neuro problems - PP Flashcards
migraines - scotomas
(blind on the scooter)
partial vision loss
cluster ha - treatment
100% O2 - nonrebreather
seizure causes
acidosis, electrolyte imbalance, hypoglycemia, barbiturate withdrawals, etc, heart, lung, liver disease, SLE, DM, HTN, septicemia
Primary Generalized Seizures
Primary Generalized Seizures (non-focal)
Involves both sides of the brain
Most people lose consciousness
Focal Seizures
Focal Seizures (Partial or Partial focal)
Begins in one hemisphere of the brain in a specific region of the cortex
Produces sensory, motor, cognitive or emotional disturbances based on the area of brain involved
Absence Seizure
Typical Absence Seizure (petit mal)
Usually occurs in children and rarely extend beyond adolescence
Simple absence seizure – blank stare “day dreaming” for 10 sec
Complex absence seizure – blank stare accompanied by some form of body movement (chewing, blinking, etc) for up to 20 sec
Atypical absence sz – similar to complex absence seizure but continue into adulthood
May occur >100x a day; easy to overlook
*Very important to diagnose and treat these as they may progress to tonic-clonic grand mal seizures
Generalized: Tonic-Clonic Seizure “Grand mal”
Most common of the generalized seizures
Loss of consciousness followed by stiffening of the body (tonic phase lasting 10-20 sec)
Then jerking of extremities (clonic phase for 30-40 secs)
Cyanosis, excessive salivation, incontinence, biting of tongue/cheek common
No memory of seizure
Postictal: fatigue, confusion, amnesia, muscle soreness
Atonic seizure (aka “akinetic”, “astatic”, “drop”)
Involves a tonic episode or an acute loss of muscle tone → person falls to ground
Person usually remains conscious. High risk for head injury
Lasts <15 secs
PARTIAL SEIZURES: SIMPLE FOCAL SEIZURE
Person remains conscious and alert
Sudden unexplained emotions: joy, anger, sadness or nausea
May hear or smell things that aren’t real
PARTIAL SEIZURES: COMPLES FOCAL SEIZURE
Person has loss of consciousness or alteration in awareness
Their eyes are open but unaware of their actions “dreamlike”. Can be dangerous or embarrassing as people may walk onto oncoming traffic or remove their clothes
May spread across the brain and evolve to become tonic-clonic type
STATUS EPILEPTICUS (SE)
Any seizure lasting >5 min or a series of separate seizures in rapid successions in which the person does not regain consciousness.
Neurons become exhausted and stop functioning → anoxic brain injury
STATUS EPILEPTICUS (SE) - complications
respiratory distress, cardiac dysrrhythmias, acidosis, hyperthermia
Do’s and Don’ts during a seizure
Observe:
Time seizure and characteristics
Safety:
Do remove objects around patient to prevent injury
Do not stick your finger in mouth to clear airway
Do not attempt to start an IV (you may harm yourself or patient)
Don’t use padded tongue blades
can chip teeth and obstruct airway or get aspirated
MS
A chronic progressive degenerative disorder of the CNS
Characterized by disseminated autoimmune demyelination of the myelin sheath of the brain and spinal cord.
Affects women more than men. Onset between 20s to 50s. Avg life expectancy is 25 years from onset
African American and Asians have lower incidence
ms - Three pathological processes
chronic inflammation
demyelination
gliosis (scarring) in the CNS
Positive MS dx requires:
At least 2 inflammatory demyelination lesions in MRI
Sx attacks occurring at different times > a month apart
All other possible dx ruled out
MS: PSEUEDO-EXACERBATION - on exam
Temporary worsening of symptoms without actual myelin inflammation or damage
Brought on by triggers such as UTI (most common), infection, stress, exercise
Uhthoff’s phenomenon (extreme heat that worsen’s MS symptoms
Once trigger resolves symptoms usually subside within 24 hrs
MS - avoid what?
heat, saunas
parkinsons symptoms - TRAP
tremor, rigidity, akenisia, postural instability
parkinsons meds - on exam
Dopaminergic: Levodopa/carbidopa (Sinemet)
MYASTHENIA GRAVIS (MG)
Auto-antibodies attack acetylcholine receptors (AChR). Prevents Ach from binding and stimulating muscle contraction.
MYASTHENIA GRAVIS (MG) - symptoms
Initial mild Sx: MAIN one = ocular palsie (can’t open eyelids), ptosis, diplopia, incomplete eye closure. In 20% of people, MG does not progress beyond ocular muscle involvement
MYASTHENIA GRAVIS (MG) - diagnosis
Ice pack test: Ptosis improves when cold applied to eye. (Colddecreases Ach breakdown)
Tensilon (Edrophonium) test – an IV Acetyl cholinesterase inhibitor that improves muscle contractility after administration
Serology test to identify for specific antibodies
CT to evaluate for thymoma
on exam - Myasthenic vs Cholinergic Crisis,
Myasthenic crisis: exacerbation of Sx caused by under-medication with anti-cholinesterase leading to decreased ACh at the receptor site. Sx: ↑ skeletal muscle weakness, ptosis, bulbar signs, dyspnea, respiratory failure requiring intubation
Sx improve after IV anticholinesterase. Pt needs a Medic Alert bracelet. Myasthenic crisis requires admission to the ICU: anticholinesterases, steroids, plasmapheresis, IVIG. Cholinergic crisis: acute. exacerbation of muscle weakness due to over medication with anticholinesterase d/t remission or after thymectomy leading to ↑ Ach activity at the receptor sites. flaccid paralsysis, resp. failure, increased salivation and broch secretions, pupillary misosi. others - defication, urination, GI stress, muscle spasm, lacrimation.
sx wores after IV antiochinesterase. have atropine on standby.
AKA LOU GEHRIGS DISEASE
Patient remains cognitively intact while the body is wasting away
als death
*Death usually results from respiratory tract infection 2/2 respiratory dysfunction
HUNTINGTON’S DISEASE
Involves the basal ganglia and extrapyramidal motor system
Results in: Excessive dopamine, deficiency of Ach and GABA
HUNTINGTON’S DISEASE - symptoms
Abnormal and excessive involuntary movement (chorea). Writhing, twisting movements of limbs, face and body
depression meds for older adults
sertraline (Zoloft), citalopram (Celexa), fluoxetine (Prozac)
