Neuro

Question 1

Autonomic dysreflexia: what’s happening?

Answer 1

Stimulus: activation of visceral or cutaneous pain receptors below level of injury (full bladder or constipation is common cause)

Stimulation of afferent pain receptors –> activate sympathetic efferents + vasoconstriction

Sustained activation below level of injury –> BP increases significantly –> initiates baroreceptor response –>
lower HR and cause vasodilation of vessels above injury –> upper body flushing

Descending signals from brain can’t pass the cord injury –> inhibition of sympathetic neurons below level of injury doesn’t occur

BP can be dangerously high and require aggressive tx

Question 2

Absence (petit mal) seizures–

Answer 2

seen in children and resolve by 20 yo; appear to be staring; onset + end are sudden; attacks that last <10 sec; unaware of surroundings + motionless (sometimes will continue walking or performing routine task)

Question 3

Atypical absence seizure

Answer 3

staring spell + other manifestations (myoclonic jerks and automatisms - jerking, eye blinking, lip smacking, repetitive semi-purposeful movements); includes brief warnings, peculiar behavior during the seizure, or confusion after the seizure

Question 4

Myoclonic seizure

Answer 4

extremely brief; one or multiple jerks

Question 5

Atonic (drop attack) seizure

Answer 5

sudden and complete loss of muscle tone; often causes falls and injuries

Question 6

Tonic seizure

Answer 6

sudden loss of consciousness + muscle rigidity; falls –> initial motor signs (opening of mouth and eyes, extension of legs, adduction of arms); possible tongue biting or high-pitched cry (air forced out of lungs thru closed vocal cords); respiratory arrest w/ possible cyanosis; bowel and bladder incontinence; lasts 10-15 sec, followed by clonic

Question 7

Clonic seizure

Answer 7

violent but rhythmic muscle contractions; eye rolling, facial grimacing, tachycardia; increased salivation and sweating; lasts 1-2 minutes w/ gradual decline in amplitude of jerks

Question 8

Tonic-clonic (grand mal) seizure

Answer 8

stiffening and repetitive jerking; during terminal or postictal phase – may regain consciousness or drift into coma-like state, disorientation and confusion, may sleep for hours; headache, drowsiness, nausea, muscle soreness, no memory of seizure, retrograde amnesia

Question 9

Simple partial seizure

Answer 9

no change in LOC; symptoms can be motor, sensory, autonomic or any combo; rarely last >1 min

Motor – may be limited to one part of the body

Sensory – may result in tingling or numbness that
spreads/marches to different parts of limb or body
(depending on location of seizure activity in brain); may
involve the special senses –> producing auditory (buzzing
sounds), olfactory, or visual manifestations (flashing lights)

Autonomic – pupillary (pupil dilation), skin (diaphoresis, flushing), or respiratory changes

Question 10

Complex partial seizure

Answer 10

loss or alteration in consciousness; many different combos of cognitive, affective, and psychomotor symptoms; automatisms at onset of impaired consciousness (may show aggressive behavior, esp if ppl nearby try to restrain); post seizure –> drowsiness, confusion; last >1 min, may be followed by postictal state

Question 11

Secondarily generalized seizure

Answer 11

seizures that begin as simple partial –> progress to involve both brain hemispheres –> clinically similar to primary generalized