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Pathophysiology I: Exam 3 > Neuro: Alterations > Flashcards

Neuro: Alterations Flashcards

1
Q

Seizures

A

Abnormal hyper-synchronous discharge of cortical neurons, that produce a brief disruption of electrical function of the brain and alter brain function

Seizure disorders: represent a manifestation of disease (NOT a specific disease entity)

Convulsion: refers to tonic-clonic (jerky, contract-reflex) movement associated with some seizures

Precipitating factors: Hypoglycemia, fatigue, stress, hypo-/hypernatremia, stimulants, withdrawal from antidepressants or alcohol, hyperventilation, environment (lights, TV, noises, odors); and febrile-induced seizures (neonates)

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2
Q

Epilepsy

A

A disease of the brain with recurrent seizures (unknown cause)

Known etiologies: Low oxygen at birth, head injuries, brain tumors, genetic conditions (tuberous sclerosis), infections, and stroke

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3
Q

Seizure types

A

Types:
1. GENERALIZED: originates on BOTH sides of the brain; motor symptoms (prone to convulsions)

  1. FOCAL: originates on ONE side of the brain; motor/non-motor symptoms and with/without LOC
  2. SECONDARY GENERALIZATION: starts focal, becomes generalized

Post-ictal state: long recovery period that may last hours to a few days following a seizure; S/S: HA, confusion, aphasia, memory loss, paralysis, and DEEP SLEEP (common)

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4
Q

Status epilepticus

A

A state of either:

  1. Continuous seizures lasting >5 min.
  2. A second seizure that is experienced before fully regaining consciousness
  3. A single seizure lasting >30 min.

Medical emergency because of possible cerebral hypoxia

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5
Q

Seizure activity

A

Metabolic demands:

  1. ATP use and cerebral blood flow are increased by 250%
  2. Cerebral oxygen consumption is increased by 60%
  3. Glucose is rapidly depleted (lactate buildup)
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6
Q

Motor dysfunctions

A

Motor dysfunctions are associated with alterations to:

  1. Muscle tone
  2. Muscle movement
  3. Complex motor performance
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7
Q

Muscle tone abnormalities

A

Abnormalities:
1. HYPOTONIA: Decreased muscle tone

  1. DYSTONIA: Increased involuntary muscle tone
  2. HYPERTONIA: Increased muscle tone
  3. GEGENHALTEN (PARATONIA): Resistance to passive movement
  4. SPASTICITY: Hyper-excitability of stretch reflexes
  5. RIGIDITY: Firm and tense muscle
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8
Q

Muscle movement abnormalities

A

Abnormalities:
1. HYPERKINESIA: Excessive movement (i.e. tremors, dyskinesia, chorea s/t Huntington’s and Parkinson’s disease)

  1. HYPOKINESIA: Decreased movement (Parkinson’s disease)
  2. PAROXYSMAL DYSKINESIA: Abnormal involuntary movements that occur as spasms
  3. TARDIVE DYSKINESIA: Continual chewing with intermittent tongue protrusion, lip smacking, and facial grimacing (frequent side effect of antipsychotic meds.)
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9
Q

Parkinson’s disease

A

Neuro disease that affects movement, and is often accompanied by systemic non-motor and other neurologic symptoms

Caused by: Loss/dysfunction of dopamine-producing brain cells in the midbrain d/t oxidative stress, mitochondrial dysfunction, loss of nerve growth factors, and apoptosis

S/S: Impaired executive functioning, higher thinking, motor control, arousal, motivation/reward, lactation, and sexual gratification

Four cardinal symptoms:
1. RESTING TREMORS: Tremors that occur when the muscles are relaxed and still

  1. COGWHEEL RIGIDITY: Stiffness of the limbs and trunk
  2. BRADYKINESIA/AKINESIA: Slowness/absence of muscle movement
  3. POSTURAL INSTABILITY: Impaired balance and coordination (i.e. shuffling gait)

Other S/S: Depression (30-40% of patients), cognitive impairment, confusion, repetitive behaviors, dementia, dysphagia, difficulty chewing, and aphasia

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10
Q

Cerebral vascular disease

A

Most frequently occurring neurologic disorder

Any abnormality of the brain that is caused by a pathologic process in the blood vessel (i.e. aneurysm, vessel occlusion/rupture, or blood abnormality)

Consequences: Ischemia (with/without infarction) and hemorrhage; Clinical manifestations: Stroke, TIA (transient ischemic attack)

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11
Q

Stroke

A

3rd leading cause of death in the U.S.; can range from minimal to severe (death)

Greatest risk factor: HTN

Types:

  1. Thrombotic or embolic ischemic stroke (87%)
  2. Hemorrhagic stroke

Clinical manifestations (depend on the artery affected):

  1. Neurons surrounding ischemic/infarcted areas undergo changes that disrupt plasma membranes
  2. Cellular edema causes compression of capillaries
  3. Contralateral weakness in arms, legs, face
  4. Possible motor, speech, swallowing problems
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12
Q

Ischemic stroke

A

Caused by obstruction to arterial blood flow from thrombus/embolus (d/t atherosclerosis), hypoperfusion (d/t HF), or hypovolemia

Inadequate blood supply = Ischemia (inadequate oxygen delivery), and ultimately infarction (tissue death)

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13
Q

Types of ischemic strokes

A
  1. Thrombotic ischemic stroke: arterial occlusions caused by arterial thrombi that supplies the brain or intracranial vessels (attributed to atherosclerosis and inflammatory disease processes)
  2. Embolic ischemic stroke: fragments break from a thrombus formed outside of the brain (a second stroke often occurs as the source of embolus continues to exist)
  3. Lacunar stroke: occlusion of the small perforating arteries, <1.5 cm. in diameter (MICROINFARCTION)
  4. Brain hypoperfusion stroke: caused by low blood flow d/t HF, pulmonary embolism, or blood loss (usually bilateral and diffuse)
  5. TIA: non-permanent stroke resulting from focal ischemia; characterized by episodes of neurologic dysfunction lasting no more than 1 hour (17% of patients will have a true stoke within 90 days; higher percentage within 1 year)
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14
Q

Hemorrhagic stroke

A

Bleeding within the brain tissue which compresses the surrounding areas (mainly caused by HTN); results in: Ischemia, edema, increased ICP, and tissue necrosis

Types:
1. Subdural hemorrhage: associated with trauma

  1. Subarachnoid hemorrhage: associated with ruptured aneurysms and other vessel anomalies
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15
Q

Traumatic brain injury (TBI)

A

Alteration in brain function or evidence of other pathologic conditions caused by an EXTERNAL force (results in physical, intellectual, emotional, social, and vocational changes)

External forces: Falls, MVA, strike or blow to the head, penetrating trauma, unknown cause

Hallmark of severe brain injury is LOC >6 hours

Types of TBI:
1. PRIMARY injury: caused by impact itself (neural injury, primary glial injury, vascular responses, and shearing and rotational forces)

  1. SECONDARY injury: indirect consequence of primary injury (cascade of cellular and molecular brain events)
  2. TERTIARY injury: long-term consequences that can develop days or months after injury (such as pneumonia, fever, infections, immobility); contributes to further brain injury and repair delays
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16
Q

Contusion

A

Brain bruise caused by blood leaking from a damaged vessel; more severe in smaller areas of impact because force is concentrated

Location of contusion:

  1. COUP: At the point of impact
  2. COUNTERCOUP: Opposite side of impact

Surrounding area of contusion are characterized by: Edema, hemorrhage, infarction, and necrosis

17
Q

Glasgow coma scale

A

Determines severity of TBI (scored 3-15); composed of the sum of three parameters (best eye, verbal and motor responses)

  1. MILD TBI (13-15): Immediate but temporary affects; No LOC or LOC <30 min; S/S: HA, N/, memory problems, dizziness, inability to concentrate, confusion; Anterograde amnesia: inability to make new memories, leading to short-term memory loss for up to 24 hours
  2. MODERATE TBI (8-13): LOC >30 min and anterograde amnesia lasting >24 hours; Prominent features: Confusion, memory loss, and unconsciousness; S/S: Deficits in attention, memory, data processing, vision, perception and/or language; and mild to severe mood changes
  3. SEVERE TBI (<8): LOC >24 hours, associated with signs of brainstem injury (changes in pupil size, HR and resp., and posturing), intracranial contusions, hematoma, and laceration; Increased ICP evident within 3-6 days; S/S: PERMANENT deficits in cognition, movement, learning, language (14% remain in vegetative state, 20-40% die)
18
Q

Epidural hematoma

A

Bleeding between the skull and dura, usually from an arterial source; Tx: Emergent surgery (high volume bleeds)

Intermittent/recurrent LOC and rapid decline as blood accumulates; SHIFT in intracranial contents d/t increased ICP

1-2% of major head injuries, usually a result from MVA (and sometimes sports injuries)

19
Q

Subdural hematoma

A

Acute or chronic bleeding between the dura and arachnoid (brain) caused by bleeding from veins (10-20% of TBIs)

As ICP rises, bleeding veins are compressed (limiting bleeding); and compression of surrounding tissues can occur

20
Q

Intracerebral hematoma

A

Bleeding within the brain caused by small vessel injury from penetrating trauma or shearing forces (2-3% of TBIs)

As hematoma expands and ICP increases, the surrounding structures are compressed causing ischemia

21
Q

Increased ICP

A

Normally 5-15 mm Hg

Caused by increased intracranial content (tumor growth, edema, excessive CSF, hemorrhage)

Can result in brain herniation

22
Q

Herniation

A

SHIFTING of brain tissue from compartments of greater pressure to lesser pressure (consequence of increased ICP)

23
Q

Cerebral death

A

Death of the cerebral hemispheres EXCLUSIVE of the brainstem and cerebellum (irreversible coma)

No behavioral or environmental responses; Brainstem continues to maintain internal homeostasis (normal cardioresp. functions, temp. control, and GI function)

24
Q

Brain death

A

Irreversible loss of all brain functions, including the brainstem and cerebellum (no potential for recovery and can no longer maintain the body’s internal homeostasis)

Characterized by: (1) Lack of motor or autonomic responses to noxious stimulation and (2) absence of cranial nerve reflexes and spontaneous breathing

25
Q

Meningitis

A

Inflammation of the brain or spinal cord; caused by viral, bacterial, fungal, or parasitic infection in the subarachnoid space

Recovery depends on prompt treatment with antimicrobials/antiviral meds.

S/S: HA, fever, stiff neck, cerebral dysfunction

26
Q

Encephalitis

A

Inflammation of the brain; most common forms caused by insect bites and oral HSV-1, viral

S/S: Mild (fever, HA) to severe (coma, seizures)

Tx: Supportive unless etiology is herpes (acyclovir)

27
Q

Brain abscess

A

Caused by: Necrotizing bacterial infections from neighboring structures (teeth, sinus, ears) or penetrating wounds

S/S: Starts with low-grade fever, HA, N/V/, drowsiness; Later manifestations (mass effect): Decreased attention, memory deficits, vision problems, ataxia, seizures

Tx: Surgical drainage and antibiotics

28
Q

Dementia

A

Acquired deterioration and PROGRESSIVE failure of many cerebral functions

Results in: Impairment of intellectual functions, orientation, memory, judgment, decision-making; and behavioral changes (aggression, wandering, agitation)

Caused by: Neurodegeneration (Alzheimer’s, Parkinson’s disease), atherosclerosis, trauma, tumors, increased ICP, metabolic disorders, vitamin deficiencies

29
Q

Delirium

A

Sudden or gradual onset; acute transient disorder of awareness, often secondary to illness (UTIs, thyroid disorders), intoxication, electrolyte imbalance, dehydration, and hospitalization

S/S: Difficulty concentrating, focusing, restlessness, irritability, insomnia, tremulousness, poor appetite, and hallucination or delusions

Types:
1. Hyperactive

  1. Hypoactive: decreased alertness, attention span, confusion, slow speech, frequent dozing off (can be confused with depression or dementia)
  2. Mixed
30
Q

Alterations in arousal (awakeness)

A

Confusion: loss of ability to think rapidly and clearly (S/S: Impaired judgement and decision-making)

Disorientation: beginning LOC (S/S: Disorientation to time, followed by disorientation to place and impaired memory; recognition of self is lost last)

Lethargy: limited spontaneous movement or speech (S/S: Easy arousal with normal speech or touch, may be disoriented to time, place or person)

Obtundation: mild-to-moderate reduction in arousal with limited response to the environment (S/S: Falls asleep unless verbally or tactilely stimulated, answers questions with minimum responses)

Stupor: condition of deep sleep or unresponsiveness (S/S: May be aroused or caused to open eyes only by vigorous and repeated stimulation, withdrawn response, grabbing at stimulus)

Coma: no verbal response to the external environment or to any stimuli (S/S: Noxious stimuli such as deep pain or suctioning yields motor movement)

Light coma: associated with purposeful movement on stimulation

Deep coma: associated with unresponsiveness or no response to any stimulus

Pathophysiology I: Exam 3 (7 decks)

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