neuro disorders

Question 1

common causes of stroke?

Answer 1

HTN
atherosclerosis
CAD, hyperlipidemia
diabetes
consequence of AF (ischaemic)

Question 2

modifiable risk factors for stroke?

Answer 2

hypertension

hyperlipidemia

smoking

obesity

inactive lifestyle

excessive alcohol intake

Question 3

non-modifiable risk factors for stroke?

Answer 3

age

previous history including TIAs

male

family history

ethnicity - African- American, Hispanic, and Asian-Pacific Islander population

Question 4

what is ischaemic stroke caused by?

Answer 4

blocked artery from an emboli or thrombus

Question 5

pathophysiology of ischaemic strokes?

Answer 5

1. vascular occlusion secondary to thromboembolic disease
2. ischaemia causes cell hypoxia and depletion ATP → ion channels are impaired→K+ leaves the cells and Na+ and Ca2+ enter→cerebral oedema
3. overwhelming inflammatory response leads to further damage
4. further neuronal cell death and irreversible damage

Question 6

pathophysiology of haemorrhagic strokes?

Answer 6

rupture of blood vessels

bleeding occurs directly into brain parenchyma

damage in surrounding area due to increased
intracranial pressure

Question 7

types of haemorrhagic strokes?

Answer 7

• Subarachnoid: bleeding occurs under the thin, delicate arachnoid membrane surrounding the brain
• Intracerebral: bleeding within brain itself

Question 8

difference between TIA and ischaemic stroke?

Answer 8

in TIA, interruption of blood flow temporary (<24 hours) and thrombus/emboli resolves spontaneously

Question 9

clinical manifestations of stroke in occipital lobe?

Answer 9

vision issues

Question 10

clinical manifestations of stroke in parietal lobe?

Answer 10

loss of sensation

issues with spatial tasks, reading or maths

Question 11

clinical manifestations of stroke in frontal lobe?

Answer 11

loss of emotional control, social skills

speech issues

Question 12

clinical manifestations of stroke in temporal lobe?

Answer 12

issues with understanding and remembering language

issues with understanding and remembering non-verbal information

Question 13

clinical manifestations of stroke in brain stem?

Answer 13

Physical and sensory problems

Autonomic regulation of BP/Resp control

Question 14

clinical manifestations of stroke in cerebellum?

Answer 14

Physical and sensory problems

Question 15

acronym associated with recognising stroke?

Answer 15

FAST

face, arms, speech, time

Question 16

common tests for Ax and Dx of stroke?

Answer 16

• Brain scans: CT scan & MRI
• ECG & echocardiogram
• Transcranial Doppler
• Cerebral angiogram
• Carotid duplex
• Blood tests: international normalised ratio or INR
• Urine tests or chest X-rays

Question 17

drug therapy for haemorrhagic stroke?

Answer 17

anticonvulsants

anti-hypertensives

osmotic diuretics

Question 18

what is epilepsy?

Answer 18

a chronic neurological disorder characterised by recurrent seizures

Question 19

increase in risk of death in epilepsy?

Answer 19

up to 2-3 times higher than general population

Question 20

common causes of epilepsy?

Answer 20

stroke
head injury
genetics
infections

Question 21

two main types of seizures?

Answer 21

focal - one side of brain, +/- impaired conscious state

generalised - both hemispheres affected, always impaired consciousness

Question 22

what is a seizure?

Answer 22

abnormal electrical activity in the brain causes an involuntary change in body movement, sensation, awareness, or behavior

Question 23

what causes a seizure?

Answer 23

a momentary ‘imbalance’ within electrical and chemical circuits in the brain; excitatory neurotransmitters > inhibitory neurotransmitters.

Question 24

triggers for seizures?

Answer 24

stress

lack of sleep/fatigue

alcohol

diet and caffeine

infections and illness

febrile illness

menstruation/hormonal changes

missed medications

N+V and diarrhoea can lead to poor drug absorption

illegal drugs

photosensitivity

N+V and diarrhoea can lead to poor drug absorption

Question 25

subtypes of generalised seizures?

Answer 25

absence - LOC sudden but transient, unresponsive, often with automa lip smacking, blank state, eyelids fluttering tonic clonic - collapse and rigidity → violent convulsions→ unconscious and deep sleep (postictal), +/- vomiting and incontinence

Question 26

manifestations of focal seizures without impaired consciousness?

Answer 26

variable according to affected area of brain experiencing auras confusion vagueness repetitive actions such as uttering unusual sounds or chewing movements muscle spasms tingling visual, olfactory, aural without a stimulus

Question 27

manifestations of focal seizures with impaired consciousness?

Answer 27

variable according to affected area of brain TEMPORAL LOBE– staring FRONTAL LOBE – impaired memory, alterations in mood (laughing, swearing)

Question 28

first seizure phase?

Answer 28

seizure initiation Increased AP → Persistent Na+ channels opening →Prolonged depolarisation

Question 29

second seizure phase?

Answer 29

seizure phase spread of AP causing associated signs and symptoms this is dependent on the type and origin of the seizure activity Inhibitory neurons release to inhibit excitatory actions

Question 30

third phase of seizures?

Answer 30

postictal phase (in tonic clonic only) use of O2, glucose and ATP leads to deficiency Can lead to exhaustion and sleep

Question 31

what is the main complication of epilepsy?

Answer 31

status epilepticus generalised recurrent seizures lasting > 30 minutes without pt regaining consciousness medical emergency → during seizures, cerebral demands increase by 200%. → if demands not met this results in a lack of O2 and glucose to brain cells → ischaemia, hypoxia, cell death

Question 32

nursing considerations during a seizure?

Answer 32

1. keep pts afe→remove objects which can harm 2. place in a recovery position 3. supplemental oxygen 4. suction to prevent aspiration 5. time seizures 6. pharmacological agents to stop seizure activity

Question 33

three main ways antiepileptic drugs work?

Answer 33

1. increase release of GABA 2. decrease action of glutamate 3. inhibit Na+ movement/close ion channels

Question 34

general adverse effects + nursing considerations around antiepileptic drugs?

Answer 34

these drugs are able to cross the BBB, therefore have many CNS adverse effects require frequent plasma level monitoring to control seizures while reducing adverse effects - constant titration!

Question 35

antiepileptic drugs that inhibit the opening of Na+ channels?

Answer 35

phenytoin | carbamezapine

Question 36

antiepileptic drugs that enhance GABA inhibitory action?

Answer 36

barbituates

Question 37

other drug classes used to treat epilepsy?

Answer 37

sodium valproate (epilim)