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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
Q

what are risk factors for bacterial meningitis?

A

age
low GCS on admission
tachycardia
positive blood culture (bacteria in blood)
elevated erythrocyte sedimentation rate (indicates inflammation)
low CSF white cell count

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25
Q

what are the classic triad of meningitis?

A

fever
nuchal (neck) rigidity
altered mental state

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26
Q

what are other clinical manifestations of meningitis?

A

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
Q

How is meningitis diagnosed?

A

Lumbar puncture to identify the causative organism in the CSF
Blood cultures
Physical examination

28
Q

how is meningitis treated?

A

dependent on causative organism

ABs
oxygenation or circulation support
antivirals

29
Q

what is parkinsons disease?

A

idiopathic neurodegenerative disorder causing motor impairment also causes changes in sensory, cognitive and emotional processing

30
Q

what is parkinsonism?

A

broad term to encompass all conditions related to parkinson’s disease

31
Q

what is the pathophysiology of Parkinson’s disease?

A

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
Q

what are the areas of the brain that are affected by Parkinson’s?

A

basal ganglia, thalamus and reticular formation (motor control)

substantia niagra (in basal ganglia) shrinks and dopaminergic cells in substantia niagra are degraded

33
Q

what are Lewy bodies?

A

cytoplasmic structures where proteins accumulate, they displace other cellular components

common formation in parkinsons

34
Q

what are the risk factors associated with Parkinson’s?

A

age
sex -men
inheritance
head injury
exposure to chemicals

35
Q

what are the clinical manifestations of Parkinson’s? in particular motor symptoms

A

TRAP

tremor
rigidity
akinesia - absence of spontaneous movement
postural instability

loss of facial expression/blinking
monotone voice
impaired swallowing
drooling
dystonia
shuffling gait

36
Q

what are the clinical manifestations of Parkinson’s? in particular non-motor symptoms

A

hypotension
constipation
abnormal sweating
urinary sphincter problems
sleep disorders
sensory disfunction
cognitive/behavioral - confusion, memory loss, insecurity, dementia, depression, anxiety, apathy)

37
Q

how is parkinson’s diagnosed?

A

relies on the consideration of the clinical picture and an assessment of neurological and psychological signs and symptoms.

38
Q

how is parkinsons managed?

A
  • prevention of falls and aspiration pneumonia
  • assessment and reassessment of postural insatbilty, hypotension, dysphagia etc
  • medication - slow deterioration i.e. levadopa
39
Q

what are the 3 types of brain injury?

A

Primary
secondary
acquired

40
Q

what is a primary brain injury?

A

damage occurring at time of insult i.e. traumatic brain injury

41
Q

what is a secondary brain injury?

A

damage occurring post injury because of other extracranial causes

hypoxia, HTN, hypoglycemia, intracranial haemorrhage/swelling/infection

42
Q

what is a acquired brain injury?

A

Drugs and alcohol
CVA
tumour
disease

43
Q

what are the 4 types of traumatic brain injury?

A

concussion
contusion
coup contrecoup
diffuse axonal injury

44
Q

what is a concussion?

A

a mild traumatic brain injury caused by an impact to the head or whiplash

45
Q

what is a contusion

A

Blood underneath the skin due to causing a bruise

46
Q

what is a coup contrecoup?

A

a contusion present at both the site of the impact and the exact opposite end of the impact

47
Q

what is a diffuse axonal injury?

A

Similar to concussion, though the brain is shaken much more violently

48
Q

what are the 3 types of skull fractures?

A

Basilar - located near brain stem
Depressed - underlying tissue may be damaged
Linear - cracks

49
Q

what are the common signs of a basilar skull fracture?

A

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
Q

how a racoon eyes caused?

A

caused by rupture of internal carotid artery

51
Q

what is Battle’s sign?

A

appears when the mastoid air cells (behind ear) fracture, allowing blood to pool in overlying skin (bruising shows)

52
Q

what does the Monro-Kellie Doctrine describe the relationship between?

A

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
Q

what is Cushing’s Triad?

A

Increase in BP
Decrease in pulse
decrease in RR

54
Q

what are the 3 types of haemotoma?

A

Extradural
Subdural
Intracerebral

55
Q

what are the main nursing management points when looking after a patient with a head injury?

A
  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
Q

what is a seizure?

A

episode of inappropriate electrical discharge resulting in disordered brain activity

whole brain affected

57
Q

what is epilepsy?

A

repetitive and unpredictable episodes of seizure activity

one area of brain affected

58
Q

how is epilepsy diagnosed?

A

EEG for brainwaves
Large waves and abnormalities in waves (i.e. large and small, not regular) show abnormal activity

59
Q

how is epilepsy managed?

A

immediate = DRSABC

60
Q

what are the two forms of status epilepticus?

A

convulsive
non convulsive

61
Q

Generalised convulsive status epilepticus involves what?

A

Tonic-clonic (stiffening and seizing) seizure activity lasting > 5 to 10 minutes

OR

≥ 2 seizures between which patients do not fully regain consciousness

62
Q

Nonconvulsive status epilepticus

A

includes focal-onset status epilepticus and absence status epilepticus.
These seizures often manifest as prolonged episodes of mental status changes.

63
Q

what is decerebrate rigidity?

A

bilateral upper and lower limb extensor posture (toes pointed, hands curled out, arms abduct) usually from damage to brain stem

64
Q

what is decorticate posture?

A

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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