UNIT 10 - ALTERATIONS IN NEUROLOGICAL FUNCTIONS Flashcards
4 REGIONS OF THE BRAIN
- Cerebrum
- Cerebellum
- Brain stem
- Neuron
CEREBRUM
THINKING PROCESS
CEREBELLUM
BALANCE
BRAIN STEM
VITAL FUNCTIONS SUCH AS BREATHING, BP
NEURON
BASIC FUNCTIONAL UNIT OF THE BRAIN
PROTECTIVE SURFACES OF THE BRAIN
BRAIN PIA MATER SUB-ARACHNOID SPACE ARACHNOID MATER SUBDURAL SPACE DURA MATER EPIDURAL SPACE SKULL
glued to brain like wallpaper. Soft layer.
PIA MATER
Space between pia mater and arachnoid mater
o Contains cerebral spinal fluid
o Lubricates brain, provides a little cushioning
SUB-ARACHNOID SPACE
looks like spiderweb. On top of pia mater.
ARACHNOID MATER
space between Arachnoid mater and dura mater
Subdural space
On top of Arachnoid mater. Protective layer
Dura mater – (tough mother)
Between dura mater and skull
Epidural space
SPINAL CORD IS PROTECTED BY THREE LAYERS CALLED THE __________________.
MENINGES
ALTERED ____________ ____ ______________ (AROUSAL AND AWARENESS) IS THE SINGLE MOST IMPORTANT INDICATOR FOR NEUROLOGICAL DYSFUNCTION
LEVEL OF CONSCIOUSNESS
CONFUSION, DISORIENTATION, STUPOROUS, LETHARGY, OBTUNDED
CLINICAL MANIFESTATIONS OF ALTERED LEVEL OF CONSCIOUSNESS IN NEUROLOGICAL DYSFUNCTION.
CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION
MEMORY LOSS IS EITHER _______________ OR
_____________ AMNESIA
RETROGRADE
ANTEROGRADE
CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION.
RETROGRADE AMNESIA
CANNOT REMEMBER BEFORE INJURY
CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION.
ANTEROGRADE AMNESIA
CANNOT FORM NEW MEMORIES. SINCE INJURY THEY CANNOT REMEMBER
CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION.
AGNOSIA
CANNOT RECOGNIZE FAMILIAR OBJECTS
CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION.
DYSPHASIA
LANGUAGE DIFFICULTIES
CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION.
DISORDER OF AWARENESS.
o TEMPORARY STATE*
o CAN OCCUR BECAUSE OF DRUGS, INFECTION OR TRAUMA
ACUTE CONFUSIONAL STATE
CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION.
DECLINE OF COGNITIVE FUNCTION
o PROBLEMS WITH ORIENTATION, PROBLEM SOLVING, DECISION MAKING
o BEHAVIOURAL ALTERATIONS MAY OCCUR
o CAN RESULT FROM VARIETY OF DISEASES
DEMENTIA
CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION.
HEADACHE, NAUSEA & VOMITING
CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION.
CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION.
PUPILLARY CHANGES & ALTERED BREATHING PATTERNS ARE ____________ ____________OF NEUROLOGICAL DYSFUNCTION
LATE SIGNS
CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION.
EYES DO NOT MOVE TOGETHER (LIZARD EYES)
DISCONJUGATE EYE MOVEMENTS
CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION
INVOLUNTARY EYE MOVEMENTS
NYSTAGMUS
CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION
– BODY SENSE (YOU KNOW WHERE YOUR BODY PARTS ARE)
SENSORY DYSFUNCTION:
LOSS OF PROPRIOCEPTION
CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION
DIFFICULTY WITH MOVEMENT
MOTOR DYSFUNCTION:
DYSKINESIA
CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION
CANNOT BEND OR EXTEND JOINTS IN A SMOOTH MANOR
MOTOR DYSFUNCTION:
COGWHEEL RIGIDITY
CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION
GAIT WHERE THEY TEND TO LEAN FORWARD
MOTOR DYSFUNCTION:
PROPULSIVE GAIT
CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION
GAIT WHERE THEY TEND TO LEAN BACKWARD
MOTOR DYSFUNCTION:
RETROPULSIVE GAIT
CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION
UNCOORDINATED GAIT
MOTOR DYSFUNCTION:
ATAXIA
CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION
- FLACCID VS SPASTIC (INCREASE IN MUSCLE TONE CAUSING RIGIDITY)
- IPSILATERAL (SAME SIDE OF BRAIN/SPINAL CORD LESION) VS CONTRALATERAL (OPPOSITE SIDE OF BRAIN/SPINAL CORD LESION)
MOTOR DYSFUNCTION:
WEAKNESS/PARALYSIS
CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION
ABNORMAL FLEXION OF EXTREMITIES TOWARD BRAIN
MOTOR DYSFUNCTION:
DECORTICATE
CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION
ABNORMAL EXTENSION OF EXTREMITIES AWAY FROM BRAIN
MOTOR DYSFUNCTION:
DECEREBRATE POSTURING
CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION
SUDDEN, EXPLOSIVE DISORDERLY DISCHARGE OF NEURONS
SEIZURES
NEURONS USUALLY FIRE IN AN ORDERLY PATTERN. WITH SEIZURES THEY FIRE AT AN ABNORMAL RATE AND PATTERN.
SEIZURES
STARTS IN ONE AREA OF THE BRAIN (FOCAL AREA), THEN SPREADS TO OTHER AREAS.
EPILEPTOGENIC FOCUS
SEIZURES
___________ (TEMPORARY) ALTERATION IN BRAIN FUNCTION
o ALTERED LEVEL OF AROUSAL
o SENSORY AND MOTOR MANIFESTATIONS
TRANSIENT
DRUGS, TOXINS, HEAD INJURY, BRAIN TUMORS, INFECTION, HYPOGLYCEMIA ARE ___________ OF SEIZURES
CAUSES
________ EPILEPSY – UNSURE OF CAUSE
IDIOPATHIC
WHICH TYPE OF SEIZURE?
ABNORMAL ACTIVITY IS ORIGINATING IN ONE PART OF THE BRAIN
SIMPLE OR COMPLEX
PARTIAL
WHICH TYPE OF SEIZURE?
NO LOSS OF CONSCIOUSNESS OR AWARENESS
MAY HAVE MOTOR DISTURBANCES
SHAKING OR TREMORS STARTING IN TIPS OF FINGERS AND TOES. BEGINS DISTALLY AND WORKS IT WAS PROXIMALLY.
MAY HAVE SENSORY DISTURBANCES
AREN’T AS VISIBLE AS MOTOR SYMPTOMS
MAY FEEL BUGS CRAWLING UP ARM, HEAR RINGING IN EARS, VISUAL DISTURBANCES
SIMPLE PARTIAL
WHICH TYPE OF SEIZURE?
NO LOSS OF CONSCIOUSNESS, BUT MAY BE A LOSS OF AWARENESS.
AUTOMATISMS – PERSON MAKE REPEATED, NON-PURPOSEFUL MOVEMENTS
COMPLEX PARTIAL
WHICH TYPE OF SEIZURE?
INVOLVES BOTH CEREBRAL HEMISPHERES OF BRAIN
GENERALIZED SEIZURES
TYPE OF GENERALIZED SEIZURE
BEGINS WITH AURA (MAY SEE LIGHTS FLASHING, ODD TASTE IN MOUTH, RINGING IN EARS)
LOSS OF CONSCIOUSNESS. TONIC PHASE – BECOMES RIGID
CLONIC PHASE – SHAKING
ALTERNATES BETWEEN RIGID AND SHAKING. CAN FROTH AT MOUTH, BECOME INCONTINENT, EYES ROLL BACK.
POST-ICTAL – COMPLETELY FLACCID, UNABLE TO MOVE.
TONIC-CLONIC – AKA GRANDE MAL.
TYPE OF GENERALIZED SEIZURE
______________ SEIZURES:
EPISODES OF COMPLETE LOSS OF AWARENESS
OCCURS IN CHILDREN. THEY CAN GROW OUT OF IT, OR IT CAN PROGRESS TO TONIC-CLONIC SEIZURES.
ABSENCE
TYPE OF GENERALIZED SEIZURE
____________ SEIZURES:
INVOLUNTARY MUSCLE CONTRACTION (TWITCHING)
LOSS OF CONSCIOUSNESS AND BRIEF MUSCLE CONTRACTION
MYOCLONIC
TYPE OF GENERALIZED SEIZURE
___________SEIZURES: LOSS OF TONE. OCCURS WHEN SOMEONE SUDDENLY LOSES MUSCLE TONE AND DROP TO THE GROUND.
CALLED DROP ATTACKS.
HELMETS MAY BE WORN TO PROTECT THEIR HEAD.
ATONIC
_____________ _________________:
PROLONGED SEIZURE
o CAN RESULT IN BRAIN DAMAGE, AS THE BRAIN IS DEPRIVED OF OXYGEN FOR SOME TIME
STATUS EPILEPTICUS
SEIZURES NORMALLY DO NOT LAST LONGER THAN ___ ________ ______________
A FEW MINUTES
- EEG MUST BE DONE TO DETERMINE THE DIFFERENCE BETWEEN ______________ & _____________ _____________ SEIZURES BECAUSE SYMPTOMS ARE SIMILAR.
- USED TO EVALUATE SEIZURES AND BRAIN FUNCTION.
ABSENCE AND COMPLEX PARTIAL
- MILD: 14 – 15
- MODERATE: 9 – 13
- SEVERE: 3 – 8
GLASGOW COMA SCALE – TEST TO EVALUATE NEUROLOGICAL FUNCTION
CATEGORIES OF NEUROLOGICAL ____________
• TRAUMA
• CEREBROVASCULAR DISEASE
• INFECTION
• DEGENERATIVE NEUROLOGICAL DISEASE
• TUMORS
• DEVELOPMENTAL ERRORS
o CEREBRAL PALSY
CATEGORIES OF NEUROLOGICAL DISEASES
TRAUMA - BRAIN INJURY (ATLS)
• MECHANISM OF INJURY
o BLUNT - define
SKIN IS NOT BROKEN
TRAUMA - BRAIN INJURY (ATLS)
• MECHANISM OF INJURY
o PENETRATING - define
SKIN AND TISSUE UNDERNEATH IS BROKEN
SEVERITY OF BRAIN INJURIES IS BASED ON _____________ ________ _____________
(<8 = POOR OUTCOME)
GLASGOW COMA SCALE
(T A SMILEY FACE WITH A HAT. ITS SERIOUS.
MORPHOLOGY
SHAPE
WITH A SKULL FRACTURE, DAMAGE TO ________ TISSUE IS THE MAIN CONCERN
BRAIN
MORPHOLOGY: SKULL FRACTURE
•VAULT (TOP, ROUND SECTION THAT IS COVERED BY HAIR)
o OPEN VS CLOSED
OPEN (SCALP IS TORN & DURA IS EXPOSED)
CLOSED (SCALP IS INTACT)
MORPHOLOGY: SKULL FRACTURE
•VAULT (TOP, ROUND SECTION THAT IS COVERED BY HAIR)
o LINEAR VS DEPRESSED
LINEAR (HAIRLINE FRACTURE – LOOKS LIKE A LINE)
DEPRESSED (BONE FRAGMENTS ARE COMPRESSING AGAINST BRAIN TISSUE)
MORPHOLOGY: SKULL FRACTURE
•___________ ___________ (BASE FORMS FLOOR OF BRAIN AND ROOF OF NOSE – FRACTURE OF CRIBIFORM PLATE) – SERIOUS HEAD INJURY
BASILAR FRACTURE
MORPHOLOGY: SKULL FRACTURE
•BASILAR FRACTURE
o WITH/WITHOUT:
PERIORBITAL ECCHYMOSIS
- DEFINE
BRUISING AROUND EYES (RACCOON EYES) CAUSED BY BLEEDING INTO THE BRAIN. IT TRICKLES DOWN AND SETTLES AROUND THE EYES
MORPHOLOGY: SKULL FRACTURE
•BASILAR FRACTURE
o WITH/WITHOUT:
MASTOID ECCHYMOSIS
- DEFINE
BRUISING BEHIND THE EAR.
MORPHOLOGY: SKULL FRACTURE
•BASILAR FRACTURE
o WITH/WITHOUT:
VII NERVE PALSY
- which nerve?
FACIAL NERVE. LOOK FOR FACIAL DROOPING
MORPHOLOGY: SKULL FRACTURE
•BASILAR FRACTURE
o WITH/WITHOUT:
CSF LEAK
- DEFINE
(CLEAR, WATERY DRAINAGE)
RHINORRHEA – DRAINAGE IN NOSE
OTORRHEA – DRAINAGE IN EARS
TRAUMATIC BRAIN INJURY CAN OCCUR BECAUSE OF A BLOW _____________ TO THE BODY
ANYWHERE
TRAUMATIC BRAIN INJURY
WHERE DOES COUP DAMAGE THE BRAIN?
DAMAGE TO BRAIN IS AT SITE OF IMPACT
TRAUMATIC BRAIN INJURY
WHERE DOES CONTRECOUP DAMAGE THE BRAIN?
DAMAGE IS AT SITE OF IMPACT AS WELL AS OPPOSITE SIDE OF BRAIN
TRAUMATIC BRAIN INJURY
WHERE DOES FOCAL BRAIN DAMAGE OCCUR?
IN ONE AREA OF THE BRAIN
TRAUMATIC BRAIN INJURY
WHERE DOES DIFFUSE BRAIN DAMAGE OCCUR?
WIDESPREAD
TRAUMATIC BRAIN INJURY
_____________ HEMORRHAGE: FOCAL INJURY. BLEEDING IN A SPECIFIC AREA OF THE BRAIN.
CEREBRAL
TRAUMATIC BRAIN INJURY
_____________ HEMATOMA: BLEEDING INSIDE OF THE ENCLOSED, EPIDURAL SPACE
EPIDURAL
MIDDLE ___________ ARTERY TEARS CAN CAUSE THE EPIDURAL HEMATOMA.
THE BLOOD HAS NOWHERE TO GO SO THE PRESSURE BUILDS UP INSIDE THE BRAIN.
MENINGEAL
EPIDURAL HEMATOMA CAUSES RAPID ________________ DETERIORATION
NEUROLOGICAL
__________ HEMATOMA:
TEARING OF BRIDGING VEINS BETWEEN DURA AND BRAIN (VEINS FEED BRAIN TISSUE)
SUBDURAL HEMATOMA
SUBDURAL HEMATOMAS ARE A _________ BLEED THAN EPIDURAL BECAUSE IT INVOLVES VEINS INSTEAD OF ARTERIES
SLOWER
BRAIN MATTER SHRINKS AS WE BECOME ELDERLY, MAKING BRAIN MORE MOBILE. INCREASES LIKELIHOOD OF______________ TO THOSE BRIDGING VEINS BETWEEN DURA & BRAIN.
DAMAGE
_________________ HEMORRHAGE:
BLEEDING INTO THE SPACE BETWEEN THE ARACHNOID MATER AND PIA MATER – SUBARACHNOID SPACE
SUBARACHNOID HEMORRHAGE
SUBARACHNOID HEMORRHAGE CAN OCCUR WITHOUT TRAUMA IF _____________ BURSTS
ANEURYSM
• RISK FACTORS OF \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ HEMORRHAGE o HYPERTENSION o ANEURYSM – POUCHING OF BLOOD VESSEL. o AVM – WEAK BLOOD VESSELS o TRAUMA
SUBARACHNOID HEMORRHAGE
INCREASED INTRACRANIAL PRESSURE:
THE _____________ THE AMOUNT OF BLEEDING IN THE BRAIN, THE ______________ THE AMOUNT OF INTRACRANIAL PRESSURE.
GREATER
GREATER
INCREASED INTRACRANIAL PRESSURE:
AS THE PRESSURE ________________, THE BRAIN TISSUE IS BEING SQUISHED AND BEGINS TO HERNIATE (SQUISHED BACK DOWN THE SPINAL CORD).
INCREASES
INCREASED INTRACRANIAL PRESSURE:
AS HERNIATION PUSHES AGAINST THE BRAINSTEM (RETICULAR ACTIVATING SYSTEM – PART OF BRAIN THAT KEEPS US AWAKE) IT CAUSES LOSS OF ___________________.
CONSCIOUSNESS
HERNIATION IS A RESULT OF _____________ INTRACRANIAL PRESSURE. THE BRAIN TISSUE BEGINS TO PROTRUDE _______________ TOWARD THE BRAIN STEM.
INCREASED
DOWNWARD
CLINICAL MANIFESTATIONS OF INCREASED INTRACRANIAL PRESSURE \_\_\_\_\_\_\_\_\_ signs • IRRITABILITY, RESTLESSNESS • CHANGES IN COGNITION • DISORIENTATION, VOMITING • IMPAIRED MOTOR FUNCTION • VITAL SIGNS Within Normal Limits
EARLY SIGNS
CLINICAL MANIFESTATIONS OF INCREASED INTRACRANIAL PRESSURE \_\_\_\_\_\_\_ signs • COMA • DECORTICATE (ARMS ARE POSITIONED TOWARDS BRAIN) OR DECEREBRATE (ARMS AWAY FROM BRAIN) POSTURING • FIXED AND DILATED PUPILS • CUSHING TRIAD o INCREASED SYSTOLIC BP o WIDENING PP o BRADYCARDIA
LATE SIGNS
CONCUSSION IS A ___________ INJURY
DIFFUSE
- TEMPORARY DISRUPTION OF NEURON TRANSMISSION IN THE BRAIN
- DAMAGE IS DONE AT THE CELLULAR LEVEL. NEURONS ARE NOT FIRING IN AN ORDERLY FASHION AS THEY ARE SUPPOSED TO BE. THE NEURONS BECOME SWOLLEN AND THIS INTERFERES WITH NERVOUS IMPULSES.
CONCUSSION
S&S OF CONCUSSION MAY NOT BE _______________
IMMEDIATE
CONCUSSIONS
HEALING RATE IS __________. AS LONG AS THE PERSON IS _____________, THEY SHOULD REST THEIR BRAIN.
VARIABLE
SYMPTOMATIC
PERSONS WHO HAVE REPEATED CONCUSSIONS AND HAVE NOT HAD A CHANCE TO HEAL, AND GET ANOTHER CONCUSSION. INCREASES RISK FOR _________ ________ OF __________
EARLY ONSET OF DEMENTIA
CONCUSSION DAMAGE IS NOT A VISIBLE AS ________ INJURY
FOCAL
_____________ CLINICAL MANIFESTATIONS OF CONCUSSION
o LOSS OF CONSCIOUSNESS (MAY OR MAY NOT OCCUR)
o POOR COORDINATION
o SLOW COGNITION
o TROUBLE FOLLOWING DIRECTIONS
o TROUBLE CONCENTRATING, READING, PROCESSING
o HEADACHE
o DIZZINESS
o NAUSEA
o DO NOT FEEL RIGHT
o AMNESIA
PHYSICAL
______________ CLINICAL MANIFESTATIONS OF CONCUSSION
o MEMORY DISTURBANCES
o TROUBLE UNDERSTANDING
COGNITIVE
\_\_\_\_\_\_\_\_\_\_\_\_\_\_ CLINICAL MANIFESTATIONS OF CONCUSSION o MAY HAVE OUTBURST o INSOMNIA o DEPRESSION o MOODY
EMOTIONAL
SET OF SYMPTOMS THAT MAY CONTINUE FOR WEEKS, MONTHS, OR OCCASIONALLY A YEAR OR MORE AFTER A CONCUSSION
POST-CONCUSSION SYNDROME
ENCEPHALOPATHY (PERMANENT DAMAGE TO BRAIN) AND STRUCTURAL BRAIN DAMAGE FROM REPEATED CONCUSSIONS.
DEMENTIA PUGLISTICA
- GRADING SYSTEMS (GRADES 1 – 4)
* SPORTS CONCUSSION ASSESSMENT TOOL – 3RD EDITION
ASSESSMENT OF CONCUSSION
MOST SERIOUS GRADE OF CONCUSSIONS ACCORDING TO THE GRADING SYSTEM (GRADES 1-4)
grade 4
SPINAL NERVES:
C1-C8 CERVICAL SPINE SUPPLIES - 4
UPPER ARMS, HEAD, NECK & DIAPHRAGM
SPINAL NERVES:
T9-T12 THORACIC SPINE SUPPLIES - 2
CHEST AND ABDOMINAL MUSCLES
SPINAL NERVES:
L1-L5 LUMBAR SUPPLIES - 1
LOWER LEGS
SPINAL NERVES:
S1-S5 SACRAL – INNERVATES - 2
THE PERINEUM, BLADDER
SPINAL CORD IS COVERED BY THE SAME 3 LAYERS OF MENINGES THAT COVER THE ____________
BRAIN
SPINAL CORD INJURY CAN BE THE RESULT OF ___________ OR ___________
INJURY OR DISEASE
POINT AT WHICH SPINAL CORD IS DAMAGED IS CALLED A _____________
LESION
SPINAL CORD INJURY:
CONTUSION VS TRANSECTION
CONTUSION - BRUISING
TRANSECTION - CORD HAS BEEN CUT (VERY RARE)
SPINAL CORD INJURY:
AT TIME OF INJURY, IF THERE IS PARALYSIS IT IS CONSIDERED A __________ INJURY.
COMPLETE INJURY
.
SPINAL CORD INJURY:
______________ INJURY – PERSON STILL HAS SOME SENSORY FUNCTION. INITIALLY, THERE IS LOSS OF FUNCTION. CHANCE OF RETURN OF NORMAL FUNCTION ONCE THE INFLAMMATION AND BRUISING GOES DOWN
INCOMPLETE INJURY
______________ IS MOST VULNERABLE BECAUSE IT IS THE MOST MOBILE.
C-SPINE
_____________ SPINAL CORD INJURY
• HYPERFLEXION – HEAD IS FORCED FORWARD. DAMAGE TO POSTERIOR LIGAMENTS THAT KEEP SPINAL CORD IN ALIGNMENT.
• HYPEREXTENSION – HEAD IS FORCED BACKWARD. DAMAGE TO ANTERIOR LIGAMENTS.
• COMPRESSION – WHEN SPINAL CORD IS COMPRESSED. CAN SHATTER BONES OF VERTEBRAE, THE FRAGMENTS ARE SHARP AND THEY RUN THE RISK OF TRANSECTING THE CORD.
• ROTATION – HEAD SPINS. CAN DAMAGE THE SPINE AS WELL.
PRIMARY
_____________ SPINAL CORD INJURY
BODY TRIES TO REPAIR THE DAMAGE THROUGH INFLAMMATION WHICH CAUSES SECONDARY DAMAGE.
1. OXIDATIVE STRESS – NEUTROPHILS CREATE FREE RADICALS THAT CAN DAMAGE SPINAL CORD
2. CYTOKINES – MATURE HELPER T CELLS & MACROPHAGES (TYPE OF CYTOKINE) WILL CAUSE FURTHER DAMAGE
3. EXCITOTOXICITY – GLUTAMATE, A NEUROTRANSMITTER, AND ALTERS SODIUM & POTASSIUM PUMP WHICH CAN CAUSE FURTHER DAMAGE TO THE SPINAL CORD.
SECONDARY
TYPES OF SHOCK IN NEUROLOGICAL SECTION (2)
SPINAL
NEUROGENIC
MORE DETAIL FOR SHORT ANSWER
WHICH SPINAL CORD INJURY
• HYPERREFLEXIA
• OVERACTIVITY OF THE AUTONOMIC NERVOUS SYSTEM CAUSED BY AN IRRITANT BELOW THE LEVEL OF THE LESION. MOST COMMON IN PEOPLE WITH INJURIES ABOVE T6.
**REQUIRES PROMPT ATTENTION
AUTONOMIC DYSREFLEXIA
CLINICAL MANIFESTATIONS OF \_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ HYPERTENSION HEADACHE FLUSHED FACE DIAPHORESIS ABOVE THE LEVEL OF INJURY GOOSE FLESH BELOW LEVEL OF INJURY
AUTONOMIC DYSREFLEXIA
AUTONOMIC DYSREFLEXIA CAN RESULT IN BURST ______ __________ IN BRAIN
BLOOD VESSEL
AUTONOMIC DYSREFLEXIA CAN OCCUR BECAUSE OF ____________ ___________ OR _________________
URINARY RETENTION OR CONSTIPATION
WHICH CEREBROVASCULAR DISEASE ?
DISEASE OF CEREBRAL BLOOD VESSELS RESULTING IN IMPAIRED CEREBRAL PERFUSION (DISORDER OF BLOOD VESSELS THAT DAMAGES THE BRAIN TISSUE)
CEREBROVASCULAR ACCIDENT (CVA)
CEREBROVASCULAR ACCIDENT (CVA) _______ _________:
o FAMILY HISTORY, AGE
o SMOKING, DYSLIPIDEMIA
o HYPERTENSION, DIABETES
RISK FACTORS
80% OF CVA’S ARE _____________
ISCHEMIC
TYPES OF ____________________ ____________
ISCHEMIA
HEMORRHAGIC
TRANSIENT ISCHEMIC ATTACK (TIA)
CVA
WHICH TYPE OF CVA?
o BLOOD CLOT OCCLUDES BLOOD VESSEL OF BRAIN. ALL TISSUE DISTAL DOES NOT RECEIVE OXYGEN. IT BECOMES ISCHEMIC AND DIES.
o SYMPTOMS ARE PERMANENT
ISCHEMIC CVA
WHICH TYPE OF CVA?
BLOOD VESSEL HAS BURST CAUSING BLEEDING INTO THE BRAIN.
o EX. SUBARACHNOID HEMORRHAGE.
o SYMPTOMS ARE PERMANENT
HEMORRHAGIC CVA
TYPE OF CVA?
TEMPORARY REDUCTION OF BLOOD FLOW TO THE BRAIN
o TEMPORARY SYMPTOMS & RESOLVES SHORTLY
HEADACHE
ONE SIDED WEAKNESS, DIZZINESS
FACIAL DROOPING
SLURRED SPEECH
o CAN BE A WARNING STROKE IS IMMINENTTRANSIENT ISCHEMIC ATTACK (TIA)
ETIOLOGY OF _____________ STROKE:
•LARGE VESSEL DISEASE
o ATRIAL FIBRILLATION CAN CAUSE STROKE
o CARDIOEMBOLISM
o ATHEROSCLEROSIS – PLAQUE IN BLOOD VESSELS
•SMALL VESSEL DISEASE (LACUNAR INFARCT) – VESSELS DEEP IN VEINS
ISCHEMIC STROKE
DEFINITION - STROKE THAT OCCURS IN YOUNG PERSONS WITH NO RISK FACTORS
CRYPTOGENIC
DEFINITION - AREAS OF CELLS THAT ARE STILL ALIVE AND VIABLE IN REFERENCE TO STROKE.
PENUMBRA
____________ STROKE IS CHARACTERIZED BY ACUTE ISCHEMIA IN AREA OCCLUDED BY THROMBUS/EMBOLUS SURROUNDED BY VIABLE CELLS (PENUMBRA)
ISCHEMIC
PENUMBRA REMAINS VULNERABLE AS IT WILL DIE WITH FURTHER _______________
DEOXYGENATION
TREATMENT OF ____________ STROKE:
TISSUE PLASMINOGEN ACTIVATOR (T-PA) WHEN ADMINISTERED WITHIN 4.5 HOURS FROM WHEN “LAST SEEN NORMAL”
o DISSOLVES CLOT
ISCHEMIC
ISCHEMIC STROKE
TISSUE PLASMINOGEN ACTIVATOR (T-PA) WHEN ADMINISTERED WITHIN _____ HOURS FROM WHEN “LAST SEEN NORMAL”
4.5
HEMORRHAGIC STROKE - ____________ INTO THE BRAIN
BLEEDING
ETIOLOGY OF HEMORRHAGIC STROKE:
_______________ – BLOOD VESSEL BURSTS LEADS TO BRAIN BLEED
PRIMARY
ETIOLOGY OF HEMORRHAGIC STROKE:
_______________ – UNDERLYING VASCULAR ABNORMALITIES (DISORDERS OF BLOOD VESSELS THAT CAN LEAD TO BLEEDING INTO THE INFARCTED SITE)
SECONDARY
_________________ IS THE MOST COMMON CAUSE OF PRIMARY HEMORRHAGIC STROKE!
HYPERTENSION (75%)
TREATMENT OF ____________ STROKE:
TO DO CAT SCAN, HAVE NEUROSURGEON SEE IT, AND SEE IF THEY CAN REPAIR IT.
HEMORRHAGIC
*CANNOT GIVE CLOT BUSTING MEDS, IT WILL MAKE BLEEDING WORSE
DEFINITION – PARALYSIS IS ON OPPOSITE SIDE BRAIN IS AFFECTED. DYARTHRIA, DYSPHAGIA, SEIZURES, VISUAL IMPAIRMENT, HEADACHES, ETC…
CONTRALATERAL PARALYSIS
Signs & Symptoms OF ____________
* dysarthria * dysphagia * paralysis * seizures * hemiplegia: paralysis on one-side of body (usually opposite side of lesion)
STROKE
_______________ OF STROKE:
* effects of stroke are permanent * effects of TIA are not permanent but can be a warning sign * paralysis * skin breakdown * loss of speech
Complications
INFECTION:
____________________
• INFLAMMATION OF THE LEPTOMENINGES & SUBARACHNOID SPACE
• MAY OCCUR SECONDARY TO PARANASAL SINUS OR EAR INFECTION
MENINGITIS
INFECTION:
_________________ - CLINICAL MANIFESTATIONS:
o HEADACHE
o FEVER
o PHOTOPHOBIA
o NUCHAL RIGIDITY – STIFF NECK,
o BRUDZINSKI’S SIGN – WHEN NECK IS FLEXED FORWARD THE HIP AND KNEE AUTOFLEX
o KERNIG’S SIGN – PERSON IS LYING ON THEIR BACK WITH HIPS FLEXED WHEN TRYING TO EXTEND LEG IT CAUSES MORE PAIN, AND CEREBRAL DYSFUNCTION
o TACHYPNEA
o SEIZURES
o CRANIAL NERVE INVOLVEMENT
MENINGITIS
EVALUATION OF MENINGITIS IS DONE VIA ______________ ______________
LUMBAR PUNCTURE
TREATMENT OF MENINGITIS INVOLVES __________________ & ________________
ANTIBIOTICS, CORTICOSTEROIDS
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ OF MENINGITIS: o HYDROCEPHALUS o HEADACHE o SEIZURES o DEAFNESS o PERSONALITY CHANGES o LANGUAGE DEFICITS o MOTOR WEAKNESS o ENDOCARDITIS o PNEUMONIA o DISSEMINATED INTRAVASCULAR COAGULOPATHY (DIC)
COMPLICATIONS
IF MENINGITIS IS LEFT UNTREATED A PERSON CAN HAVE _______________ & ______
SEIZURES & DIE
DEFINITION – INFLAMMATION OF THE BRAIN
ENCEPHALITIS
_______ ________ VIRUS is a form of encephalitis
West Nile Virus
WHICH INFECTIVE NEUROLOGICAL DYSFUNCTION:
S&S
o FEVER, HEADACHE, NAUSEA
o USUALLY SELF-LIMITING BUT CAN PROGRESS TO COMA AND DEATH
o INCREASED RISK IN ELDERLY & THOSE WITH CHRONIC ILLNESS
ENCEPHALITIS
________________ NEUROLOGICAL DISEASES
ALZHEIMER'S HUNTINGTON'S DISEASE PARKINSON'S DISEASE AMYOTROPHIC LATERAL SCLEROSIS GUILLAIN BARRE SYNDROME MULTIPLE SCLEROSIS
DEGENERATIVE
DEMENTIA IS NOT A DISEASE, IT IS A \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ IN MEMORY & COGNITIVE SKILLS SUCH AS: o MEMORY o COMMUNICATION AND LANGUAGE o ABILITY TO FOCUS AND PAY ATTENTION o REASONING AND JUDGMENT o VISUAL PERCEPTION
DECLINE
DEMENTIA CAN SOMETIMES BE ______________
REVERSIBLE
TYPES OF ______________:
o ALZHEIMER’S DISEASE
o VASCULAR DEMENTIA
DEMENTIA
DEFINITION - DISEASE THAT LEADS TO DEMENTIA
ALZHEIMER’S DISEASE
ALZEIMER’S DISEASE IS NOT ______________ & IS NOT PART OF NORMAL AGING.
REVERSIBLE
TWO MAJOR FEATURES OF ALZEIMER’S
o _________________ TANGLES
o ________ DEPOSITS
NEUROFIBRILLARY
PLAQUE
PATIENTS WITH ALZHEIMER’S HAVE ABNORMAL ____ PROTEIN. IT ACCUMULATES AS DEPOSITS OF PLAQUE.
TAU
RISK FOR \_\_\_\_\_\_\_\_\_\_\_ DISEASE o AGE o GENETICS o FEMALE GENDER o CARDIOVASCULAR DISEASE o DIABETES o DOWN SYNDROME o HEAD INJURY o OTHER
ALZHEIMER’S
WHICH DEGENERATIVE NEUROLOGICAL DISEASE?
AUTOSOMAL DOMINANT TRAIT – GENETIC DEFECT ON CHROMOSOME 4 (INHERITED DISEASE)
HUNTINGTON’S DISEASE
HUNTINGTON’S DISEASE
INDIVIDUAL HAS A _____% CHANCE OF INHERITING THE GENE FROM THEIR PARENTS. IF THEY INHERIT THE GENE THEY WILL GET THE DISEASE
50%
CLINICAL MANIFESTATIONS OF HUNTINGTON’S DISEASE
MOVEMENT DISORDER
HUNTINGTON’S _________ – MOVING IN A RHYTHMIC TYPE OF FASHION
CHOREA
CLINICAL MANIFESTATIONS OF ___________ DISEASE
o DEMENTIA
o IRRITABLE, ANGRY
o EMOTIONAL DISTURBANCES
o TELL PEOPLE OFF
HUNTINGTON’S
HUNTINGTON’S DISEASE
DEATH USUALLY OCCURS YOUNG AS A RESULT OF _____________ INFECTION
SECONDARY
DOPAMINE PLAYS A ROLE IN ____________
POSTURE
DOPAMINE DEFICIENCY CAUSES RESTING ________ AND ______________ GAIT
TREMORS
SHUFFLING
CLINICAL MANIFESTATIONS OF \_\_\_\_\_\_\_\_\_\_\_\_ DISEASE o RIGIDITY, TREMOR, STOOPED POSTURE, o COGWHEEL RIGIDITY, BRADYKINESIA, o PROPULSIVE/RETROPULSIVE GAIT, o MASKLIKE FACIAL EXPRESSION, o DYSARTHRIA, DYSPHAGIA
PARKINSON’S DISEASE
PROGRESSIVE DEGENERATION OF UPPER MOTOR NEURONS IN CEREBRAL CORTEX AND LOWER MOTOR NEURONS IN BRAIN STEM AND SPINAL CORD.
DEATH USUALLY OCCURS WITH 3-5 YEARS
• occurs in CENTRIPETAL DIRECTION (FINGERS TO ARMS)
• PROGRESSIVE MUSCLE WASTING AND ATROPHY OF HANDS, ARMS AND LEGS
• PATIENTS MAINTAIN SENSORY AND COGNITIVE FUNCTION
AMYOTROPHIC LATERAL SCLEROSIS
AKA LOU GEHRIG’S DISEASE
WHICH DEGENERATIVE NEUROLOGICAL DISORDER?
CAN OCCUR AFTER A VIRAL INFECTION. IMMUNE SYSTEM ATTACKS ITSELF AND CAUSES DEMYELINATION IN PNS.
• FOLLOWS VIRAL INFECTION
GUILLAIN BARRE SYNDROME
WHICH DEGENERATIVE NEUROLOGICAL DISORDER?
• CHARACTERIZED BY ASCENDING PARALYSIS
• PARESTHESIA (PINS & NEEDLES) BEGINS IN FEET WORKS ITS WAY UP LEGS, ATAXIA, BLURRED VISION, DYSPHAGIA, DYSPNEA, RESP FAILURE
• CAN BE REVERSIBLE IF TREATED EARLY & AGGRESSIVELY BUT RECOVERY TAKES SOME TIME (SEVERAL MONTHS)
o TREATED WITH IMMUNOGLOBINS TO FIGHTS ANTIGENS THAT ARE TRYING TO DAMAGE PNS
GUILLAIN BARRE SYNDROME
WHICH DEGENERATIVE NEUROLOGICAL DISORDER?
- PROGRESSIVE DEMYELINATION OF THE CNS – SLOWS NEURONS SIGNAL
- CAN BE AUTOIMMUNE AS WELL
- ONSET: 20-40 YEARS; FEMALES>MALES; TEMPERATE CLIMATE; 15% HAVE AFFECTED RELATIVE; ABNORMAL IMMUNE RESPONSE
MULTIPLE SCLEROSIS
WHICH DEGENERATIVE NEUROLOGICAL DISORDER?
- CHARACTERIZED BY REMISSIONS & EXACERBATIONS
- CLINICAL MANIFESTATIONS: FATIGUE, DIPLOPIA, ATAXIA, IMBALANCE, UNCOORDINATED GAIT, BLURRED VISION, PROGRESSIVE PARALYSIS
- VARIES DEPENDING ON INDIVIDUALS
MULTIPLE SCLEROSIS
WHICH DEGENERATIVE NEUROLOGICAL DISORDER?
• CHRONIC DISEASE WITH FLAIR UPS SUCH AS:
o PAROXYSMAL ATTACKS
• EVALUATION AND TREATMENT
o NO CURE
o LIMIT EXTENT OF DAMAGE AND SLOW DISEASE PROGRESSION
MULTIPLE SCLEROSIS
DEVELOPMENTAL ERRORS:
• NONPROGRESSIVE, PERMANENT ENCEPHALOPATHY OCCURRING PRENATALLY, PERINATALLY, OR POSTNATALLY
CEREBRAL PALSY
ALL TYPES OF CEREBRAL PALSY EFFECTS _______ FUNCTION
MOTOR
CEREBRAL PALSY CAN CAUSE SEVERE MENTAL _________ OR NONE AT ALL
DEFICITS
HYDROCEPHALUS – ACCUMULATION OF ______________ INSIDE VENTRICLES IN BRAIN
WATER
HYDROCEPHALUS CAN DEVELOP AFTER ________________
MENINGITIS
THE AQUEDUCT THAT NORMALLY DRAINS CEREBRAL SPINAL FLUID BECOMES _________ & COLLECTS FLUID CAUSING HYDROCEPHALUS.
BLOCKED
TREATMENT OF HYDROCEPHALUS:
• A _________ IS INSERTED TO DRAIN THE VENTRICLES INTO THE PERITONEAL CAVITY.
o MUST BE CAREFUL NOT TO DEVELOP HEAD INJURY
o MAY DEVELOP SEIZURES
SHUNT
WHEN NECK IS FLEXED FORWARD THE HIP AND KNEE AUTOFLEX
o BRUDZINSKI’S SIGN –
PERSON IS LYING ON THEIR BACK WITH HIPS FLEXED WHEN TRYING TO EXTEND LEG IT CAUSES MORE PAIN, AND CEREBRAL DYSFUNCTION
o KERNIG’S SIGN –
