Neuro Final Exam Review Sheet Flashcards
- Describe status epilepticus
Continuous tonic-clonic attacks during which patient does not completely recover consciousness between attacks
What is the most common cause of status epilepticus?
abrupt withdrawal of anticonvulsant meds
why is status epilepticus a medical emergency.
b. This is a medical emergency because it risks permanent damage from hypoxia, hypoglycemia, lactic acidosis, cardiac arrhythmias, and respiratory depression – 25% mortality rate
What are the two types of partial seizures?
simple and complex
which type of partial seizure experiences loss of consciousness?
complex partial has consciousness impaired but not lost initially. When it spreads to both hemispheres is when we expereince LOC
describe the characteristics of a simple partial seizure
- Consciousness NOT impaired
- Only involves part of the brain
- May have aura
- Motor or sensory signs can spread to involve regions of motor cortex – spread through homunculus
describe the characteristics of complex partial seizure
- Consciousness is impaired but not lost initially, THEN lose consciousness
a. Spread to both hemispheres loss of consciousness - Most often begin as partial seizure
- 90% start in temporal lobe
- Aura is common
- Automatisms common
- lasts 1-2 min but can be longer
What are the common automatisms associated with complex partial seizures?
a. Orobuccolingual
b. Facial or Neck Movements
c. Sitting or standing up
d. Fumbling with objects
e. Walking
f. Talking
What are the types of generalized seizures?
absence tonic-clonic myoclonic tonic clonic atonic
What is another name for absence seizures?
petit mal
How long do absence (petit mal) seizures last?
less than 15 seconds
How are absence and tonic-clonic (grand mal) seizures different?
absence seizures have full orientation after
tonic-clonic seizures present with 10-30 minutes of confusion afterwards
what can petit-mal seizures be diagnosed as?
an intellectual disability or ADHD because someone can have hundreds of them per day with a brief period of LOC but full orientation afterwards
subtle motor manifestations such as eye blinking are common
how long do grand mal (tonic-clonic) seizures last?
3-5 minutes or less
what happens during the tonic phase of a grand mal seizure?
Tonic phase: unconscious and has tonic contractions for 10-30 seconds, extension of trunk and extremities, may have high pitched cry due to tonic contraction of muscles of respiration
what happens during the clonic phase of a grand mal seizure?
alternating muscle contraction and relaxation for 30-60 seconds or longer, gradually subsides, may become incontinent, may be unconscious for up to 30 minutes
What happens during a myoclonic seizure?
sudden brief shock like contractions
What 2 types of generalized seizures are rare?
tonic and clonic are rare
what happens during atonic seizure?
complete loss of tone in the body and LOC
occurs most commonly after brain damage
Describe the process of prescribing medications for the treatment of seizures.
a. Must establish a firm diagnosis before beginning anticonvulsants
b. Choose right drug for the type of seizure
c. Control symptoms – not looking for target serum level
i. Different for different patients
ii. Increase dose based on blood levels and patient response
iii. Evaluate one drug at a time
What should you do if a patient has a seizure?
a. Get others out of the room
b. Observe, time
c. Be the calm professional
d. Try to stay safe, stay away from mouth! (NO wallet in mouth… sorry!)
e. > 5 minutes, call 911
f. Second seizure right afterwards, call 911
What are the 7 types of spinal cord defects?
- Meningomyelocele
- Meningocele
- Spina bifida occulta
- Lipomeningocele
- Diastematomyelia
- Syringomyelia
- Chiari type II malformation
Which type of spinal cord defect has an abnormal tuft of hair over the arch that didn’t form right?
spina bifida occulta
What are the2 types of spinal cord defects that are considered closed neural tube defects?
diastematomyelia and lipomeningocele
What are the characteristics of syringomyelia?
hydrocephalus of the spinal cord caused by accumulation of CSF in the central canal
What is the most common type of spinal cord defect?
Myelomeningocele (meningomyelocele) make up about 95% of spinal cord defects
What part of the body is herniated with a meningomyelocele (myelomeningocele)?
the spinal cord and meninges herniates usually with the baby lacking skin over the site at birth
Which type of spinal cord defect has the spinal cord intact usually?
meningocele is less common with the spinal cord deeper inside and usually ok
In Lipomeningocele what is compressing the spinal cord?
fat deposits latch onto the spinal cord and can cause compression or even worse tethering which means the spinal cord will not migrate upwards and will be stuck
What can tethering/compression of the spinal cord cause?
may lead to bowel and bladder issues
What type of spinal cord defect has just the vertebrae affected with NO herniation?
spina bifida occulta has just the vertebra affected. they lack the spinous processes
What is occurring in diastematomyelia?
longitudinal splitting of the cord with each half having its own dorsal and ventral roots
What symptoms are possible in syringomyelia?
sensory loss and quadriplegia
what malformation has experiences elongation of the cerebellum and medulla?
Chiari type II presents with elongation of the cerebellum and medulla which protrude through the foramen magnum
What symptoms can occur in chiari type II malformation?
we can have lower brainstem symptoms because of the compression of the hindbrain
the medulla and pons are also small and deformed
there is also blockage of CSF flow resulting in hyrdocephalus
What are some possible causes of spina bifida?
a. multifactorial
b. folate deficiency
c. polygenetic
d. other: maternal diabetes, exposure to chemicals, extreme alcoholism, thalidomide-valporic acid/ antiseizure med
What are some common S&S of tethered cord?
Increased new spasticity, changes in bowel and bladder, changes in foot position, back pain, development of hamstring contracture, rapid scoliosis
What are some common S&S of a shunt dysfunction?
increasing head size, vomiting, sweating, swelling of head, headache, irritability, seizures, rapid scoliosis, lethargy
Why is VP shunting used for patients with SB?
It is used to relieve the pressure on the brain caused by accumulation of fluid