Neurology Flashcards
acute confusional state
sudden cerebral dysfunction, causes confusion, agitation, memory impairments, distractibility, compulsive behavior & obsession
very sudden onset
Hyperactive delirium
- overstimulation of autonomic nervous system
- overactivity of middle temporal gyrus or L temporal-occipital junction disruption
- increased levels of dopamine and norepinephrine and glutamate, decreased levels of acetylcholine and melatonin
Excited Delirium Syndrome AKA agitated delirium
hyperkinetic delirium which can cause sudden death
- individuals are combative, aggressive, are able to tolerate pain, breathe rapidly, sweat, have fever, are agitated and have superhuman strength
- hypoglycemia, thyroid storm, seizures, cocaine, meth use, and catecholamine induced arrhythmias are associated with syndrome
Hypoactive Delirium
Right sided frontal-basal ganglion disruption
- seen in persons who have fevers, with metabolic disorders like renal or liver disease, taking CNS depressants, recovering from surgery
- symptoms: decreased mental function, decreased LOC, decreased attention span, inaccurate perception and interpretation of the environment, forgetful, confused, apathetic
Delirium causes
usually from an underlying, correctable condition
- ETOH withdrawal, drug intoxications, electrolyte imbalances (Na & Ca), hypoglycemia, seziure activity, hypoxia, hypercapnia, infections, head injury or cerebral lesions, medications (freq. cause for elderly)
- most common in critical care units, post op and in the elderly
Dementia
loss of cognitive function (memory, orientation, language), that occurs over time, is chronic and usually irreversible.
- ex: Alzheimer’s disease
- older people may get confused when pulled out of normal routine- could be dementia emerging and not delirium
Meningitis (bacterial)
infection of the meninges, specifically the pia mater
- most common bacterial causes are meningococcus or pneumococcus
- meningococcus: communicable, tends to occur in close living conditions, severe form and is deadly; can be passed on without getting sick
- meningococcal is transmitted via air and individuals must be on isolation for 24 hours after abx therapy is started
- contacts should be given prophylactic meds
Aseptic Meningitis
no causative organism can be found or has a viral etiology
classic meningitis symptoms
photophobia, kernig’s sign, brudzinski’s sign, nuchal rigidity, focal neuro deficits, seizures
newborn meningitis
most common causes of bacterial meningitis in newborns are group B strep (from mother’s birth canal), E. Coli, and listeria
infant & children bacterial meningitis causes
most common bacterial causes are Strep Pneumoniae, Neisseria Meningitidis, and Haemophilus
Alzheimer’s disease (symptoms & risk factors)
progressive, degenerative disease of the brain
- symptoms: memory impairment, confusion, visual spatial disorientation, inability to calculate, impaired judgement and hallucinations
- progressive, leads to loss of function & death
- onset is usually late middle life, death occurs in 5-10 years post dx
- risk factors: diabetes, midlife HTN, HLD, obesity, smoking, depression, cognitive inactivity, low educational attainment, female, estrogen deficiency at the time of menopause, physical inactivity, head trauma, neuro inflammation & oxidative stress
extrapyramidal/ nonspastic CP
- associated with damage to cells in the basal ganglia, thalamus or cerebellum
- two subtypes: dyskinetic CP and ataxic CP
- dyskinetic CP: movements that are stiff, uncontrolled, abrupt and repetitive
- ataxic CP: difficulty with gait, cerebellar injury. infants tend to have hypotonia but a stiff trunk.
pyramidal/spastic CP
- associated with UMN damage
- children have increased muscle tone, persistent primitive reflexes, hyperactive DTR, clonus, rigidity of extremities, scoliosis and contractures
- most common type
cerebral palsy
disorder of movement, muscle tone or posture
- occurs secondary to injury (before or during birth) or abnormal gestational development in the brain
- an injury up to one year of age may also cause CP
- prenatal or perinatal cerebral hypoxia, hemorrhage, infection, genetic abnormalities, or LBW increase risk
spina bifida
most common NTD
- includes ancephaly (soft, bony portion of skull and part of brain are missing)
- encephalocele (protrusion of brain and meninges through a defect in skull)
- meninogocele (sac filled with meninges and spinal fluid and is a mild form of spina bifida- may have no neuro deficits)
- myelomeningocele (hernial protrusion of meninges, spinal fluid and part of spinal cord with attached nerves through vertebrae, most commonly in lumbar and lumbosacral areas, associated with development of hydrocephalus)
- typically spinal cord and nerve root are malformed below level of lesion
-spina bifida occulta is common but does not result in any neuro deficit because the spinal cord and spinal nerves are normal
neural tube defects
most common neuro anomaly
- folate deficiency in pregnancy
- occurs during first month of gestation and restuls from failure of the neural tube to close completely
- two main types: anterior midline defects and posterior defects
- anterior defects: cause brain and face abnormalities, like cyclopia (presence of a single, midline orbit and eye)
- posterior defects: cause the development of variety of myelodysplasias, defectts of spinal cord and vertebrae
tension headache
most common type
- usually mild-moderate
- felt throughout head
- described as if a tight band has been placed across person’s head
- onset is gradual
- occurs less than 15 times a month
cluster headaches
- not common
- men> women
- ages 20-50
- described as severe, stabbing and throbbing. typically unilateral and may alternate sides with each episode.
- occurs in clusters (up to 8 per day) and lasts minutes to hours
- assoicated with tearing eye, nasal drainage, occur at night and wake person up
Chronic migraines
increase in frequency over time
- occur at least 15 days a month for more than 3 months
- typically rebound headache from overuse of migraine medications
- obesity and caffeine may trigger
4 phases of migraines
- premonitory phase: symptoms which precede the onset of a migraine. may occur hours to days before: fatigue, irritability, loss of concentration, stiff neck, food cravings
- migraine aura: symptoms which affect vision and other sesnses or motor skills. no focal neuro deficits noted.
- headache phase: throbbing pain that starts on one side of head and may spread. may have fatigue, N/V, dizziness. lasts 4-72 hours.
- recovery phase: irritability, fatigue, depression. may take days to resolve.
Migraines
type of HA which occurs intermittently and lasts 4-72 hours
- typically present as unilateral head pain (throbbing), worsens with activity
- assoicated with symptoms: N/V, photophobia, phonophobia
- 3 classifications: migraine with aura, migraine without aura, chronic migraine
- occur most commonly between ages 25-55
- more often in women (before and during menstrual cycles, frequency decreases during pregnancy and menopause)
- increase risk for developing epilepsy, depression, anxiety disorders, CV disease, & ischemic stroke
- triggered by altered sleep patterns, skipping meals, overexertion, weather changes, sress or relaxation from stress, hormone changes, bright lights, strong smells, alcohol or nitrates
Guillain-Barre’ Syndrome
demyelination of the axons in the PNS
- may occur after a respiratory or GI infection, surgery, immunizations, viral infections (zika)
- autoimmune disease, thought to be B or T cell mediated
- causes ascending paralysis (starts in extremities and moves up)
- treatment is supportive and patient may require vent support until recovery (can be weeks-years)
Myasthenic Crisis
- characterized by impairment of breathing and is assoicated with severe quadriparesis or quadriplegia
- symptoms: progressive muscle weakness and fatigue
- muscles of eyes, face, mouth, throat & neck are affected first
- may have diplopia, ptosis, ocular movement paralysis
- paralysis descends and person will require vent support, eventually leads to death
Myasthenia Gravis
chronic autoimmune disease
- affects neuromuscular junction
- characterized by fatigue and weakness, both improve with rest
- more common in women
- etiology unknown
- autoimmune disease> IgG attaches to the post synaptic acetylcholine receptors and prevent the attachment of acetylcholine and the trasmission of nerve impulses> eventually receptors are destroyed
4 types of MS
1) relapsing/remitting: most common and most common in women. episodes of exacerabations followed by a full or partial recovery
2) primary progressive MS: least common. ongoing progression of the disease without any periods of remission. most commonly affects the spinal cord and is less likely to affect cognitive function
3) secondary progressive MS: initially occurs as relasping/remitting MS which is then followed by a gradual worsening of symptoms between relaspes
4) progressive relasping MS: progressively worsening of symptoms from the onset of the disease with clear abrupt relapses but with more severe symptoms
