Neuro AHN 572 Flashcards
Loss of blood supply to brain, causing loss of function is…
Stroke
Severity of the stroke depends on
The vessel and the amount of brain area involved
Cause of ischemic stroke
atrial fibrillation
Heart attack
atherosclerosis
Causes of hemorrhagic stroke
hypertension (ICH)
aneurysms
arteriovenous malformations
Risk factors for stroke
Hypertension Atrial fibrillation hyperlipidemia diabetes smoking PVD/CAD/Carotid disease
Other modifiable risk factors for stroke, less well documented
Obesity physical inactivity Alcohol Drug Hypercoagulability HRT Oral contraceptives Inflammatory processes
Seven step stroke chain of survival and recovery
detection dispatch delivery door data decision drug
Hold anticoagulants and fibrinolytic until…
Ct has ruled out hemorrhage
Stroke mimickers
seizures confusional states syncope toxic and metabolic disorders (electrical imbalances) hypoglycemia brain tumors subdural hematomas
Absolute contraindications for t-PA
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
Relative contraindications
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
NINDS time target door to doctor
10 minutes
NINDS time target door to CT
25 minutes
NINDS time target door to CT read
45 minutes
NINDS time target door to treatment
60 minutes
Tension HA account for…
90% of all HA’s
Etiology of HA
Tension (90%) migraine cluster toxic SDH SAH Meningeal irritation Giant cell arteritis structural lesions referred pain visual strain narrow angle glaucoma hypertensive headache
Components of HA evaluation
Chronology location, duration, quality associated activity timing in menstrual cycle associated symptoms presence of trigger age of onset
Tension headache treatment
stress reducing techniques
explore cause of stress
when other measures fail, a trial of anti migraine agents is appropriate
Theories for the cause of migraine headaches
Dilation and excessive pulsation of external carotid artery
excessive release of the neurotransmitter serotonin, leading to an inflammatory process involving the trigeminal nerve
Migraine triggers
emotional or physical stress lack of or excessive sleep missed meals specific foods alcohol menstruation weather changes nitrate containing foods
Migraine management
avoid triggers
relaxation and stress management
drugs for migraine to abort migraine or prevent the migraine
Migraine abortive therapy
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
Triptans
First line drug for terminating migraine
Relieve pain by constricting intracranial blood vessels and suppressing release of inflammatory neuropeptides
Triptan SE
Greatest concern is coronary vasospasm
Cluster HA
Among the most painful of all HA
Cluster HA etiology
Histamine mediated dilation of external carotid artery
Cycles occur the same time each time each year most often during fall and spring
Parkinsons disease is…
a progressive, neurodegenerative disease
Neurons loss in parkinsons
dopamine neurons
dopamine neurons live in the…
substantia nigra
Parkinsons movement trouble
shakiness, stiffness, slowed movements, balance trouble
Risk factors for parkinsons
genetics some pesticides cleaning chemicals gender history of concussions heavy metal exposure
treatment for parkinson’s
medication- dopamine replacement
Later in disease can try surgery
Parkinson movement disoder
tremor-“resting”
rigidity- “cogwheel rigidity”
Slowed movement- “bradykinesia”
postural instability “
non movement symptoms of parkinsons
depression anxiety memory concentration sense of smell
Types of CNS infections
Meningitis
Cerebral abscess
encephalitis
Meningitis pathology
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
Causes of meningitis
Bacteremia from pneumonia, empyema, osteomyelitis, endocarditis sinusitis, otitis media, encephalitis brain abscess viral infection idiopathic trauma or invasive procedure
Bacterial meningitis is…
Life threatening
Exudate forms in..
Bacterial meningitis- neutrophil
Does not form in viral meningitis where lymphocytes gather
S/sx of meningitis
Fever Tachycardia Hypotension Petechial hemorrhage, ecchymosis of skin Photophobia, diplopia deafness and vertigo Nuchal rigidity headache seizures sensory loss
Diagnostic testing for meningitis
LP with CSF analysis
CT brain to rule out edema
Culture urine, sputum, nasopharynx if suspected as possible source
LP data for bacterial meningitis
Growth on culture Gram + in >70% of patients >1000 molymorphonuclear cells Protein increased > 100 Glucose decreased < 40 Pressure- increased Color- turbid, cloudy
LP data for viral meningitis
No growth on culture Gram stain negative WBC increased lymphocytes Protein elevated Glucose normal Opening pressure moderate to high Color clear to bloody
Treatment for bacterial meningitis
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
Cerebral abscess definition
An infected space occupying lesion in the brain
Cerebral abscess causes
infection from a different sit in or near the brain otitis media mastoid infection sinusitis oral surgery
s/sx of cerebral abscess
depends on the location of the abscess speech, visual disturbances hemiparesis seizures severe HA
Hydrocephalus definition
A condition in which CSF builds up around the brain
Causes of hydrocephalus
Spina bifida brain infections hemorrhage tumors brain trauma
Types of hydrocephalus
Communicating- problem is in the subarachnoid space
noncommunicating-problem is in the ventricles
Normal pressure hydrocephalus
Seen in elderly
due to obstruction of the CSF pathways- communicating hydrocephalus
ventricles enlarged
no increase in pressure
S/S of normal pressure hydrocephalus
urinary incontinence
Mental status change- mild dementia
Gait disturbances
Mimics alzheimers
Encephalitis definition
Acute inflammation of the brain caused by viral or other infection, often carried by mosquitos
Causes of encephalitis
HSV- most common cause in US Varicella-zoster virus influenza tick infestation Toxoplasmosis- more common in AIDS patients
West nile virus s/sx
fever nystagmus, ocular paralysis N/V nuchal rigidity severe HA, ataxia, dysphagia, hemiparesis, seizures
Guillian-Barre syndrome (GBS) definition
Acute, rapidly progressive form of inflammatory polyneuropathy characterized by muscular weakness and mild distal sensory loss
Causes: infectious disorder, surgery or an immunization
s/sx of GBS
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
GBS diagnostic
CSF- very high protein elevation (> 1000)
CBC- leukocytosis
