Neurologic Disorders Flashcards
Sodium
sodium abnormalities
can lead to AMS and Seizures
Hyponatremia effects on brain
intravascular compartment is hypotonic
fluid will flow out into the neurons of the brain
neuron brain swelling
Nausea and vomiting.
Headache.
Confusion.
Loss of energy, drowsiness and fatigue.
Restlessness and irritability.
Muscle weakness, spasms or cramps.
Seizures.
Coma.
Hypernatremia effects on brain
hypertonic intravascular space
fluid to flow into the vessels shrinking/dehydrating neurons
Muscle weakness.
Restlessness.
Extreme thirst.
Confusion.
Lethargy.
Irritability.
Seizures.
Unconsciousness.
Seizures
inappropriate discharge of impulses by the cerebral neurons, sudden onset, transient loss of brain function
epilepsy –> seizure disorder with no underlying cause
what can cause seizures
cerebral lesions, cerebral trauma, idiopathic, genetic predisposition, perinatal injury, post-natal trauma, infection, brain tumor, vascular disease, congenital malformations, hypoglycemia, fatigue, lack of sleep, stress, fever, hyponatremia, constipation, use of stimulate drugs, ETOH withdrawal, withdrawal from depressant medications, hyperventilation and environmental stimuli (blinking lights, odors and loud noise)
focal/partial seizure
involves one cerebral hemisphere
often originate from the medial temporal lobe
and are often preceded by an Aura
simple partial seizure
-no LOC
complex partial seizure
-LOC (forgetful)
Jacksonian march –> seizure begins at one part and spread throughout whole limb
Automatism
actions without conscious thought
person may appear wide-eyed
lip smacking, chewing, facial grimacing, swallowing movements, patting, picking, rubbing oneself or clothes.
Generalized Seizure
both cerebral hemispheres
whole body manifestation of the seizure
LOC
Absence
-blank stare
Tonic
-muscle contraction and increase muscle tone
Clonic
-quick repetitive movement
Tonic Clonic/Grand Mal
-both alternating stiffening and jerking movements
Status Epilepticus
state of continuous seizures which last more than 5 minutes or seizures which occur rapidly before patient reaches a baseline.
one seizure that last greater than 30 minutes
medical emergency
can lead to permanent neurology injury
Postictal state
follows a seizure characterized by drowsiness, headache, confusion, aphasia, memory loss and paralysis which can last for hours or days
Non-convulsive Status Epileptic
presents without any signs of seizure activity
patient will have AMS that is not explained by any other cause
only way to Dx EEG
Acute confusion state
marked by sudden cerebral dysfunction which causes confusion, agitation, memory impairments, distractibility, compulsive disorders and obsession.
Delirium
Hyperactive Delirium
overstimulation of the ANS
decreased Acetylcholine and melatonin
increased dopamine, norepinephrine and glutamate
S/S: combative, aggressive, able to tolerate pain, breath rapidly, sweat, fever, are agitated, superhuman strength.
Hypoactive Delirium
seen in people with fevers, metabolic disorders (renal or liver disease) CNS depressants, recovering from Sx
S/S: decreased LOC, decreased LOC and attention span, inaccurate perception and interpretation of the environment, forgetful, confused and apathetic
Delirium Causes
ETOH withdrawal, drug intoxication, electrolyte abnormalities (sodium and calcium)
hypoglycemia, seizure activity, hypoxia, hypercapnia, infection, head injury or cerebral lesion.
reversible by treating underlying cause
Dementia
loss of cognitive function
(memory, orientation, and language)
occurs over time and not reversible
chronic
Meningitis
infection of the meninges
specifically the Pia Mater
bacterial
-meningococcus or pneumococcus
meningococcal is a communicable occurs in close living conditions (severe) and deadly causes inflammation process some people are carriers without getting sick
viral
fungal and TB
S/S: photophobia, nuchal rigidity, seizures, kernig’s and brudzinski’s sign
kernig’s
raising one leg to 90 degree causes pain or unable to extend leg
Brudzinski’s
flex neck –> causes involuntary hip and knee flexion
Alzheimer’s Disease
progressive, degenerative disease of the brain that results in impairment of memory, confusion, visual spatial disorientation, inability to calculate and impaired judgement.
hallucinations may also occur
most common form of dementia
decline in function and death
typical onset late middle life and death occurs in 5-10 years
autosomal dominant inheritance pattern
Apolipoprotein E gene allele 4 —> apoE4 on chromosome 19
interfere with amyloid clearance which is toxic to neurons triggers the formation of plaque and tangles in the brain
leads to neuron death, disruption in nerve impulses, loss of function and death.
gradual loss of independence and require assistance with ADLs
Risk factors for Alzheimer’s
DM, midlife HTN, HLD, obesity, smoking, depression, cognitive inactivity, low education, female gender, estrogen deficiency at the time of menopause, physical inactivity, head trauma, neuro-inflammation and oxidative stress.
Parkinson’s disease
disorder of the basal ganglia resulting in the lack of the neurotransmitter dopamine.
normal basal ganglia fx:
transmit movements of the extrapyramidal spinal tract
normally responsible for gross motor movements, facial expressions, posture, muscle tone, speech and swallowing.
presents after age 40 with mean onset 60’s
more common in men than women
-secondary Parkinson’s causes by another underlying cause (usually a drug)
degeneration of dopamine-producing neurons in the base ganglia.
parkinsons S/S: progressive dementia, hypertonia, resting tremors, rigidity, bradykinesia or akinesia, dysphagia, flexed forward (abnormal posture), shuffling gait, mask-like face, incontinence
Multiple Sclerosis
disorder which results in the destruction of the CNS myelin
CNS demyelination
more common in whites and women
average age of onset 20-40 years
RF: smoking, vitamin D deficiency, and Epstein-Barr infections
autoimmune disease T and B cells recognized myelin as an antigen
leading to progressive loss of function in grey and white matter of the CNS
initial symptoms waxes and wanes –> permanent
S/S: paresthesia, dysarthria (speech disorder) diplopia, bladder and bowel control problems, vertigo, ataxia (incoordination) difficultly walking, spasticity quadriparesis, and paraparesis.
relapsing/remitting MS the most common
when symptoms exacerbations followed by a full recovery.
Myasthenia Gravis (MG)
chronic autoimmune disease affecting neuromuscular junctions
characterized by muscle fatigue and weakness with improvement at rest
more common in women
IgE attaches to acetylcholine receptors blocking acetylcholine, eventually receptors will be destroyed.
Myasthenic Crisis
descending paralysis
impairment in breathing and is associated with severe quadriparesis/paralysis
S/S: progressive muscle weakness and fatigue
muscles of the eye, face, mouth, throat and neck are usually affected first
may experience diplopia, ptosis, and ocular movement paralysis
paralysis will descend and pt will need a ventilator
Guillain-Barre’ syndrome -GBS
PNS demyelination, autoimmune disorder
ascending paralysis
supportive treatment
triggered by respiratory or GI infection, surgery, immunization, viral infections (zika)
chronic relapses
recover or die weeks to years
Migraines
headache that occurs immediately and last 4-72 hours
common in women 25-55
unilateral throbbing head pain
worsens with activity
S/S: nausea, vomiting, photophobia, phonophobia
occur more frequently with women’s menstrual cycles frequency decreases with pregnancy and menopause
increases the risk for: epilepsy, depression, anxiety disorder, cardiovascular disease, and ischemic stroke
triggers: alternation in sleep patterns, skipping meals, overexertion, weather changes, stress or relaxation from stress, hormonal changes, bright lights, strong smells, alcohol or the use of nitrates
chronic migraines: more than 15 a month for 3 months
-caffeine, obesity, and rebound headache from overuse of migraine medication
Cluster Headache
common in men 20 - 50 years old
-severe, throbbing stabbing pain
unilateral and may alternate sides with each episode
occurs in clusters up to 8x per day and last minutes to hours
tearing eyes, nasal drainage and occur at night and wake up the person
tension headache
most common headache
pain felt throughout entire head
tight band
onset is gradual and episodic
Spinal bifida
neural tube defect when the neural tube fails to close
common with folate deficiency and occurs within the first month of gestation
two main types of NTD anterior and posterior
anterior NTD affect the face and brain abnormalities such as cyclopia
Posterior NTD affect the spinal cord and vertebrae
Anencephaly
-skin and brain might be missing
-babies often still born and die
Encephalocele
-protrusion of the brain and meninges through a defect in the skull
-often the occipital area
meningocele
-sac filled with meninges and spinal fluid
-most mild form
myelomeningocele
-hernial protrusion often in the lumbar area
-includes meninges, spinal cord and spinal fluid.
-nerves below the lesion are not developed properly
–> loss of motor fx, sensory reflex, and autoimmune functions
-common with hydrocephalus
-seizures may occur
Cerebral Palsy
disorder of movement, muscle tone or posture.
CP can occur secondary to an injury or abnormal gestational development of the brain.
factors that can cause CP: cerebral hypoxia, hemorrhage, infection, genetic abnormalities or low birth wt.
Spastic/Pyramidal CP
-upper motor neuron damage
-most common type of CP
-increased muscle tone, persistent primitive reflexes, hyperactive DTR, clonus, rigidity of the extremities, scoliosis and contractures
Extrapyramidal/Non-spastic CP
-damage to the cells in the basal ganglia, thalamus and cerebellum
–Dyskinetic CP
movements that are stiff, uncontrolled, abrupt and repetitive.
difficulty with fine motor skills
–Ataxic CP
difficulty with gait and is associated with cerebellar injury
hypotonia with stiff trunk
CP kids have seizure and intellectual impairment, communication disorders, dysphagia, respiratory problems, bowel and bladder problems, malnutrition, and orthopedic disabilities.
Febrile seizures
occur secondary to fever and in the absence of CNS infection
simple febrile seizures occurs in 5% of children
most common childhood seizure and are benign, may be genetically linked
characteristics
-typically occur between 3 months and 5 years
-temperature greater than 102 F or 39 C
-acute respiratory infection or ear infection with the absence of CNS infection or inflammation
-will occur in the first 24 hours of illness
-seizures are short and lasts less than 15 minutes mainly tonic in nature
-normal EEG
-reoccurrence does not happen during the same infection
complex febrile seizures
-last longer than 15 minutes
-focal characteristics and confined to one side of the child’s body
-occur more than once in 24 hr period
