SCI&CNS Disorders (Gas#15&16) Flashcards
upper motor neurons carry impulses to or from brain?
away (descending)
Damage to upper motor neurons results in
increased muscle tone, loss of voluntary control, decreased coordination, hyperactive/abnormal reflexes
Damage to lower motor neurons results in
decreased muscle tone, absent or decreased reflexes, muscle atrophy
Ascending paths
Sensory, carry pain, temp (Afferent)
Afferent
Ascending sensory paths
Descending pathways
Motor, voluntary purposeful movements (efferent)
Efferent
Descending motor pathways
Muscular Dystrophy
progressive muscle degeneration and wasting
Duchenne’s Muscular Dystrophy
loss of muscle tissue thats replaced with connective tissue; muscles deteriorate
Patients with Duchenne’s Muscular Dystrophy have an absense of what?
Dystrophin-protein
Duschenne’s Muscular Dystrophy s/s
weak pelvic & shoulder gait, waddling gait, toe walking, hypertrophy of calf muscles, fatigue, skeletal deformities, cardiomyopathy
What age does Duschenne’s Muscular Dystrophy occur
3-5 yrs old
Acute stage of Guillain-Barre Syndrome (GBS)?
Severe rapid weakness, loss of strength, resp failure, loss of facial movement, bradycardia, hypotension, sweating, SIAH (retaining H2O &NA)
what happens after 2-3 weeks after initial onset of Acute stage of Guillain-Barre Syndrome (GBS)
they go into a plateau stage, their symptoms level off
Is Guillain-Barre Syndrome (GBS) an emergency?
yes because they don’t know how fast
Guillain-Barre Syndrome (GBS)
Rapid muscle weakness & paralysis (disorder of the PNS), paralysis starts from the feet and goes up
what can cause Guillain-Barre Syndrome (GBS)
eating undercooked poultry, ebstein barr virus
what gets inflamed with Guillain-Barre Syndrome (GBS)
segmental demyelination of peripheral nerves causes inflammation & degeneration in sensory & motor nerve roots
s/s Guillain-Barre Syndrome (GBS)
Ascending paralysis, poor nerve conduction, facial nerve involvement, may have respiratory involvement
what system is not affected with Guillain-Barre Syndrome (GBS)
cognitive & LOC
Myasthenia Gravis
A chronic progressive neuromuscular disorder, it destroys, alters receptors for ACH
What do you need ACH for?
muscle contractions
Without ACH in Myasthenia Gravis what happens to muscles?
This results in voluntary muscle weakness that escalates with continued activity
Myasthenia Gravis s/s
Diplopia (double vision), Ptosis (drooping of eye lid), generalized muscle weakness (therefor at risk for aspiration), laryngeal involvement
Diplopia
double vision
Ptosis
drooping of eye lid
what system is not effect with Myasthenia Gravis
Sensory changes
Dianosis for Myasthenia Gravis
Edrophonium test
Edrophonium test
used for Myasthenia Gravis, IV Tensilon is used. It prevents the breakdon of ACH so youll see an improvement within 5 mins. If no improvement its not MG
IV Tensilon is used for?
Edrophonium Test, it prevents the breakdown of ACH in Myasthenia Gravis
Myasthenia Gravis medications
Pyridostigmine (mestinon, Regonol), Glucocorticoids (to reduce production of antibodies), Immunosuppressants (Imuran), plasma exchanges, IV immune globulin
Why are immunosuppressants (Imuran) used for Myasthenia Gravis used?
it inhibits T Lymphocytes & reduces ACH receptor antibody levels
Myasthenia Crisis
A sudden exacerbation of motor weakness
What is Myasthenia Crisis caused by
most often due to undermedication, missed doses or a developing infection
Myasthenia Crisis s/s
Tachycardia, Tachypnea, severe respiratory distress, dysphagia, restlessness, impaired speech, anxiety
What surgical operation can patient have with Myasthenia crisis
thymectomy
Myasthenia Gravis teaching
avoid extreme temperatures, avoid others who have respiratory infections
what things can cause an exacerbation of Myasthenia gravis
extreme temperatures, respiratory infection
Pyridostigmine (mestinon, Regonol) are used for & why?
used for Myasthenia gravis & used because they inhibit the breakdown of ACH
Amyotrophic Lateral Sclerosis (ALS) is also called
Lou Gehrig’s Disease
Amyotrophic Lateral Sclerosis (ALS)
a progressive degenerative neurological disease, loss of motor neurons in spinal cord & brain, muscles basically waste away.
what systems does Amyotrophic Lateral Sclerosis (ALS) not effect
no sensory or cognitive changes
what is destroyed with Amyotrophic Lateral Sclerosis (ALS)
Nerves are destroyed FIRST then Myelin Sheath is destroyed & replaced with scar tissue along spinal cord
Amyotrophic Lateral Sclerosis (ALS) s/s
Dyspnea, difficulty clearing airway, depression, difficulty chewing, dysphagia, malnutrion, visual changes
Disorders that mimic Amyotrophic Lateral Sclerosis (ALS)
Hyperthyrodism, hypoglycemia, compression of the spinal cord, infection, neoplasms, lymme disease,
Amyotrophic Lateral Sclerosis (ALS) medication
Riluzole (Rilutek) first med developed to prolong survival
Riluzole (Rilutek) is used for?
Amyotrophic Lateral Sclerosis (ALS); helps prolong survival
Amyotrophic Lateral Sclerosis (ALS) diagnostics
MRI, MRS, Nerve conduction
Primary vs secondary HA
Primary:no cause Secondary: due to tumor ex
Tension HA
pain is like a band squeezing head; most common, “stress HA”
Causes of Tension HA
stress, anxiety, depression, lack of sleep, abnormal posturing (bending over) 2ndary disorders of eye, ears, sinuses
Tension HA treatment
ibprofen, ASA, no real med specifically for it
Migraine HA
unilateral pain (can point to it), intense, throbbing or pounding pain located in foreheads, eye, back of head
Migraines last how long?
4-72 hrs
Stages of migraine HA
Prodrome, Aura (a sensation occurs just before), attack, postdrome (residual HA, difficulty concentrating)
Migraine Dietary Triggers
Caffeine, chocolate, nuts, yeast, MSG, marinated foods
Migraine Physical triggers
menses, ovulation, sleep, odors, high altitude, fasting,
@ least 4 symptoms that need to be present in order to be a Migraine
unilateral pain, pulsating or throbbing, produces moderate to severe pain, worsens with ADL’s, Accompanied by N/V or sensitivity to light or noise
2 kinds of Migraine treatments
Abortive & preventative
Abortive migraine treatment
used to treat the symptoms during an attack
Preventative migraine treatment
bb (inderal), anti-seizure (depakote, Topamax), antidepressants
Medications used for abortive migraine treatment
OTC analgesics & NSAIDS (take early), Triptans (Imitrex, Axert, Zomig), Narcotics, Combinations (treximet)
Triptans (Imitrex, Axert, Zomig) are used for ?
Migraine HA
What 3 triptans are used as abortive treatment with migraine HA
Imitrex, Axert and Zomig
Which antiseizure meds are used to prevent migraine HA
Valproate sodium (Depakote) & topiramate (Topamax)
Cluster HA
Unilateral, excessive tearing, redness in eye, congestion on affected side, excruciating pain
How long do cluster HA last?
1/2-3 hours
Abortive treatment for cluster HA
100% O2 for 10-15 mins, imitrex
Preventative treatment for cluster HA
Ccb (calan)
What other things can a patient do to treat a cluster HA
Acupuncture, relaxation, massage, regular exercise, herbs
Primary tumors
Cause unknown, originate from brain cells, meninges, nerves, or glands
Gliomas
Most aggressive brain tumor, malignant, poor prognosis
Astrocytomas
Less malignant brain tumor
Meningiomas
Brain tumor 90% benign. More common in women. If found in kids don’t remove because it’ll cause more brain damage. Slow growing! Grows on the meninges
Risk factors for primary tumor
Female, Caucasian, 70 yrs or older, family hx, chemical exposure
Secondary tumors are usually due to
Metastasis
Neurological s/s of a secondary brain tumor
HA, gait disturbances, visual impairment, personality changes, altered mental status, focal weakness, paralysis, Aphasia (inability to communicate )
SIADH is what kind of disorder?
ADH disorder
What happens with SIADH
Increased levels of ADH so you’ll have water retention, hyponatremia, aldosterone will be suppressed
How is ADH affected with diabetes insipidus?
There is a deficit of ADH so you’ll have large amounts of dilute urine
A deficit in ADH is related to what kind of problems?
Increased ICP, severe head injuries, glasgow coma scale 8 or lower diabetes insipidus
ADH
Hormone that limits the amount of water excreted by the kidneys
3 major risk factors for SCI
Age (16-30), gender (male), alcohol or drug abuse
Why are head injuries associated with SCI
Because with a head injury, blood supply could be cut off or lowered to spinal cord
Most common cause of abnormal spinal cord movements
Acceleration & deceleration
SCI occur most often at which sites?
C1-2, C4-6, T11&12, L1&2
Complete SCI
Total loss of sensation & voluntary muscle control below the level of injury. Loss of ability to perspire below level of injury
A complete SCI can result in what?
Paraplegia ( paralysis of lower body) or tetraplegia ( paralysis of all 4 extremities)
Incomplete SCI
Sensory or motor function or both are preserved below level of injury.
What region is the injury located with a tetraplegia and what is a tetraplegia
Cervical region and they have paralysis of all four extremities
What region is the injury located at with a paraplegia and what is a paraplegia
Injury at thoracic or lower levels of the spine. Paraplegia is the paralysis of just the lower body
What injury to the spine do you have to have I order to have respiratory paralysis and be put on a ventilator?
Injury to C1-C4
Brown-Sequard Syndrome
Loss of movement on same side as the cord damage; loss of pain, temp & sensation on opposite side of cord damage
Central cord syndrome
More muscle weakness/paralysis in upper body than lower half of body
Horners syndrome
Incomplete cord transection of the cervical sympathetic nerves, ptosis of eyelid, constricted pupil
Anterior cord
Localized injury
Spinal shock
Temporal sudden loss of reflex below the level of injury (areflexia)
Areflexia
Absence of reflexes
When does spinal shock appear? And how long does it last?
Can begin within an hour of injury and can last for a few minutes to months
Spinal shock s/s(including vs)
Bradycardia, hypotension, loss of sensation of pain, temp, & pressure, bowel & bladder dysfunction, flaccid paralysis of skeletal muscles
Why would you give an NG tube to a pt with spinal shock
To decompress the intestines if bowel distention & paralytic ileus occur
Neurologic shock s/s (including vs)
Orthostatic hypotension, tachycardia, respiratory insufficiency, hypothermia, paralytic ileus, urinary retention, oliguria(<400 output), inability to perspire
Autonomic dysreflexia (autonomic hyperflexia)
Serious complication of a SCI.blood pressure rises to dangerous levels Of=stroke &death
Autonomic dysreflexia (autonomic hyperflexia) vs
Bradycardia, HTN
Autonomic dysreflexia (autonomic hyperflexia) s/s
Severe HA, sweating above injury, nasal congestion, red blotches on skin, goose bumps & cold clammy skin below injury,
What causes Autonomic dysreflexia (autonomic hyperflexia) besides a SCI?
Visceral contractions & pain, distended bladder, constipation, UTI, catheter bag too full
What are pts who have Autonomic dysreflexia (autonomic hyperflexia) at risk for?
Stroke & death
How to prevent Autonomic dysreflexia (autonomic hyperflexia)
Look for blocked catheter, check collection bag, irrigate catheter, remove kinks, dis impact stool, loosen clothing, check for pressure sores
Triheminal neuralgia effects which cranial nerve
C5
Bell’s palsy effects which cranial nerve
C7
Glossopharyngeal neuralgia effects which cranial nerve & what is it
C9; it causes pain in back of throat, tonsils, & middle ear
Third nerve palsy effects which cranial nerve disorder and what is it
C3; pupil dilation, ptosis, abduction of eye
Trigeminal neuralgia what is it & what triggers it
Extreme sudden unilateral burning facial pain that is triggered by sneezing light touch, talking, washing face, change in temp, exposure to wind or eating. lasts seconds c intermittent episodes
Trigeminal neuralgia is also called?
Tic douloureux
Trigeminal neuralgia treatment
Anti-convulsants (1st line) (tegretol, Dilantin, neurontin, lioresal) tricyclic antidepressants & neurosurgical procedures
Surgical treatments for trigeminal neuralgia
Microvascular decompression (pad is inserted under nerve), rhizotomy (nerves are cut)
What’s a benefit of a rhizotomy?
Provides immediate nerve pain relief, pt can gradually be weaned off of meds
What is a microvascular decompression used for and what is it
Nerve pain, a pad is inserted under nerve
Bell’s palsy & what can cause it
C7; unilateral nerve inflammation; vascular ischemia, viral infections, autoimmune can cause it
Bell’s palsy risk factors
Family members who have had it, pregnancy (bc of hormonal changes), cold or flu, diabetes, weakened immune system
Bell’s palsy s/s
Facial weakness/paralysis, usually on one side, not able to smile, forehead is smooth, dropping corner of the mouth, drooling, inability to close eye, impaired taste, difficulty speaking, sound sensitivity in one ear, tearing
Bell’s palsy treatment and why
Steroids (to decrease inflammation), antivirals, analgesics (to control pain), eye production, physical therapy, acupuncture
What vitamins are used with Bell’s palsy and why
B12 because it helps nerve impulse/conduction
What kinds of people does postpoliomyelitis syndrome effect and what is it and what gets inflamed
Affects polio survivors. It’s a new weakness with unaccustomed fatigue, muscle atrophy and pain-joint degeneration. Inflammation of gray matter of spinal cord
Criteria for postpoliomyelitis diagnosis
Hx of polio, period of partial or complete recovery, gradual onset of progressive/persistent NEW muscle weakness, symptoms last over 1 year
How long can a postpoliomyelitis syndrome diagnosis take?
It can take up to a yr to diagnose it
Treatment of postpoliomyelitis and what if you have pain with activities
Whatever symptoms are: physical therapy, pulmonary rehab programs; if activity causes pain, stop activity
Complications of postpoliomyelitis
Falls, malnutrition, dehydration, acute respiratory failure, osteoporosis
Neurological disorders
Multiple sclerosis, Parkinson’s, huntingtons, ALS
Infections
Postpoliomyelitis
Multiple sclerosis
Autoimmune disease, myelin sheath is destroyed and replaced with scar tissue, axons are eventually destroyed causing permanent damage. It’s gradual, slow most of time
Triggers of ms
Febrile states (hot bath, fever), pregnancy, extreme physical exertion, fatigue, stress
What happens after a pt with ms gives birth
She’ll go into remission for 3 months after birth
Risk factors of MS
Female, age 20-40, temperate climates
MS vision s/s
Blindness in one eye, red/green color distortion, double/blurred vision
MS muscle/GI s/s
Muscle weakness, ataxia (coordination & balance problems), spasticity (excess of muscle tone)/ loss of bowel/bladder function
MS sensation/emotional s/s
Pins and needles sensation/ depression
Specific test for MS
No specific test. MRI, spinal tap, neuro exam done to rule out other disorders
MS disease modifying medications
Interferon beta 1 (rebif) and interferon beta 2 (betaseron) Sq, Avonex IM weekly, Copaxone SQ daily, methylprednisolone IV & novantrone IV q 3 months
MS medication for Spasticity problems
Baclofen, klonopin
MS medication given to pts with optic neuritis
Solumedrol
MS medication given for fatigue
Antidepressant
Because pts with MS have fatigue when should activities be done?
In the am when they have most of their energy
Parkinson’s
Lack of dopamine resulting in abnormal nerve functioning which causes loss of ability to control movements
1st symptoms of Parkinson’s
Muscle rigidity, tremors, bradycardia
Later s/s of Parkinson’s
Hypokinesia (decreased motor rxn to stimulus), changes in speech/writing, loss of balance & increased falls, expressionless face, shuffling gait, heat intolerance, constipation
What will a pt with Parkinson’s facial expression look like?
It’ll look frozen
Total disability is seen how long after diagnosis of Parkinson’s?
10-20 years poor prognosis
Parkinson’s diagnostic tests
H&P, PET scan, drug screens (to make sure it’s not a rxn of a med)
How long do dopamine agonists take to work with Parkinson’s
Can take 6 months to work
Sinemet, levodopa are what?
Dopamine agonists used for Parkinson’s
Med category’s used for Parkinson’s
Dopamine agonists, anticholinergics, MAOIs
Why are anticholinergics (Cogentin) used for Parkinson’s?
They help limit the breakdown of dopamine
Sinemet and levodopa are what? What’s important about them
Dopamine agonists used for Parkinson’s. Pt can develop a Plato effect so pt increases dose & therefore has to get off it completely
When do you give a dopamine agonist?
Before they get out of bed
Surgery for Parkinson’s
Thalamotomy (destruction of portion of thalamus), pallidotomy (destruction of the globus pallidus)
Huntingtons disease s/s
Increased dementia & chorea (jerky, rapid involuntary movements), intellectual decline, emotional disturbances
Huntingtons disease symptoms occur between which age
30-40yrs old
What happens to the brain with huntingtons disease
Premature death of brain cells-basal ganglia & Cortex. There is a relative excess of dopamine
Chorea
Jerky rapid involuntary movements associated with huntingtons
Why is it important to get genetic counseling with Huntingtons disease
It’s a dominant gene. Kids have 50% chance of getting it from parents
