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Patho > Lecture 9 & 10 - Neurological disorders > Flashcards

Lecture 9 & 10 - Neurological disorders Flashcards

1
Q

what is the key role of the reticular activating system

A

Consciousness for arousal and waking state
also contributes to muscle tone, mood, attention, motivation, learning and memory

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2
Q

what are the 7 levels of consciousness?

A
  1. fully conscious
  2. confusion
  3. delirium
  4. lethargy
  5. Obtundation
  6. Stupor
  7. Coma
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3
Q

what are intracranial causes of altered level of consciousness?

A

related to direct impact on anatomical structures

head injury
haemorrhage
degenerative conditions
lesions
increased intracranial pressure
vasospasm of cerebral vasculature

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4
Q

what are extracranial causes of altered level of consciousness?

A

related to secondary insult from issues orginating outside cranial vault

hypoxia
hypertension
hypotension
infection
hepatic/renal dysfunction
hypo/hyperglycaemia
electrolyte imbalance
pH imbalance
medications and other chemicals

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5
Q

what is a CVA?

A

Stroke
localised vascular lesion that develops suddenly within the cerebral circulation where the vessel becomes blocked or bleeds

results in cerebral infarction (dead neurons)

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6
Q

what is a TIA?

A

Transient ischemic attack
episode of cerebral eschaemia that resolves within 24 hours
warning sign of CVA, indicator of underlying thrombotic disease

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7
Q

what are risk factors for CVA?

A

age
being male
european heritage
HTN
diabetes
high cholesterol
smoking
family hx
alcohol consumption
heart disease

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8
Q

How is a CVA diagnosed?

A

determine type for appropriate management
Hx - time of insult
CT
MRI
angiography
bloods - rule out other causes of ALOC
physical ass (obs/neuro obs)

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9
Q

how is a CVA treated?

A

ischemic – thrombolysis within the first 90 minutes
hemorrhagic – surgical clipping, craniotomy, or endovascular embolisation

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10
Q

what is brain displacement?

A

following hemorrhagic stroke accumulated blood can displace the brain laterally and inferiorly

causes altered brain function

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11
Q

what are clinical tests used to assess consciousness?

A

GCS - verbal, eye and motor responses
Dolls eye test - assess absence of corneal reflex which would imply brain function impairment

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12
Q

how is consciousness clinically diagnosed?

A

AVPU scale - gross level of consciousness
full set of Obs
Bloods (glucose, electrolyte and pH imbalances)
motor function test
CT scan
lumbar puncture - eg for meningitis

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13
Q

what is the management required for ALOC?

A

Airway management
safe environment

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14
Q

what are the primary and secondary infarction zones in relation to a cerebral infarction?

A

primary zone will be repaired but neurons irreversibly injured (do not regenerate)

secondary zone is the area around teh primary zone - cells are injured but may recover with adequate blood flow in a timely manner

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15
Q

what is an ischaemic stroke?

A

result of sudden obstruction to cerebral artery due to thrombus (atherosclerotic plaque) or embolism

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16
Q

what is a haemorrhagic stroke?

A

occurs when a cerebral artery ruptures and there is a bleed into brain tissue

associated with chronic hypertension (inc pressure on artery walls)

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17
Q

why is there a higher morbidity rate with haemorrhagic stroke?

A

can displace brain tissue resulting in compression of brain tissue and shift of brain laterally or inferiorly

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18
Q

what is an aneurysm?

A

vascular lesion where blood vessel wall becomes weakened

weakened area of arterial wall dilates and baloons

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19
Q

what are three types of aneurysms?

A

saccular/berry - outgrowth that is sac/ berry like
fusiform - dilation of segment of vessel wall
giant

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20
Q

what are the clinical manifestations of a stroke?

A

manifestations dependent on site of lesion

language - Broca’s and Wernicke’s area
speech - broca
muscle movement and weakness - frontal lobe, brain stem
vision - occipital and brain stem
confusion - frontal lobe
balance - brain stem, cerebellum
eye movement - brain stem
coordination/gait - cerebellum

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20
Q

what is meningitis?

A

infection of the membranes surrounding the brain and spinal cord

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21
Q

what are the two classifications of meningitis?

A

bacterial and viral

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22
Q

how does bacterial meningitis impact the body?

A

enters CNS by violating BBB after upper airway infection disables cilia and immune protection or via blood through bacteremia.

release bacterial toxins to damage CNS structures > inflammation > oedema > intercranial pressure > compression/herniation

usually caused by streptococcus pneumoniae or neisseria meningitides

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23
Q

what are the main causative agents of viral meningitis?

A

HSV
cytomegalovirus
enterovirus

much milder and short lived - high chance of recovery

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24
what are risk factors for bacterial meningitis?
age low GCS on admission tachycardia positive blood culture (bacteria in blood) elevated erythrocyte sedimentation rate (indicates inflammation) low CSF white cell count
25
what are the classic triad of meningitis?
fever nuchal (neck) rigidity altered mental state
26
what are other clinical manifestations of meningitis?
headache photophobia lethargy vomiting purpural or petechial rash (bleeding into skin) seizures Kernig’s sign – flexing the hip & extending the knee to elicit pain in the back & the legs Brudzinski’s sign – passive flexion of the neck elicits flexion of the hips Opisthotonos - extreme hyperextension of the head and arching of the back due to irritation of the meninges
27
How is meningitis diagnosed?
Lumbar puncture to identify the causative organism in the CSF Blood cultures Physical examination
28
how is meningitis treated?
dependent on causative organism ABs oxygenation or circulation support antivirals
29
what is parkinsons disease?
idiopathic neurodegenerative disorder causing motor impairment also causes changes in sensory, cognitive and emotional processing
30
what is parkinsonism?
broad term to encompass all conditions related to parkinson's disease
31
what is the pathophysiology of Parkinson's disease?
degeneration of the dopaminergic nigrostriatal pathway in the brain dopaminergic cells within the basal ganglia are targeted for degradation. results in an altered balance of these neurotransmitters such that dopamine is decreased, causing a relative increase in acetylcholine.
32
what are the areas of the brain that are affected by Parkinson's?
basal ganglia, thalamus and reticular formation (motor control) substantia niagra (in basal ganglia) shrinks and dopaminergic cells in substantia niagra are degraded
33
what are Lewy bodies?
cytoplasmic structures where proteins accumulate, they displace other cellular components common formation in parkinsons
34
what are the risk factors associated with Parkinson's?
age sex -men inheritance head injury exposure to chemicals
35
what are the clinical manifestations of Parkinson's? in particular motor symptoms
TRAP tremor rigidity akinesia - absence of spontaneous movement postural instability loss of facial expression/blinking monotone voice impaired swallowing drooling dystonia shuffling gait
36
what are the clinical manifestations of Parkinson's? in particular non-motor symptoms
hypotension constipation abnormal sweating urinary sphincter problems sleep disorders sensory disfunction cognitive/behavioral - confusion, memory loss, insecurity, dementia, depression, anxiety, apathy)
37
how is parkinson's diagnosed?
relies on the consideration of the clinical picture and an assessment of neurological and psychological signs and symptoms.
38
how is parkinsons managed?
- prevention of falls and aspiration pneumonia - assessment and reassessment of postural insatbilty, hypotension, dysphagia etc - medication - slow deterioration i.e. levadopa
39
what are the 3 types of brain injury?
Primary secondary acquired
40
what is a primary brain injury?
damage occurring at time of insult i.e. traumatic brain injury
41
what is a secondary brain injury?
damage occurring post injury because of other extracranial causes hypoxia, HTN, hypoglycemia, intracranial haemorrhage/swelling/infection
42
what is a acquired brain injury?
Drugs and alcohol CVA tumour disease
43
what are the 4 types of traumatic brain injury?
concussion contusion coup contrecoup diffuse axonal injury
44
what is a concussion?
a mild traumatic brain injury caused by an impact to the head or whiplash
45
what is a contusion
Blood underneath the skin due to causing a bruise
46
what is a coup contrecoup?
a contusion present at both the site of the impact and the exact opposite end of the impact
47
what is a diffuse axonal injury?
Similar to concussion, though the brain is shaken much more violently
48
what are the 3 types of skull fractures?
Basilar - located near brain stem Depressed - underlying tissue may be damaged Linear - cracks
49
what are the common signs of a basilar skull fracture?
Racoon eye Battle’s signs Rhinorrhea and otorrhea Headache ALOC memory loss Blurry or double vision unequal pupils facial paralysis swelling CSF leak from ear or nose (halo sign)
50
how a racoon eyes caused?
caused by rupture of internal carotid artery
51
what is Battle's sign?
appears when the mastoid air cells (behind ear) fracture, allowing blood to pool in overlying skin (bruising shows)
52
what does the Monro-Kellie Doctrine describe the relationship between?
Contents of the cranium and intracranial pressure three components exist in equilibrium to maintain normal intracranial pressure the brain tissue the blood the cerebrospinal fluid small changes can be compensated for large changes may lead to increases in intracranial pressure and potential tissue damage
53
what is Cushing's Triad?
Increase in BP Decrease in pulse decrease in RR
54
what are the 3 types of haemotoma?
Extradural Subdural Intracerebral
55
what are the main nursing management points when looking after a patient with a head injury?
1. monitor vitals closely 2. Maintain patent airway 3. Administer meds as ordered 4. elevate head of bed 30 degrees 5. admin hypertonic IV as ordered (restricts fluid and therefore pressure) 6. protect patient from injury should seizure occur 7. maintain normal body temp
56
what is a seizure?
episode of inappropriate electrical discharge resulting in disordered brain activity whole brain affected
57
what is epilepsy?
repetitive and unpredictable episodes of seizure activity one area of brain affected
58
how is epilepsy diagnosed?
EEG for brainwaves Large waves and abnormalities in waves (i.e. large and small, not regular) show abnormal activity
59
how is epilepsy managed?
immediate = DRSABC
60
what are the two forms of status epilepticus?
convulsive non convulsive
61
Generalised convulsive status epilepticus involves what?
Tonic-clonic (stiffening and seizing) seizure activity lasting > 5 to 10 minutes OR ≥ 2 seizures between which patients do not fully regain consciousness
62
Nonconvulsive status epilepticus
includes focal-onset status epilepticus and absence status epilepticus. These seizures often manifest as prolonged episodes of mental status changes.
63
what is decerebrate rigidity?
bilateral upper and lower limb extensor posture (toes pointed, hands curled out, arms abduct) usually from damage to brain stem
64
what is decorticate posture?
bilateral flexion of upper limbs, extension of lower limbs (abduction and flexion of arms and hands closed, legs rotate internally, flexed feet) usually damage to cerebral hemispheres

Patho (10 decks)

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