Nervous System: Part 2 Flashcards
Cerebral Vascular Attack (CVA)
- Stroke
- Brain Attack
Types of CVA
- Ischemic
2. Hemorrhagic
What causes an ischemic CVA?
interruption of blood flow in a cerebral vessel
What causes an hemorrhagic CVA?
bleeding into brain tissue
What events can prompt a CVA?
- Vessel rupture
- HTN
- Aneurism
- Arteriovenous malformation
- Head injury
- Blood dyscrasias
Is ischemic or hemorrhagic stroke more common?
Ischemic
What percentage of CVA are ischemic?
70-80%
- Ischemic Penumbra
- Transient Ischemic Attack (TIA)
- Large Vessel (Thrombotic)
- Small Vessel (Lacunar
- Infarct
- Cardiogenic Embolic Stroke
Types of ischemic CVA
Types of ischemic CVA
- Ischemic Penumbra
- Transient Ischemic Attack (TIA)
- Large Vessel (Thrombotic)
- Small Vessel (Lacunar
- Infarct
- Cardiogenic Embolic Stroke
Example of Ischemic stroke
- embolus like a blood clot in the brain
- causing death to that area
Cerebral Aneurysms
A weakness in a blood vessel in the brain that balloons and fills with blood
Symptoms of small Aneurysms
asymptomatic
Symptoms of large Aneurysms
- chronic headache
- neurologic deficits
- signs of meningeal irritation
- cranial nerve deficits
- stroke syndrome
- cerebral edema
- increased ICP
- pituitary dysfunction
Manifestations of Aneurysms
Manifestations of Aneurysms
- signs of meningeal irritation
- cranial nerve deficits
- stroke syndrome
- cerebral edema
- increased ICP
- pituitary dysfunction
What can be the result of subarachnoid hemorrhage?
- subarachnoid hemorrhage
- massive release of catecholamines
- HTN and cardiac dysrhythmias
Types of Aneurysms
- Saccular
- Fusiform
- Ruptured
Saccular Aneurysms
- sac
- forms like a berry
- formed from wall
- very thin walled out pouch
Where do saccular Aneurysms typically occur?
The anterior circulation of major artery branch points
What percentage of Saccular Aneurysms occur in the anterior circulation of major artery branch points?
90%
Why is management of aneurism different from ICP and stroke management?
- You want low BP
- keep aneurism from growing and rupturing
Aneurysmal Subarachnoid Hemorrhage
Ruptured aneurism bleeds into subarachnoid space
Phases of Aneurysmal Subarachnoid Hemorrhage
- Before rupture
- After rupture
Causes of Aneurysmal Subarachnoid Hemorrhage
- Congenital defect
- Acute increases in ICP
- Smoking
- HTN
- Excessive alcohol
Encephalitis
Infection of parenchyma of brain or spinal cord
Result of Encephalitis
- Local necrotizing hemorrhage
- Progressive degeneration of nerve cell bodies
- Prominent edema
Transmission of Encephalitis
- Ingestion
- Mosquito
- Rabid animal
Types of Encephalitis
- Viral
- Bacteria
- Fungi
What are some examples of types of viral encephalitis are there?
- Herpes simplex virus
- West Nile virus
- HIV
- Enteroviruses
What are some examples of types of bacterial encephalitis are there?
bacterial meningitis
Symptom of Encephalitis
ICP
How does encephalitis cause ICP?
- infection
- inflammatory process
- swelling of brain and spinal cord
Symptoms of encephalitis
- nuchal rigidity
- Brudzinski’s sign
nuchal rigidity
inability to flex the neck forward due to rigidity of the neck muscles
Brudzinski’s sign
Severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed
Symptoms of bacterial meningitis in children
- nuchal rigidity
- stiff neck pain
- N&V
- rash
Seizure
Sudden, uncontrolled electrical disturbance in the brain
Types of Seizures
- Generalized Seizures
2. Focal/Partial Seizures
Types of Generalized Seizures
- Tonic Clonic (Grand Mal)
- Atonic
- Myoclonic
- Clonic
- Tonic
- Absence/petit mal
Types of Focal/Partial Seizures
- Simple
2. Complex
Tonic Clonic (Grand Mal) Seizure
- loss of consciousness
- violent muscle contractions
Atonic Seizure
muscles suddenly become limp
Myoclonic Seizure
brief shock-like jerks of a muscle(s)
Clonic Seizure
repeated jerking movements
Tonic Seizure
sudden stiffness or tension in the muscles
Absence/petit mal Seizure
brief, sudden lapses in attention
Simple vs Complex partial seizure: : Sense of surroundings
Simple: No loss
Complex: Yes loss
Simple vs Complex partial seizure: Duration
Simple: <2 min
Complex: > 2 min
Example #1:
- 1-5 min
- Entire body falls
- Stiffens
- Jerks
- Bites tongue
- Blueish
- lack of oxygen
- incontinence
- sleepy
Which type of seizure:
a. tonic clonic
b. absence seizure
c. complex partial
d. simple partial
a. tonic clonic
Example #2:
- few seconds
- staring spell or blinks eyes
- most common in children
- mistaken for daydreaming
Which type of seizure:
a. tonic clonic
b. absence seizure
c. complex partial
d. simple partial
b. absence seizure
Example #3:
- 1 to 2 min
- purposeless activity
- impaired consciousness
- may appear confused, drunk, psychotic
- smacks lips
- struggles when restrained
Which type of seizure:
a. tonic clonic
b. absence seizure
c. complex partial
d. simple partial
c. complex partial
Example #4:
- jerking of one limb or side of body
- consciousness maintained
Which type of seizure:
a. tonic clonic
b. absence seizure
c. complex partial
d. simple partial
d. simple partial
Major difference between generalized and partial seizures
Generalized- usually lose consciousness
Partial- usually consciousness maintained
Which type of seizure typically causes the most issues?
Tonic clonic
Status epilepticus
- continuous seizures
- constant seizure activity in brain
- Doesn’t stop spontaneously
Treatment for Status epilepticus
- Not much you can do
- Benzodiazepines to get seizure activity to stop
If Status epilepticus untreated or not stopped it can lead to what?
death
Why would someone with untreated status epilepticus die?
respiratory failure
Which neurotransmitter is important in regard to seizures? Why?
- GABA
- too much excitatory
Myasthenia Gravis
-Disorder of transmission at neuromuscular junction that -affects communication between motor neuron & innervated muscle cell.
What causes Myasthenia Gravis?
- Autoimmune disease
- Antibody mediated loss of acetylcholine receptors in neuromuscular junction
Without acetylcholine what happens to the body?
Cannot eat, talk, swallow, ect…
Myasthenic Crisis
- complication of myasthenia gravis
- worsening of muscle weakness
Result of Myasthenic Crisis
- respiratory failure
- requires intubation
Cholinergic Crisis
over-stimulation at a neuromuscular junction due to an excess of acetylcholine
Neuropathy
Weakness, numbness, and pain from nerve damage
Mononeuropathy
neuropathy involving a single nerve
Polyneuropathy
neuropathy involving multiple nerves
Peripheral Neuropathy
damage to a nerve outside the brain and spinal cord
What is an example of a Mononeuropathy?
Carpal tunnel Syndrome
Carpal tunnel Syndrome
-Compression of the median nerve
Where is the median nerve located?
Travels with the flexor tendons through a canal made by the carpal bones and transverse carpal ligament
Symptoms of Carpal tunnel Syndrome
- Pain
- paresthesia
- numbness of thumb, 1st, 2nd and ½ digits of the hand
- pain in wrist and hand which worsens at night
- atrophy of abductor pollicis muscle
- weakness in precision grip
What can be used to diagnose Carpal tunnel Syndrome?
Tinel or Phalen sign
Results of Peripheral Neuropathy
Muscle weakness with or without atrophy & sensory changes
Involvement of nerves in Peripheral Neuropathy
Can involve a single nerve (mononeuropathy) or multiple nerves (polyneuropathy)
Symptoms of Peripheral Neuropathy
- loss of feeling
- freezing
- tingling
- hypersensitivity
- sharp, jabbing pain. burning sensation
- numbness
Diabetic Peripheral Neuropathy
nerve damage that can occur with diabetes
As a clinician what is important to teach patients with Diabetic Peripheral Neuropathy?
need to wear good shoes
Why do pts with Diabetic Peripheral Neuropathy need to wear good shoes?
- loss of feeling
- ex: could get splinter in foot and they aren’t going to feel it
Guillain-Barre Syndrome
-destruction of myelin sheath
Cause of Guillain-Barre Syndrome
- Can be autoimmune
- Can result from mild infection
What disorder is Guillain-Barre Syndrome similar too?
MS
How are Guillain-Barre Syndrome and MS differnt?
- Guillain-Barre Syndrome- PNS
- MS-CNS
How does Guillain-Barre Syndrome progress?
- begins in lower extremities
- ascends bilaterally
- Paralysis
Symptoms of Guillain-Barre Syndrome?
- weakness
- ataxia
- bilateral paresthesia
Does muscle atrophy in Guillain-Barre Syndrome?
Minimally
is paralysis in Guillain-Barre Syndrome bilateral or unilateral?
bilateral
How long does it take for Guillain-Barre Syndrome to progress?
hours to days
Risk factors for Guillain-Barre Syndrome
- possibly autoimmune
- association with immunizations
- frequently preceded by mild resp or intestinal infection
What problems occur in Guillain-Barre Syndrome?
- Respiration
- Talking
- Swallowing
- Bowel/Bladder Function
How does Guillain-Barre Syndrome symptoms travel?
PNS to CNS
Treatment for Guillain-Barre Syndrome
Supportive care
Why is supportive care provided for Guillain-Barre Syndrome
- After a few days the lungs become atrophied.
- Pt needs help moving around
