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CERT STUDY > Neurologic Dysfunction > Flashcards

Neurologic Dysfunction Flashcards

1
Q

Potential signs of neurologic complications

A

Development of handedness before 1 year, absence/persistence/asymmetry of reflexes

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2
Q

Spinal cord in neonates ends at ____

A

L13

L1-L12 in adults, affects lumbar puncture placement

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3
Q

Children have ____ of CSF

A

60-140ml

Adults have 90-150ml

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4
Q

Increased ICP

A

Excessive pressure in the rigid cranial vault that disrupts neurologic function
Caused by tumors, accumulation of CSF in the ventricular system, intracranial bleeding, edema of cerebral tissues, craniocerebral trauma, hydrocephalus, meningitis, encephalitis, Guillain-Barre syndrome

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5
Q

Increased ICP signs - infants and young children

A

Tense, bulging anterior fontanel, high-pitched cry, increased head circumference, “setting sun” sign (eyes), Macewen’s sign (cracked pot sign), irritability, restlessness, changes in feeding habits, crying with cuddling and rocking

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6
Q

Increased ICP signs - older children

A

Headache, vomiting, cognitive/personality/behavior changes, diplopia, blurred vision, anorexia, nausea, weight loss, seizures

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7
Q

Late manifestations of increased ICP

A

Decreased LOC (lethargy, coma), abnormal pupil size and reactivity, abnormal sensation, decerebrate and decorticate posturing, papilledema, abnormal breathing, Cheyne-Stokes respirations

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8
Q

Increased ICP treatment

A 
Medications - diuretics, steroids
Keep head and neck neutral
No suctioning, percussion, fast movements, flexion or extension of neck 
Strict I/Os
Laxatives to prevent straining
Prevent weight loss
Monitor for DI and SIADH
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9
Q

Generalized seizure

A

Involves both hemispheres of the brain, are bilateral and symmetrical
Includes tonic, clonic, tonic-clonic, absence, atonic, myoclonic, and febrile seizures

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10
Q

Tonic seizure

A

Rigidity, extension and stiffening of extremities, fixed jaw, respiratory cessation, dilated pupils, loss of consciousness

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11
Q

Clonic seizure

A

Rhythmic jerking

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12
Q

Absence seizure

A

Staring spell, may not remember what happened during seizure, usually returns to normal state of awareness immediately afterward

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13
Q

Atonic seizure

A

Sudden loss of muscle tone

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14
Q

Myoclonic seizure

A

Short muscle contractions - body “jolts”
Infantile spasms - occurs in first few months of life - sudden jerk then stiffening that lasts 1-2 seconds, can occur in clusters, most often just after waking up or falling asleep

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15
Q

Partial seizure

A

Occurs in a limited area of the cerebral cortex - symptoms vary depending on what area it affects - one-sided contractions, abnormal head and eye movements, lip smacking, sensory issues, inappropriate behavior
Includes simple and complex partial seizures

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16
Q

Simple partial seizure

A

Maintains consciousness, no memory loss

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17
Q

Complex partial seizure

A

Progress to unconsciousness

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18
Q

Neural tube defects

A

Group of related defects of the CNS involving the cranium or spinal cord that vary from mild to severely disabling
Cystic or non-cystic
Include anencephaly, encephalocele, spina bifida

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19
Q

50% of neural tube defect cases are due to ____

A

Deficiency of folic acid in diet

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20
Q

Anencephaly

A

Absence of entire brain or cerebral hemispheres - incompatible with life

21
Q

Encephalocele

A

Meningeal and cerebral tissue protrudes in a sac through a defect in the skill
In mild forms, there is little to no residual neurologic impairment

22
Q

Spina bifida

A

Defective closure of the vertebral column, most common defect in the CNS
Types - occulta, meningocele, myelomeningocele

23
Q

Spina bifida occulta

A

Does not usually affect the spinal cord - dimpling of the skin, nevi, or tufts of hair over a dural sinus

24
Q

Meningocele

A

Characterized by a sac which contains meninges and CSF protruding outside of the vertebrae, but the spinal cord is not affected

25
Myelomeningocele
Spinal cord and accompanying nerve roots are involved - most severe type of spina bifida - causes sensorimotor deficits, urinary and bowel problems, joint deformities
26
Thoracic myelomeningocele
Causes leg paralysis
27
L3 myelomeningocele
Causes ankle and toe paralysis
28
L4-5 myelomeningocele
Causes weak or absent ankle and toe flextion
29
Sacral myelomeningocele
Causes mild ankle and toe weakness, may have bladder or bowel issues
30
Neural tube defects pre-op care
Preventing infection Sterile dressing to lesion, constantly moisten with saline, examine for leakage Avoid placing diaper or other covering over lesion to prevent fecal contamination Place in prone or side lying position to prevent contamination Prevent hip subluxation by maintaining legs in abduction with pad between knees, keep feet in neutral position Use protective devices, handle infant with care
31
Hydrocephalus
Caused by imbalance in production and absorption of CSF in the ventricular system - production exceeds absorption, CSF accumulates and produces dilation of ventricles
32
Communicating hydrocephalus
Caused by impaired absorption of CSF - meningitis, leukemia, lymphoma
33
Non-communicating hydrocephalus
Caused by obstruction of flow of CSF - trauma, infection
34
Hydrocephalus signs
abnormal rate of head growth, bulging fontanel, dilated scalp veins, Macewen's sign (cracked pot sign), "sun setting" sign, sluggish pupils
35
Hydrocephalus treatment
Placement of shunt
36
Signs of shunt malfunction
Rapid onset of vomiting, severe headache, irritability, lethargy, fever, redness along shunt tract, fluid around shunt valve
37
Reye's syndrome
Acute, multi-system disorder that follows viral infection, usually flu A/B or varicella zoster - can lead to death within hours Causes brain encephalopathy and fatty degeneration of liver, hyperammonia results from reduction in enzyme that converts ammonia to urea
38
Causes of Reye's syndrome
Salicylates (aspirin), toxins, antidiarrheals
39
Reye's syndrome stages
Stage 1 - vomiting, lethargy, confusion, slowing of EEG, liver dysfunction Stage 2 - disoriented, combative, hallucinations Stage 3 - coma, decorticate rigidity, hyperventilation, preservation of pupillary and ocular reflexes Stage 4 - deep coma, decerebrate rigidity, large fixed pupils, brain stem dysfunction Stage 5 - seizures, respiratory arrest, loss of deep tendon reflexes
40
Reye's syndrome treatment
Supportive care, ICU setting
41
Comminuted fracture
Eggshell appearance
42
Basal fracture
Linear fracture through base of skull - raccoon eyes, blood leakage into frontal sinuses, battle sign (bruising behind ears from blood leakage into mastoid sinus) Can cause cranial nerve damage
43
Diastatic fracture
Occurs along a suture line
44
Cervical injury
Do not move child until possibility of injury is ruled out or managed HOB 30 degrees if there is NO cervical injury
45
Subdural hematoma
Bleeding between dura and arachnoid layers, occurs within 48 hours of head injury
46
Lead toxicity
Results from ingesting or inhaling lead containing substances - common cause is household dust or contaminated yard soil No safe blood lead level (BLL) in children - intervention is warranted for BLL ≥5
47
Lead toxicity signs
Behavioral changes, distractibility, learning problems, cramping pain, vomiting, constipation, anorexia, anemia, glycosuria, proteinuria, ketonuria, hyperphosphaturia High dose - encephalopathy, seizures, paralysis, blinding, coma, death
48
Lead toxicity treatment
Chelation therapy, succimer - binds with lead and is eliminated through urine BLL ≥70 - immediate hospitalization for inpatient lead chelation BLL 45-69 - hospitalization if child is symptomatic
49
Submersion injury
Survival for at least 24 hours after submersion (death within 24 hours = drowning) Good prognosis if submersion was less than 5 mins and required resuscitation for less than 10 mins

CERT STUDY (14 decks)

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