Motor and Brain Function: Intracranial Regulation Flashcards
Non-Surgical Interventions for Low Back Pain
- Massage, spinal manipulation, heat and acupuncture
- NSAIDS, Mild Opioids, Topicals
- William’s Position: Semi Fowler with pillow under knees
- Stress Reduction
- Tramadol, duloxetine, SNRI, muscle relaxants
- PT
- Weight Reduction
Complications from Low Back Pain
- Cerebrospinal Fluid Leak: Examine wound for drainage; halo like, sudden HA
- Fat Emboli; Chest pain, SOB
- Cauda Equina: Part of spinal cord that branches into bundle of free flowing nerve roots at L1-L2
: CES, may cause neurologic impairment
: Causes: Massive lumbar disc herniation, spinal stenosis, epidural hemotoma, trauma
: Sym: Saddle area numbness, urinary/ fecal incontinence, sudden weakness, need surgery asap!
Parkinson Disease
- Idiopathic, chronic, progressive degenerative disorder of CNS
- Over age 50 ( Males )
- Helps: Cig smoking, caffeine, high blood urate levels
Parkinson Disease Cause
- Overstimulation of the basal ganglia by acetylcholine occurs because degeneration of the substantia nigra results in DECREASED dopamine production = Acetlycholine to dominate
- Treatments focuses on increasing dopamine and decreasing acetylcholine
Parkinson Disease Manifestations
- Insidious onset
- ” Pill rolling “ resting tremor of hand
- Rigidity
- 4 Cardinal Signs: tremor, bradykinesia, rigidity, postural instability
- Venus stasis ( brown )
- Glossy look to leg bc of decreased protein
- Ortho hypotension
Parkinson Disease Responding
- Extra time to answer questions
- Speak slow and clear
- Monitor eating / swallowing
- Do not focus on feet when walking!
- No cure
Migraine H/A W / Aura
W / Aura
Prodromal Phase: Irritability, depression, food cravings, frequent urination
Aura ( 1 hr ) : Numbness, tingling of mouth, lips, face, hand, acute confusion, visual disturbances
Second Phase: HA ( Severe ) , N/V , Drowsiness, Vertigo
Third: Pain changes from throbbing to dull
Recovery: Muscle ache, sleep
- Avoid tyramine
Migraine H/A W / O Aura
- Pain aggravated by physical activities
- Unilateral
- N/V
- Photophobia
- Phonophobia
- Lasting 4 to 72 hrs
- Cluster HA: Shorter, give 12l/min O2 15-20 min at onset of HA
Spinal Shock
- Complete but temporary loss of motor, sensation, reflex and autonomic function that often lasts less than 48 hrs but may continue for several weeks.
Tissue Perfusion
- Neurogenic Shock: Complication of spinal trauma, causes sudden loss of communication within the sympathetic nervous system
- Greater risk for VTE
Monro- Kellie Hypothesis
- If the volume of one component of intracranial pressure increases slightly it is offset by reduction in volume of the other two.
- A brain tumor increases volume of brain tissue —> blood and csf volume are reduced in response
Early signs of ICP
- HA , NV, Confusion, Visual Changes ( blurred / double )
Late signs of ICP
- Cushings Triad: Include the widening of pulse pressure, bradycardia and irregular breathing
- Pupils fixed and dilated, posturing, coma
Decorticate Posturing
- Hands in
Decerebrate Posturing
- Hands out
Treatments for ICP
- Diuretics, osmotic ( mannitol ) , sedation, pain control, barbiturates, hemicraniectomy
TIA
-Temporary episode of neurlogic dysfunction
- Caused by focal brain, spinal cord, or retinal ischemia without acute infarction
- Resolves in 1-24 hrs
Stroke Risk Factors
Nonmodifiable:
- Age, family history, prior, race, sex, sickle cell
Modifiable:
- CV, diabetes, excess weight, high bp, high chol, smoking, drinking, no activity, poor nutrition, use of birth control
Ishchemic Stroke
: Partial or complete occlusion of cerebral blood flow due to thrombus or emboli
1. Atherosclerosis
2. A Vib
3. Breakage of atherosclerotic plaque from carotid artery
- ***Most common: Emboli that pass through carotid arteries typically occlude the middle cerebral artery
- Less: Emboli that pass through vertebral / basilar lodge at apex of basilar artery
Hemorrhagic Stroke
- Bleeding into the brain from a burst blood vessel
- 3: Intracerebral, Intraventricular, Extracerebral
Hematologic Conditions that increase stroke risk….
- Thrombocytosis
- Hypercoagulable States - Med
Diagnosis Stroke:
- Exclusion of conditions that mimic TIA
- Blood glucose
- CBC
- Noncontrast CT *** : First if bleeding
- CT
- Cartoid Doppler
- Dysphagia screening
Aphasia
- Cerebral hem damage resulting in speech / language problems
Expressive ( Brocca / Motor )
- Motor speech problem, can understand but cannot speak
Receptive ( Wernickle / Sensory )
- Cannot understand spoken word
Unilateral Neglect
Most common with right cerebral stroke
Teach pt …
- Touch and use both sides of body, dress affected side, turn head side to side, support affected arm b/c subluxation can occur from weigh of arm
Mild TBI
- LOC seconds to mins
- Amnesia
- Change in mental status at time of event
- Sensitive to light
- N/V
- GCS 13-15
Mod to Severe TBI
- GCS 9-12
- LOC for mins to hours
- Seizures
- Difficulty communicating / understanding
- Long term disabilities as high as 50%
Treatment
: Treat ICP / SAH with mannitol, hypertonic saline, barbiturates
- Sedation, pain
- Fever control
- Surgery: External ventricular drains or decompressive cranectomy
End of Life Managing Symptoms
- Pain, weakness, dyspnea, N/V, agitation, delirium, seizures
End of life Managing Pain
- Pain is the symptom that pt’s fear the most
- Opiod / Non opiod used
- CBMS: Only for refractory cancer pain as adjunct to other prescribed analgesics
- Addresses fatigue, anorexia, sleep, anxiety, N/V
Meningitis Treatment
: Vaccine for prevention
- Ceftriaxone, with Vanco
- Phenytoin for seizures
- Rifampin ( Otto Toxic )
MS
- Chronic inflammatory, demyelinating disorder of CNS
- Autoimmune reaction
- No cure
- More common in females
- Farther from equator
- Viruses
MS Most Common
- Relapsing Remitting ***
MS Features
- Sensory, sym of extremities or face ( numb, tingling, drooping )
- Visual problems
- Vertigo
- Pain
MS Treatment
- Comfort
- Diplopia : Eye patch
- Massage therapy
Autonomic Dysreflexia
: Life threatening
- GOOSEBUMPS, high bp, flushed, something is not flowing right ( urine )
Spinal Cord Injury Management
- Bowel and Bladder program!
Spastic: Upper motor neuron injuries
Flaccid: Lower motor neuron injuries
