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AHN 568 Unit #5 > Neuro AHN 572 > Flashcards

Neuro AHN 572 Flashcards

1
Q

Loss of blood supply to brain, causing loss of function is…

A

Stroke

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2
Q

Severity of the stroke depends on

A

The vessel and the amount of brain area involved

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3
Q

Cause of ischemic stroke

A

atrial fibrillation
Heart attack
atherosclerosis

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4
Q

Causes of hemorrhagic stroke

A

hypertension (ICH)
aneurysms
arteriovenous malformations

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5
Q

Risk factors for stroke

A 
Hypertension
Atrial fibrillation
hyperlipidemia
diabetes
smoking
PVD/CAD/Carotid disease
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6
Q

Other modifiable risk factors for stroke, less well documented

A 
Obesity 
physical inactivity
Alcohol
Drug
Hypercoagulability
HRT
Oral contraceptives
Inflammatory processes
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7
Q

Seven step stroke chain of survival and recovery

A 
detection
dispatch
delivery
door
data
decision
drug
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8
Q

Hold anticoagulants and fibrinolytic until…

A

Ct has ruled out hemorrhage

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9
Q

Stroke mimickers

A 
seizures
confusional states
syncope
toxic and metabolic disorders (electrical imbalances)
hypoglycemia
brain tumors
subdural hematomas
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10
Q

Absolute contraindications for t-PA

A 
ICH or history of
SAH
Neurosurgery, head trauma or stroke in past 3 months
uncontrolled HTN
Known AVM, aneurysm or neoplasm
active internal bleeding
suspected endocarditis
Abnormal BG < 50 > 400
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11
Q

Relative contraindications

A

improving stroke symptoms
major surgery in previous 14 days
history of GI or GU hemorrhage in 21 days
Recent arterial puncture at a non compressible site
recent LP
post MI
pregnancy

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12
Q

NINDS time target door to doctor

A

10 minutes

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13
Q

NINDS time target door to CT

A

25 minutes

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14
Q

NINDS time target door to CT read

A

45 minutes

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15
Q

NINDS time target door to treatment

A

60 minutes

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16
Q

Tension HA account for…

A

90% of all HA’s

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17
Q

Etiology of HA

A 
Tension (90%)
migraine
cluster
toxic
SDH
SAH
Meningeal irritation
Giant cell arteritis
structural lesions
referred pain
visual strain
narrow angle glaucoma
hypertensive headache
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18
Q

Components of HA evaluation

A 
Chronology
location, duration, quality
associated activity
timing in menstrual cycle
associated symptoms
presence of trigger
age of onset
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19
Q

Tension headache treatment

A

stress reducing techniques
explore cause of stress
when other measures fail, a trial of anti migraine agents is appropriate

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20
Q

Theories for the cause of migraine headaches

A

Dilation and excessive pulsation of external carotid artery

excessive release of the neurotransmitter serotonin, leading to an inflammatory process involving the trigeminal nerve

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21
Q

Migraine triggers

A 
emotional or physical stress
lack of or excessive sleep
missed meals
specific foods
alcohol
menstruation
weather changes
nitrate containing foods
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22
Q

Migraine management

A

avoid triggers
relaxation and stress management
drugs for migraine to abort migraine or prevent the migraine

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23
Q

Migraine abortive therapy

A

Treatment should commence at the earliest sign of migraine
For mild to moderate sx- ASA, Ibuprofen, Acetaminophen, Excedrine migraine
If milder treatments are ineffective then you can use “triptans” (SSRIs), ergot alkaloids, or an opioid in that order

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24
Q

Triptans

A

First line drug for terminating migraine

Relieve pain by constricting intracranial blood vessels and suppressing release of inflammatory neuropeptides

25
Q

Triptan SE

A

Greatest concern is coronary vasospasm

26
Q

Cluster HA

A

Among the most painful of all HA

27
Q

Cluster HA etiology

A

Histamine mediated dilation of external carotid artery

Cycles occur the same time each time each year most often during fall and spring

28
Q

Parkinsons disease is…

A

a progressive, neurodegenerative disease

29
Q

Neurons loss in parkinsons

A

dopamine neurons

30
Q

dopamine neurons live in the…

A

substantia nigra

31
Q

Parkinsons movement trouble

A

shakiness, stiffness, slowed movements, balance trouble

32
Q

Risk factors for parkinsons

A 
genetics
some pesticides
cleaning chemicals
gender
history of concussions
heavy metal exposure
33
Q

treatment for parkinson’s

A

medication- dopamine replacement

Later in disease can try surgery

34
Q

Parkinson movement disoder

A

tremor-“resting”
rigidity- “cogwheel rigidity”
Slowed movement- “bradykinesia”
postural instability “

35
Q

non movement symptoms of parkinsons

A 
depression
anxiety
memory
concentration
sense of smell
36
Q

Types of CNS infections

A

Meningitis
Cerebral abscess
encephalitis

37
Q

Meningitis pathology

A

inflammation of the pia and arachnoid mater begins with entry of a microorganism into the CNS
The meninges attempt to destroy the m/o
Neutrophils gather and cause thickened CSF which doesn’t flow well

38
Q

Causes of meningitis

A 
Bacteremia from pneumonia, empyema, osteomyelitis, endocarditis
sinusitis, otitis media, encephalitis
brain abscess
viral infection
idiopathic
trauma or invasive procedure
39
Q

Bacterial meningitis is…

A

Life threatening

40
Q

Exudate forms in..

A

Bacterial meningitis- neutrophil

Does not form in viral meningitis where lymphocytes gather

41
Q

S/sx of meningitis

A 
Fever
Tachycardia
Hypotension
Petechial hemorrhage, ecchymosis of skin
Photophobia, diplopia
deafness and vertigo
Nuchal rigidity
headache
seizures
sensory loss
42
Q

Diagnostic testing for meningitis

A

LP with CSF analysis
CT brain to rule out edema
Culture urine, sputum, nasopharynx if suspected as possible source

43
Q

LP data for bacterial meningitis

A 
Growth on culture
Gram + in >70% of patients
>1000 molymorphonuclear cells
Protein increased > 100
Glucose decreased < 40
Pressure- increased
Color- turbid, cloudy
44
Q

LP data for viral meningitis

A 
No growth on culture
Gram stain negative
WBC increased lymphocytes
Protein elevated
Glucose normal
Opening pressure moderate to high
Color clear to bloody
45
Q

Treatment for bacterial meningitis

A

Antibiotic therapy must be started IMMEDIATELY
Empiric treatment begins with Cefotaxime
If immunocompromised or over 50- Ampicillin
If no improvement in 24 hours- intrathecal treatment
Then treat s/sx of meningitis
fever, seizures, hydration

46
Q

Cerebral abscess definition

A

An infected space occupying lesion in the brain

47
Q

Cerebral abscess causes

A 
infection from a different sit in or near the brain
otitis media
mastoid infection
sinusitis
oral surgery
48
Q

s/sx of cerebral abscess

A 
depends on the location of the abscess
speech, visual disturbances
hemiparesis
seizures
severe HA
49
Q

Hydrocephalus definition

A

A condition in which CSF builds up around the brain

50
Q

Causes of hydrocephalus

A 
Spina bifida
brain infections
hemorrhage
tumors
brain trauma
51
Q

Types of hydrocephalus

A

Communicating- problem is in the subarachnoid space

noncommunicating-problem is in the ventricles

52
Q

Normal pressure hydrocephalus

A

Seen in elderly
due to obstruction of the CSF pathways- communicating hydrocephalus
ventricles enlarged
no increase in pressure

53
Q

S/S of normal pressure hydrocephalus

A

urinary incontinence
Mental status change- mild dementia
Gait disturbances
Mimics alzheimers

54
Q

Encephalitis definition

A

Acute inflammation of the brain caused by viral or other infection, often carried by mosquitos

55
Q

Causes of encephalitis

A 
HSV- most common cause in US
Varicella-zoster virus
influenza
tick infestation
Toxoplasmosis- more common in AIDS patients
56
Q

West nile virus s/sx

A 
fever
nystagmus, ocular paralysis
N/V
nuchal rigidity
severe HA, ataxia, dysphagia, hemiparesis, seizures
57
Q

Guillian-Barre syndrome (GBS) definition

A

Acute, rapidly progressive form of inflammatory polyneuropathy characterized by muscular weakness and mild distal sensory loss
Causes: infectious disorder, surgery or an immunization

58
Q

s/sx of GBS

A 
symmetrical distal muscle weakness beginning in legs, ascends rapidly to the arms
hypotonia
loss of DTR's
Difficult swallowing
urinary retention
respiratory paralysis
Autonomic dysfunction
59
Q

GBS diagnostic

A

CSF- very high protein elevation (> 1000)

CBC- leukocytosis

AHN 568 Unit #5 (14 decks)

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