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Patho > Neurological Conditions and Emergencies > Flashcards

Neurological Conditions and Emergencies Flashcards

1
Q

What are important questions/assessments for suspected neurological emergencies?

A

-Headache, dizziness, visual disturbances (blurred, black, lights, stars, etc.)
-Nausea, vomiting
-Any altered LOA/GCS (obtain a baseline)
-Pupillary assessment (size, reactivity, equality), H test
-Stroke assessment (grips, gas pedals, smile, arm/leg drop)
-Incontinence

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2
Q

What causes a migraine?

A

-When a migraine occurs, cranial nerve V (trigeminal) is activated and likely releases
mediators that trigger an inflammatory response in the meningeal vasculature - causing pain
-Many people with chronic migraines have hormonal or dietary triggers

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3
Q

What are the clinical manifestations of a migraine?

A

-Migraine Aura - reversible symptoms that precede (warn) the onset of a migraine headache
-Visual disturbances (flickering lights, spots or lines)
-Partial or complete loss of vision (blackness/ blurred)
-Pins and needles, numbness
-Speech disturbances
-Pulsatile, throbbing, unilateral headache that may last 1-2 days and is aggravated by routine physical activity
-Commonly associated with nausea, vomiting and photophobia (light sensitivity)
-Patients without aura may experience unexplained fatigue or irritability preceding the
onset

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4
Q

What is a tension headache?

A

-The most common type of headache and usually not severe enough to interfere with daily activities
-Exact mechanism isn’t known but may be a result of sustained tension of the muscles of the
scalp and neck
-May also be caused by stress, anxiety, depression, or caffeine

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5
Q

What are the clinical manifestations of a tension headache?

A

-Dull, aching and diffuse headaches located in a “hatband” distribution around the head
-Typically, not worsened by activity and not associated with nausea/vomiting

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6
Q

What is a stroke?

A

-An acute focal neurologic deficit from a vascular disorder that injures brain tissue
-Classified as either ischemic (87% of all strokes) or hemorrhagic
-Hemorrhagic strokes have a much higher fatality rate

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7
Q

What is an ischemic stroke?

A

Caused by cerebral vascular obstruction by thrombosis or emboli

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8
Q

What is the penumbra?

A

-During the evolution of a stroke there is usually a core of dead or dying cells (due to disrupted blood flow) surrounded by an ischemic band of minimally perfused cells
-Cells in the penumbra can survive provided there is a timely return of adequate circulation
-Should cerebral blood flow not return, the core of dead cells grows, and the penumbra grow

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9
Q

What is a thrombotic ischemic stroke?

A

A thrombus is the most common cause of ischemic stroke, usually occurring in
atherosclerotic blood vessels, resulting in infarction

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10
Q

What is a thrombus?

A

stationary mass of clotted blood or other formed elements

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11
Q

What is atherosclerosis?

A

buildup of fats, cholesterol and other substances in and on the walls of an artery (buildup is called plaque) - narrows the vessel

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12
Q

What is infarction?

A

necrosis or death of tissues due to local ischemia resulting from obstruction of blood flow

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13
Q

What is an embolic ischemic stroke?

A

-An embolic stroke presents the same as a thrombotic stroke, but the obstruction
originates in another region of the body
-The most common origin of an embolic stroke is from a thrombus in the left side of the heart
-May also originate in atherosclerotic carotid arteries

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14
Q

What is an embolus?

A

a mass of clotted blood or other formed elements (calcium fragments, air bubbles, loose tissue), that circulates in the blood until it becomes lodged
in a vessel, obstructing circulation

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15
Q

What is a transient ischemic attack (TIA)?

A

-A temporary disturbance in focal cerebral blood flow that reverses before infarction occurs
-Causes of TIA are similar to ischemic stroke (atherosclerosis, emboli)
- A TIA can be seen as a warning sign of an impending stroke
-10-15% of patients with TIA have a stroke within 3 months - 50% of those occur within 48hours
-only way to diagnose the difference between a stroke, clinically, is if the symptoms resolve

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16
Q

What is a hemorrhagic stroke?

A

-Result of a ruptured cerebral blood vessel, often during physical or emotional exertion
-The hemorrhage can cause a focal hematoma, edema, compression of brain contents and spasm of adjacent blood vessel
-Ruptured aneurysms and arteriovenous malformations are the origins

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17
Q

What is an aneurysm?

A

outpouching or dilation in the wall of a blood vessel

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18
Q

What is an AV malformation?

A

a tangle of malformed arteries and veins linked by fistulas, lacking a capillary bed and with a deficient muscularis layer

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19
Q

What are symptoms of a CVA?

A

-Unilateral arm/leg weakness or drift
-Slurred speech or inappropriate words or mute
-Unilateral facial droop
-Vision loss in one eye, language disturbance (aphasia, dysarthria), imbalance, hemineglect, apraxia, agnosia or ataxia

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20
Q

What is aphasia?

A

-varying inability to comprehend, integrate and express language
-caused by the stroke affecting the speech center in the brain
-can be receptive (comprehension of speech or written words) or expressive (communication using speech or writing)

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21
Q

What is dysarthria?

A

-imperfect articulation of speech sounds or changes in voice pitch or quality
-caused by stroke affecting the muscles in the larynx or any part of the airway related to speech

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22
Q

What is apraxia?

A

loss of ability to carry out familiar, purposeful acts or to manipulate objects

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23
Q

What is ataxia?

A

inability to coordinate voluntary muscle movement

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24
Q

What is agnosia?

A

inability to recognize and identify objects

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25
Q

What is hemineglect?

A

-inability to attend and react to stimuli from the contralateral side
-may not visually track or reach to the affected side

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26
Q

What are the clinical manifestations unique to a hemorrhagic stroke?

A

-Many patients describe an acute “thunderclap” headache - sudden and severe
-Some patients describe hearing or feeling a “pop” in their head that precedes the headache
-Following the onset of symptoms there can be a rapid deterioration to unconsciousness and death - timeline varies with size and location of ruptured
vessel

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27
Q

What is meningitis?

A

Meningitis is an inflammation of the meninges, specifically the pia mater, arachnoid mater and subarachnoid space

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28
Q

What is bacterial meningitis?

A

-Bacterial meningitis spreads easily with close contact but people are at higher risk if they are immunocompromised
-Bacteria replicate and release endotoxins into the CSF that initiates a release of inflammatory mediators
-The infiltration of inflammatory cells produces a cloudy purulent exudate and damage to the nearby vessels
-Impaired CSF flow and tissue infarction is possible

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29
Q

What are the clinical manifestations of bacterial meningitis?

A

-Fever, chills, nausea, and vomiting
-Headache, stiff neck, back/abdominal/extremity pain
-Seizures and other focal cerebral symptoms are also possible

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30
Q

What is viral meningitis?

A

-Viral meningitis is very similar to bacterial, but the clinical course and CSF findings are typically less severe
-Treatment is usually symptom oriented as the virus is self-limiting
-Many different viruses can cause viral meningitis

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31
Q

What is encephalitis?

A

-Generalized infection of the brain or spinal cord parenchyma
-Usually caused by a virus but may be caused by bacteria, fungi and other organisms
-Common origins include: Mosquito bites, rabid animal bites, and viral ingestion
-Local necrotizing hemorrhage, which becomes generalized, and cerebral edema

32
Q

What are the clinical manifestations of encephalitis?

A

-Fever
-Headache
-Nuchal rigidity
-Other neurological disturbances - lethargy, seizures, disorientation, delirium, etc

33
Q

What is Guillain-Barre Syndrome?

A

-An acute immune-mediated polyneuropathy (simultaneous malfunction of many peripheral nerves)
-Caused by the demyelination of spinal roots (usually motor, but may be sensory and
motor)
-Onset of symptoms may be rapid and severe or a slow insidious process
-There is no known cure, however, if symptoms are treated quickly and appropriately patients often recover completely within months

34
Q

What are the clinical manifestations of Guillain-Barre Syndrome?

A

-Progressive ascending muscle weakness of the limbs (legs to arms), producing a symmetric flaccid paralysis
-If respiratory muscles become affected, the patient may require a ventilator
-ANS involvement may cause: postural hypotension, arrhythmias, facial flushing,
abnormalities of sweating and urinary retention
-Pain, paresthesia and numbness
-Cranial nerve involvement may cause facial or oculomotor disruption

35
Q

What is a neoplasm (tumour)?

A

an abnormal mass of tissue that forms when cells grow and divide more than they should or do not die when they should

36
Q

What does benign mean?

A

Non-cancerous

37
Q

What does malignant mean?

A

Cancerous

38
Q

What are the clinical manifestations of a brain tumour?

A

-Vary depending on the area of brain tissue affected
-Blood vessel disruption
-Brain swelling/compression
-Edema
-Increased ICP

39
Q

What is a hemangioma?

A

-A hemangioma is a benign (non-cancerous) vascular tumour caused by an excessive growth of blood vessels
-In the brain, they typically develop in the cerebellum or spinal cord
-They do not spread and are not life threatening

40
Q

What are the clinical manifestations of a hemangioma?

A

(dependent on area of brain effected)
-Seizures
-Blurred vision
-Facial droop
-Unsteady gait
-Unilateral weakness
-Headaches
-Dizziness
-Tinnitus
-Impaired speech

41
Q

What is a seizure?

A

A seizure represents the abnormal behavior caused by an electrical discharge from neurons

42
Q

What is a generalized seizure?

A

-The most common type of seizure - classified when clinical signs, supporting symptoms
and EEG changes indicate involvement of both hemispheres
-Symptoms include unconsciousness and bilateral degrees of symmetric motor responses
-Two categories of generalized seizures include motor and non-motor

43
Q

What are tonic-clonic seizures (grand mal)?

A

-Tonic and clonic muscle contractions followed by a period of unconsciousness called the “post- ictal” period (seizure activity typically lasts 30-90 seconds)
-Urinary and/or fecal incontinence is common as is cyanosis due to respiratory muscle contraction
-Post-ictal Phase - time and presentation vary drastically from patient to patient (5-45
minutes). It is common for patients to be confused, amnesic and combative

44
Q

What is a tonic muscle contraction?

A

sustained contractions of muscle fibers

45
Q

What is a clonic muscle

A

alternating contraction and relaxation of a muscle

46
Q

What is a myoclonic seizure?

A

-Brief, involuntary muscle contractions
-Bilateral jerking of muscles, generalized or confined to the face, trunk or extremity

47
Q

What is a clonic seizure?

A

Initial unconsciousness and hypotonia followed by limb jerking that may or may not be symmetrical

48
Q

What is a tonic seizure?

A

A sudden onset of increased tone maintained in the extensor muscles

49
Q

What is an atonic seizure?

A

Sudden loss of muscle tone leading to a slackening of the jaw, drooping of the limbs and falling to the ground

50
Q

What is a non-motor seizure?

A

-generalized non- convulsive seizures
expressed mainly as disturbances in
consciousness
-aka absence seizures (petit mal seizures)
-often occur in children and cease in adulthood or progress to generalized motor seizures

51
Q

What are the clinical manifestations of a non-motor seizure?

A

-Blank stare
-Motionless
-Unresponsive
-Automatisms (lip smacking, mild clonic movements in the eyelids or hands)
-Usually only last a few seconds to a minute

52
Q

What is a focal seizure?

A

-Origin of a seizure in a specific focal area of one hemisphere
-Can be classified as with or without impairment of consciousness or awareness

53
Q

What are the clinical manifestations of a focal seizure without impairment?

A

-Symptoms depend on the focal area of the brain involved
-May include motor or sensory impairment/ hyperactivity on the contralateral side of
the body
-Patient remains conscious and aware throughout the seizure

54
Q

What are the clinical manifestations of a focal seizure with impairment?

A

-Symptoms depend on the focal area of the brain involved but may rapidly spread to both hemispheres
-May initially present with focal symptoms but progress to tonic-clonic activity
-Automatisms are also common
-Patient does not remain conscious and aware throughout the seizure

55
Q

What is a febrile seizure?

A

-A form of generalized motor seizure occurring mainly in young pediatric patients
-Can be due to a very high sustained fever (>39) but more commonly occurs when the fever spikes rapidly
-Febrile seizures are self limiting and typically do not cause harm to the patient
-Treatment should be directed at the underlying cause of the fever and reassuring the family

56
Q

What is status epilepticus?

A

A- seizure that does not stop spontaneously or reoccurs without recovery (minimal to no post-octal phase)
-A true emergency and may lead to respiratory failure and death
-Treatment includes: Management of life support (ventilators support), identification and treatment of the underlying cause, medications to stop the seizure (midazolam - ACPs)

57
Q

What is an upper motor neuron disorder?

A

-Involve neurons that are fully contained within the CNS
-This includes the motor neurons arising in motor areas of the cortex and their fibers as they project to the anterior horn of the spinal cord

58
Q

What is a lower motor neuron disorder?

A

Involve the nerve fibers travelling from the anterior horn of the spinal cord to the
associated effectors (muscles)

59
Q

What is Amyotrophic Lateral Sclerosis (ALS) aka Lou Gehrig disease?

A

-A neurological disorder that selectively affects motor function
-ALS is a mixed disorder of UMN and LMN that mainly affects males in their 50s
-Affects the LMNs of the spinal cord, motor nuclei of the brain stem and the UMNs of the cerebral cortex
-Disease process is more severe in the distal parts of the affected nerves than the proximal parts
-Sensory neurons, regulatory mechanisms that control coordination and intellect are not affected
-Death of LMNs leads to enervation, shrinkage of musculature and muscle fiber atrophy
(amyotrophy)

60
Q

What are the clinical manifestations of ALS?

A

-Weakness, spasticity or stiffness and impaired fine motor control
-Dysphagia, dysarthria, and dysphonia (hoarse voice)
-Fasciculations, weakness, muscle atrophy, hyporeflexia
-Muscle cramps in the distal legs is often an early warning sign
-Common clinical progression is a slow but progressive weakness and atrophy of the distal muscles of one upper extremity followed a regional spread of the illness
-Facial, neck and respiratory muscle involvement can make eating impossible and aspiration a common complication
-When the cranial nerves and respiratory muscles become severely involve, death usually occurs

61
Q

What is cerebral palsy (CP)?

A

-An abnormal development of the brain or damage to the developing brain that affects a
child’s ability to control his/or muscles (usually occurs during pregnancy but may also
develop during, or shortly after, delivery)
-A common cause is fetal hypoxia
-Symptoms are non-progressive and permanent

62
Q

What are the clinical manifestations of CP?

A

-Abnormal muscle tone, reflexes, motor development or coordination
-Problems with sensation, vision, hearing, and speaking
-Seizures and cognitive deficiencies
-Unequal growth between tendons and bones can lead to bone and joint deformities, often leads to significant alterations in gait

63
Q

What is multiple sclerosis (MS)?

A

-Inflammation and destruction of the myelin sheath in the CNS (brain, spinal cord and optic nerve) - PNS is unaffected
-Typical onset is 20-30yrs old and more common in females
-Likely an immune-mediated response occurring in genetically susceptible people
-MS lesions consist of demyelinated patches mostly in the white matter of the CNS and are distributed throughout the CNS

64
Q

What are the clinical manifestations of MS?

A

Common initial presentations include:
-Acute episodes of paresthesia
-Optic neuritis (pain with eye movement, vision loss)
-Diplopia (double vision)
-Gaze paralysis (difficulty tracking or looking a certain way)

Physical Symptoms:
-Paresthesia (numbness, tingling, burning, itching, pressure)
-Abnormal gait, bladder and sexual dysfunction
-Vertigo
-Nystagmus (“dancing eyes”)
-Speech disturbances

Psychological Symptoms:
-Depression
-Mood swings
-Euphoria
-Loss of memory
-Apathy
-Inattentiveness
-Fatigue

65
Q

What is the clinical course of MS?

A

-Can occur as periods of remission and relapsing with near stable recovery between episodes
-Can be a gradually worsening progression without periods of remission
-MS is incurable but the severity of the disease varies drastically, and the treatment is
directed at managing symptoms and delaying progression of the disease

66
Q

What is muscular dystrophy?

A

-A genetic disorder that produces progressive deterioration of muscles due to a mix of muscle cell hypertrophy, atrophy and necrosis
-This is a primary muscular system disease that likely doesn’t involve the nervous system, however, the most common form of the disease is a genetic deficiency

67
Q

What causes muscular dystrophy?

A

-The genetic disorder causes an abnormality in a plasma protein called dystrophin
-Dystrophin forms a link between the actin filaments and the extracellular connective tissue
-Dystrophin abnormalities can compromise the integrity of the plasma membrane of a muscle cell
-Increases muscle fiber fragility, can cause an excessive influx of Ca2+ ions and a release of muscle enzymes
-This process leads to necrosis of muscle fibres with subsequent repair and fibrosis of muscle tissue
-Eventually, the affected skeletal muscles become replaced with fibrous, fatty connective tissue

68
Q

What are the clinical manifestations of muscular dystrophy?

A

-Muscle weakness and frequent falls are typically noted by age 2 or 3
-Distal muscle function is often preserved enough for certain motor skills
-Respiratory muscles are affected: Weak cough, frequent RTIs, decreased respiratory reserve
-Cardiac muscles are affected: not always coinciding with the severity of skeletal muscle involvement

69
Q

What is Parkinson’s disease?

A

A degenerative disorder of the basal ganglia function that results in variable combinations of tremor, rigidity, akinesia/bradykinesia, and postural changes

70
Q

What is akinesa?

A

loss or impairment of voluntary movement

71
Q

What is bradykinesa?

A

slowness of movement and speed

72
Q

What is the basal ganglia?

A

a group of nerve cells responsible for: control of voluntary movements, eye movements, and coordination of automatic movements. They are also involved in cognitive and perceptual function

73
Q

What are the clinical manifestations of Parkinson’s?

A

-Tremors- rhythmic, alternating flexion and contraction movements
-Rigidity (resistance to flexion and extension)
-Akinesia/bradykinesia
-Facial and throat rigidity produce drooling and difficulty speaking
ANS involvement:
-Sweating
-Sebaceous gland hyperactivity
-Dysphagia
-Orthostatic hypotension
-Thermal regulation
-Constipation
-Impotence
-Urinary incontinence
-Cognitive dysfunction, such as dementia, is common late in the progression of the disease

74
Q

What is polio?

A

-A life-threatening disease caused by the polio virus that, in severe cases, can cause paralysis
-Can be a mild, asymptomatic cause or severe causing permanent paralysis or death
-Most cases result in basic flu-like symptoms as the virus replicated in the GI tract and lymphatic system
-If it spreads to the CNS it can either cause self-limiting inflammation to the meninges or
permanent destruction of nerve fibres

75
Q

What is a neurocognitive disorder?

A

A NCD is a term for a decline in mental function severe enough to interfere with a person’s ability to perform usual daily activities and is NOT a normal part of the aging process

76
Q

What are the clinical manifestations of Alzheimer’s disease?

A

Follows an insidious and progressive course lasting approximately 8-10 years, hallmark symptoms are:
-Loss of memory
-Difficulty with language,
-Changes in behavior
-Depression, agitation and sleep disorders

Patho (9 decks)

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