neuro abnormalities Flashcards
multiple sclerosis patho
progressive autoimmune disorder
- combo of inflammation and degeneration of the myelin of the brain’s white matter, leading to decreased brain mass and obstructed transmission of nerve impulses
multiple sclerosis subjective
fatigue
urinary freq, urgency, or hesitancy
sexual dysfunction
vertigo, weakness, numbness
blurred vision, diplopia, loss of vision
emotional changes
relapse symptoms develop rapidly over hours or days
multiple sclerosis objective
muscle weakness, ataxia hyperactive DTR paresthesia, sensory loss intention tremor optic neuritis cognitive changes MRI: brain lesions
intracranial tumor patho
abnormal growth within the cranial cavity that may be a primary or metastatic cancer
intracranial tumor subjective
persistent HA nausea, early morning vomiting unsteady gait, impaired coordination memory loss and confusion reduced vision acuity, visual loss, diplopia behavior or personality change seizure
intracranial tumor objective
s/s vary by location of tumor altered consciousness, confusion papilledema cranial nerve impairment aphasia, language disorder vision loss- hemianopia, nystagmus gait disturbances, ataxia
pseudotumor cerebri patho
clinical syndrome of intracranial HTN that mimics brain tumors
pseudotumor cerebri subjective
severe daily HA, throbbing pain behind eye vomiting short episodes of blurred vision, double vision whooshing in ears
pseudotumor cerebri objective
papilledema, retinal hemorrhages on fundoscopic inferior nasal vision field defect dec. visual acuity alert, unimpaired consciousness absence of focal neurologic signs
Sz disorder (epilepsy) patho
chronic disorder characterized by recurrent, unprovoked seizures secondary to an underlying brain abnormality
- episodic abnormal electrical discharges
Sz disorder subjective
hx of prior sz premonition or aura body is stiff and rigid, followed by rhythmic jerking movements eyes roll upward drooling loss of bladder or bowel control
sz disorder objective
tonic phase:
- brief flexion and characteristic cry with contraction of abdominal muscles, followed by generalized extension for 10-15 minutes; loss of consciousness for 1-2minutes, eyes deviated upward, dilated pupils
- Clonic phase: contractions alternate with muscle relaxation
- postictal state: coma followed by confusion and lethargy
encephalitis patho
acute inflammation of the brain and spinal cord involving the meninges, often due to a virus
encephalitis subjective
mild viral illness with fever
recovery and quiet stage followed by onset of lethargy, restlessness, and mental confusion
encephalitis objective
altered mental status, confusion, stupor, coma
photophobia
stiff neck
muscle weakness, paralysis, ataxia
meningitis patho
inflammation of the meninges of the brain or spinal cord
- bacterial, viral, or fungal infection crosses the BBB
meningitis subjective
fever, chills HA, stiff neck lethargy, malaise vomiting irritability sz
meningitis objective
altered mental status, confusion nuchal rigidity fever brudzinski and kernig signs petechiae and purpura with meningococcal meningitis
myasthenia gravis patho
autoimmune disorder of neuromuscular junction involved with muscle activation
- autoantibodies directed against the acetylcholine Rc in the neuromuscular junction -> destruction and inflammatory changes in the postsynaptic membranes -> muscle dysfunction
myasthenia gravis subjective
drooping eyelids
double vision
diff. swallowing or speaking
fluctuating fatigue or weakness; worse with exercise
inability to work with arms raised above head
difficulty walking
s/s worse later in the day and improve with rest
myasthenia gravis objective
ptosis that develops within 2 minutes of upward gaze
facial weakness w/ puffing out cheeks
hypophonia
difficulty managing secretions
resp. compromise or failure
weakness of skeletal muscles without reflex, sensory, or coordination abnormalities
guillain-barre syndrome patho
postinfectious disorder following a nonspecific GI or respiratory infection that causes an acute neuromuscular paralysis
- autoimmune disorder triggered by bacterial or viral infection -> peripheral nerve denervation and atrophy
guillain-barre syndrome subjective
hx of recent illness and recovery
progressive weakness, more in legs than arms
difficulty walking
paresthesia
pain in the shoulder, back, or posterior thigh
double vision
guillain-barre syndrome objective
distal weakness, usually bilateral and symmetric
diminished rerlexes in ascending pattern
ataxia, progressing to flaccid paralysis
facial nerve weakness, diplopia
dysphagia, difficulty handling secretions
resp. distress
trigeminal neuralgia (tic douloureux) patho
recurrent paroxysmal sharp pain that radiates into one or more branches of CN V
- compression the nerve -> demyelination
trigeminal neuralgia subjective
- sharp pain episodes on one side of the face that lasts seconds to minutes; rarely bilateral
- potential pain triggers: chewing, swallowing, talking, washing face, brushing teeth, exposure to cold
- episodes may occur several times a day to several times a month followed by a pain free period
trigeminal neuralgia objective
may be normal neurologic findings
may have slight sensory impairment in the regions of pain
pain occurs in the distribution of one or more divisions of the facial nerve
peripheral neuropathy patho
disorder of the peripheral nervous system that results in motor and sensory loss in the distribution of one or more nerves
peripheral neuropathy subjective
- gradual onset of numbness, tingling, burning, and cramping, most commonly in the hands and feet
- night pain in one or both feet
- early s/s: may be unusual sensations of walking on cotton, floors feeling strange, or inability to distinguish between coins by feel.
- sensations of burning accompanied by hyperalgesia and allodynia: all sensation painful
peripheral neuropathy objective
- reduced sensation in the foot with the monofilament, dec. sensation of pain or touch sensation.
- distal pulses may be present or diminished
- diminish or absent ankle and knee reflexes
- dec. or no vibratory sensation below the knees
temperature sensation may be less impaired - distal muscle weakness, inability to stand on toes or heels
- skin ulceration or injuries to extremities the pt does not feel
cerebral palsy patho
group of permanent disorders of movement and posture development associated with nonprogressive disturbances that occurred in the developing fetal or infant brain.
- infection, trauma, anoxia in perinatal period, intracranial hemorrhage in fetus or premature infant
cerebral palsy subjective
- delays in gross motor development that become more obvious as the infant ages
- activity limitation, stiff joints and positioning
- may have hearing, speech, and language disorders
- feeding diff., poor sucking and swallowing coordination
- sz
cerebral palsy objective
- cognitive impairment or learning disabilities
- spastic
- dyskinetic
- ataxic
spastic CP
hypertonicity tremors scissor gait toe walking persistent primitive reflexes exaggerated DTR
dyskinetic CP
involuntary slow writhing movements of the extremities, tremors may be present
- exaggerated posturing
- inconsistent muscle tone that varies during the day
ataxic CP
abnormalities of movement involving balance and position of trunk and extremities
- intention tremors, past pointing
- inc. or dec. muscle tone, may have hypotonia as infant
- instability, wide-based gait.
myelomeningocele (spina bifida) patho
congenital vertebral defect that allows spinal cord content to protrude
myelomeningocele subjective
may have loss of bowel control or constipation
may have loos of bladder control
mobility problems
myelomeningocele objective
exposed meningeal sac filled with fluid and nerves is apparent at birth
- sensory deficit and paralysis or weakness are dependent on level of defect (higher = greater)
- rapidly inc. head circumference (hydrocephalus)
- may have hip or foot abnormalities
- learning disability and perceptual motor skills
shaken baby syndrome patho
severe form of child abuse resulting form the violent shaking of infants younger than 1 year old
shaken baby syndrome subjective
fever irritability or lethargy dec. food intake breathing difficulty or apnea sz loss of consciousness
shaken baby syndrome objective
reported HPI does not match nature and severity of findings
altered LOC
sz
bilateral retinal hemorrhages with retinal detachments
absence of visible trauma to head
possible fingerprints on arms and body
bruising, bite marks, or burns possible
parkinsons disease patho
slowly progressive, degeneration neurologic disorder in which motor function is primarily affected along with behavioral and cognitive problems
- destruction of neurons that transmit dopamine -> poor communication between parts of the brain that coordinate and control movement and balance
parkinson’s disease subjective
- tremors occur initially at rest and with fatigue, disappearing with intended movement and sleep, progress to pill-rolling movement of fingers bilaterally and tremor of head
- slowing of voluntary and automatic movements, “feel wooden” freezing or unable to continue movements
- numbness, aching, tingling, and muscle soreness
- difficulty swallowing, drooling
parkinson disease objective
tremors
muscular rigidity, cogwheel rigidity with jerks
stooped posture, balance and postural instability
short steps, shuffling, freezing gait, gait may accelerate to maintain upright posture
slow, slurred, monotonous speech, voice softening
impaired cognition, dementia
normal pressure hydrocephalus patho
syndrome simulating degenerative disease that is cuased by noncommunicating hydrocephalus (dilated ventricles with ICP nml)
normal pressure hydrocephalus subjective
gait impairment is 1st s/s
unsteady and difficulty turning
forgetfulness, cognitive impairment
urinary freq. that progresses to urgency and incontinence over time
normal pressure hydrocephalus objective
gait impairment, wide-based stance, short, small-steps
no tremor
no sensory impairment
cognitive impairment, attention and executive function impaired
impaired memory recall for recent events
postpolio syndrome patho
reappearance of neurologic signs 10 or more years after an acute poliomyelitis infection
postpolio syndrome subjective
hx of paralytic or nonparalytic polio new onset muscle weakness, muscle cramps inc. pain sensitivity fatigue cold intolerance difficulty with swallowing or speaking SOB difficulty sleeping
postpolio syndrome objective
focal and asymmetric muscle weakness and atrophy
fasciculations
dysphagia, dysarthria
sleep apnea, hypoventilation
