Week 2: Neuro Flashcards
most common cause of brain trauma
mvc & falls
brain trauma severity measured by the
glasgow coma scale
glasgow coma scale
mild (gcs 13-15)
moderate (gcs 9-12)
severe (gcs 3-8)
blunt tbi types
concussion epidural subdural subarachnoid intracerebral hemorrhage
penetrating tbi types
missiles
fractures
mild concussion characteristics
Immediate clinical manifestations with no LOC or LOC that is less than 30 min
GCS is 13-15
Mild retrograde amnesia may exist for <24 hours
May be no diagnostic imaging evidence
Headache, attention deficit, dizziness
moderate concussion characteristics
LOC >30 min
Amnesia lasting 24 hours or more
GCS 8-13
Basal skull fracture may be present but no brain stem injury
Transitory decerebration or decortication with unconc.
Confusion, may have permanent deficits, vision
severe concussion characteristics
GCS <8
Associated with brainstem injury (pupillary reaction, cardiac and resp symptoms)
LOC may last >24 hours
Immediate autonomic dysfunction that may last weeks
Increased ICP
Severe compromised coordination
physical consequences of DAI
spastic paralysis, peripheral nerve injury, dysphagia, dysarthria, hearing and vision, taste and smell
cognitive consequences of DAI
disorientation, confusion, dyspasia, poor judgement
behavioural consequences of DAI
agitation, blunted affect, impulsiveness, social withdrawal, depression
clinical manifestations of epidural hematomas
Loss of consciousness -> period of lucidity -> inc. headache, vomiting, drowsiness, seizure, hemiparesis, if temporal lobe herniation begins - ipsilateral pupillary dilation
spinal cord injury patho
- Vertebral injuries d/t acceleration, deceleration, or deformation injuries
- Injure tissues through compression, exerting tension or traction, or shearing tissues through hyperextension, hyperflexion vertical rotation of the spine
- Classified into:
simple fracture, compressed fracture, comminuted fracture (burst or shattered) or dislocation
spinal cord injuries occur mostly at
C1-2, C4-7, T1-L2
SCI Clinical Manifestations
- All motor, sensory, reflex and autonomic functions cease below level of transected area and also may cease with concussive, contused, compressed or ischemic areas
- Paraplegia, quadraplegia
- Return of spinal neuron excitability occurs slowly
hyperrflexia occurs
any time after spinal shock ceases
hyperrflexia sx
Hypertension, pounding headache, blurred vision, sweating above level of lesion, nasal congestion, nausea, bradycardia
spinal cord injury dx and tx
dx made by physical, radiologic, and myelographic exam
tx includes immobolizing the spine, surgical decompression and stabilization, and corticosteroids
primary brain tumor types
intracerebral and extracerebral
intracerebral tumor types
astrocytoma
glioblastoma multiforme
pituitary adenoma
extracerebral tumor types
meningioma
neurofibroma
astrocytoma
arises from astrocytes
relatively slow growing
glioblastoma multiforme
from more mature glial cells
rapidly growing
pituitary adenoma
from pituitary cells
resulting in secreting tumour
meningioma
from arachnoid cells
problems due to location
neurofibroma
arises from schwann cells
nerve sheath
cva risk factors
Arterial hypertension ( systolic & diastolic) Smoking Diabetes Insulin resistance Polycythemia and thrombocythemia Impaired cardiac function Atrial fibrillation
ischemic stroke cause
arterial occlusions due to thrombi in the brain
transient ischemic attacks
intermittent blockage - all neurologic deficits completely clear within 24 hours
completed stroke
CVA that has reached its maximum destructiveness in producing neurologic deficits
embolic stroke
involves fragments of thrombi from outside the brain
hemorrahagic stroke
from hypertension, ruptured aneurysms, bleeding into a. tumor, bleeding disorders, head trauma, illicit drug use
subarachnoic hemorrahagic stroke
uncontrolled bleeding on surface of the brain
intracerebral hemorrahagic stroke
an artery deep in the brain ruptures, usually due to increased BP
cerebral infarction patho processes
global and focal
global process
affects neurons most susceptible to ischemia
focal process
central zone of cell loss surrounded by a zone of injured cells that could survive if reperfused in one hour
hemorrhagic infarcts result from
reperfusion d/t resumption of blood flow
cerebral hemorrhage primary cause
hypertension, bleeding precipitated by aneurysms in smaller vessles or arteriolar necrosis, mass of blood forms
CVA dx and tx
dx through CT and CM
tx through drug therapy to prevent further thrombotic events, augments blood flow, reperfuses tissues and protects neurons
thrombotic strokes tx
controlling cerebral edema and increasing ICP
embolic strokes tx
preventing further emboli
seizures description and characteristics
sudden explosive disorderly discharge of cerebral neurons characterized by sudden transient alteration in brain function
conditions associated with seizures
cerebral lesions, biochemical disorders, cerebral trauma, epilepsy
seizure triggers
hypoglycemia fatigue emotional or physical stress febrile illness excess H2O ingestion constipation use of stimulant drugs withdrawal from depressant drugs hyperventilation environmental stimuli
generalized seizures
bilateral neuron involvement, general onset, originate from subcortical or deeper brain focus, impaired or lost consciousness
partial seizures
unilateral neuron involvement, originate from cortical brain tissue, maintain consciousness if only unilateral, but may become generalized
status epilepticus
multiple seizures without regaining consciousness or seizure lasting >30 minutes
epileptogenic focus
group of neurons with more permeable plasma membranes that are hypersensitive to stimuli like hyperthermia, hypoxia, hypoglycemia
seizures dx
- health history
- PE & lab tests to look for systemic diseases that can cause seizures
- rule out neuro diseases
- EEG to assess type of seizure and identify cause
seizures tx
correct or control cause of seizure
Drugs to suppress seizure without intolerable side effects
Social stigma/family and client counselling
meningitis
Infection of meninges caused by bacteria, virus, fungi, or parasites
In CSF through the subarachnoid space
Starts elsewhere in body and crosses blood brain barrier
Meningococcus and steptococcus most common
Fever chills, petechial rash, neck stiffness
multiple sclerosis
Demyelinating disease with white matter plaques
Relapsing, remitting most common
Primary and secondary progressive types also
Steroids acutely, interferon chronically
myasthenia gravis
Insidious onset with progressive muscle weakening
Diagnosed with Tensilon test and antibody assay
EMG is diagnostic
Steroids, anticholinesterase drugs, immunosuppressants such as azothiprine or cyclosporine used
guillain barre syndrome
Acquired inflammatory disease that results in demyelination of peripheral nerves
Almost always preceded by viral illness, often mild
Starts with leg paralysis and goes to entire body
Treatment is supportive with ventilation common
alzheimer’s disease
Dementia disease characterized by global progressive loss of cognitive mental function
Pathophysiology not understood but neurofibrillary tangles seen microscopically and neuritic plaques
Diagnosis is clinical
parkinson’s disease
Degenerative disease of dopamine pathway in the substantia nigra
Primary and secondary
Secondary due to trauma, infection, or neoplasm
Usually after age 40, peaking in onset around 60
