Neurological System Disorders Flashcards
Pressure required to get oxygen into brain to perfuse cells of brain
Cerebral Perfusion Pressure (CPP)
Decreased CPP are caused by?
- Hypovolemia
- Hypotension
- Hypertension
- Blockage of arterial flow into brain
Increased ICP is caused by?
- Head injury
- Brain tumor
- Brain Attack (Stroke)
Abnormal CPP resulting in IICP
Hypotension, Hypovolemia, atherosclerosis of carotid arteries -> Ischemia & hypoxia of brain -> Cerebral edema => increased ICP
Caused of Increased ICP
Hemorrhage, infection, acidosis -> Cerebral edema -> Increased ICP => Decreased oxygenated blood going into brain arteries (CPP decreases)
General sequela (S/s of IICP)
- Change of LOC
- Pressure on respiratory centers (Cheyne stokes) -> Pressures other parts of brain stem -> Decerebrate & Decorticate posturing (Only Comatose pt’s)
- Affected reflexes (Babinski - plantar reflex)
Autonomic, LOC, Mental status manifestation as a result of brain/brain stem stroke
- Diminished LOC
- HR & BP changes due to (pressure on medulla)
- Breathing changes (Apnea or Cheyne-stroke)
Sensorimotor Manifestations seen as a result of brain/brain stem abnormalities
- Sensations, muscle tones, movement & strength weakness
- Pt’s are often comatose (Abnormal motor responses to stimuli) (Decerebrate & Decorticate posturing)
- Mixed degree of CN abnormalities (Both pupils either fixed or dilated, fixed, or pinpoint)
Reflex Manifestations seen as a result of Brain/Brain Stem Abnormalities
- Protective reflexes (Sneezing, coughing, gagging, & Swallowing) diminished or lost
- Reflexes weaker (Symmetrically)
- Bilateral (Postive Babinski)
Left hemispheric CVA (S/s)
- Dysphasia or aphasia (Speech)
- Inability to comprehend, integrate, & express language
Right hemispheric CVA (S/s)
- Left-sided neglect (Completely ignores the environment on left side)
- Seat of insight (Creativity, face recognition, muscle ability, etc)
Expected Level of Consciousness (LOC)
- Being alert or arousable to alertness if asleep
- Being oriented x4 (self, time, place, events)
- Following command
- Normal speech
- Conversing appropriately
Focal cerebral edema around right CN 7 that innervates a smile
- What would you expect to see?
Facial drooping on left side of mouth
Focal cerebral edema around right CN 2 that transmits visual image to brain
- What would you expect to see?
Visual defects in two left halves of both eyes (Homonymous hemianopia)
When assessing pupillary response (CN 2 & CN 3) what would you expect to see?
- Both pupils should equally respond to light
- Both pupils should constrict to the same size
Pyramidal tracts carrying impulses that produces voluntary movements of purpose & skill from brain (via: Spinal cord)
- (Descending Tract)
Corticospinal tracts
Carries sensation of pain, temperature, crude & light touch from body to brain (thalamus) for processing
- (Ascending tract)
Spinothalamic tracts
If there is a focal/lesion related to corticospinal or spinothalamic tract in the brain
- What would you expect to see?
- Asymmetric sensorimotor changes
- Unilateral on (Contralateral side) due to decussation
Stroking plantar surface of foot makes the big toe flex (“Upgoing toe”)
Postive Babinski
If there is focal pressure (Lesion, edema, etc) on motor tracts, what would likely occur?
- Paresis (Reflex changes) on contralateral side of body below the neck (Opposite of where the brain lesion is
If there is focal pressure on cranial nerves, what would likely occur?
- Abnormalities in facial movement, visual disturbance and pupillary response to light
Treatments for Brain disorders
- Keep head of bed up @ (30 degrees)
- Keeping BP not too high or too low
- Giving diuretics (to decrease cerebral edema)
Hemorrhagic brain attack (S/s)
- Intense headache
- Neck pain
- Light intolerance
- Nausea & Vomiting
- High mortality rate
Dx & Tx for Brain attack (Stroke) BA
BEFAST
B- Balance (sudden loss of balance
E- Eyes (Vision loss)
F- Face (uneven smile)
A- Arms (one arm weaker)
S- Speech (Slurred speech)
T- Time (Call 911 ASAP)
Pupil Dilation
- Sympathetic response occurs upon exposure to darkness
Mydriasis
Pupil Constriction
- Parasympathetic response occurs upon exposure to light
Miosis
Abnormal finding of pupillary assessment, such as a lack of constriction to light, would be what finding?
Ipsilateral finding (Increased ICP causing ipsilateral cranial nerve to behave abnormally
Thrombus forms in arteries going to brain or within brain itself & causes ischemia to distal tissues
Thrombotic
Clot breaks off from a thrombus & lodges somewhere else in cerebral artery & causing ischemia
Embolic
Not a true stroke
- last 10 mins to <24 hours
Transient ischemic attack (TIA)
Intracranial bleeding from head injury, burst aneurysm, HTN, coagulation disorders, etc
Hemorrhagic
- Paresis on Contralateral side below neck & shoulders (Due to decussation of corticospinal tract)
- Facial drooping & visual defects contralateral to the lesion
- Hemispheric-specific problem
What kind of stoke is this?
Hemispheric stroke
Vertigo, nystagmus, loss of balance
What kind of stroke is this?
Cerebellar stroke
Tx for Ischemic stroke
- Clot-busting drugs
- Anti-coagulants (Heparin)
Tx for Hemorrhagic stroke
- Surgery to fix aneurysm
Tx for any kind of stroke
- Any intervention to decrease hypoxia & IICP
- HOB up (30 degrees)
- give O2
- BP management
(S/s): Severe memory, behavioral, & motor changes
- abnormal accumulation of amyloid in brain tissue & neurofibrillary tangles inside cell bodies of neurons of brain
What is this degenerative brain disease?
Alzheimer’s
(S/s): (Cog-wheel rigidity), Slow movement (hypokinesia), pill-rolling tremors (dyskinesia), shuffling gait (Parkinsonian gait, basal ganglion gait)
- Decrease in dopamine, acetylcholine bombards receptors cells with excitatory impulses
Parkinsons
Tx for Parkinson’s Disease
- Give dopamine (L-lopa)
-Give Anticholinergic meds (Benadryl)
- Overall rigidity (Mask-like face)
- “Cog-wheel rigidity” of forearm
- Dysarthria (Diff. forming words)
- Dysphagia (Diff. Swallowing)
What is the manifestation?
Hypertonia
- Involuntary facial & trunk movement
- Inability to make appropriate posture adjustment (tipping & falling)
- Stopped, shuffling posture, decrease arm swing
What is the manifestation?
Dyskinesia
Autoimmune disorder our own T-cells attack myelin sheaths of random axons in brain (Deterioration of axons)
- Causes demyelination (Scarring & Sclerosing of myelin sheath cells)
- Transmits nerve impulses 10x slower
What is this disease?
Multiple Sclerosis
(S/s): Asymmetric, weakness of an extremity, bladder problem, ataxia, vision problems (Double vision)
- Cerebellum affected (Vertigo, incoordination)
What is this disease?
Multiple Sclerosis
Headache syndrome thought to be a disorder of blood flow to brain + hyperactivity of certain neural pain-information tracts (Red wine, chocolate, certain cheese)
- Vasodilation, increased capillary permeability, pulsating one-sided throbbing headache
- (Prodrome) : Visual or sound aura
- (Headache): Photo/phono phobia
- (Postdrome): Tired & weak
Migrane
Tx for Migrane
- Trigger avoidance (NSAIDS)
- Abortive drugs (Immitrex) @ first sign of headache (Prodrome)
Sudden, Chaotic discharge of neurons in brain
Seizures
Continued unbated seizures
Epilepticus
Patient is always unconscious, tonic-clonic movement
General Seizures
Varied degree of consciousness & motor involvement; local)
Partial Seizures
Post-seizures state of re-organization of brain signals
- Pt is groggy & confused
Post-ictal
Inflammation causes increased permeability of meningeal structure -> edema -> nerve endings pf spinal meninges irritated => Cerebral edema
Meningitis
(S/s):
- Photophobia, headache, irritability, restlessness, confusion
- Neck stiffness, Positive Brudzinski’s & Kernig’s signs
- CSF - High protein, High WBC, & low glucose
Meningitis
Virulent endotoxin that cause petechiae & purpura
Meningococcal
Dx for Bacterial Meningits
- Lumbar puncture
- CSF lab report (High WBC & Protein count) & Low glucose levels
PNS disorder (Neuromuscular junction disorder)
- Caused by autoantibodies that destroy acetylcholine receptors at the distal end of neuromuscular junction
Myasthenia Gravis
(S/s): Weakness of muscle (Control eye & eyelid movement), facial expressions, chewing, talking, swallowing, & neck & limb movement
Myasthenia Gravis
(S/s): Muscle weakness + breathing is affected
Myasthenia Crisis
