Nuerological Disease

Question 1

What are the functions of the neurological system

Answer 1

Senses changes within the body

Interprets stimuli

Responds to changes identified in order to maintain homeostasis

Question 2

What is the central nervous system made up of

What is the peripheries nervous system made up of

Answer 2

The brain and the spinal cord

31 pairs of spinal nerves
12 pairs of cranial nerves
Parts of the autonomic nervous system

Question 3

What are the functions of nerve cells

Answer 3

Control and recurve transmission of impulses

Receive and transmit signals from organs to the brain
Irritability and contractibility

Question 4

In the central nervous system what cells can regenerate and which can’t

Answer 4

The myelinated cells (white matter) can

Unmyelinated (grey matter) can’t

Question 5

Describe the cerebrum

Answer 5

Two hemispheres

Grey matter (cortex) develops faster than white matter causing folds and rolls on itself

Folds= gyri
Deepest groves= fissures
Shallowest groves = sulci

Loves frontal
Parietal
Temporal
Occipital

Question 6

What does the cerebrum deal with

Answer 6

Read
Write
Speak
Calculate
Reasoning
Conscious coordination

Question 7

What does the cerebellum do

Answer 7

It's a motor area
Movement of skeletal muscle
Equilibrium
Balance
Posture

Question 8

What does the medulla oblongata do

Answer 8

Contains the respiratory centre
Cardiovascular centre controlling heart rate, force concentration, blood vessel diameter
Other centres for vomiting, coughing, sneezing

It’s located above the foramen magnum

Question 9

Name the maniges

Answer 9

Dura matter
Arachnoid matter
Pis matter

Question 10

Describe cerebral spinal fluid

Answer 10

Clear, colourless
Mechanical protection
Chemical protection
Circulation for exchange of nutrients and waste
80-150ml circulating
Produced and stored in 4 ventricles to circulate around the brain and spinal cord

Question 11

Discribe the blood and glucose supply to the brain

Answer 11

Comes in through the circle of Willis at the base of the brain

Must have a constant supply of glucose as it has no reserves

Question 12

Label the arteries of the head and neck in diagram

Answer 12

Vertebral artery
Internal carotid artery
External carotid artery
Common carotid artery
Superficial temporal artery
Brachiocephalic trunk
Subclavian artey

Question 13

Label the arteries of the brain

Answer 13

Frontal lobe
Optic chiasma
Internal carotid artery
Mammillary body
Temporal lobe
Pons
Occipital lobe
Cerebral arterial circle
Basilar
Vertebral artery
Cerebellum

Question 14

Where does the spinal cord taper

Answer 14

L1-L2
Into the cauda equina
Nerves leave column lower than the cord

Question 15

What is the decision of spinal nerves and which do what

Answer 15

31 pairs
8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal

C3 4 5 keep diagram alive
T2-11 keep the intercostal alive

Question 16

Name the medical conditions associated with neurological system

Answer 16

Paraplegia
Tetraperliagia/quadrapliagia
Hemiplegia
Monoplegia
Meningitis
Epilepsy
Stroke
Parkinson
Multiplesclorosis
Beware of hypoxia

Question 17

What is the cell structure of a nerve cell

Answer 17

Dendrites
Cell body
Axon
Neuclous

Question 18

What are the sensory receptors

Answer 18

Somatic: pain touch hear and cold
Proprioceptors: originate in the joints and muscles and contribute to the maintenance of balance and posture
Special senses: sight, hearing, balance, smell and taste

Question 19

What does the frontal lobe deal with

Answer 19

Higher centre function/ judgement/problem solving/ Broca’s area- motor speech/empathy/personality
Parietal lobe sensory perception and body position
Temporal sensory speech area, understand spoken language
Occipital-receives visual information, interprets colour shape and distance

Question 20

Brain stem

Answer 20

Mid brain- communication of motor signals
Pons- sleep/dreaming- also relay sensory information between the cerebellum and cerebrum/ respiratory function-depth and intensity of breathing

Medulla maintains life

Question 21

What is a stroke

Answer 21

Stroke idle a clinical syndrome consisting of readily developing clinical signs of focal and sometimes global disturbance of the cerebral function, lasting more than 24 hours or resulting in death with no other apparent cause other than vascular origin

Question 22

What is a transient ischeamic attack

Answer 22

A stroke with signs and symptoms that resolve with 24 hours.

Question 23

What happens in a ischeamic stroke

Answer 23

A blockage of the blood vessel due to an embolus or thrombosis causing damage to a critical area of brain tissue.

Question 24

What happens in an hemoragic stroke

Answer 24

A blood vessel rupture within the brain which applies pressure to or bless into the surrounding brain tissue

Question 25

What are the signs and symptoms of a stroke

Answer 25

Slow full pulse with raised BP
Flushed, warm skin
Pupils possibly unequal on the affected side, pupils may be slow to react.
Noisy breathing and snoring (stertorous), often with puffing of the cheeks.
Flaccid or paralysed muscles on one side with drooping of the mouth.
Difficult or slurred speech with dribbling from the mouth.
Possible incontinence
Possible vomiting
Cerebral irritation
Confusion due to cerebral hypoxia, agitation and aggression.
Fits induced by hypoxia
Possible loss of consciousness
Headaches

Question 26

What are the risk factors for a stroke

Answer 26

Modifiable- diet, smoking, excess alcohol, sedentary life style (lazy), stress, CVD, diabetes, obesity,
Atrial Fibrillation

Non modifiable- age, gender, ethnicity, hereditary, previous stroke,

Question 27

What is the management of a conscious stroke patient

Answer 27

Ensure airway open
Suction if necessary be careful not to endure bracycarida.
Position the patient carefully so as to facilitate drainage from the mouth.
Administer oxygen in accordance to latest evidence based recommendations
Encourage patient to take deeper and more regular respirations
T.l.c patients may be frightened or confused
FAST
Acquire baseline observations and basic ECG
Consider placing the patient in the semi recumbent position or best position for postural drainage.
Send pre alert to appropriate department i.e. Stroke centre.

Question 28

What is the management of a unconscious stroke patient

Answer 28

Open airway
Aspirated if necessary
Consider o.p airway
Administer oxygen to relieve hypoxia
Consider assisting respirations if they are less than 10 per min with 100% oxygen to relieve hypoxia if required
Continually monitor vital signs for change
Position in supine or recovery position as appropriate
Smooth and rapid transport with ASHICE to appropriate department

Question 29

What other conditions can mimic a stroke

Answer 29

Hypoglycaemia
Infection
Hemiplegic migraine
Dementia
Bell's palsy
Hypoxia
Acute confusional state

Question 30

What needs to happen with a stroke patient

Answer 30

Rapid transport
Pre alert to hyper acute stroke unit, or ED
Patient requires immediate CT scan
If ischeamic and within 4.5 hours of onset thrombolysis may be provided with alteplase

Question 31

What is epilepsy

Answer 31

A tendency to have recurrent seizures

A single seizure is not epilepsy.

Of those people who have a single seizure 20% will have no further attack.

It is not an illness in its own right but is a symptom of many different diseases with different causes, many of which are not diagnosed.

Question 32

What causes seizures

Answer 32

Paroxysms of uncontrolled discharges of the nerve tissue of the brain.

Question 33

Other than epilepsy what are other causes of confusions

Answer 33

Acute insult to the brain
Low blood sugar
Lack of oxygen
Drug or alcohol withdrawal
Fever in child (febrile convulsions)
Stroke
Eclampsia (in pregnant women)
Drugs or poisons.

Question 34

What are the two types of seizure

Answer 34

Focal involves part of the brain
Can be simple where consciousness is not impaired or complex where consciousness is impaired
These can lead to generalised seizures
Generalised involves the whole brain

Question 35

What are the types of generalised seizures

Answer 35

Tonic-clonic- both sides of the brain are involved from onset, patient becomes rigid, falls to the ground and jerks all over with subsequent injuries common

Tonic- sudden muscle stiffening, patient becomes ridged and falls

Atonic (drop attack) loss of muscle tone and drop to the floor

Absences (petit mal) may be blank staring, fluttering eyelids

Question 36

Describe the 4 stages of generalised seizures.

Answer 36

Aura
Sudden unconsciousness preceded by an ‘aura’ the patient experiences a subconscious warning. They may cry out as they fall.

Tonic
Brief tonic rigidity, only for a short period

Clonic
Convulsing of whole or groups of muscles
Loss of bowel or bladder control
Cyanosis due to spasmodic contraction of chest muscles affecting respiration
Severe contraction of jaw muscles, the patient may bite their tongue

Post Ictal
Consciousness returns slowly, patient remains disorientated
Heart and respiratory rates remain increased
Patient is likely to sleep.

Question 37

What is status epilepticus

Answer 37

Uncommon but potentially life threatening condition.

Occurs when you have a seizure that lasts 30 minutes or more or you have a cluster of short seizures for 30 minutes or more with little or no recovery inbetween

Question 38

What is the management for epilepsy

Answer 38

ABC
remove dangers
Protect head and limbs-do not hold down
Oxygen to address hypoxia a coursing to guidelines
Reduce stimulus
Seek clinical guidance e.g. Paramedic
Do not restrain conclusion movements or
Attempt to force an OPA into the airway
Consider and NPA

Question 39

Management of status eplilepticus

Answer 39

Establish an open airway
Assist ventilations if required
Administer high concentration of oxygen
Paramedic assistance is required
Assume seizures likely to resume
Smooth and rapid evacuation to hospital
Alert receiving hospital ASHICE call
Diazepam IV or PR by paramedic

Question 40

What is febrile convulsions

Answer 40

Tonic-colonic conclusions not caused by epilepsy but by high temperature resulting from illness or infection
Predominantly affect children between 6 months to 6 years
Usually self-contained,stoping within 5-10 minutes