9- Neurology Flashcards
(111 cards)
1
Q
Add types of
A
Seizures
2
Q
CNS
A
Central nervous system, responsible for: Thought Perception Feeling Autonomic body functions
3
Q
PNS
A
Peripheral nervous system, responsible for:
Transmitting commands from brain to body and receiving feedback from the body
4
Q
What are the parts of the brain (7)
“Oh please to find like that helps”
A
Occipital lobe Parietal lobe Temporal lobe Frontal lobe Limbic system Thalamus (Diencephalon) Hypothalamus (Diencephalon)
5
Q
What are the parts of the Brain Stem
A
Mid brain
Pons
Medulla Oblongata
6
Q
What are the parts of the PNS
A
Cranial nerves
Peripheral nerves
7
Q
Parts of a neuron (5)
A
Cell body Axon Dendrite Synapse Neurotransmitter
8
Q
Occipital lobe role
A
-Vision and storage of visual memories
9
Q
Parietal lobe role
A
- Touch and texture
- Storage of tactile memories
10
Q
Temporal lobe role
A
- Hearing and smell
- Language
- Storage fo sound and odor memories
11
Q
Frontal lobe role
A
- Motor cortex- Voluntary muscle control, storage fo spatial memories
- Prefrontal cortex- Judgement and prediction of consequences, abstract intellectual functions
12
Q
Limbic System role
A
- Basic emotion
- Basic reflexes (chewing, swallowing)
13
Q
Thalamus (Diencephalon) role
A
-Prioritize signals to hone in on important messages
14
Q
Hypothalamus (Diencephalon) role
A
- Emotions
- Temperature control
- Interface with endocrine system
15
Q
Midbrain role
A
- LOC
- Home of reticular activating system (RAS), which controls arousal and consciousness
- Muscle tone and posture
16
Q
Pons role
A
-Respiratory pattern and depth
17
Q
Medulla oblongata role
A
- Pulse rate and BP
- Respiratory rate
18
Q
Spinal cord role
A
- Reflexes
- Relay info to and from body
19
Q
Cranial nerves role
A
-Special peripheral nerves that connect directly from brain to body parts, send information to the brain
20
Q
Peripheral nerves role
A
-Receive stimulus to body, send commands to body
21
Q
Neuron cell body role
A
Home to nucleus and site of protein synthesis
22
Q
Axon role
A
Projection from cell body to other neurons or organs and sends messages
23
Q
Dendrite role
A
Projection from cell body that receives signals from axons
24
Q
Synapse
A
Gap between an axon and dendrite
25
Neurotransmitter role
Chemical released by synapse that helps make the connection between one neuron and another
26
Decorticating posturing
| Effected part
Abnormal flexion, armors contracted towards chest
-Maybe damage to area directly below cerebral hemispheres
27
Decerebrate posturing
| Effected part
Abnormal extension, arms extended outward, palms probated, wrists flexed
Damage is near the brainstem
28
What cranial nerves are responsible for airway control
Trigeminal
Glossopharyngeal
Vagus
Hypoglossal
29
What is trismus
Tightly clenched teeth
30
Myelin is what color; white or grey?
WHITE
31
What do unmyelinated axons control
Gross motor function
32
What do myelinated axons control and another name for them
Fine motor skills
Schwann cells
33
Nodes of Ranvier
Allow impulse to jump from node to node for more rapid conduction
34
What is the pre synaptic neuron
The end of one neuron
35
What is the post synaptic neuron
The beginning of a neuron
36
Reflex process
- Initiate in PNS
- Synapse with Interneurons in CNS
- Interneurons synapse with motor neurons
- Motor neurons send out axons
37
What provides blood to the brain
2 carotid arteries, 80% of blood to brain
| 2 vertebral arteries, for basilar artery
38
Circle of Willis
Encircles pituitary
| -A back up if carotids are blocked
39
Cerebrum and its role
Largest portion of brain, has left and right hemispheres
Thought, personality, mood, memory, intelligence
40
Cerebellum and its role
In posterior fossa of cranium, closely related to brain stem and higher brain centers
Spatial coordination, fine motor movement, muscle tone
41
How to measure CPP
CPP = MAP - ICP
42
Normal CPP range
50-160 mmHg
43
Critical CPP range
Below 40
44
Unconscious patient means what
Provide an airway
45
What does Cushings triad identify and the signs of it
Early stages of increased ICP
Increased systolic pressure
Widening pulse pressure
BradyC
Abnormal respirations
46
Hyperpnea and causes
Rapid, regular, deep respirations
Causes- Stimulants, OD, exercise
47
Cheyne-Stokes and causes
Crescendo, decrescendo with apnea
Causes- Brain stem injury, pre death pattern
48
Biots/Ataxic and causes
Irregular with periods of apnea
Causes- Brain stem injury
49
What are hallmark signs of ICP
```
Cushing reflex
Posturing
Biots
Apneustic
Cheyne-Stokes
Unresponsive with dilated pupils or anisocoria
```
50
Unreactive dilated pupils indicate what
Brain stem injury
51
What should be considered if pupils are constricted
Narcotic overdose
52
What does anisocoria indicate
Increased ICP
53
What is a conjugate gaze
Deviation of both eyes in the same directions
54
What is dysconjugate gaze
Deviation of eyes to opposite directions, brain stem conduction problem
55
What are the causes of Coma (AEIOUTIPS)
```
Alcohol/acidosis
Epilepsy
Infection
Overdose
Uremia
Trauma
Insulin
Psychosis
Stroke
```
56
What is a structural coma
| -Causes
Focal (asymmetrical) signs
Rapid onset
Unresponsive pupils
- Trauma
- Intracranial bleed
- Tumor
57
Toxic metabolic coma
| -Causes
Symmetrical signs, slow onset, present pupil response
Causes- Hypo/Hyperglycemia, Kidney/Liver failure, Postictal, anoxia
58
Coma management
ABC’s
No gag reflex = Intubate
BGL
Narcan
59
Ischemic stroke
From atherosclerosis or tumor, block blood flow to the brain
Develops slowly
60
Hemorrhagic stroke
From aneurysm, HTN, bleeding within the brain
Develops quickly and will get worse
61
Transient Ischemic Attack (TIA)
Last minutes to hours
Mini strokes
Same S/S as ischemic strokes, may improve though
62
Stroke S/S
- Unilateral weakness/paralysis of face, opposite side extremity
- Abnormal speech
- Headache
- Drooling
- Numbness of face
Can cause seizures
63
Cincinnati Stroke scale components
Facial droop
Arm drift
Speech
64
Stroke management
- ABC’s
- Head elevated 15 degrees
- BGL and vitals
- Fluid only if hypotensive
65
Seizure triggers
- Specific time of day
- Sleep deprivation
- Fever or illness
- Flashing lights
- Drugs/Alcohol
- Stress
- Menstrual cycle
- HypoGlycemia
- Specific foods
66
Focal seizure
Begins on one side of brain
67
Generalized seizure
Both sides of the brain
68
Motor seizure
Change in muscle activity
- Clonic = Jerking
- Tonic = Stiffness
- Loss of muscle tone = Atonic
- Automatism = Repetitive movement
69
Non-motor seizure
- Vitals change
- Behavior change
- Cognitive change
- Emotional change
- Sensory change
70
Focal onset seizure
| Awareness vs Impaired awareness
Awareness- Most common, usually <2min
-At risk for head injury, brain infection, stroke, brain tumor
Impaired awareness- Pt unaware, aura before, includes automatisms, usually 1-2 minutes
-Same risks as awareness
71
Focal to Bilat Tonic Clonic
- Starts in one area on one side, then both sides
- Sometimes dont remember beginning of seizure
- Focal <1 min
- Tonic-clonic 2 to 3 min, but rare
72
Myoclonic seizure
Shock like jerking
73
Gelastic seizure
Imitates laughter
74
Dacrrtystic seizure
Imitates crying
75
Refractory seizure
Frequency and severity interrupts quality of life
- Different seizure types throughout the day
- Chronic problem
76
Tonic-Clonic seizures (Grand Mal) steps
1. Loss of consciousness
2. Tonic phase: Rigid
3. Hypertonic: Ached back, rigid
4. Clonic phase: Vfib in the brain
5. Post seizure, muscles relax, nystagmus
6. Postictal
77
Signs of Postictal phase
- Initially aphasic (unable to speak)
- Confused
- Emotional
- Tired
- Headache
- Gradual return to normal
78
Psuedoseizures
| -Explain
The same as Tonic Clonic seizures however the root is psychogenic, most cases it is unintentional
-Usually display with “organized” movement
79
Absence seizures (Petit mal seizures)
Stops all activity and freezes up, last no more than several seconds, no postictal period, typically in children
80
Partial seizure
- Effect limited portion of the brain, can effect one part then spread
- Considered simple partial or complex partial
81
What is Jacksonian march
Seizure begins in one area (hand) and moves to the next (arm) then next (shoulder) and continues
82
Seizure management steps
1. Determine concern for trauma, inline stabilization if suspect
2. History
3. Do not restrain or prevent movement, dont place anything in patients mouth
4. Provide ventilation for >30 sec apnea
5. Place padding on cot to prevent injury
83
Status epilepticus
| -The goal
Seizure lasting more than 4-5 min or consecutive seizures without regaining consciousness in between
- It IS life threatening
- Can damage or kill neurons
-Stop the seizure and ensure ABC’s
84
Status epilepticus Treatment
Benzos
Airway
Sedate and paralyze for airway ONLY if needed
85
Seizures Physical exam (9)
- Head/neck/tongue trauma
- Swelling of gums (Chronic Dilantin therapy)
- Amnesia
- Pupils and cranial nerves intact
- Motor/Sensory coordination
- HypoT or Hypoxia
- Incontinence
- Automatisms
- Dysrhythmias
86
Syncope
| S/S
Sudden/temporary loss of consciousness with accompanying loss of postural tone, possibly from life threatening dysrhythmia, stroke
-Typically a result of loss of blood flow to the brain
S/S- Warning of lightheaded, brief LOC, short focal Clonic phase, BradyC
87
ALS seizure management
- ABC’s
- Meds
- Diazepam (Valium) 5-10 mg
- Midazolam (Versed) 1-2.5 mg
- Lorazepam (Ativan) .5-2 mg
- BGL
- Constant reevaluation
88
Common home seizure meds
```
Phenytoin
Valproic acid
Clonazepam
Gabapentin
Phenobarbital
```
89
What is the Brachial plexus
A network of nerves located in the posterior neck
90
What parts make up the diencephalon
Thalamus, Hypothalamus, limbic system
91
Types of headaches (4)
Tension
Migraine
Cluster
Sinus
92
Tension Headache
- Cause
- S/S
- Treatment
From muscle contractions of face, neck and/or scalp
-Stress, noise, eye strain, poor posture
S/S- Dull, persistent, non-throbbing
Treatment- ASA, Acetaminophen, Ibuprofen
93
Migraine headache
- Cause
- S/S
- Treatment
Causes by dilation and constriction of blood vessels in brain from hormone imbalance, caffeine, altitude changes, various foods
S/S- Intense throbbing on 1 side, nausea, vomiting, visual disturbance, photophobia
```
Treatment- Phenergan (Promethazine)
-Class: Antihistamine
-Dose: 12.5-25 mg IV/IM
-SFx: Fluctuations in BP and HR
-Note: Solid IV line needed to avoid arterial occlusion
Ondansetron (Zofran)
-Class: Antihistamine
-Dose: 4 mg
```
94
Cluster headache
- Causes
- S/S
- Treatment
Burst headaches that are severe and usually accompanied by severe pain around one eye, 30 min to 2 hrs
Causes- Histamine release
S/S- Uniorbital pain, tearing, nasal congestion
Treatment- Antihistamines, Corticos, Ca channel blockers
95
Sinus headaches
- Causes
- Treatment
Pressure behind face with pain in forehead, nose and eyes
Causes- Infections of sinuses
Treatment- Analgesics, antihistamines, antibiotics
96
“Thunder clap” Headache
Sudden intracerebral hemorrhage; CVA. Report worst headache of life followed by rapid deterioration
97
Brain Tumor (Neoplasm)
Mass in the cranial vault and can cause compression of the brain
Treatment- Analgesics for pain and benzos for seizures
98
Brain abscess
| -S/S
Accumulation of puss in the brain from bacterial infection
S/S- Headache, fever, nausea/vomiting, seizures, ALOC
99
11 degenerative diseases
- Muscular dystrophy
- Multiple sclerosis
- Dystonia
- Parkinson’s disease
- Central Pain syndrome
- Bell’s palsy
- Amyotrophic Lateral sclerosis (ALS)
- Peripheral neuropathy
- Myoclonus
- Spina Bifida
- Polio
100
Muscular Dystrophy
S/S
Treatment
Inherited muscular disorder where muscle of the body degenerate
S/S- Waddle gait, bulky calves, progressive weakness, unable to eventually walk, usually dead before 20
Treatment- Supportive
101
Multiple Sclerosis
Autonomic condition where myelin of of brain and spinal cord are destroyed by the body, not fatal
S/S- Numbness, weakness, paralysis, slurred speech, visual changes, unstable gait, vertigo
Treatment- Mainly supportive
102
Dystonia
S/S
Treatment
Localized alterations in muscle tone creating spasms, fixed postures and strange movement. Can result from stroke, Parkinson’s, schizophrenia
S/S- Listed above
Treatment- Mainly supportive, Benadryl 25mg IV can help with spasms
103
Parkinson’s disease
S/S
Treatment
Decrease in dopamine, which helps muscles move smooth, from damage to ganglia nerve cells
-Progressive disease
S/S- (Postural instability, Tremor, Rigidity, Bradykinesia) Numbness, weakness, paralysis, visual changes, unstable gait, tremors, vertigo, rigid walking
Treatment- Mainly supportive
104
Central pain syndronme
S/S
Treatment
Infection or damage to Trigeminal nerve (V)
S/S- Severe pain (electrical shocks) and painful twitch to face, lips, cheek, gums on one side
Treatment- Mainly supportive
105
Bells Palsy
S/S
Treatment
Paralysis of face due to inflammation of the facial nerve (VII)
S/S- Eyelid, corner of mouth droop, possible numbness. S/S only in face
Treatment- Supportive
106
Amyotrophic Lateral Sclerosis (ALS)
S/S
Treatment
Very fatal degenerative disease of voluntary muscle neurons
S/S-Progressive weakness arms and legs, eventually swallowing and respiratory problems, peripheral to medial
Treatment- Supportive
107
Peripheral Neuropathy
S/S
Treatment
Group of conditions damaging peripheral nerves of the body
- Mononeuropathy, Single nerve damage-Trauma, infection
- Polyneuropathy, Multiple nerves damaged-Diabetes, GBS
S/S-Sensory/Motor impairment, numbness, burning, pain, muscle weakness
Treatment- Supportive
108
Spina Bifida
S/S
Treatment
Congenital defect where one part of vertebra does not form, allowing spinal cord to be exposed
S/S- Can develop small pouch on the back, S/S vary
Treatment- Supportive
109
Polio
S/S
Treatment
Infection that attacks the bodies nervous system, through feces
S/S-Mild infection to respiratory arrest, weakness, pain, muscle spasms, paralysis, inability to swallow
Treatment-Ensure patent airway
110
Myasthenia Gravis
| S/S
Autoimmune disease, resulting in chronic muscle weakness and neurotransmitters dont work
S/S-Look like death, double vision, facial muscle problems
111
Guillain-Barré syndrome
S/S
Treatment
Immune system attacks portions of the nervous system resulting in nerve inflammation with progressive weakness and paralysis moving towards core of body
S/S- Recent infection, rapid progression of paralysis/tingling/numbness, toe to head paralysis pattern
Treatment- Supportive, ventilation if needed
