Other neurological conditions Flashcards
cerebral palsy
neuromuscular disorder
spastic: hypertonia, hyperreflexia
dyskinetic: dystonia, athetosis, chorea
ataxic: cerebellum
monoplegia (one extremity), hemiplegia (half of body), paraplegia (both LEs), quadriplegia (all extremities), diplegia (greater LEs and some UEs)
complications: seizures, intellectual disabilities, contractures, language and cognitive deficits, dysarthria, visual impairments
ataxia
lack of coordination while performing voluntary movements
clumsiness, inaccuracy, instability
not smooth, jerky
chorea
brief, purposeless, involuntary movements of distal extremities and face
dyskinesias
involuntary, non repetitive, stereotyped movements
writhing
dystonia
abnormal postures and disruptions of ongoing movement
hemiballismus
flinging motions of the extremities
myoclonus
brief and rapid contraction of a muscle or group
tremors
rhythmic, alternating, oscillatory movements produced by repetitive patterns of muscle contraction and relaxation
parkinson’s
hypo kinetic CNS movement disorder
slowly progressive and degenerative pathways in basal ganglia (substantial nigra)
cardial signs: tremor, RIGIDITY, resistive motion, akinesia, festinating gait, falling
stage 1 - 5 (worst)
spina bifida
failure of the spinal column to fully form to protect the neural tube
occulta: bony malformation; may not discover until late childhood, red birthmark or patch of hair
cystica: exposed pich of SC and meninges
- with meningocele: protrusion of a sac through the spine with fluid and meninges, but not the spinal cord
- with myelomeningocele: protrusion of a sac through the spine with spinal cord/nerve roots
medical management of spina bifida
may not have many symptoms unless severe (such as tethered cord syndrome) and depending on what parts of the spine are involved
may change during growth spurts
during pregnancy, protect the sac from rupturing and from infections that could result in meningitis
shunt may be placed
increase in intracranial pressure
could cause intellectual disability
could result in Arnold chiari syndrome (portion of cerebellum and medula oblongata slip down into the foramen magnum to the cervical spinal cord)
if a shunt is blocked or infected (s/s are headache, vomiting, vision/mem problems, inc head size - medical emergency)
muscular dystrophies and atrophies
degenerative disorders resulting in mx weakness and decrease in mx mass
hereditary
due to absent mx protein - dystrophin and high creatine kinase
Duchenne’s muscular dystrophy
sex linked, recessive, males
enlarged calves
weakness in proximal joints
ambulating with a trendelenburg (waddling) gait, frequent falls
Gower’s sign - use hands to crawl up to thighs to get up off the floor
die around 20s
Becker’s muscular dystrophy
variant of duchennes
slower to progress, less severe, less predictable
survival can be in late adulthood if minimal cardiac involvement
arthrogryposis multiplex congenita
deformities and joint contractures
may be stable, mild progressive, or improve
heart and spinal defects, torticollis, diaphragm involved
club feet, internal rotation of UEs
other types of muscular dystrophy
- limb-girdle: slow progression, pelvis/shoulder initially affected
- fascioscapulohumeral: early adolescence involves face and UEs/scapula, relatively normal life expectancy
- spinal: earlier the age of diagnosis, the greater of severity of functional deficits/shorter life expectancy
- congenital myasthenia gravis: disorder of transmission of impulses, males
- charcot-marie-tooth disease: peripheral nerves, distal leg muscles
- myopathies: progress slower and better prognosis, weakness of face/neck/limbs
progressive supra nuclear palsy
later middle life
loss of voluntary but preserved reflexive eye movements, bradykinesia, rigidity, axial dystonia, pseudo bulbar palsy, dementia
huntington’s chorea
onset 30-50
choreiform movements and progressive intellectual deterioration
psychiatric disturbance
progressive
ALS
progressive degeneration of corticospinal tracts (LMN)
onset around 50s
treatment aimed at secondary complications - spasticity, preventing aspirations, contractures, pain
Brachial plexus disorder
Erb’s palsy: paralysis of C5+6 cervical nerves, partial C7, cannot raise arm, weak elbow flexion, weak scapula, “waiter’s tip”
Klumpke’s palsy: C7+8 + T1 cervical nerve paralysis, no hand/wrist movements, Horner’s syndrome (mitosis, ptosis, sweating)
Guillain-Barre syndrome
recovery is 2-4 weeks after symptoms
s/s:acute, rapidly progressive polyneuropathy, symmetric mx weakness, mild sensory loss distally, painful extremities, loss of deep tendon reflexes
prognosis: mild/residual neurological deficits, most are ambulatory within 6 mo
myasthenia gravis and how is it confirmed
autoimmune attacks on neuromuscular receptors
very rare
episodic muscle weakness, usually muscles innervated by cranial nerves
ptosis, diplopia, muscle fatigue after exercise, dysarthria, dysphagia
sensation and deep tendon reflexes intact
**confirmed by response to anticholinesterase drugs
multiple sclerosis
20-40 yrs
- degeneration of myelin sheath in brain and spinal cord
- CNS lesions, varied neurological symptoms, remissions and exacerbations and/or progressive
deficits in: muscles, sensation, vision (double and acuity), emotion, balance, bladder, cognition, spasticity
seizures
primary generalized: widespread involvement of both sides of the brain
partial: smaller, localized area (can spread)
generalized seizures
- tonic-clonic/grand mal (starts with aura, then LOC/stiffeneing, then rigidity and relaxation of muscles
- myoclonic-akinetic: loss of tone, jerking
- petit mal: absence
partial focal seizures
simple and complex
simple - sudden movement in 1 body part and no change in vital signs
lennox-gastaut syndrome
severe seizures, intellectual disability, specific EEG pattern
brain disorders
landau-kleffner syndrome
acquired epileptic aphasic
progressive encephalopathy
simple febrile seizures
precipitated by a fever
lasts under 10 min
LOS and jerking
do not cause damage/lead to epilepsy
status epilepticus
prolonged seizures
can sometimes be triggered when medication is stopped abruptly
can be life threatening, medical emergency
remove dangerous objects, place them in sidling, allow seizure to happen, protect head from injury from shaking
GBS – residual paresthesia and pain
educate the pt on sensory deficits and related ADL adaptive strategies (hot packs are contraindicated, massage will not remedy the hands)
other symptoms of MS
Early MS adaptation in classroom teaching – high stool to compensate for LE weakness (this is the most common symptom in early stages)
Heat intolerance is a symptom of multiple sclerosis that may be exacerbated in a client who works in a kitchen. Recommending a cooling vest is a solution to decrease this risk of overheating.
post concussion syndrome
occurs when symptoms of a mild traumatic brain injury last longer than expected after an injury. These symptoms may include headaches, dizziness, and problems with concentration and memory. They can last weeks to months
typically exacerbated by exercise
call for medical help with seizure if
- first seizure
- in water
- has a second one
- no consciousness within 5-10 min
- if it lasts over 5 min
- diabetic or pregnant
