Neurologic disorders Flashcards
what is the CNS
brain and spinal cord
what is the PNS
peripheral nerves
what are glial cells
support cells
structure for neurons
assessment of neuro system
cognitive fx- remember words, dates, draw
facial droop- ask pt to smile, open up mouth
extremities- tremors, rigidity, lack of strength
motor strength- bilateral grip and quadriceps strength against resistance
DTR- babinski- should be neg
sensation- pt eyes closed
what is generalized onset seizure
whole brain
what is focal onset seizure
1 side of brain
what is clonic
rhythmic muscle twitching
what is atonic
go limp
what is myoclonis
nonrhythmic muscle twitching
what are absence seizures
staring spell
gone from presence
what is aura
sensation b4 seizure
smell, feeling, etc
what is ictal period
time of seizure
do not touch pt
what is postictal
after seizure
exhausted
confused
what is interictal
period btwn multiple seizures
what is status epilipticus
seizure lasting >5 min
medical emergency: can lead to permanent brain damage
what causes seizures
head trauma
stroke
brain neoplasms
congenital malformation
degenerative brain disorder
environmental stimuli
genetic predisposition
infections
metabolic disturbances: electrolye imbalance
perinatal injury
withdraw from alc or sedative-hypnotic drugs
what is epilepsy
chronic neurological disorder with recurrent seizures
2 unprovoked seizures at least 24 hrs apart
characterisitcs of migraine headaches
1 sided
periodic, throbbing headaches
altered perceptions, nausea, and severe pain
lasting 4-72 hrs
aggravated by routine physical activity
sensitivity to light and or sound
risk factors for migraines
female
oral contraceptive use
excessive exercise
stress/worry
fatigue/lack of sleep
foods with nitrites, aspartate, tyranmine
hypoglygemia
how to treat migraines
NSAIDs
serotonin receptor agonists
dopamine receptor antagonists
preventative, prophylactic treatment
botox
characteristics of tension type headaches
most common
bilateral pain with mild to moderate pressure
does not worsen with physical activity
no nausea and vomiting
increased cervical and pericrainial muscle activity
lasting from 30 min-7 days
sensitivity to either light or sound
treatment for TTH
pain relievers
relaxation therapy
SSRIs
what is MS
chronic demyelinating disorder
affects brain, spinal cord, and optic nerves
remissions and exacerbations
sensory and motor
symptoms of MS
weakness
numbness
balance probs
blurred vision
dysphagia
hemiparesis
paraparesis
memory probs
what is guillain barre syndrome
t cell mediated d/t virus
postinfectious disease: epstein barr, covid
acute inflammatory demyelination
symptoms of guillain barre
weakness
complete paralysis- starts @ feet- ascending- breathing
peripheral neuropathy
treamtnet for GBS
supportive
neuromuscular respiraotry failure- vent
continuous hemodynamic monitoring- autonomic nerves involved
immunomodulating agents
what is myasthenia gravis
autoimmune
chronic
fights acetylcholine
muscle weakness and fatigue
extraocular muscles affected first
b and t cell mediated
thymus gland hyperplasia- overproduces t cells
diagnostics tests for MG
edrophonium testing
serum ach receptor antibodies
EMG
treatments for MG
physostigmine
iv immunogobulin
plasmapharesis
thymectomy
what is myasthenic crisis
weakness severe enough to cause respiratory failure necessition vent
requires ICU monitoring of forced vital capacity and neg inspiratory force every 2-4 hrs
what is obtunded
difficult to arouse
what is normal ICP
5-15 mm/hg
3 elements of ICP
brain tissue
blood volume/circulation
CSF
how to decrease pressure
drain fluid
decrease bp
hypertonic
vasoconstrict
remove brain tissue
remove part of skull (decompressive crainiotomy)
what oercentage is brain tissue
80
what percentage is CSF
10
what percentage is blood
10
what can caused increased icp
mass
tumor
trauma
bleed
ischemic stroke
hydrocephalus
airway obstruction
hypoventilation
seizures
what is the monroe-kellie hypothesis
one of above volumes compensates for the other that rises
once the need for volume can not be compensated for, ICP rises
assessment of TBI
head trauma
neuro exam
durations of unconsciousness
post-traumatic amnesia
consciousness vs unconsciousness
cranial nerve testing both sides- pupil reaction to light, extraocular movements, corneal reflex, hearing, uvula and tongue position
sensory testing- light touch, pain, positioning
motor testing
DTR
coordination and gait
mental status
glascow coma scale
coma and posturing
what does the glascow coma scale assess
severity of brain injury
eye opening, verbal response, motor response
lowest: 3
highest: 15- conscious
what is decoritacte
flexed arms, clenched fists, rigid legs
indicates corticospinal tract damage
what is decerebate
arms held striaght outward with toes pointed downward
indicates upper brainstem damage
what is post concussion syndrome
may persist for several months
treatment of mild tbi
certain activities should be resitrcted
frequent rest
stop playing sport/activity immediately until assessment and cleared by clinician to return to activity
treatment of modereate to severe tbi
intensive care unit
what is diffuse axonal injury
common type of tbi
widespread damage to brain tissue
major cause of unconsciousness and persistent coma after head trauma
immediate loss of consciousness, most remain in coma
treatment for DAI
neurovascular stabilization
IV mannitol, steroids
what is a concussion
mild TBI
traumatic force causes disruption in brain fx
what is a simple concussion
resolve without complication
may take up to 10 days
what is a complex concussion
symtoms may persist for longer
longer loss of consciousness
what may a pt state after a concussion
seeing stars
dazed
confused
headache
dizzy
retrograde and antegrade amnesia
diagnosis for concussion
rule out cervical spine injury, epidural hematoma, subdural hematoma, subarachnoid hemorrhage
neuro exam
s&s may evolve over time so do repeat evals
ct scan normal in most cases
what is post-concussion syndrome
persistence of symptoms for more than 3 weks
what is a cerebral contusion
scattered areas of bleeding on brain surface
most commonly undersurface frontal and temporal lobes
cerebral edema around contusion within 48-72 hrs
medical emergency- decreased HR, decreased respirations, hypertension, can not be awakened
treatment for cerebral contusion
crainectomy/crainotomy
evacuation of blood through crainiotomy
what is intracranial bleeding
epidural and subdural hematoma
can cause excessive pressure on brain and cause neuro damage or death
what is epidural hematoma
collection of arterial blood above dura mater that is caused by rupture of the middle meningeal artery
commonly associated with skull fracture
what is a subdural hematoma
collection of venous blood that is beneath dura mater
what is a spinal cord injury
compression, stretching, or laceration of spinal cord d/t trauma
can result in impaired blood flow
causes temp or permanent sensory, motor or autonomic fx that are seen immediately after injury
deficits can worsen over time r/t edema
quadriplegia is most common type: all 4 limbs
paraplegia is second most common type
where is a complete SCI
c4 or above
where is an incomplete SCI
t11 or below
what is a primary sci
mechanical- stretching or shearing forces injure neurons and glial cells
hemorrhage, cell death, and necrotic enviornment
what is a secondary sci
ischemia caused by primary forces causes secondary injury processes that worsen damage over hours to weeks
ischemia cause cytotoxic edema, inflammation, cascade of tissue damage and scarring which inhibits regeneration of neurons at side of injury
assessment for sci
abc’s
log roll- treat all back injuries as if they have sci until confirmed they do not
pulmonary -injuries at c4 and above tend to have respiratory complications
look for signs of hemorrhage, hypotension and shock
sensory testing
motor strength testing
extent of injury
treatment for sci
ABCs
stabilization
neuro exam
pain management
SCDs-immobile
wound care
urinary cath
warmed IVF
surgery
LMW heparin if no bleeding risk
what is spinal shock
areflexia: absence of reflexes
results from primary injury
flaccid muscles, paralysis, lack of sensation below injury, bowel and bladder dysfunction
loss of anal reflex or bulbocavernosus reflex
autonomic fx also disrupted
cannot assess extent of injury until shock resolves, may take weeks to days
indicated by return of anal reflex
what is neurogenic shock
acute
occurs in pt’s with injuries at t6 and above
autonomic probs
abnormal SNS signaling
bradycardia
hypotension
peripheral vasodilation
hemodynamic monitoring and stabilization required- fluids
