Neuro (Exam 2) Flashcards
What is hydrocephalus?
excess CSF accumulation within the skull;
ventricles dilate and the brain and blood vessels become compressed
pressure thins the cortex causing brain damage
What are some causes of hydrocephalus?
CSF flow disruption (noncommunicating or obstructive hydrocephalus)
CSF NOT PROPERLY ABSORBED BY BLOODSTREAM (communicating hydrocephalus)
What are some risk factors for hydrocephalus?
prematurity
pregnancy complications
other congenital defects (especially neuro)
nervous system tumors
CNS infections
cerebral hemorrhage
severe head injuries
OFTEN FATAL IF UNTREATED
Name 6 manifestations for infants regarding hydrocephalus?
• unusually large head
• rapid increase in head size
• bulging fontanelle
• vomiting (projectile)
• lethargy
• irritability
• high-pitched cry
• feeding difficulties
• seizures
• eyes that gaze downwards
• development delay
Name 6 manifestations in older children and adults regarding hydrocephalus
• headache followed by vomiting and nausea
• blurred vision/diplopia
• sluggish pupil response to light
• eyes that gaze downward
• uncoordinated movements
• extreme fatigue
• slowing or regression of development
• memory loss and confusion
• urinary incontinence
• irritability or personality changes
• impaired performance at school or work
What is spina bifida?
the posterior spinous processes on the vertebrae fail to fuse, permitting the meninges and spinal cord to herniate (usually lumbar)
MOST COMMON NEURAL TUBE BIRTH DEFECT IN THE US, AMONGST WHITE AND HISPANICS
What are some maternal risk factors of spina bifida?
family history
folate deficiency
certain meds (antiseizures)
diabetes mellitus
pre-pregnancy obesity
increased body temp
What are some complications regarding spina bifida?
physical and neurological impairments
hydrocephalus
meningitis
learning problems
MANIFESTATIONS VARY
What is spina bifida occulta?
mildest form; defect may not be evident other than birthmark, etc.; usually no manifestations or defects
results in a small gap in one or more vertebrae; the spinal nerves and meninges do not usually protrude
What is meningocele?
RARE FORM; MENINGES PROTRUDE THROUGH VERTEBRAL OPENING
meninges and CSF form a sac on back, membranes can be removed by surgery with little damage
INFECTION/RUPTURE OF SAC CAN LEAD TO NEUROLOGICAL IMPAIRMENT
What can be done to confirm the absence of nerve tissue in the space in meningocele?
transillumination
What is myelomeningocele?
MOST SEVERE FORM OF SPINA BIFIDA; spinal canal remains open in lower back
MENINGES, SPINAL CORD, AND CSF PROTRUDE THROUGH LARGE OPENING AT BIRTH AND FORMS A SAC, TISSUES AND NERVES EXPOSED
What are some complications regarding myelomeningocele?
neurological impairment (paralysis)
bowel and bladder issues
seizures
What is cerebral palsy?
NONPROGRESSIVE DISORDERS AND PERMANENTLY AFFECT MOTOR MOVEMENT AND MUSCLE COORDINATION
MORE COMMON IN MALES, AA’s, LOWER SES
USUALLY DAMAGE TO CEREBELLUM DURING PRENATAL PERIOD BUT CAN OCCUR ANYTIME DURING FIRST THREE YEARS OF LIFE
What are some contributing factors towards cerebral palsy?
prematurity
low birth weight
breech birth
multiple fetuses
hypoxia
maternal/fetal hypoglycemia
cerebral hemorrhage
neurological infections
head injury
maternal infections during pregnancy
maternal exposure to toxins during pregnancy
severe jaundice
What are some complications regarding cerebral palsy?
balance and coordination issues
contractures
atrophy below the waist
scoliosis
malnutrition
communication issues and speech delays
learning difficulties
seizures
vision or hearing issues
urinary incontinence
constipation
osteoporosis
chronic pain
injury
Name 6 manifestations of cerebral palsy (15 total)
• persistence of early reflexes
• development delays
• ataxia (impaired coordination)
• spasticity
• flaccidity
• hyperreflexia
• asymmetrical walking gait
• unusual positioning of limbs
• excessive drooling
• difficulty swallowing
• impaired sucking
• speech issues
• facial grimaces
• tremors
• difficulty with precise motions
What is meningitis?
inflammation of the meninges and subarachnoid space; CSF can be affected
BACTERIAL (LIFE THREATENING) AND VIRAL (SELF LIMITING)
Meningitis: Infection or irritant triggers inflammation, leading to?
swelling of the meninges and increased intracranial pressure (ICP)
What are some risk factors regarding meningitis?
younger than 25
living in a community setting
pregnancy (listeria)
working with animals
immunodeficiency
Name 6 manifestations of meningitis (14 total)
- fever
- chills
- LOC changes
- nausea
- vomiting
- photophobia
- severe headache
- stiff neck
- agitation
- bulging fontanelles
- poor feeding or irritability in children
- tachypnea
- tachycardia
- rash
What are some complications for meningitis?
permanent neurological damage
seizures
hearing loss
blindness
speech difficulty
learning disability
behavior problems
paralysis
acute renal failure
adrenal gland failure
cerebral edema
shock
death
What is encephalitis?
inflammation of the brain and spinal cord, usually from infection
VIRAL OR BACTERIAL
Encephalitis: Infection triggers inflammation which causes?
vasodilation, increased capillary permeability and leukocyte infiltration
Encephalitis: Primary vs Secondary
P: direct viral infection of the brain and spinal cord
S: travels from elsewhere in the body
What are some complications of encephalitis?
nerve cell degeneration
cerebral edema
cerebral hemorrhage
brain damage
Name 6 manifestations of encephalitis (16 total)
- flulike symptoms
- headache
- neck rigidity
- confusion
- hallucinations
- personality changes
- diplopia and photophobia
- seizures
- muscle weakness
- ataxia
- parasthesia or paralysis
- loss of consciousness
- tremors
- abnormal deep tendon reflexes
- rash
- bulging fontanelles
How can Zika Virus be contracted and spread?
FLAVIVIRUS
mosquitos, foreign travel, sexual transmission, mother to fetus, blood transfusion
CAN CAUSE GUILLAN-BARRE SYNDROME
What causes increased intracranial pressure (ICP)?
INCREASED VOLUME IN CRANIAL CAVITY (CSF, BRAIN TISSUE, BLOOD)
traumatic brain injury
tumor
hydrocephalus
cerebral edema
hemorrhage
ICP: What is the Monro-Kellie hypothesis?
increase in volume of one component must be compensated for by a decrease in volume of another; accompanied most by shifts in CSF AND BLOOD VOLUME
ICP: Autoregulation compensatory mechanism
the blood vessels dilate to increase blood flow and constrict IF ICP INCREASES
ICP: Cushing’s reflex compensatory mechanism
the hypothalamus increases sympathetic stimulation when the mean arterial pressure drops BELOW ICP
CUSHINGS TRIAD
What is Cushing’s triad?
increased BP, bradycardia, and cheyne-stokes respirations
What is herniation?
displacement of brain tissue; feared complication of ICP
Name 5 common manifestations for ICP
- decreasing LOC
- vomiting (projectile)
- Cushing’s triad
- fixed and dilated pupils
- posturing
What is a specific manifestation for infants for ICP?
separated sutures and bulging fontanelle
What are specific manifestations for older children and adults in ICP?
behavior changes, severe headaches, lethargy, neurological deficits, seizures
What is hematoma?
a collection of blood in the tissue that develops from ruptured blood vessels
can develop immediately or slowly (traumatic brain injury or surgery)
What is an epidural hematoma?
bleeding between the dura and skull, usually caused by an arterial tear
What are some common manifestations for epidural hematomas?
marked neurological dysfunction within few hours of injury
brief loss of consciousness, followed by short period of alertness, than another loss of consciousness
What is a subdural hematoma?
develop between the dura and arachnoid by a small VENOUS tear; develops slowly but progresses rapidly
ICP INCREASES OVER A WEEK OF INJURY
What are the differences in a chronic subdural hematoma?
manifestations develop several weeks after injury instead of 24 hours due to slow leak
MORE COMMON IN ELDERLY DUE TO BRAIN ATROPHY
What is an intracerebral hematoma?
bleeding within the brain tissues
What are some causes of intracerebral hematoma?
contusion or shearing injuries
hypertension
CVA (stroke)
aneurysms or vascular abnormalities
What is a subarachnoid hemorrhage?
bleeding in the space between the arachnoid and pia
What is the primary clinical presentation in a subarachnoid hemorrhage?
severe headache with a sudden onset that is worse near the back of the head
What are some complications of hematoma?
INCREASED ICP DUE TO BLEEDING
BLOOD MAY COAGULATE AND FORM SOLID MASS
HEMATOMA BECOMES ENCAPSULATED BY FIBROBLASTS AND BLOOD CELLS WITHIN CAPSULE LYSE
FLUID FROM HEMOLYSIS EXERTS OSMOTIC PRESSURE DRAWING MORE FLUID INTO CAPSULE
EDEMA INCREASES MASS SIZE, INCREASING ICP
VASOSPASMS FROM BLEEDING, WORSEN ISCHEMIA
HERNIATION
What is a spinal cord injury?
result from direct injury to spinal cord or indirectly from damage to surrounding bones, tissues or vessels
What are some causes of spinal cord injuries?
motor vehicle accidents
falls
violence
sports injuries
weakening vertebral structures (rheumatoid arthritis and osteoporosis)
What can occur inside/outside the spinal cord in a spinal cord injury?
hemorrhage, fluid accumulation and edema
COMPRESSES SPINAL CORD AND COULD DAMAGE IT (SECONDARY INJURY)
What is spinal shock?
temporary suspension of neurological function because of spinal cord compression; neurological function gradually returns
What demographic is more likely to get spinal cord injury?
caucasians and males, 43 years (used to be 29)
What are some complications regarding spinal cord injuries?
loss of neurologic functioning
varying degrees of paralysis
cauda equina syndrome
autonomic hyperreflexia
neurogenic shock
respiratory failure
effects of immobility
changes in bowel and bladder function
sexual dysfunction
chronic pain
death
What is cauda equina syndrome?
injury to the nerve roots in the area of the cauda equina
What are some signs/symptoms of cauda equina?
bladder dysfunction
bowel dysfunction
pain or altered sensation in legs
loss of sexual sensation
saddle numbness
What is autonomic hyperreflexia?
massive sympathetic response that can cause headaches, hypertension (crisis), tachycardia, seizures, stroke and death
MOST COMMON WITH SPINAL INJURIES ABOVE T6
Name 6 manifestations of cervical spinal injuries (12 total)
MOST SIGNIFICANT AT/ABOVE C4
- upper and lower extremities affected
- breathing difficulties
- loss of normal bowel and bladder control
- parasthesia
- sensory changes
- spasticity
- pain
- weakness
- paralysis
- BP instability
- temperature fluctuations
- diaphoresis
What are the manifestations for thoracic spinal injuries?
TRUNK AND LOWER EXTREMITIES IMPACTED
many manifestations can be same EXCEPT BREATHING DIFFICULTIES
What is neurogenic shock?
an abnormal vasomotor response secondary to disruption of sympathetic impulses (hemodynamic impact- DECREASED HR AND BP)
What is a transient ischemic attack (TIA)?
temporary episode of cerebral ischemia that results in a mini stroke, resolving in 24 hours
What are some causes of a TIA?
cerebral artery occlusion (thrombus, embolus)
cerebral artery narrowing (spasms, atherosclerosis)
cerebral artery injury (inflammation, hypertension)
How is a TIA related to a CVA?
warning sign of a CVA, but not all CVA’s are preceded by a TIA
1 in 3 people experiencing a TIA eventually have a CVA, half of these CVAs occur within a year of the TIA
What are some risk factors for a TIA?
smoking
diabetes mellitus
advancing age
inadequate nutrition
hypercholesterolemia
oral contraceptive use
excessive alcohol consumption
illicit drug use
What are some complications for a TIA?
PERMANENT BRAIN DAMAGE
INJURY FROM FALLS
CVA
Name 6 manifestations of a TIA (13 total)
- muscle weakness or paralysis (usually unilateral)
- ataxia
- changes in sensation
- agnosia (loss of ability to identify objects or people)
- unilateral parasthesia
- aphasia or receptive aphasia
- dysphasia
- dysgraphia
- vision issues
- changes in LOC
- personality, mood changes
- vertigo or dizziness
- incontinence of bowel or bladder
What is agnosia?
inability to recognize or identify sensory stimuli
What is a cerebrovascular accident (CVA) and what demographic is it more common in?
an interruption of cerebral blood supply; AA’s and those living in Southeast region
ISCHEMIC DAMAGE IS PERMANENT
What are some causes of a CVA?
total vessel occlusion (thrombus, embolus)
cerebral vessel rupture (aneurysm, hypertension)
What are the two major types of CVA?
ischemic (most common)
hemorrhagic (most fatal)
What are the complications of a CVA?
neurologic deficits
death
What are risk factors of a CVA?
physical inactivity
stress
obesity
hypertension
smoking
dyslipidemia
diabetes mellitus
atherosclerosis
oral contraceptive use
excessive alcohol consumption
drug use
advancing age
Name 5 manifestations of a CVA (9 total)
- facial drooping
- arm and leg weakness
- speech difficulties
- vision loss
- dizziness
- confusion
- incontinence
- tingling or numbness
- headaches due to increasing ICP
What is a cerebral aneurysm?
a localized outpouching of a cerebral artery due to weakening of artery wall
CAN PUT PRESSURE ON SURROUNDING TISSUE CAUSING CVA OR DEATH
What are some causes of a cerebral aneurysm?
congenital defects
hypertension
diabetes mellitus
dyslipidemia
connective tissue diseases (Marfans)
traumatic brain injury
arteriovenous malformations
cigarette smoking
drug use
brain tumor
What are some characteristics of a cerebral aneurysm?
most are berry or saccular, will occur in multiples on CIRCLE OF WILLIS, asymptomatic until they grow large enough to compress surroundings structures or rupture
Name 5 manifestations of a cerebral aneurysm
- vision issues
- headache
- eye pain
- neck pain
- SUDDEN SEVERE HEADACHE INDICATION OF RUPTURE
What are headache (cephalalgia) disorders?
recurrent headaches, pain may be sharp throbbing or dull and may develop gradually or suddenly (lasts from hours to days)
What are primary headache disorders?
no apparent underlying cause
possible causes involve a combo of genetic and environmental factors
What are secondary headache disorders?
underlying causes and are less common
intracranial tumors, CNS infections, intracranial hemorrhage, aneurysm, etc.
Name the 6 red flag symptoms of secondary headache disorders?
- thunderclap headache
- new onset headaches
- persistent morning headache with nausea
- progressive headache
- headaches associated with postural changes
- aura symptoms lasting longer than an hour
What is a seizure?
transient physical or behavior alteration that results from an abnormal electrical activity in the brain
What are the primary causes of a seizure?
altered membrane ion channels
altered extracellular electrolytes
imbalanced excitatory and inhibitory neurotransmitters
What are the secondary causes of a seizure?
trauma
hypoglycemia
electrolytes disorders (acidosis)
infection
fever
chemical ingestion
cerebral ischemia
hypoxia
What is epilepsy?
seizure disorder resulting from spontaneous firing of abnormal neurons; recurrent seizures for which there is no underlying cause
What are some complications of epilepsy?
brain damage
traumatic brain injury
aspiration
mood disorders
status epilepticus
What is status epilepticus?
seizure activity lasting longer than 5 minutes or subsequent seizures that occur before the person has fully regained consciousness within this timeframe
What are the 2 broad categories of seizures?
focal (partial) and generalized; focal can become generalized and some people can have both types of
What is the postictal period?
just after the seizure, the individual may be confused, fatigued and fall into a deep sleep
What can generalized seizures cause?
loss of consciousness, falls or massive muscle spasms
What is an absence seizure (petit mal)?
individual may appear to be staring into space and/or having jerking or twitching muscles
What is a tonic seizure?
causes stiffening of muscles of the body, generally those in the back and extremities
What is a clonic seizure?
causes repeated jerking movements of muscles on both sides of the body
What is a myoclonic seizure?
causes jerks or twitches of the upper body, arms, or legs
What is an atonic seizure?
causes a loss of normal muscle tone; will fall down or may drop their head involuntarily
What is a tonic-clonic seizure (grand mal)?
causes stiffening of the body and repeated jerks of the arms and/or legs as well as loss of consciousness
What is multiple sclerosis and what demographic is it more common in?
debilitating autoimmune condition; PROGRESSIVE AND IRREVERSIBLE DEMYELINATION OF BRAIN, SPINAL CORD AND CRANIAL NERVES; most common in women 20-40 years, whites and those living in temperate climates
DAMAGE OCCURS IN DIFFUSE PATCHES THROUGHOUT NERVOUS SYSTEM AND SLOWS/STOPS IMPULSES
What are the complications of multiple sclerosis?
epilepsy
paralysis (legs)
depression
REMISSIONS AND EXACERBATIONS
Name 6 manifestations of multiple sclerosis (15 total)
- vision issues
- slurred speech
- parasthesia
- hearing loss
- fatigue and dizziness
- decreased attention span, poor judgement, and memory loss
- difficulty reasoning and solving problems
- dysphagia
- problems moving arms or legs
- weakness and or tremor in arms and legs
- ataxia
- unsteady gait, muscle spasms
- constipation and stool leakage
- urinary frequency, urgency, or incontinence
- sexual dysfunction
What is parkinson’s disease and what demographic is it more common in?
progressive condition involving the destruction of the substantia nigra with an unknown cause; men and those who live in rural areas
RESULTS IN LACK OF DOPAMINE!!
What happens when 80% of dopamine-producing cells are destroyed in someone with Parkinson’s disease?
movement issues like tremors (involuntary movements) of the hands and head develop
pill rolling tremors (finger thumb rubbing)
Name 5 manifestations of Parkinson’s disease (9 total)
- slowing or stopping of automatic movements like blinking
- constipation
- urinary hesitancy or urgency
- dysphagia
- drooling
- anosmia (loss of sense of smell)
- mask like appearance to face
- myalgia
- muscle cramps and dystonia
What are the problems of movement that someone with Parkinson’s may deal with?
difficulty initiating or continuing movement
loss of fine hand movements
shuffling and unsteady gait
slowed movements
What is amyotrophic lateral sclerosis (Lou Gehrigs disease)?
damage of the upper motor neurons of the cerebral cortex and lower motor neurons of the brain stem and spinal cord
What do nerves lose their ability to do in Lou Gehrig’s disease, and what does it result in?
trigger muscle movement; muscle weakness, disability, paralysis, and death (within 3 years)
INCREASE RISK OF DEMENTIA
What are some possible causes of amyotrophic lateral sclerosis?
no definitive cause
POSSIBLE CAUSES: free radical damage (inherited ALS mutation), excess glutamate (toxic to nerve cells), autoimmune
What are 6 early manifestations of amyotrophic lateral sclerosis (ALS)?
- foot drop
- lower extremity weakness
- hand weakness or clumsiness
- slurred speech
- dysphagia
- muscle cramps and twitching in upper extremities and tongue
What does the loss of upper motor neurons do in ALS?
spastic paralysis and hyperreflexia
What does the loss of lower motor neurons do in ALS?
flaccid paralysis
What is myasthenia gravis?
an autoimmune condition; ACETYLCHOLINE RECEPTORS ARE DESTROYED BY IGG ANTIBODIES, leading to a disruption of normal communication between the nerve and muscle at the junction
In myasthenia gravis, what causes the weakness of voluntary skeletal muscles?
inadequate nerve stimulation; muscle weakness increases during periods of activity and gets better with rest
What triggers are thought to play a role in myasthenia gravis?
unclear but thymus abnormalities, autoimmune hyperthyroidism and other autoimmune disorders
What is myasthenic crisis?
potentially life threatening complication that occurs when the muscles become too weak to maintain adequate ventilation
What are factors that worsen/cause a myasthenic crisis?
fatigue
illness
stress
extreme heat
alcohol consumption
certain meds (beta-blockers, calcium channel blockers)
Name 5 manifestations of myasthenia gravis (9 total)
- difficulty climbing stairs, lifting objects, or rising
- dysarthria
- drooping head
- facial paralysis or weakness
- fatigue
- hoarseness or changing voice
- eye and vision issues
- breathing difficulty
- dysphagia
What is Huntingtons disease (Huntington’s chorea)?
AUTOSOMAL DOMINANT DISORDER ON CHROMOSOME 4, genetically programmed degeneration of neurons in the brain
What does Huntingtons disease lead to?
progressive atrophy of the brain (basal ganglia and frontal cortex); ventricles dilate, gamma-aminobutyric acid levels diminish, acetylcholine levels fall
Huntington’s disease demographics
30-40 years, may appear earlier (as it’s passed on, presenting age gets younger)
illness duration 10-30 years
What are the most common causes of death for those with Huntingtons disease?
infection (pneumonia), injuries related to falling, other complications like suicide
Name 6 manifestations of Huntingtons disease
- UNCONTROLLED RAPID JERKY MOVEMENTS LIKE TREMORS, FALL RISKS
- uncharacteristically irritable and emotional changes, mood swings
- antisocial behavior
- hallucinations
- paranoia
- psychosis
What are some early signs of Huntingtons disease?
trouble driving, learning new things, remembering facts, answering questions, making decisions
What are some indications that Huntingtons disease has progressed?
increasing difficulty with concentrating on intellectual tasks
speech is slurred
functions like swallowing, eating, etc. decline
some cannot recognize family members
What is dementia?
a group of conditions in which cortical function is decreased, impairing cognitive and motor skills
ISSUES WITH MEMORY, PERSONALITY CHANGES
What are the 6 types of dementia, and which one is the most common?
ALZHEIMERS (MOST COMMON)
vascular
Lewy body
frontotemporal
creutzfeldt-jakob
AIDS dementia complex
What is Alzheimer’s disease?
brain tissue degenerates and atrophies, causing a steady decline in memory and mental abilities
Name the 3 pathologic characteristics of Alzheimer’s disease
- amyloid plaques mix with a collection of additional proteins, neuron remnants and other nerve cell pieces
- neurofibrillary tangles
- connections between neurons responsible for memory and learning are lost and cannot survive
What are the risk factors of Alzheimer’s disease?
risk increases with age, female sex, lower education levels
family history
hypertension
hypercholesterolemia
diabetes mellitus
history of traumatic brain injury
What are the complications of Alzheimer’s disease?
infections (pneumonia and UTIs)
injuries related to falls
malnutrition
dehydration
decubitus ulcers
Name 5 manifestations of Alzheimer’s disease (10 total)
- memory loss
- problems with abstract thinking
- difficulty finding the right words
- difficulty reading or writing
- disorientation
- loss of judgement
- difficulty performing familiar tasks
8.. personality changes - hallucinations
- incontinence of bowel or bladder
What are the characteristics of brain tumors?
INCREASED ICP AND DIFFICULTY ACCESSING
MAY BE PRIMARY OR SECONDARY FROM ANOTHER CANCER
What are the risk factors for primary brain tumors?
genetic mutations (exposure to radiation and chemicals)
advancing age
WHITES AND MALES
What are some complications of brain tumors?
neurologic deficits
seizures
personality changes
death
Name 4 manifestations of brain tumors (8 total)
- new onset or altered pattern of headaches
- unexplained nausea and vomiting
- vision problems
- gradual loss of sensation or movement in an extremity
- balance and speech difficulties
- confusion
- hearing problems
- hormonal disorders
What are neurofibrillary tangles?
abnormal collections of a protein called tau that clump together
