What would you assess for in a cluster headache?
§Precipitating factors
§Duration of the HA
§Frequency in 24 h
§# of weeks before remission
§characteristics of the HA
§
§Characteristics:
–origin of HA tenderness of arteries facial flushing
–spread of HA bradycardia tearing, rhinorrhea
–Pacing, rocking behavior
What are some medications used to treat cluster headaches?
Medications
- Oxygen – briefly inhale 100% O2 via mask at minimum of 7 l/min
- Reduces cerebral blood flow, helps manage pain
- Triptans
Preventive medications
–Calcium channel blockers
–Corticosteroids
–Lithium
–Nerve block
–Ergots
–Melatonin
–Wear sunglasses, O2 therapy
What are seizures and what are the 3 types?
Seizures are an abnormal, sudden excessive discharge of electrical activity within the brain.
Types:
- Generalized
- Partial
- Unclassified
What causes seizures?
- metabolic disorders
- tumor
- acute ETOH withdrawal
- CVA electrolyte disturbances
- Infection
What can cause primary seizures?
- usually inherited & age-related.
- Scar tissue from a head injury
- vascular disease
- brain tumors
- aneurysm
- OI’s from AIDS
- Meningitis
- Stroke
What causes secondary seizures?
- metabolic disorders
- electrolyte disorders
- hyperkalemia
- hypoglycemia
- drug withdrawal
- acute ETOH withdrawal
- water intoxication
- kidney or liver failure
What are some precipitating factors for seizures?
- increased physical or emotional stress
- increased physical activity
- alcohol or caffeine consumption
- certain foods or chemicals
What are some characteristics of partial seizures?
- Seizures that initially affect one specific area in one hemisphere of the brain
- May or may not cause an alterationof consciousness
- Symptoms can include muscle twitching, repetitive motions, and the appearance of “daydreaming”
- Partial seizures can become generalized seizures
What are some characteristics of generalized seizures?
- Seizures that affect both hemispheres of the brain
- Result in a loss of consciousness
- Symptoms can include blank stares, falling to the floor, sudden muscle jerks, and repetitive stiffening and relaxing of muscles
What are the 2 types of partial seizures?
–Simple partial
- Patient remains conscious throughout episode. Patients often have an aura or a déjà vu phenomenon with perception of an offensive smell or sudden pain
–Complex partial
- patient losses consciousness for several seconds. May have “automatisms” such as lip smacking, patting, picking at clothes, etc. (look like they are having a daydream)
–Jacksonian seizure- focal seizure extends into adjacent area (goes from one part of the body towards the spinal cord)
–Usually in the temporal lobe - psychomotor seizures
What are the 4 types of generalized seizures?
- tonic-clonic - “grand mal”
* begins with tonic phase characterized by stiffening or rigidity of the muscles, particularly of arms & legs & immediate loss of consciousness. Followed by clonic (rhythmic) jerking of all extremities. - Absence - “Petit mal”
- Brief period of loss of consciousness like day dreaming. More common in children.
- During Seizure:
- Vacant stare
- Eyes roll upward
- Lack of response
- Myoclonic - brief jerking or stiffening of the extremities which occur singly or in groups of muscles.
- Atonic - sudden loss of muscle tone, pt. falls, pt. is unconscious
What are the different phases of tonic-clonic seizures?
1. Prodromal Phase
- Irritability/tension precede several hours to days
- Aura with or without warning
- Sudden loss of consciousness
2. Tonic Phase
- 1minute- average 15 seconds
- Major tonic contraction- increased tonus
- Body stiffens – legs & arms extended
- Person falls if standing
- Jaw snaps shut, tongue bitten
- Bowel/bladder empties
- Apnea for several seconds (pale, cyanotic)
3. Clonic Phase
- 30 seconds plus
- Inhibitory neurons active -> interrupting tonic seizure with clonic activity
- Violent, rhythmic muscular contractions
- Hyperventilate
- Face contorted, eyes roll (becuase both hemisphere’s are involved)
- Excessive salivation, frothing of the mouth
- Profuse sweating
- tachycardia
4. Postictal phase
- Cease fire
- Extremities limp
- Breathing is quiet
- Pupils equal or unequal response to light reflex
- Confused, disoriented, amnesic
- Generalized aching
- Fatigue
- Deep sleep for several hours
- Todd’s paralysis - not permanent, prolonged period of weakness involving 1 or more extremity.
How would you respond to a tonic-clonic seizure?
Your primary responsibility during a seizure is to make sure the seizing student is as safe as possible. Here are some steps you can take:
- Remain calm and let the seizure happen. You will not be
- able to stop a seizure. Most last from 30 seconds to 2 minutes
- Help the student to the floor and place something
- soft under his or her head. Do not hold the student down
- Move aside any objects that may cause injury
- Do not put anything in the student’s mouth. Contrary to popular belief, a person who’s seizing cannot swallow his tongue
- Help maintain the student’s dignity by moving onlookers away
- Once the jerking movements have stopped, lay the student on his or her side. This will help prevent choking should the student vomit
- –While regaining consciousness, the student will likely be confused and disoriented. Reassure the student that he or she is safe
- –Stay with the student and do not let him or her eat or drink until
- fully alert
What would you assess for when a patient is having a seizure?
History - need to know description of the type of seizure activity, events surrounding the seizure assists in determining best plan.
–How often the seizure occurs
–A description of each seizure
–Whether more than 1 type of seizure occurs
–Sequence of seizure progression
–How long seizure last
–When last seizure took place
–seizure preceded by an aura
–If the client knows that a seizure has taken place
–What the client does after the seizure
–how long it takes for the client to return to pre-seizure status
–whether the client becomes incontinent of bowel or bladder during the seizure
