Neurology Flashcards
(The Nervous System) Body’s principal control system
Network of cells, tissues, and organs regulate bodily functions via electrical impulses transmitted through nerves
(The Nervous System) Endocrine System
Related to the nervous system, exerts control vial hormones
(The Nervous System) Circulatory System
assists in regulatory functions by distributing hormones and chemical messengers
Dendrites
Receive chemical messengers from other neurons - messengers then converted into impulses
Soma
Central cell body
Axon
Sends messages (impulses) to other neurons
Synapse
Connects
Small gabs that separate neurons (between axons of one neuron and the dendrites of the other)
Axon Terminal
Buds at end of axon from which chemical messages (impulses) are sent
CNS Anatomy
Spine 33 vertebrae
Cervical spine: 7 vertebrae
Thoracic Spine: 12 vertebrae
Lumbar spine: 5 vertebrae
Sacral spine: 5 vertebrae
Coccyx spine: 4 vertebrae
CNS Anatomy Meninges
Main job is to protect or “PAD”
Pia Mater: innermost layer, directly on CNS
Arachnoid Mater: middle layer, web-like (arachnoid = spider)
Dura Mater: Outermost layer (“durable”)
Cranial Nerves
1 = Olfactory - Smell
2 = Optic - Vision
3 = Oculomotor - Eye movement, pupillary constriction
4 = Trochlear - Down and inward eye movement
5 = Trigeminal - Jaw movement
6 = Abducens - Lateral eye movement
7 = Facial - Facial movement
8 = Vestibulocochlear - hearing and equilibrium
9 = Glosspharyngeal - swallow
10 = Vagus - parasympathetic nervous system
11 - Accessory - shoulder shrug
12 - Hypoglossal - tongue movement
Brain Anatomy Cerebrum
Cerebrum: The “actual” brain itself…when you think of “brain” you probably picture the cerebrum
Brain Anatomy Reticular Activating System
Responsible for maintaining consciousness and ability to respond to stimuli
Brain Anatomy The brain receives how much blood flow and glucose
20% of the body’s total blood flow per minute
Consumes 25% of body’s glucose
Brain Anatomy Diencephalon (interbrain)
Diencephalon (interbrain) Involuntary actions (temperature, sleep, water, balance, stress, emotions)
Brain Anatomy Mesencephalon (midbrain)
Pons, Medulla Oblongata (Respirations, blood pressure, heart rate) = brain stem “we live and die in the brainstem”
Mental Status AEIOU TIPS
AEIOUS TIPS
A-lcohol
E-pilepsy
I-nsulin
O-verdose
U-remia
T-rauma
I-nfection
P-sychogenic
S-troke/syncope
Severity of AMS: DERM
D-epth of coma
E-yes
R-espiratory pattern
M-otor function
Glass coma score
EVM: 456
Mental Status: Babinski Reflex
Dorsiflexion of the great toe and fanning of others - indicates dysfunction of the CNS
Mental Status - Decorticate Posturing
Deep cerebral brainstem injury - flexes towards the “cord”
Mental Status -Decerebrate Posturing
Deep Cerebral brainstem injury (more severe than decorticate)
Stroke Ischemic
Occlusive: Most common (80%) cerebral artery blocked by clot
Results in ischemia, inadequate blood supply to brain tissue, progresses to brain muscle infarction
Possible TPA (fibrinolytic) candidate, gain last time seen normal, etc. Typically a more gradual onset
Stroke Hemorrhagic
Bleed: Less common (20%), bleeding can be within brain or on outer surface of brain
Sudden onset, severe headache
Stroke Transient Ischemic Attack (TIA)
Temporary interference with blood supply to brain (“mini stroke”)
Lasts for few minutes to several hours, symptoms fully resolve in no more than 24 hours
No evidence of residual brain or neurological damage
Stroke Patients
- Check blood glucose on all suspected stroke patients
- Gain a good history from patient or family members, specifically, time of symptom onset/lat seen normal
- Be cautious with oxygen administration - do not give oxygen unless SP02/patient presentation warrant
Seizures Generalized
Electrical Discharge in small area of brain
Spreads to involve entire cerebral cortex causes widespread malfunction
Includes tonic-clonic and absence seizures
Tonic-clonic = “grand mal seizure”
Generalized motor seizure
Produces loss of consciousness
Specific progression of events
Aura
-> Loss of consciousness
-> Tonic phase, hyper tonic phase
-> Clonic phase
-> Post seizures
-> Postical
Petit-mal/absence seizures
Brief, generalized seizure 10-30 seconds loss of consciousness or awareness
Eye or muscle fluttering
Occasional loss of muscle tone
Partial Seizure
Confined to limited portion of brain
Localized malfunction
May spread and become generalized
Simple Seizures
Focal motor, sensory, Jacksonian seizures
Chaotic movement or dysfunction of one area of the body
No loss of consciousness
Complex Seizures
Temporal lobe or psycho motor seizures
Distinctive aura Seizures
Unusual smell, taste, sound, Metallic taste in mouth is common
Status Epilepticus
Two or more generalized motor seizures without intervening return of consciousness
Management Seizures
1 cause of seizure activity is non-compliance with medications
Move objects from around patient
Oxygen
IV access
Benzodiazepine administration
Obtain BGL on all seizure patients
Neurology Syncope
Syncope - Sudden, temporary loss of consciousness caused by insufficient blood flow to the brain
Regains consciousness when lying supine
Potential causes:
- Cardiovascular conditions
- Hypovolemia
- Non-cardiovascular disease
- Idiopathic (unknown cause)
Neurology Headache
- Acute (Sudden)
- Chronic (constant or recurring)
Generalized (all over)
Localized (specific area)
Range from mild to severe
Neurology Vascular
- Migraines & Cluster headaches
- Significant percentage are tension headaches
- Continuous throbbing headache with fever, confusion, and/or nuchal rigidity = think meningitis
Neurology Migraines
- Last minutes to hours to days
- Usually very intense, throbbing pain
- photosensitivity
- Nausea/Vomiting
- Often unilateral
- Occurs commonly in women
CNS conditions - Bells Palsy
Sudden, unilateral weakness or paralysis of the facial muscles
Occurs due to dysfunction of seventh cranial nerve (facial nerve)
Often follows vial infection
Herpes Simplex Virus can also be a cause
Trigeminal neuralgia
“Tic Doloureux”
Extremely painful, affects 5th cranial nerve (trigeminal nerve)
Electrical shock type of spasms and pain
Tends to be chronic
Anti seizure medications used as treatments
Alzheimer’s
Results from death and disappearance of nerve cells in cerebral cortex. Marked atrophy of the brain
Pick’s
Permanent form of dementia similar to Alzheimer’s disease
Tends to affect only certain areas of the brain, rare condition
Huntington’s
Genetic Defect in chromosome 4
Adult onset and early onset types
Creutzfeldt-Jakob
Form of brain damage
Rapids decrease in mental function and movement, results from protein called “prion” No treatment
Muscular Dystrophy
Genetic disease
Progressive muscle weakness
Degeneration of skeletal or voluntary muscle fibers
Multiple Sclerosis
Unpredictable disease of CNS
Inflammation of nerve cells
Demyelination or destruction of myelin sheath - protective covering of nerve body
Nerves unable to conduct impulses properly
Duhenne Dystrophy
Most common childhood muscular dystrophy
Onset by age 6
symmetrical weakness/wasting
Progressive to death
Gullain-Barre Syndrome
Serious disorder
Body’s immune system mistakenly attacks peripheral nerves
Leads to nerve inflammation that cause muscle weakness
Parkinson’s Disease
Degenerative changes in basal ganglia due to dopamine deficiency
Rhythmical muscular tremors
Rigidity of movement
Droopy posture
Usually occurs after 40 years of age
Leading cause of neuro disability > 60
Spina Bifida
Neural tube defect
Failure of one or more fetal vertebrae to close in utero
Nerve damage is permanent
No cure
Amyotrophic Lateral Sclerosis
“Lou Gehrig’s Disease”
Progressive motor neuron disease
Disease of the motor tracts of the lateral columns and anterior horns of the spinal cord
Results in progressive muscular atrophy, increased reflexes, spastic irritability of muscles
No cure
Poliomyelitis (Polio)
Infectious, inflammatory viral disease of CNS
May result in permanent paralysis
New cases are rare
