Neurologic Disorders

Question 1

Sodium

Answer 1

sodium abnormalities
can lead to AMS and Seizures

Question 2

Hyponatremia effects on brain

Answer 2

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.

Question 3

Hypernatremia effects on brain

Answer 3

hypertonic intravascular space
fluid to flow into the vessels shrinking/dehydrating neurons

Muscle weakness.
Restlessness.
Extreme thirst.
Confusion.
Lethargy.
Irritability.
Seizures.
Unconsciousness.

Question 4

Seizures

Answer 4

inappropriate discharge of impulses by the cerebral neurons, sudden onset, transient loss of brain function

epilepsy –> seizure disorder with no underlying cause

Question 5

what can cause seizures

Answer 5

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)

Question 6

focal/partial seizure

Answer 6

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

Question 7

Automatism

Answer 7

actions without conscious thought

person may appear wide-eyed

lip smacking, chewing, facial grimacing, swallowing movements, patting, picking, rubbing oneself or clothes.

Question 8

Generalized Seizure

Answer 8

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

Question 9

Status Epilepticus

Answer 9

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

Question 10

Postictal state

Answer 10

follows a seizure characterized by drowsiness, headache, confusion, aphasia, memory loss and paralysis which can last for hours or days

Question 11

Non-convulsive Status Epileptic

Answer 11

presents without any signs of seizure activity

patient will have AMS that is not explained by any other cause

only way to Dx EEG

Question 12

Acute confusion state

Answer 12

marked by sudden cerebral dysfunction which causes confusion, agitation, memory impairments, distractibility, compulsive disorders and obsession.

Question 13

Delirium

Answer 13

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

Question 14

Delirium Causes

Answer 14

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

Question 15

Dementia

Answer 15

loss of cognitive function
(memory, orientation, and language)
occurs over time and not reversible
chronic

Question 16

Meningitis

Answer 16

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

Question 17

Alzheimer’s Disease

Answer 17

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

Question 18

Risk factors for Alzheimer’s

Answer 18

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.

Question 19

Parkinson’s disease

Answer 19

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

Question 20

Multiple Sclerosis

Answer 20

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.

Question 21

Myasthenia Gravis (MG)

Answer 21

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

Question 22

Guillain-Barre’ syndrome -GBS

Answer 22

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

Question 23

Migraines

Answer 23

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

Question 24

Cluster Headache

Answer 24

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

Question 25

tension headache

Answer 25

most common headache

pain felt throughout entire head

tight band

onset is gradual and episodic

Question 26

Spinal bifida

Answer 26

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

Question 27

Cerebral Palsy

Answer 27

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.

Question 28

Febrile seizures

Answer 28

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