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pathophysiology > neurological diseases > Flashcards

neurological diseases Flashcards

1
Q

What does the somatic nervous system control?

A

skeletal muscle effectors

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2
Q

what does the autonomic nervous system control ?

A

smooth muscle, cardiac muscle, gland effectors (the sympathetic and parasympathetic nervous system)

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3
Q

What is the sympathetic nervous system?

A

fight or flight

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4
Q

what is the parasympathetic nervous system?

A

rest and digest

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5
Q

What is epilepsy?

A

a physiological disease, recurrent seizures.

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6
Q

What happens in normal brain activity?

A

Neuron fires (sodium potassium junction) -> so action potential
(the neuron’s fire in sequence and it is coordinated)

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7
Q

What happens during seizure brain activity?

A

the neurons fire randomly and not coordinated (this means it affects all primal functions including muscles and breathing)

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8
Q

What are the different types of seizures?

A

generalised (tonic-clonic/absense seizures) - affect entire body
localised (focal seizures)
- will partially affect/ only affect one part of body as they are in one place

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9
Q

Tonic-clonic seizures are a presentation of generalised epilepsy, what does each stage of the seizure present like?

A

can make the person cry out and fall to the ground, lose consciousness.
tonic phase - muscles will stiffen (might bite tongue (bleeding)
clonic phase - muscles will jerk rhythmically
following this is the Post-ictal phase

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10
Q

What is the post-ictal phase and what happens during it?

A

it is the period of rest that follows the convulsions/active part of seizure.
the pt can be asleep or demonstrating unusual behaviour :
- extreme fatigue
- confusion
- emotions
- combative behaviour
the first sense that returns is hearing so you must communicate with the pt letting them know they are okay

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11
Q

What are the risk factors for seizures?

A
  • age (children/ older adults, could happen at any age tho)
  • family history
  • head injuries
  • history of strokes
  • dementia
  • meningitis
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12
Q

There are other types of seizures called non-epileptic seizures (NES), what are these types?

A

divided into two types
- seizures that have a physiological cause \
- seizures that have a psychological cause

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13
Q

What are some things that cause NES, which have a physiological cause? and how are they treatable?

A
  • fainting (syncope)
  • hypoglycaemia (in diabetics)
    are usually relatively easy to treat as you treat the physical cause
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14
Q

What are somethings that cause NES that have a psychological cause? and how are they treatable?

A

they are attacks that resemble epileptic seizures but are due to underlying psychological distress rather than abnormal brain activity
- panic attacks
- anxiety
-depression
- emotional stress
- experienced a traumatic event
it is harder to determine the cause as they can happen straight after or years after an event,
they are treatable with psychotherapy

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15
Q

Facticious seizures are a type of PNS related to a psychological cause, when do they happen and what are they?

A

the person will have some level of conscious control over them, e.g. part of munchausens syndrome (a psychiatric condition where the person is driven by the need to have medical investigations and treatment)

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16
Q

What are risk factors for PNS?

A
  • more common in women
  • more likely in young adults
  • to people who have experienced, injury, severe trauma, stressful life events, severe emotional upset
  • more common in people with other mental health/psyhiatric disorders (depression, anxiety, personality disorders, or people who self harm)
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17
Q

What treatment will not work for PNS?

A

anti-seizure medications (ASM) as they are not epileptic
if they are caused by anxiety/depression they may potentially respond to antidepressants etc.

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18
Q

What drug taken can respond the same as a tonic-clonic seizure ? and how will your treatment need to change

A

cocaine - toxicity
will need to give narcan
be VERY careful getting history as giving epileptic drugs can cause further respiratory depression

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19
Q

Any condition change in the internal environment of the brain can cause a seizure, what are some examples?

A
  • hypoxia
  • raised ICP: head injury, stroke, meningitis (irregular RR, widened pulse pressure, bradycardia -cushing’s)
  • hypoglycaemia (must do BM) - diabetics
  • drug induced, ecstasy without sufficient rehydration can drain your CFS
  • alcohol dependancy/toxicity
  • PNES
  • febrile convulsions, new presentation in children
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20
Q

What is the management for chronic seizures that don’t break on their own accord?

A
  1. if they have their own midazolam (put on gums) under PGD (legally allowed if its their own prescription)
  2. or Diazepam (rectal or IV)
  3. any seizures lasting over 5min or 3x repeated within the hour must convey
  4. 4Hs + 4Ts treat underlying causes? (hypoxia? hypothermia? hypokalaemia (sodium potassium pump? diabetic?)
  5. prevent injury
  6. ensure pt is fully recovered post-ictal phase if considering non-conveyance
    allow rest.
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21
Q

What is meningitis ?

A

an infectious disease, inflammation of the meninges - the 3 layers known as meninges protect the brain and spinal cord.

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22
Q

What are the 3 layers, meninges, affected by meningitis?

A
  • inner layer (delicate) pia mater
  • middle layer(web-like cushions the brain) arachnoid
  • outer layer (tough) dura mater
23
Q

What are the two infection causes of meningitis?

A
  • viral meningitis
    is more common, rarely serious, is chronic onset and does not respond to antibiotics
  • bacterial meningitis
    less common, more serious
24
Q

What are the symptoms of meningitis?

A
  • generally ill
  • pyrexia
  • headache
  • cold hands and feet
  • GI upset - nausea and vomiting and diarrhoea
  • stomach/ muscle/ joint/ back pain
  • drowsiness or losing consciousness (not in all cases)
  • rash: red or brown ish pinprick spots that don’t blanch (petechiae)
25
Q

What are peterchiae?

A

when capillaries bleed, leaking blood into the skin
they are pin point, non-blanching
can be due to many reasons including less concerning
- sudden increase is pressure in blood vessels e.g. due to coughing or vomiting
- drop in platelets due to infection spreading

26
Q

What is the meningeal triad? (of symptoms)

A
  • neck stiffness (inability to place chin to chest)
  • photophobia
  • intense constant headache which is aggravated by movement
27
Q

What is Brudzinskis sign ?

A

often in children is a sign of meningitis
if you flex the pt head forward (one hand on head one on chest to keep chest down) this will cause the patients hips and knees to flex upwards in relation.

28
Q

What are the signs and symptoms of meningitis in under 3yo ?

A
  • drowsiness, display lack of eye contact
  • lethargy/ floppy
  • irritability - dislikes being handled
  • poor feeding
  • vomiting
  • unexplained pyrexia (cold extremities)
  • high pitched cry
    LATER SIGNS
  • wide spread rash, coma, bulging fontanelle (raised pressure in skull swelling the top of their head (brain is trying to escape), convulsions with or without fever
29
Q

Management and treatment for meningitis?

A
  • O2 (be mindful this is a drug)
  • fluid therapy
  • benzylpenicillin (ben-pen) gets rid of the infection which is the trigger (only for bacteria caused, not viral as is an antibiotic)
  • not long on scene
  • may require time critical transfer (bacterial meningitis is quick onset)
30
Q

What is a concussion/TBI?

A

concussions can be called mild TBI (traumatic brain injury)
are both when a person experiences a change in normal brain function for no-longer than a minute following a trauma. concussions are not usually life-threatening but the effects can be serious

31
Q

What are the types of movement that TBI can occur from ? (how your brain moves in your head)

A
  • linear/translational movement
    (front <-> back) forwards and backwards
    ACCELERATION INJURY
    DECELERATION INJURY
    COMBINES ACCELERATION + DECELRATION (whiplash)
  • rotational movement
    (left <-> right) a twist
    ROATATIONAL INJURY
  • angular movement
    (a tilt head backwards or like chin to chest forwards)
    COMPRESSION INJURY
32
Q

Where do the forces applied in angular or rotational movement put stress on?

A

the brainstem (that controls primary function including consciousness)
they will usually result in LOC are usually more serious than translational

33
Q

Where does the impact force cause damage?

A

not only at the area the source of impact is from but also the associated shock waves travel through the brain resulting in damage to the neurons
this can stretch and potentially tear the axions
= an axon shear injury

34
Q

What happens due to axon shear injuries?

A

the damaged neurons can’t regualte their ions
(sodium/potassium pump issues)

35
Q

What further damage can be caused due to the forces from concussion/ TBI?

A

The forces from these events can lead to microvascular damage or rupture of major vessels due to the sheering forces these structures experience and can lead to subsequent development of the intracerebral or subarachnoid haemorrhage.

36
Q

Symptoms of concussion TBI?

A

LOC, headache, dizziness, nausea, vomiting
(can have delayed onset, history of event in necessary to identify TBI of severity and be mindful that some symptoms may take time to show due to the damage of the cells and associated tissue)

37
Q

What are some more progressive or severe TBI symptoms include?

A
  • change in consciousness - out - back - out
  • focal neuralgia changes (isolated areas of the brain) - new nerve damage to specific areas
    speech, moving cognition etc.
  • ipsilateral pupil dilation (new presentation)
  • seizures
  • abnormal posturing
38
Q

What is a stroke?

A

When something blocks blood supply to part of the brain (about 85% blockage) or when a blood vessel ruptures. this leads to ischema and potentially necrosis

39
Q

What are the 3 types of stroke?

A
  • ischemic (blockage)
  • hemorrhagic (bleed)
  • transient ischemic attack (TIAs) can also be called a mini stroke
40
Q

What are the modifiable stroke risk factors?

A
  • smoking
  • high cholesterol
  • unhealthy diet
  • alcohol
  • stress, anxiety, depression
  • blood thinners
  • obesity
41
Q

What are the non-modifiable risk factors for a stroke?

A
  • diabetes
  • atrial fibrillation
  • high BP
  • higher chance under 1yo and increases with age
  • aneurisms
  • ischemic heart disease
  • fam history
  • ethnicity (more common African)
  • sex (men>women)
    people with other medical conditions that are at higher risk include migraines, sleeping disorders, bleeding disorders
42
Q

What is an ischemic stroke?

A

they are caused by a blockage cutting off blood supply to the brain
most common type
they’re mostly due to modifiable factors
85%- of strokes

43
Q

What is a hemorrhagic stroke ?

A

due to bleeding around the brain, blood supply is cut off due to the bleeding, killing the braincells. this damage can affect how the body works - change how you think and feel
15%- of strokes

44
Q

What is a TIA?

A

a transient (means comes and goes - hasn’t caused a full occlusion) ischemic (stops blood flow) attack
TIA is the same as a stroke but with shorter lasting symptoms.
are a sign to worsening condition
the risk is greatest in the days/weeks following a TIA

45
Q

The most common strokes affect the cerebrum split in 2 halves, what are the left brain functions?

A
  • movement and sensation of right side of the body
  • understanding and expressing language
  • reading and writing
  • vision on the right side
46
Q

The cerebrum is split into two halves, what are the right brain functions?

A
  • movement and sensation on left side of body
  • facial and object recognition
  • body awareness
  • vision on the left side
47
Q

The stroke symptoms are dependant on which part of the brain is affected, they will usually be sudden onset. what are some general common symptoms?

A
  • loss of movement or sensation in an arm or leg
  • problems speaking
  • drooping on one side of the face
  • problems with vision
48
Q

What symptoms occur if the right hemisphere of the brain is affected?

A

-L sided weakness, paralysis or sensory impairment
- ‘left neglect’ denial of paralysis or impairment and reduced insight into the problems created by the stroke
- vision problems, inability to see the left visual field of each eye
- spatial problems, depth perception or directions
- inability to localise or identify body parts
- memory problems
- behavioural changes, lack of concern about situations, impulsivity, innapropriateness and depression

49
Q

What symptoms occur if the left hemisphere of the brain is affected?

A
  • R side weakness, paralysis, sensory impairment
  • aphasia (problems with speech and understanding language)
  • visual problems, inability to see the right visual field of each eye
  • impaired ability to do maths or organise, reason and analyse items
  • behavioural changes, depression, cautiousness, hesitancy
  • impaired ability to read, write and learn new info
  • memory problems
50
Q

What happens for you to have a secondary stroke?

A

you can have a ischemic stroke and then a hemorrhagic following due to the pressure build-up and a combination of weaker vessels

51
Q

What is the BEFAST test? and which strokes are more difficult to identify using this due to different symptoms?

A

Balance
Eyes
Face
Arms
Speech
Time (critical) pre-alert is essential and where they are taken too
- posterior strokes in the cerebellum or brain stem may have different symptoms or develop without presentation

52
Q

treatment within hospital for haemorrhagic strokes ?

A
  • reduce BP
  • reverse blood thinning medication that pt may be on
  • surgery may be required to reduce pressure on the brain
  • use drugs to help break down any resultant blood clots
53
Q

treatment in hospital for ischemic strokes?

A
  • remove the clot thrombolytic drugs such as anistreplase or tenecteplase
  • thrombectormy in IR
54
Q

What is the other more in-depth test for strokes?

A

pathophysiology (8 decks)

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