Neuro Pathology Flashcards
Meningitis
Bacterial: sicker, more rapid course; treat infective organism
OR
Viral: treat with antibacterial therapy (antibiotic, antipyretic) and maintain fluid/electrolyte balance
Provide supportive symptomatic therapy
Bed positioning, PROM, skin care, safety measures
Encephalitis
Severe infection and inflammation of the brain
Caused by arboviruses or a sequela of influenza, chronic and recurrent sinusitis, otitis, or other infections; bacterial encephalitis, prioncaused disease (“mad cow”)
Treat infective organism (bacterial encephalitis)
Provide supportive symptomatic therapy
Brain abscess
Infectious process in which there is a collection of pyogenic material in the brain parenchyma
S/S: H/A, fever, brainstem compression, focal signs CN II and VI
Can be an extension of an infection, typically frontal or temporal lobes or cerebellum
Treat infective organism, surgical intervention
Provide supportive symptomatic therapy
Acquired immunodeficiency syndrome (AIDS)
Viral syndrome characterized by acquired and severe depression of cell-mediated immunity
S/S: wide ranging, 1/3 exhibit CNS/PNS deficits
- AIDS dementia complex (ADC): range from confusion to memory loss to disorientation
- Motor deficits: ataxia, weakness, tremor, loss of fine motor coordination
- Peripheral neuropathy: hypersensitivity, pain,s sensory loss
Treat with anti-HIV drugs
Provide palliative and supportive therapy
Cerebrovascular Accident (CVA) (PT GOALS only)
ROM and prevent deformity Skin integrity Sensory compensation strategies Strengthen all available muscles Normalize of tone Selective movement control (out of synergy) Postural control, balance and symmetry Task-specific training Respiratory and oromotor control Isokinetic training Locomotor training with body weight support Biofeedback training Constraint-Induced movement therapy (CIMT)
DO NOT:
Use overhead pulleys on hemiplegic UE (traction injury risk)
Prescribe exercise/progressive physical activity without monitoring HR/BP
Use CIMT if pt doesn’t meet minimal movement criteria at wrist and fingers
Traumatic Brain Injury (TBI)
MOI
Concussion
MOI is contact forces to skull and rotational acceleration forces, causing varying degrees of injury to brain
Concussion: LOC either temporary or permanent resulting from injury or blow to head with impaired functioning of RAS
TBI: PRIMARY BRAIN DAMAGE
Primary brain damage (types of injuries):
(1) Diffuse Axonal: disruption/tearing of axons and small blood vessels from shear-strain of angular acceleration leading to neuronal death and petechial hemorrhages
(2) Focal: contusions, lacerations, mass effect from hemorrhage and edema
(3) Coup-Contracoup: injury at point of impact and opposite point of impact
(4) Closed or Open: fracture of skull
TBI: SECONDARY BRAIN DAMAGE
Secondary brain damage:
(1) Hypoxic-ischemic: systemic problems (respiratory or cardiovascular) that compromise cerebral circulation
(2) Swelling/edema: mass effect with increased ICP, brain herniation and death
(3) Electrolyte imbalance: mass release of damaging neurotransmitters
TBI DEFINITIONS
COMA
State of unconsciousness in which there is neither arousal nor awareness
Eyes remain closed, No sleep/wake cycles
TBI DEFINITIONS
UNRESPONSIVE VIGILIANCE/VEGETATIVE STATE
Marked by the return of sleep/wake cycles and normalization of vegetative functions (respiration, digestion, BP control)
Persistent vegetative state: vegetative state >1 year post TBI
TBI DEFINITIONS
MUTE RESPONSIVENESS/MINIMALLY RESPONSIVE
State in which patient is not vegetative and does show signs, even if intermittent, of fluctuating awareness
TBI DEFINITIONS
CONFUSIONAL STATE
Mainly a disturbance of attention mechanisms
All cognitive operations are affected, patient is unable to form new memories
May demonstrate either hypoarousal or hyperarousal
TBI DEFINITIONS
EMERGING INDEPENDENCE
Confusion is clearing and some memory is possible
Significant cognitive problems and limited insight remain
Frequently uninhibited social behaviors
TBI DEFINITIONS
INTELLECTUAL/SOCIAL COMPETENCE
Increasing independence, although cognitive difficulties (problem solving, reasoning) persist along with behavioral and social problems (enhancement of premorbid traits, mood swings)
TBI
PT GOALS FOR RANCHOS LOS AMIGOS LEVELS OF COGNITIVE FUNCTIONING (LOCF) I-III
(5)
(1) Maintain ROM, prevent contracture development: PROM, positioning, splinting and serial casting
(2) Maintain skin integrity, prevent decubitus ulcers through frequent position changes
(3) Maintain respiratory status, prevent complications: PD, percussion, vibration, suctioning to keep airway clear
(4) Sensory stimulation for arousal and to elicit movement: environmental/direct stimulation
(5) Promote early return of FMS: upright positioning and proper body alignment
TBI
PT GOALS FOR RANCHOS LOS AMIGOS LEVELS OF COGNITIVE FUNCTIONING (LOCF) IV-VI
(7)
(1) Structure and prevent overstimulation for confused, agitated patient: closed, reduced stimulus environments, daily logs, relaxation
(2) Provide consistency: team-determined behavioral modification techniques, clear feedback, written contacts
(3) Task-specific training: familiar and well-liked activities, off options, break down complex task
(4) Verbal or physical assistance
(5) Control rate of instruction, frequent orientation to time, place, etc.
(6) Safety, behavioral management
(7) Model calm, focused behavior
TBI
PT GOALS FOR RANCHOS LOS AMIGOS LEVELS OF COGNITIVE FUNCTIONING (LOCF) VII-VIII
(5)
(1) Increasing independence
(2) Assist in behavioral, cognitive, emotional reintegration: honest feedback, prepare for community re-entry
(3) Independence in functional tasks: FMS, ADLs, real-life environments
(4) Improve postural control, symmetry and balance
(5) Active lifestyle, improve endurance
SPINAL CORD INJURY
CENTRAL CORD SYNDROME
Loss of more centrally located cervical tracts/arm function with preservation of more peripherally located lumbar and sacral tracts/leg function
Typically caused by hyperextension of cervical spine
Loss of spinothalamaic tracts: B pain/temp
Loss of ventral horn: B motor function (UE)
Preservation of proprioception and discriminatory sensation
SPINAL CORD INJURY
BROWN-SEQUARD SYNDROME
Hemisection of spinal cord typically caused by penetration wounds (gunshot or knife) with asymmetrical symptoms
IPSI loss of dorsal col: tactile discrim, pressure, vibration and proprioception
IPSI loss of corticospinal: motor function and spastic paralysis below level of lesion
CONTRA loss of spinothalamic: pain/temp below level and B pain/temp loss at level
SPINAL CORD INJURY
ANTERIOR CORD SYNDROME
Damage mainly in anterior cord leading to loss of motor function, pain and temperature with preservation of light touch, proprioception and position sense
Typically caused by flexion injuries of cervical spine
Loss of lateral corticospinal: motor function and spastic paralysis below level
Loss of spinothalamic: B loss pain/temp
Preservation of dorsal col: proprio, kinesthesia and vibratory sense
SPINAL CORD INJURY
POSTERIOR CORD SYNDROME
Loss of posterior columns with preservation of motor function, sense of pain and light touch; extremely rare
Loss of dorsal col B
B loss proprioception, vibration, pressure, and epicritic sensations (stereognosis, 2pt discrim)
Preservation of motor function, pain and light touch
SPINAL CORD INJURY
CAUDA EQUINA
Injury below L1 results in injury to lumbar and sacral roots of peripheral nerves (LMN) with sensory loss and paralysis and some capacity for regeneration
A LMN lesion with autonomous or nonreflex bladder
Flaccid paralysis with no spinal reflex activity
Flaccid paralysis of bowel and bladder
Potential for nerve regeneration
SPINAL CORD INJURY
SACRAL SPARING
Sparing of tracts to sacral segments with preservation of perianal sensation, rectal sphincter tone or active toe flexion
SPINAL CORD INJURY
CHANGES TO MONITOR FOR (5)
(1) Spinal Shock: transient period of reflex depression/spasticity, up to 24 weeks
(2) Spasticity/Spasms: location of tone, examine nociceptive stimuli that trigger incr tone
(3) **Autonomic Dysreflexia: emergency situation in which noxious stimulus precipitates pathological autonomic reflex
- Leads to bradycardia, H/A, diaphoresis, flushing, diplopia, or convulsions
- Examine for irritating stimuli
- ELEVATE head, check/empty catheter FIRST
(4) Heterotopic bone formation: abnormal bone growth in soft tissues; soft tissue swelling, pain, erythema–generally near large joints
(5) Deep venous thrombosis: edema and tenderness in LE
SPINAL CORD INJURY
PT GOALS
Respiratory capacity: deep breathing, strengthening, assisted coughing, respiratory hygiene, abdominal support Maintain ROM, prevent contracture Maintain skin integrity, free of decubitus ulcers and injuries Improve strength Reorient patient to vertical position Promote early return of FMS and ADLs Improve sitting tolerance Cardiovascular endurance
SPINAL CORD INJURY WHEELCHAIR PRESCRIPTION: C1-4
Electric wheelchair with tilt-in-space seating or reclining seat back
Microswitch or puff-and-sip controls
Portable respirator may be attached
