classic concussion - Grade IV
- disconnection of cerebral systems from brainstem
- physiological and neurological dysfunction without substantial anatomic disruption
- loss of consciousness <6 hours
- amnesia (anterograde and retrograde
mild concussion grade I-III
Grade I - confusion, disorientation, momentary amnesia
Grade II- momentary confusion and retrograde amnesia
Grade III - confusion with retrograde and anterograde amnesia
autonomic dysreflexia - triggered by sustained stimuli at T6 or below
caused by - restrictive clothing, pressure areas, full bladder or UTI, fecal impaction
autonomic dysreflexia - triggered by sustained stimuli at T6 or below
responses above level of injury
vasodilation
- increased BP (severe and rapid)
- flushed face
- headache
- distended neck veins
- lowered heart rate
- increased sweating`
autonomic dysreflexia - triggered by sustained stimuli at T6 or below
responses below level of injury
- vasoconstriction
- pale
- cool
- no sweating
arteriovenous malformation (AVM)
defects of the circulatory system that are generally believed to arise during embryonic or fetal development or soon after birth. They are comprised of snarled tangles of arteries and veins.
Positive Kernig and Brudzinski sign
subarachchnis hemorrhage - blood escapes from defective or injured vasculature into subarachnoid space.
most common primary central nervous system tumor
astrocytoma
multiple sclerosis
autoimmune - usually familial - usually in 40’s and 50’s and comes and goes
tinnitus - decreased hearing - diplopia - blurred vision - urinary retention - spastic bladder - constipation - weakness leading to paralysis - muscle spasticity - vertigo
coup injury
primary impact of head injury - intial bang on the head
contrecoup/countercoup injury
when the brain moves inside the head in the opposite direction of the original bang
myasthenia gravis
caused by chronic autoimmune - IgG antobodies against acetylcholine receptors.
fatigue of muscle in eyes and throat - difficulty chewing, talking, swallowing - diplopia -
myasthenic crisis
undermedicated - muscle weakness - can impact respiratory muscle - can’t give meds to remedy
cholingergic crisis
overmedicated - causes muscle twitching
guillain-Barre syndrome
begins in lower extremities and goes up bilaterally-causes symmetrical weakness leading to paralysis - increased pain at night - increased BP - lowered pulse- possible autoimmune cause - affects respiratory, talking, swallowing, bowel and bladder control
ischemic stroke - 80% of strokes
decreased blood to an area of the brain - usually caused by a blood clot
hemorrhagic stroke - 20% of strokes
blood vessel rupture - can be intracerabral or subarachnoid
clinical manifestations immediately following spinal cord injury
necrosis consumes 40% within 4 hours and 70% within 24 hours. cord swelling increases degree of dysfunction - release of toxic excitatory amino acids, accumulation of of endogenous opiates, lipid hydrolysis with production of active metabolites, and local free radical release.
produce further ischemia, vascular damage, and necrosis of tissue.
cavernous angioma
a blood vessel abnormality characterized by large, adjacent capillaries with little or no intervening brain. The blood flow through these vessels is slow.
symptoms - seizures, headache, hemorrhage or compression of surrounding brain tissue, weakness, numbness, double vision, visual disturbance or language difficulties.
capillary telangiectasia
small areas of abnormally dilated capillaries within otherwise normal brain tissue.
arteriovenous malformation
defects of the circulatory system that are generally believed to arise during embryonic or fetal development or soon after birth. They are comprised of snarled tangles of arteries and veins.
arteriovenous angioma
a congenital tumor consisting of a tangle of coiled, usually dilated arteries and veins, islets of sclerosed brain tissue, and, occasionally, cartilaginous cells. The lesion, which may be distinguished by an intracranial bruit, generally arises in the vascular system of the pia mater and may grow to project deeply into the brain, causing seizures and progressive hemiparesis.
right cerebral vascular accident/stroke
left body paralysis - short attention span - spacial/perceptual difficulties - visual field difficulties - minimize problems - impaired judgement - impulsivea
left cerebral vascular accident/stroke
paralyzed right side - impaired speech and language - visual field deficits - aware of dificits - depressin and anxiety - impaired laguage and math skills
FASTG
Pneumonic stroke assessment - F - facial droop A - arm drift S - speech "you can't teach an old dog new tricks" T - Time last normal G - glucose - test to rule hypoglycemia