Neurologic Disorders Flashcards
What are seizures?
Abnormal discharges in the brain for a single event of which results in an abrupt and temporary altered cerebral function state
What are the 3 conditions a patient must meet to be diagnosed w/ Epilepsy?
- at least 2 unprovoked seizures occurring more than 24 hours apart
- 1 unprovoked seizure and probability if more
- diagnosis of epilepsy syndrome
Epilepsy Syndromes are classified by what?
Specific patterns of clinical features including age at onset, family history, and seizure type
Status Epilepticus
continuous seizure activity for more than 5 minutes or two or more sequential seizures w/o full recovery of consciousness b/t seizures
Seizures can also occur as a result of what besides epilepsy?
- hyponatremia
- high fever
Epilepsy is a disease that refers to what?
Recurrent, unpredictable, and unprovoked seizures
Seizures require what 3 conditions?
- excitable neurons
- increase in excitatory glutaminergic activity
- reduction in activity of normal inhibitory GABA projection
When do seizures occur?
When there is an imbalance b/t inhibition and excitation w/in the CNS
Causes of Acquired Seizures
- cerebrovascular disease
- hypoxemia
- fever
- head injury
- HTN
- CNS infection
- metabolic/toxic conditions-hyperkalemia,hyponatremia, hypoglycemia
- brain tumor
- drugs/alcohol
What are the goals of treatment for seizures?
- Stop the seizure as quickly as possible
- ensure adequate cerebral oxygenation
- maintain patient in seizure free state
What medications may be administered to halt seizures?
- lorazepam (Ativan)
- diazepam (Valium)
- midazolam (Versed)
What drugs may be administered later to maintain a seizure free state?
Antiepileptic drugs
- levetiracetam
- phenytoin
- phenobarbitol
Why must Phenytoin (Dilantin) IV be administered slowly?
- B/c of its effect on the myocardium and potential for arrhythmia development
- irritating to veins so must be monitored for phlebitis
Focal Seizures w/ Retained Awareness S/S
- finger/hand shake
- mouth may jerk uncontrollably
- unintelligible speech
- dizziness
- unusual/unpleasant sights, sounds, odors, or taste
Focal Seizures w/ Altered Awareness S/S
- remains motionless or moves automatically but inappropriately
- excessive emotions of fear, anger, elation, irritability
- person won’t remember what happens
Generalized Seizures S/S
- intense rigidity
- alternating muscle relaxation and contraction
- epileptic cry
- incontinent of urine or feces
After the Generalized Seizure is over patients usually appear?
- confused
- hard to arouse
- headache
- sore muscles
- extremity weakness
- fatigue
- depression
What is the SPECT useful for?
identifying the epileptogenic zone so that the area in the brain giving rise to seizures can be removed surgically
What is an EEG useful for w/ seizures?
Assists in classifying the type of seizure
A patient who has received long term antiepileptic therapy is at increased risk for what?
Fractures resulting from bone disease
Bacterial meningitis is commonly caused by what bacteria?
streptococcus pneumonia
neisseria meningitidis
What increases a persons risk for developing bacterial meningitis?
- tobacco use
- otitis media
- mastoiditis
- pneumonia
- immunosupressed
- chronic steroid therapy
- HIV
- traumatic injury
- surgery
Meningeal Infections generally originate in what two ways?
- direct contact
- through blood stream from other infection
Prophylactic agents are given to what type of traumatic injury patients to prevent bacterial meningitis?
Traumatic injury where CSF is escaping through ears or nose
What are some complications of bacterial meningitis?
- visual impairment
- deafness
- seizures
- paralysis
- hydrocephalus
- septic shock
What are frequently the initial symptoms of Bacterial meningitis?
headache and fever
S/S of Meningitis
- nuchal rigidity
- positive kernig sign
- positive brudinski sign
- photophobia
What is Nuchal Rigidity?
stiff neck
Positive Kernig Sign
patient is lying supine w/ the hip flexed 90 degrees, resistance/pain to passive extension of the knee is positive sign
Positive Brudzinski Sign
when the patient’s neck is flexed, flexion of the knees and hips is produced
What is included in the classic triad of bacterial meningitis?
- stiff neck
- altered LOC
- fever
If bradycardia and decreased respirations are seen w/ bacterial meningitis the nurse should suspect what?
ICP
What is the gold standard for diagnosis of bacterial meningitis?
Bacterial culture and gram staining of CSF and blood
What medications may be used to treat bacterial meningitis?
- penicillins
- cephalosporins
- vancomycin w/ or w/o rifampin
What signs are first present w/ viral meningitis?
- headache
- low grade fever
- stiff neck
- photophobia
- malaise
- flu like symptoms
What type of disease is Multiple sclerosis?
immune-mediated progressive demyelinating disease of the CNS
Multiple Sclerosis typically affects who?
Adults ages 20-40
women more than men
What is the Secondary Progressive course of Multiple Sclerosis?
Disease progression occurs w/ or w/o relapse
Primary Progressive course of Multiple Sclerosis
disabling symptoms steadily increase w/ rare plateaus and temporary improvement
Primary Progressive MS may result in what?
- quadriparesis
- cognitive dysfunction
- visual loss
- brain stem syndromes
Progressive Relapsing form of MS
characterized by relapses w/ continuous disabling progression b/t exacerbations
What are the symptoms most commonly reported w/ MS?
- unilateral vision loss
- orbital pain w/ eye movement
- fatigue
- depression
- weakness
- limb numbness
- poor coordination/balance
- pain
Visual disturbances w/ MS may also include what?
- blurred vision
- diplopia
- nystagmus
- patchy/total blindness
What happens during exacerbations of MS?
New symptoms appear and existing ones worsen
What happens during remission of MS?
symptoms decrease or disappear
What are some secondary complications of MS?
- UTI
- constipation
- pressure ulcers
- contracture deformities
- pedal edema
- pneumonia
- depression
- decreased bone density
