Neurological system Flashcards
describe normal cerebral activity
neurones transmit information through chemical and electrical signals
interneurons are inhibitory cells which regulate activity
what happens to cerebral activity causing seizures?
hypersynchronisation of neurones due to imbalance of inhibitory and excitatory input
define seizure
abnormal, uncontrollable, hypersynchronous electrical activation of large groups of neurones
list the types of seizures
isolated cluster status epilepticus partial/focal generalised tonic clonic
what is an isolated seizure?
one seizure lasting less than 5 minutes
what is a cluster siezure?
2 or more seizures within 24 hours with complete recovery between
what is status epilepticus?
seizure lasting more than 5 minutes or 2 seizures without full recovery between
what are partial/focal seizures?
asymmetric seizures where one part of the brain affected
simple or complex
what is a simple seizure?
no change in mentation
what is a complex seizure?
changed mentation
list signs of partial/focal seizure
facial twitching
hypersalivation
changes in behaviour
maintained consciousness
what are generalised tonic clonic seizures?
bilateral cerebral hemisphere involvement
pre and post ictal phases
list signs of generalised tonic clonic seizures
autonomic signs
excreting
loss of consciousness
what is pre-ictal phase of seizures and what can be seen?
before seizure
behavioural changes, altered mentation, attention seeking
what is ictal phase of seizures and what can be seen?
seizure phase
unconsciousness
muscle contraction
excretion
what is post-ictal phase of seizures and what can be seen?
after seizure
abnormal neurological signs for minutes to days
list extracranial causes of seizures
toxins
portosystemic shunt causing toxin build up
hypoglycaemia
hypocalcaemia
list intracranial causes of seizures
tumour
inflammation
hydrocephalus
idiopathic epilepsy
what is seen with idiopathic epilepsy?
recurrent but not cluster seizures
normal inter-icteral neuro exams, metabolic investigations, MRI and CSF
how are seizures diagnosed?
history blood tests MRI CSF analysis videos monitoring retinal exam and BP to rule out other causes
what is meant by seizure mimics?
disorders that look like seizures but aren’t
list seizure mimics
narcolepsy fly catching movement disorder syncope 3rd degree AV block canine epileptoid cramping syndrome
what is narcolepsy?
inherited sleep wake disorder
what is seen in narcolepsy?
loss of muscle tone during episode
no autonomic signs
what are signs of fly catching?
fly catching behaviour with normal mentation and no autonomic signs
what happens in movement disorders?
episodes of involuntary, spontaneous movement
patient stays conscious
normal between episodes
what causes syncope?
reduced oxygenation to the brain cardiac issues neurological issues hypoglycaemia hypocalcaemia
what causes seizure like activity from 3rd degree block?
prolonged hypoxic event
what is canine epileptoid cramping syndrome?
movement disorder
with normal consciousness, mentation
what is emergency management for seizures?
oxygen IV placed if possible diazepam assess circulation and temperature intubate as needed cool if hyperthermic mannitol if seizure over 15 minutes or cerebral oedema full blood tests
what is phone triage for seizure patients?
keep owner calm history of seizures toxin exposure head trauma length of seizure consciousness excretions travel when no longer seizing get contact number
what are considerations for seizure patients on ward?
quiet area dim lights as can be sensitive bottom kennel for access seizure plan on kennel with meds available limited traffic
how do you respond if patient seizes?
note time call clinician for help remove dangers dim lights reduce noise observe and monitor follow seizure plane
what do you do initially when owner brings in seizure patient?
reassure triage ABCs oxygen anticonvulsants if needed check temperature CRI and intubation as needed
what is the main aim when patient presents with seizure in an emergency?
stop the patient seizing
what are the aims or managing patients with recurrent seizures?
improve quality of life
reduce frequency and severity
manage side effects and cost
educate owner
how can phenobarbital help manage seizures?
increases frequency of synaptic inhibition
reduces neuronal excitability
what are potential side effects of phenobarbital?
hepatotoxicity sedation PUPD polyphagia ataxia
how does potassium bromide help control seizures?
reduces neuronal excitability alongside other drugs or alone
list possible side effects for use of potassium bromide
gastric irritation nausea PUPD sedation pancreatitis
how does imepitoin help manage idiopathic epilepsy?
reduces electrical activity
what are potential side effects of imepitoin?
ataxia
vomiting
polyphagia
what are considerations for owners with pets who have seizures?
managed expectations
situation and ability to care for pet
finances as life time treatment needed
home environment
how can nurses provide long term support to owners with pets with seizures?
consistency in who they see in follow ups
follow up calls
written communication
support groups
what part of the body does NMD affect?
peripheral nervous system particularly motor neurones innervating skeletal muscle
what is polyradiculoneuritis?
immune mediated disease affecting myelin and axons causing axonopathy
how does polyradiculoneuritis present?
short strides progressing to tetraparesis
dysphonia
normal autononic functions such as eating and toileting
varys between patients
how is polyradiculoneuritis diagnosed?
history physical exam neuro exam EMG nerve and muscle biopsy
how is polyradiculoneuritis treated?
recumbency care
keep muscles moving to prevent contracture
physio
define myasthenia gravis
disease of neuromuscular transmission affecting NMJ
juncionopathy
what causes myasthenia gravis?
congenital or immune mediated reduction in NMJ receptors
less functional receptors so muscles cant contract normally
describe presentation of myasthenia gravis
muscle weakness and fatigue, focal or generalised
regurgitation due to oesophageal weakness
how is myasthenia gravis diagnosed?
history
presentation
megaoesophagus
edrophonium/tensilon test showing normal walking after medication
how is myasthenia gravis treated?
anticholinesterase therapy
immunosuppressive corticosteroids
intensive nursing
manage aspiration pneumonia risk
define polymyositis
immune mediated inflammatory myopathy
what causes polymyositis?
idiopathy
clinical diseases
what are the two types of polymyositis?
focal affecting muscles of mastication
diffuse affecting multiple groups over the body across the body
describe presentation of polymyositis
exercise intolerance stiffened gait muscle weakness and atrophy dysphonia regurgitation
how is polymyositis diagnosed?
rule out other causes clinical history increased creatinine kinase electrodiagnostic testing muscle biopsy megaoesophagus
how is polymyositis treated?
immunosuppressive corticosteroids
manage aspiration pneumonia risk
prevent pressure sores from low muscle coverage
what is the effect of aspiration pneumonia?
pulmonary damage
inflammatory response
list signs of aspiration pneumonia
coughing
tachypnoea
crackles on auscultation
how is aspiration pneumonia managed?
prevention intense monitoring to catch early signs antibiotics IVFT oxygen respiratory physio turning patients to prevent fluid accumulation food balls from height to prevent inhaling ventilation in severe cases
how do pressure sores form?
increased pressure on bony prominences in recumbent patients
what is seen in type 1 pressure sore?
light pigmentation
what is seen in type 2 pressure sore?
broken skin
what is seen in type 3 pressure sore?
wound deep to fat
what is seen in type 4 pressure sore?
wound deep to muscle or bone
necrotic or infected
how can pressure sores be prevented?
thick bedding turning every 2-4 hours donut bandages vet bed physio close monitoring boots if cant lift feet
how are pressure sores treated?
debridement
antibiotics
prevention better
how does muscle contracture happen?
recumbency and immobilisation causes adaptive shortening of muscle and soft tissue
how is muscle contracture treated?
intensive physiotherapy
what are considerations when treating muscle contracture patients?
temperament client expectations disease process previous injuries other conditions
why is it important for nurses to understand spinal cord injury?
provide best care
identify progression of disease
correct monitoring
support owners
describe the anatomy of spinal cord
extracranial part of CNS encased in spinal column
how are SCD patients assessed?
history physical exam neurological exam potential diagnosis diagnostic tests diagnosis prognosis treatment
when are neurological exams indicated in SCD patients?
seizures
altered behaviour
gait abnormality
why are neuro exams done in SCD patients?
identify if NS involved
identify location of disease
aid diagnosis and prognosis
assess condition continually
what is assessed in neuro exams for SCD patients?
mentation gait posture cranial nerves proprioception spinal reflexes of limbs sensory evaluation of panniculus and deep pain palpation of head, spine and limbs
what are the tests for cranial nerves?
menace PLR gag palpebral vestibulocular reflexes
define panniculus
dense fatty tissue layer consisting of excess SC fat around lower abdomen
define neurolocalisation
determine part of spinal cord effected
where are upper motor neurones located?
between cerebral cortex and spinal cord
what is the role of upper motor neurones?
send signals to lower motor neurones
what are signs of upper motor neurone disease?
loss of motor function paresis normal to high reflex high muscle tone muscle atrophy
what is the role of lower motor neurones?
connect CNS to effector causing contraction
what are signs of lower motor neurone disease?
paresis
low reflexes
low muscle tone
muscle atrophy
define ataxia
uncoordinated gait
define paresis/paretic
weakness, decreased voluntary movement
define paralysis/plegic
no voluntary movement
define mono-
one limb affected
define hemi-
both limbs on one side effected
define quadra/tetra-
all 4 limbs affected
what is one of the most common presentation for SCD?
gait abnormalities
how is gait assessed in SCD?
can they generate and make coordinated movement
walked up and down with or without support
what are examples of abnormal postures caused by SCD?
head tilt head turn neck ventroflexion curving of spine decerebrate rigidiy decerebellate rigidity wide stance
define scoliosis
sideways curve of spine
define lordosis
ventral deviation
define kyphosis
arched dorsally
what is decerebrate rigidity?
extension of all limbs, head, neck
what is decerebellate rigidity?
extension of thoracic limbs, head and neck
how are postural reactions tested?
proprioceptive repositioning
visual placing- should reach out to table
tactile placing- place paw on table with eyes covered
hopping
hemi walking
wheelbarrowing
how are spinal reflexes tested in thoracic limbs?
withdrawal reflex of toes
tapping extensor carpi radialis and biceps brachii
how are spinal reflexes tested in pelvic limbs?
patella reflex
cranial tibial and gastrocnemius reflex
perineal reflex
panniculus reflex to locate injury along cord
why is pain evaluation usually done last in SCD patients?
allows other tests to be done
what is the purpose of pain evaluation in SCD pateints?
test deep pain sensation
how are pain evaluations carried out in SCD patients?
pinching or pressure on digits of each limb and looking for reaction
list acute causes of spinal cord injury
IVDD
trauma
fracture
lesion
list chronic causes of spinal cord injury
DDD
degenerative myelopathy
cervical stenotic myelopathy
what are other causes of spinal cord injury?
alanto-axial subluxation
vertebral abnormalities
neoplasia
inflammatory disease
how is SCD diagnosed?
radiography
MRI is gold standard
cisternal or lumbar CSF tap
what is conservative treatment for SCD?
6 weeks cage rest physio anti-inflammatories analgesia steroids
what are examples of surgical treatment of SCD?
hemilaminectomy
ventral slot
dorsal laminectomy
spinal fixation
what is the likely bladder status of SCD patients?
incontinent
what are signs of UMN bladder?
hard to manually express so need catheter
intermittent squirting of urine
describe UMN bladder
increased urethral resistance
detrusor and urethral sphincter can contract simultaneously
uncontrollable bladder function
urinary retention
describe LMN bladder
flaccid bladder causing continual filling without expression
what are signs of LMN bladder?
overflow incontinence
easy to manually express
state nursing considerations for SCD patients
long term care enrichment nutrition recumbency care physio excretion management hygiene
what is intercranial disease?
disease affecting the brain
what is contained in the skull?
80% brain
10% blood
10% CSF
why does the brain need constant supply of oxygen
high demand of oxygen and nutrients with little storage
what is normal ICP?
5-10mmHg
define ICP
pressure between skull and IC tissue
what is the effect of IC hypertension?
reduced CPP
reduced blood flow
how does ICP increase?
increase in IC volume without compensatory decrease
what is the effect of ICP increase without compensation?
MAP decreases and ICP increases so CPP decreases
CBF decreases
what is the cushings reflex?
rise in MAP and reflex bradycardia triggered by severe acute increase in ICP
list causes of ICD
trauma meningoencephalitis of unknown origin infection neoplasia toxins seizures hydrocephalus
what is alert mentation?
normal responses to surrounding
what is obtunded mentation?
less responsive but awake
what is stuporous mentation?
only responsive to noxious stimuli
define coma
unresponsive to all stimuli
what does pupil size indicate about neurological status?
poor prognosis if mid sized fixed pupils unresponsive to light or if goes from miotic to mydriatric
define miosis/miotic
constricted pupils
define mydriasis/mydriatic
dilated pupils
define anisocoria
asymmetrical pupils
list some clinical signs of ICD
ataxia blindness altered mentation seizures abnormal posturing non-responsive pupils coma nystagmus
how is GCS used not monitor neuro patients?
assessment of motor activity, brainstem reflex and consciousness scored 1-6 so total 3-18 with lower the score the worse prognosis
how is high ICP treated?
mannitol infusion hypertonic saline sedatives analgesia ventilation intensive nursing
how does mannitol infusion help treat increased ICP?
hyperosmolar so reduces cerebral oedema and increases CPP and CBF with rapid onset of effect
describe nursing management for ICD patients
recumbency care elevation of cranial body no jugular samples eye lube clean excretions from mouth monitor and reduce coughing nutrition anaesthetic monitoring
define hydrocephalus
excess accumulation of CSF in ventricular system
what causes hydrocephalus?
obstruction of CSF outflow
decreased absorption of CSF
increased production of CSF
congenital tumour inflammation haemorrhage infection
list clinical signs of hydrocephalus
behavioural changes loss of coordination visual deficits seizures depression enlarged dome shaped skull
how is hydrocephalus managed?
prednisolone, omeprazole to reduce CSF production
ventriculoperitoneal shunt to divert CSF
what is prognosis for hydrocephalus?
depends on cause and severity
good if infectious cause treated
guarded if tumour obstruction
good with VP shunt
what is MUO?
meningoencephalitis of unknown origin
non-infectious inflammatory disorder of CNS
list the types of MUO
granulomatous
necrotising
necrotising leukoencephalitis
what are signalment of MUO?
small dogs
females
over 6 months
list signs of MUO
seizures muscle tremors blindness head tilt altered posture circling
how is MUO managed?
immunosuppressive drugs
antiepileptics
nursing
how is MUO diagnosed?
clinical exam
bloods
MRI of brain
CSF analysis to see inflammation
what is the prognosis for MUO?
poor if seizures
better if focal rather than multifocal lesions
can relapse
what needs considering for neurology patients?
ambulation ability surgical or non-surgical continence temperament recumbency normal routine
describe how kennels are set up for neuro patients
thick bedding as bottom layer
layered inco pads so dont need to change whole bed every time
vet bed as top layer to wick urine
pad sides for comfort and prevent injury
how is urination managed in neuro patients?
manual expression
catheterisation
prevent urine scalding
check for UTI
how does urine scalding happen?
when left on skin causes soreness, erythema, scalding and skin breaking
how often do you express bladders?
6-8 hours minimum
how often should you empty bladder with intermittent catheter?
2x daily as risks trauma
how often are indwelling catheters emptied?
3-4x daily
how do you care for patients with faecal incontinence?
keep clean and remove quickly
monitor for sores
define decubital ulcer
open skin wound caused by continued pressure of skin on firm surface
why is it important to provide neuro patients with exercise?
aids mental wellbeing
allows to exhibit normal behaviour
mobilise joints and muscles
how do you aid paretic/plegic patients with exercise?
sling or harness
cover hind paws
keep back neutral
how do you aid tetraparetic/plegic patients with exercise?
chest harness and sling
may need multiple people
cover all paws
what are considerations for patients wounds following neuro surgery?
ventral slot needs care when walking hemilaminectomy has risk of seroma as more movement cold therapy analgesia anti inflammatories primapore for 72 hours prevent interference use harness
how can self mutilation occur in neuro patients?
paraesthesia when deep pain negative
boredom
stress
define paraesthesia
feeling of something wrong in limb
what is the purpose of physiotherapy?
keep joints and muscles mobile
retrain correct movement in limbs
promote recovery
prevent complications
when can nurses do physio?
following plan and under guidance of physiotherapist
what conditions benefit from physiotherapy?
NM conditions
SCD
degenerative myelopathy
list benefits of pysio
pain management improved ROM reduce muscle contracture stimulate NS improve blood perfusion encourage relearning motor skills weight management
what is the role of nurses in physio?
carry out plans
monitor and record chnages
what are safety considerations for physiotherapy?
need to be clinically stable
nursing care plan in place for potential problems, interventions and evaluations
how should you handle neuro patients?
encourage natural movement
keep spine in line
TLC
positive reinforcement
list types of physio
massage coupage passive ROM assisted exercise proprioceptive exercise NM electrical stimulation hydrotherapy laser therapy
what is the purpose of massage?
relax and aid circulation
describe how massages are performed?
effleurage- stroking towards heart
petrissage- rolling, compressing of skin and muscles
percussion- gentle tapping
vibration- gently shaking limbs
what is coupage and when is it used?
respiratory therapy
recumbent or patients with pulmonary disease
what is the benefit of coupage?
loosen secretion and assist airway clearance
what is the purpose of passive ROM?
help joint mobilisation and stretching in normal ROM in flexion and extension
list examples of assisted exercises
standing walking sit to stand 3 legged standing weight shifting
list examples of proprioceptive exercises
standing
wobble board
uneven surfaces
over poles weaving
list reasons for active exercises in physio
improve strength
promote independence
what is the process of active exercises?
actively carry out movement
repetition
list examples of active exercises
lead exercise figure 8s sitting and standing pole walking weight shifting hydrotherapy
how is hydrotherapy done?
underwater treadmill gradually reducing water height to increase strength used
pool swimming
what is meant by e-stim?
NM electrical nerve stimulation to skeletal muscle percutaneously
electrical muscle stimulation by needle electrodes
list benefits of e-stim
increase muscle strength and tone increase ROM pain control oedema reduction improve perfusion slow muscle atrophy
how are effective muscle contractions generated in e-stim?
clip hair
clean and place conducting gel
1 electrode on motor point of muscle and other on belly
check for contraction then do contraction cycles
10-20 minutes daily
