Nervous system Flashcards
Any head injury that maybe damaged the spine shoudl get?
Immobilization
Basilar skull fx ssx?
Periorbital ecchymosis (raccoon eyes)
Ecchymosis behind ear (battle’s sign)
Hemotympanum (bloody TM)
CSF rhinorrhea/otorrhea (halo sign on gauze)
Blood accumulating between skull/dura
Classically, middle meningeal artery torn by temporal fragment
Expanding hematoma SLOWLY separates dura from skull
epidural hematoma (minutes to hours before hematoma is large enough to cause ssx)
Clinical features of epidural hematoma
Initial LOC, followed by regained consciousness (lucid interval)
Hours later… cerebral compression -> HA, N/V, confusion, vision changes
Tx = surgery
Blood between dura and arachnoid
Typically, blunt trauma when skull hits fixed object (elderly falls/hits head; MVA)
Subdural hematoma
repeated small traumas may have same cumulative effect as single large trauma… boxing, football, blasts
Clin features of subdural hematoma?
Slow cerebral compression… hours, days, weeks after head injury
Nonspecific symptoms (e.g., worsening HA) to lateralizing signs such as unilateral dilated/blown pupil, unilateral weakness, decorticate/decerebrate posturing
Requires sx to tx
Bleeding b/w arachnoid membrane/pia mater
Can be from brain trauma
OR
Bleeding from cerebral aneurysm/AVM
Subarachnoid hemorrhage
small saccular aneurysm in Circle of Willis
Often rupture spontaneously (35% mortality)
berry aneurysm
abnormal connection bw arteries/veins
AVM (rare but increased risk of bleed0
Thunderclap HA = sudden bleed
Vomiting
Hemiparesis/hemiplegia
Rapidly advances/requires immediate tx to avoid death
subarachnoid hemorrhage
CT image
Blood ouside dura
Concave shape
epidural hematoma
CT image
Blood under dura
Crescent shape
subdural hematoma
CT image
Blood within brain
compresses ventricles
subarachnoid hemorrhage
Pupil dilation (anisocoria)0
Papilledema (swelling of optic nerve)
Posturing (abnormal flexion = decorticate, abnormal extension = decerebrate)
Clinicial features of ICP
Cushing’s triad?
Respiratoyr changes (Cheyne-Stokes, agonal)
Widening pulses pressure
Bradycardia
Most common CVA (stroke)
Thrombosis formation (slower ssx onset) Embolism (rapid onset)
Ischemic stroke - blood flow to brain is decreased
stroke is 3rd most common cause of death in US
Less common CVA…. associated w/ HTN or ruptured aneurysm/AVM
Hemorrhagic
Weakness/paralysis (contralateral to affected side of brain)
Difficulty speaking (aphasia)
Tx?
Clincal features of stroke…
Tx = CT to r/o hemorrhage!
Then fibrinolytics/transport to stroke center
Mini stroke
Milder/rapidly resolving symptoms
HIGH RISK OF FULL STROKE W/IN MOS
TIA
WHAT TYPE OF STROKE DOESN’T GET FIBRINOLYTICS?
HEMORRHAGIC DUH DON’T KILL PEOPLE
MOst common form of meningitis?
Viral
Adults = flu
Children = rubella, adenovirus, measles
Common pathogens for bacterial meningitis?
Adults = strep pneumo
Children/Young adults= Neisseria meningitides
Neonates = GBS
Clinical features of meningitis?
Fever/HA
Nuchal rigidity
Kernig’s/Brudzinski’s
forced flexion of neck -> flexion of hips/knees
Brudzinski’s sign = meningitis
supine pt flexes hip at 90, then attempt to full extend leg upward
Leg extension = pain/spasm in hamstring muscles
kernig’s
Meningitis… all CSF get sent…
for culture
Clear CSF, lymphocytes
Normal to high protein
NORMAL glucose
viral meningitis
Cloudy CSF
neutrophils
HIGH PROTEIN AND LOW GLUCOSE
bacterial meningitis
HIGH DOSE ABX STAT
Bite, or urine, blood from dogs, yote, raccoon, bats, foxes, skunks
Can take months to reach CNS
Flu like illness then eventual agitation/delirium (death w/in 1-3 weeks)
Rabies
Fatal if not immediately given postexposure rabies shot (once ssx manifest, no effective tx available)
Demyelinating dz presumed to be auto-immune
Onset 25-45 years (women 2x more than men)
MS
Episodes of exacerbation/remission
Sensory ssx (loss of touch, blurred vision)
Motor ssx (muscle weakness, unsteady gait)
Urinary incontinence
MS
What is the diagnostic criteria for MS?
2-nerve related ssx in 2 or more episodes separated by at least one month
No tx, but steroids to manage ssx
Atrophy of brain cortex w/ neuritic (senile) plaques and neurofibrillary tangles
90% w/ apolipoprotein E4 gene mutation
alzheimers
Dementia (loss of memory)
Decreased judgment and personality changes
Sundowning… pt becomes restless/irritbale towards end of day
Alzheimers
No cure… ACEIs and memantine
OTs for ADLs
Degeneration of extrapyramidal motor system
Loss of pigmented (dopaminergic) neurons in substantia nigra
Parkinson’s
Lewy’s bodies?
Parkinson’s
eisonophilic inclusion wthin depigmentaed neural tracts
Parkinson’s pyramidal vs extrapyramidal?
Pyramidal = fine motion/completion of movt
Extrapyramidal = involuntary
CLin features of parkinson’s?
Resting tremor of hands (pill rolling)
Slow shuffling walk w/ stooped posture (slowing of voluntary movt = bradykinesia)
Cogwheel rigidity/stuffness (UE on PROM)
Mask-like face (gradual loss of expression/drooling)(
Tx for parkinson’s?
No cure, but dopamine eases ssx
Atrophy of caudate nucleus and motor cortex of frontal lobe
Onset usually by 40
Presents w/ motor disturbances
Huntingtons chorea
also progressive dementia/abnormal behavior
Involuntary, gyrating movt
Choreiform
Huntington’s chorea
(on CT - wide sulci, large ventricles)
No cure, meds may ease ssx
Rare dz w/ progressive muscle wasting
DZ SPARES COGNITION/INTELLECT (UNIQUE FEATURE)
Onset, middle-aged to older
Amyotrophic Lateral Sclerosis
Hand muscle fasciculations (involuntary twitching that doens;t move limb)
Rapidly increasing paralysis (difficulty swallowing, speaking)
ALS (Lou Gehrig’s)
No tx (meds minimally slow progression)
Onset 25-40
Autoimmune
Demyelinating (brain)
Blurred vision
sensory loss
muscle weakness
MS
onset 70+
Amyloid plaques and neurofibril tangles
Memory loss
dementia
Alzheimers
60+
Decreased dopaminaergic neurons in substantia nigara
extrapyramidal motor d/o
Pill rolling
cogwheeling
mask-like face
Parkinson’s
40+
Atrophy of caudate nucleus/cerebral cortex
gyrating movt
dementia/behavioral changes
Huntington
35+
Spinal cord (ant horn), medulla, cerebral cortex
Fasciculations
Muscle wasting
INTELLECT SPARED
Lou Gehrig (ALS)
