Neurological Conditions Flashcards
At which rate must blood flow in the brain be maintained for normal functioning?
750-1000mL/min
Which lobe of the brain is affected if the patient has Broca aphasia?
Frontal
(Broca is like “boca” which is in front)
Which information will a transcranial doppler ultrasonography (TCD) provide?
It measures the velocity of blood flow in the cerebral arteries
What is agnosia?
The inability to recognize familiar objects by touch, sight, or sound
Describe the associated defects of each vertebral artery after a stroke
Vertebral:
Anterior: Rooting reflex
Middle:
Posterior:
What type of stroke would be suspected if the patient presents with head trauma, a stiff neck, and cranial nerve deficits
Subarachnoid hemorrhage
What is digital subtraction angiography?
What is carotid duplex scanning?
What is an Electroencephalogram (EEG)?
Diagnostic test that determines the electrical activity of the brain
What is hemiplegia?
Paralysis on one side
What is apraxia?
Failure to carry out learned sequential movements on command
Describe the different types of seizures
Atonic:
Clonic:
Myoclonic:
Myoclonic-atonic:
Myoclonic-tonic-clonic:
Tonic:
Tonic-clonic:
Hyperkinetic:
What are the 4 phases of a seizure?
1) Prodromal phase: Sensation or behavior changes hours or days before a seizure
2) Aural Phase: Sensory warning that is similar each time and is part of the seizure
3) Ictal Phase: Time period from first symptoms to the end of seizure activity
4) Postictal Phase: Recovery period after the seizure
What is an atonic seizure?
-B
What is a clonic seizure?
-Begins with loss of awareness & sudden loss of muscle tone
-Rhythmic jerking (doesn’t have to be symmetric)
What is a myoclonic seizure?
What is a myoclonic-atonic seizure?
What is a myoclonic-tonic-clonic seizure?
What is a tonic seizure?
-Sudden onset of increased muscle tone in extensor muscles
-Occur mostly in sleep
-Usually less than 20 seconds
-Pt usually stays aware
What is a tonic-clonic seizure?
- Most common generalized-onset motor seizure
- Patient loses consciousness and will fall if standing
- Body stiffens for 10-20 seconds (tonic phase) and then the extremities jerk (clonic phase)
What is a hyperkinetic seizure?
Describe a focal awareness seizure
-Patient is conscious and alert but has unusual feelings or sensations
-Sudden & unexplainable feelings of joy, anger, sadness, or nausea
-May hear, smell, taste, see, or feel things that are not real
-May have localized twitching
Describe a focal impaired awareness seizure
-Loss of consciousness or change in awareness
-Eyes are open
-Movements seem purposeful but cannot interact with others
-Can do things that are dangerous or embarrassing
-Last 1-2 minutes
-No memory of activity during seizure
What is a psychogenic nonepileptic seizure?
Imitate seizures but are triggered by emotional events instead of neuronal activity
What is status epilepticus?
State of continuous seizure activity and can occur with any type of seizre
What is an aura regarding seizure disorders?
An unusual sensation or feeling that warns of an impending seizure
During a generalized-onset tonic-clonic seizure, when should you call EMS?
-Longer than 5 minutes
-Events recur without recovering
-Irregular breathing pattern
-Injury
-Pregnancy
-Don’t know if it’s a 1st time seizure
What is the difference between primary and secondary restless leg syndrome?
Primary:
-Genetic link
-Cause is unknown
Secondary:
-Iron deficiency
-Renal disease
-Hemodialysis
-Neuropathy
What are first-line therapy drugs for restless leg syndrome?
Antiseizure drugs
How long does the tonic phase of a tonic-clonic seizure last?
10-20 seconds
What class of medications can worsen symptoms of restless leg syndrome?
Antihistamines
Describe the location of tension-type headaches
Bilateral base of skull
What is the first-choice drug to prevent cluster headaches?
Verapamil
Which cranial nerve is the trigeminal nerve?
5th CN
What are some manifestations of trigeminal neuralgia 1?
Excruciating pain in lips, gums, cheek, forehead, or side of nose
Can last a few seconds to several minutes and can happen 1-50 times per day
What are some manifestations of trigeminal neuralgia?
Pain has a lower intensity than in TN 1 and does not subside completely
What can cause a pain episode of trigeminal neuralgia?
Light touch at a trigger point that can be caused by:
-Brushing teeth
-Chewing
-Face washing
-Yawning
-Talking
-Blast of hot or cold air on face
What are some drug classes that can be used to treat TN?
-Antiseizure drugs
-Tricyclic antidepressants
-Local nerve blocks
What is Bell’s Palsy?
Temporary facial paresis due to damage or trauma to the facial nerve
Which cranial nerve is the facial nerve?
CN VII
What is the most common facial nerve disorder?
Bell’s Palsy
What are the risk factors of Bell’s Palsy?
Obesity
Hypertension
Diabetes
What are some symptoms of Bell’s Palsy?
-Drooping of eyelid and corner of mouth
-Drooling
-Facial twitching
-Dryness of eye or mouth
-Facial numbness
-Altered taste
-Hearing loss
-Excessive tearing in 1 eye
What does the suffix esthesia mean?
Ability to feel sensations
What is Guillain-Barre syndrome?
Autoimmune process that occurs soon after a viral or bacterial infection
Describe the etiology of GBS
After an infection, the immune response can injury the myelin sheath or the nerve axon itself
What 2 treatments are most effective if done within the first 2 weeks of symptom onset?
-Plasma exchange (plasmapheresis)
-High dose IV Immunoglobulin
What are the similarities in chronic inflammatory demyelinating polyneuropathy and GBS?
-Both are autoimmune diseases that damage and demyelinate the nerves
What are the differences in chronic inflammatory demyelinating polyneuropathy and GBS?
Onset:
GBS is rapid and CIDP is gradual
Treatment:
Steroids won’t work with GBS. CIDP is treated using everything GBS uses plus steroids
Causes:
GBS preceded by infection. CIDP doesn’t have a preceding illness
What are the classic presentations of patients with CIDP?
-Progressive symptoms lasting over 2 months
-More weakness than sensory deficits
-Symmetric weakness in arms and legs
-Impaired sensation
-Paresthesia and dysesthesia
-Decreased or absent reflexes in all extremities
What is found in the CSF for GBS and CIDP that can be used as a diagnosis?
High protein levels
What medications are given to a patient with tetanus?
-Diazepam and Barbiturates for sedation and relaxation of muscles
-Neuromuscular blocking agents to paralyze muscles
-Antibiotics
What is autonomic dysreflexia?
A life-threatening condition when the autonomic system overreacts and causes a severe increase in blood pressure
What are clinical manifestations of autonomic dysreflexia?
-Hypertension
-Throbbing headache
-Sweating above level of injury
-Goosebumps
-Skin flushing
-Blurred vision/spots
-Nasal congestion
-Anxiety
-Nausea
What are the immediate interventions for a patient suffering from autonomic dysreflexia?
-Elevate head of bed 45 degrees or sit patient upright
-Determine cause
-Notify HCP
What drug classes are used to treat a neurogenic bladder
-Anticholinergic (suppress bladder contraction)
-alpha-Adrenergic (relax urethral sphincter)
-Antispasmodic (decrease spasticity of pelvic floor muscles)
-Botox
What is the difference between primary and secondary spinal cord tumors?
Primary: Arise from some part of the spinal cord
Secondary: Started somewhere else in the body and metastasized to the spinal cord
What are early symptoms of spinal cord tumors?
-Back pain that radiates along nerve path that worsens with:
-activity
-coughing
-straining
-lying down
Name the types of spinal cord tumors based on the location in the spinal cord?
Intradural-extramedullary: Meningiomas, neurofibromas, schwannomas
Extradural: Metastatic lesions, benign schwannomas
Intramedullary: Astrocytomas, ependymomas
Why should a wrench always be close to a patient with a halo vest?
In case emergency removal of the vest is needed
What are the differences between spinal shock and neurogenic shock?
Spinal shock:
-May occur shortly after SCI
-Loss of deep tendon reflexes
-Loss of sphincter
-Loss of sensation
-Flaccid paralysis below level of injury
Neurogenic:
-Occurs from unchecked parasympathetic response
-Causes peripheral vasodilation, venous pooling, and decreased cardiac output
-Manifestations include hypotension (<90 mm Hg), bradycardia, and temperature dysregulation
Any cord injury above what level will lead to SNS dysfunction?
T6
What is tic douloureux?
Another name for trigeminal neuralgia
Which level of spinal injury could result in failure of the diagphram?
C3-C5
What are the signs of neurogenic shock?
-Peripheral vasodilation
-Venous pooling
-Blood pressure <90
-Temperature dysregulation
