Neurological Flashcards
What is the dura mater?
The tough outer membrane. It lies next to the skull, although the arteries that supply it lie between it and the skull
What is the arachnoid mater?
The second layer of the meninges. Has spider like projections which project into the sub arachnoid space, where there is also CSF and the arteries suppling the brain
What are the meninges?
The three membranes surrounding the brain.
Dura mater
Arachnoid matar
Pia Matar
What is the GCS eye score?
4 eye opening spontaneously
3 eye opening to voice
2 eye opening to pain
1 no eye opening
What is the verbal GCS score?
5-Orientated 4-mildly confused 3-very confused 2-moans and groans 1-no verbal response
What’s the motor GCS score?
6-obeys commands 5-localises pain 4-withdraws from pain 3-flexion 2-extension 1-none
What is a simple partial seizure?
Involves only one region of the brain
Patient remains conscious
May experience strange sensations
May experience involuntary movement such as jar eking of a single limb
What is a complex partial seizure?
Involves only one region of the brain
Patient remains conscious but acts spaced out and may not responded to commands
Patient may manifest unusual repetitive behaviours such as picking their clothes or wandering in circles
What is an absence seizure?
Most common in children
Brief blank stare often mistaken for daydreaming/poor attention
Lasts only a few seconds. It can occur as many as 200times a day
What is a generalised seizure?
Patient may experience an aura-essentially a partial seizure which spreads to the entire brain
Patient becomes unconscious, may moan or cry
Initially body is rigid
Muscle jerks, frothing at mouth, shallow/absent Respirations, possible bladder/bowel control
Usually lasts 2-3min then normal resps resume level of consciousness gradually normalises
What are common anticonvulsants used in NZ?
Tegretol
Dilantin
Epilim
Rivet rail
How do we manage simple partial seizures?
No management needed
How do we manage complex partial seizures.
Guide them away from danger, do not attempt to restrain. Reassure and reorientate when they have recovered.
How do we manage absence seizures?
Reassure and reorientate
How do ewe manage generalised seizures?
Ensure will not hurt themselves by moving objects etc.
Place soft object under their head
Administer oxygen
Clear airway of secretions and consider placing an opa
Left lateral position when seizure has stopped
What is status epilepticus?
If a tonic clonic seizure continues for more than 5 minutes, if they do not regain consciousness between seizures.
Serious risk of hypoxia.
Requires ICP back up
What are some acute causes of tonic clonic seizures?
Fever Infections such as meningitis Hypoxia Head injury Hypoglycaemia Alcohol withdrawal Heat exhaustion Drug poisoning Stroke Hypertension
What is hemiplegia?
Paralysis of the muscles of the face, arms and legs on one side of the body
What is the difference between a TIA and a stroke?
Stroke lasts longer an 24 hours
What vessels supply blood to the brain?
Carotids
Vertebral arteries - these branch from arteries supplying the arm. They pass through the cervical spine and unite at the top of the spinal cord to form the basilar artery.
What is the circle of Willis?
At the base of the skull all the arteries supplying the brain form a network called the circle of Willis.
What is an ischaemic stroke?
An obstructive stroke
What is an intracerebral haemorrhage?
A haemorrhage into the brain substance
What is a subarachnoid stroke?
A haemorrhage into the subarachnoid space around the brain
What are the common clinical features of stroke?
Paralysis or weakness in the face, arms legs on one side of the body Loss if sensation on one side of the body Language disruption Visual problems Nausea and vomiting Seizures Dizziness Altered level of consciousness Headache
What are the clinical features of a subarachnoid stroke?
Severe headache Photophobia Nausea Vomiting Altered LOC Collapse They typically deteriorate very rapidly
What are alpha 1 adrenergic receptors involved in?
Constriction of peripheral blood vessels Constriction of arterioles Pupil dilation Decreased motility and tone of GI tract Retention of urinary (through urinary bladder sphincter)
What are the actions of alpha 2 adrenergic receptors?.
Contraction of smooth muscles
Aggregation of platelets
Noradrenaline uptake in the synaptic cleft (negative feedback)
What are the actions of beta 1 adrenergic receptors?
Increased cardiac output
Increased heart rate
Increased contractility
Increased conductivity
What are the actions of beta 2 adrenergic receptors?
Relaxation of bronchiole smooth muscle
Uterus relaxation
Glycogen breakdown in the liver
Stabilisation of mast cells
What are the actions of beta 3 adrenergic receptors?
Enhancement of the breakdown of lipids in fatty tissue
Stabilisation of mast cells
