Neurological Flashcards
1
Q
What is a focal or partial seizure?
A
- Arises from a localized region of the brain and has clinical manifestations that reflect that area of the brain.
2
Q
True or false: Focal discharges only remain local.
A
False: Focal discharges can remain localized or they can spread to nearby cortical areas, to sub-corticol structures and/or transmit thought commissural pathways to involve the whole cortex. The latter sequence describes the secondary generalization of focal seizures.
3
Q
What is a secondary generalization of a focal seizure?
A
When focal discharges transmit thought commissural pathways to involve the whole cortex.
ex: A seizure arising from the left motor complex may cause jerking movements of the right upper extremity. If epileptiform discharges spread to adjacent areas and then the entire brain, a secondary generalized tonic-clonic seizure ensues.
4
Q
What is a primary generalized seizures?
A
A seizure that begins with abnormal electrical discharges in both hemispheres simultaneously.
5
Q
What are some of the manifestations of primary generalized seizures?
A
Manifestations range from:
- Brief impairment of consciousness (as in an absence seizure)
- Generalized motor activity accompanied by loss of consciousness. (generalized tonic-clonic seizure)
6
Q
In general, what is an epileptic seizure?
A
A transient symptoms of abnormal excessive or synchronous neuronal activity in the brain.
7
Q
What characterizes an absence seizures? (3)
A
- Temporary loss of consciousness
- Usually with a sudden cessation of motor activity without falling
- Total amnesia of the event
8
Q
How long to absence seizures usually last for?
A
They are brief (most last less than 20 seconds)
9
Q
Do absence seizures include and aura?
A
No
10
Q
Do absence seizures end with post-octal changes?
A
No
11
Q
Do Grand mal seizures have auras of abnormal smells, taste, sounds, or visual changes?
A
Yes
12
Q
Do Grand mal seizures have LOC?
A
yes
13
Q
What is included in the tonic phase of a grand mal seizure?
A
muscle contraction
14
Q
What is included in the hypertonic phase of a grand mal seizure?
A
extreme muscular contractions
15
Q
What is included in the Clonic phase of a grand mal seizure?
A
spasmotic muscular rigidity followed by relaxation
16
Q
What occurs in the post-ictal phase of a grand mal seizure?
A
Patient is unresponsive and awakes feeling confused and fatigued. HA is commonly noted
17
Q
Are epilepsy and seizures synonymous?
A
No.
18
Q
What reasons other than epilepsy can cause a seizure? (4)
A
- hypotension
- trauma
- electrolyte imbalance
- low blood sugar
19
Q
What are the eight steps of First Aid for Seizures?
A
- Cushion head, remove glasses
- Loosen tight clothing
- Turn on side (so they don’t aspirate vomit)
- Time the seizure with a watch
- Don’t put anything in mouth
- Look of ID (seizure disorder info)
- Don’t hold down
- As seizure ends, offer help
20
Q
Unprovoked seizures are often associated which two conditions?
A
Epilepsy
Related seizure disorder
21
Q
Causes of provoked seizures in epilepsy and Related seizure disorder include:
A
- Dehydration
- Sleep deprivation
- Metabolic disturbances - hypoglycemia, hyponatremia, or hypoxia
- Withdrawal from drugs
22
Q
What does the recovery position look like?
A
patient is turned on side.
23
Q
What is status epileptics?
A
A potentially life-threatening condition in which the brain is in a state of persistent seizure.
Definition: One continuous, unremitting seizure lasting longer than 5 minutes
OR
Recurrent seizures without regaining consciousness between seizures for greater than 5 minutes
24
Q
What is Syncope?
A
A transient loss of consciousness and postural tone, characterized by rapid onset, short duration, and spontaneous recovery, due to global cerebral hypo perfusion to the brain that often results in hypotension.
25
What are some symptoms that can precede syncope? (9)
- weakness
- sweating
- a feeling of heat
- palpitations
- dizziness
- loss of vision
- loss of hearing
- nausea
- abdominal discomfort
This state is also known as Pre-syncope
26
Does a patient with syncope need to be sent to the ER?
Generally not unless you are concerned there was some kind o ischemic event.
27
A stroke is one form of ________ _______
Cerebrovascular disease
28
Another name for a stroke is a ________ _______
cerebrovascular accident
29
What are the 3 major categories of cerebrovascular disease?
Thrombotic
Embolic
Hemorrhagic
30
Which four factors are the survival of ischemic tissues dependent upon?
1. duration of ischemia
2. availability of collateral circulation
3. magnitude of reduction of flow
4. rapidity of reduction of flow
AKA - how many neurons were damaged
31
True or False: cerebral ischemia may be focal or global
True
32
Focal cerebral ischemia follows reduction of blood flow to a localized area due to an _______ or _______ in a large vessel, or vasculitis in a medium or small sized vessel
Embolus
| thrombosis
33
True or false: In focal ischemia the signs and symptoms will change depending on which artery is effected.
True
34
What is a TIA?
Transient ischemic attack (mini-stroke)
If neurological symptoms resolve within 24 hours, the diagnosis is TIA
35
How long does a TIA last for
Can last for seconds-minutes, to up to 24 hours!!!!! which is much longer than a stroke.
36
How does a TIA present
Can present like a stroke in every way.
If milder symptoms are present, there is greater likelihood for the symptoms of be reversed.
37
How long can a stoke last up to?
1 - 60 minutes
38
What does RIND stand for?
Reversible Ischemic Neurological Defect
39
True or False: In TIA and RIND you can return to your previous pre-event neurological status
true
40
What are some conditions where local ischemia and resulting global hypoxia can occur? (3)
1) cardiac arrest
2) shock
3) severe hypotension
41
What are the risk factors for stroke? (6)
- advanced age
- HYPERTENSION
- DM
- high cholesterol
- tobacco use
- ATRIAL FIB
42
There are very physical finds that definitively distinguish between hemorrhagic and ischemic strokes, BUT...
Nausea, vomiting, headache and change in LOC are symptoms that are more common in which type of stroke?
hemorrhagic strokes
43
Which two conditions together lead to a SIGNIFICANT increase the risk of a stroke?
HTN and DM together...why statins are prescribed so regularly
44
In ischemic stroke a ____ blocks blood flow to an area of the brain
clot
45
In hemorrhagic stroke ________ occurs inside or around brain tissue
bleeding
46
Which stroke is more common?
Ischemic
Approximately 80% of strokes are ischemic
47
Which stroke has a greater mortality rate?
hemorrhagic
48
What is the most common cause of hemorrhagic stroke?
Poorly controlled HTN
49
Which race has a higher incidence of hemorrhagic and ischemic strokes than other races in the US?
African Americans
50
T or F: Individual can have many items strokes without having symptomology that is recognizable
True
51
What is the most common cause of thrombotic occlusion (ischemic stroke)?
In what areas of the brain? (2)
ATHERSCLEROSIS!!!!!
1. Carotid bifurcation
2. Vertebrobasilar system
52
Which vessel is found to have the greatest degrees of compromise? / have the worst consequences if occluded?
Middle cerebral artery
53
Approximately 50% of all stroke deaths occurs within the first ______hours
48
54
Common symptoms of stroke include abrupt onset of: (10)
- Monoparesis (weakness in one limb)
- Hemiparesis (weakness in the entire half of the body)
- quadriparesis (weakness of all four limbs)
- monocular or binocular vision loss
- visual field deficits
diplopia
- dysarthria (difficult articulation of speech)
- ataxia
- vertigo
- aphasia
- change in LOC
Symptoms are usually unilateral
Symptoms can occur alone much are more likely to occur in combination.
55
What is the different between dominant hemisphere strokes and non-dominant hemisphere stroke
If the dominant hemisphere (usually left) is involved, a classic syndrome consisting of right hemiparesis, right hemisensory loss, left gaze preference, right visual field cut and APHASIA may result.
If the non-dominant (usually right sided) hemisphere is involved, a syndrome of left hemiparesis, left hemisensory loss, right gaze preference and left visual field cut may result. (NO APHASIA)
56
Which hemisphere is most commonly dominant?
Left (most people are right handed)
57
What drug can be given to a person with a cerebral infarction (ischemic stroke)?
Clot busting drug - thrombolytic therapy!!!
The better you get to an ER after a stroke, the better!
58
True or False: TIAs may be clinical markers for an increased risk of subsequent cerebral infarction.
True!
59
What is the primary etiology of middle cerebral artsy strokes?
Embolism
60
Emboli can arise from which sources? (3)
1. intravascular coagulation
2. rigid foreign matter (eg, shotgun pellets, catheter tips, large thrombi combined with bacteria)
3. As a result of large calcific plaques formed through direct internal carotid trauma or puncture.
61
Hemorrhagic stroke is usually due to what 4 kinds of hemorrhage?
1) Intracerebral hemorrhage (In the cortex)
2) Subarachnoid hemorrhage!!! (highest chance of death) - beneath arachnoid matter and cortex)
3) Subdural hemorrhage (between dura and arachnoid layer)
4) Epidural hemorrhage (between dura and bone)
62
What is the most effective way to prevent hemorrhagic stroke?
Lower blood pressure
63
What is the best way to reduce chance of items stroke?
Using aspirin or related compounds that inhibit platelets from aggregating (however this may increase likelihood of hemorrhagic stroke)
64
What are the main risk factors of hemorrhagic strokes?
- Advanced age
- HYPERTENSION!
- Previous history of stroke
- Alcohol abuse
- Use of illicit drugs (cocaine)
65
What imaging is important to do before giving a patient with a supposed ischemic stroke anticoagulation therapy and why?
CT scan to rule out hemorrhagic stroke.
You would not want to give anticoagulants to a person with a hemorrhage in their brain.
66
How does an ischemic stroke appear on a CT scan?
Dark tissue is ischemia
Blood shows up as opaque, so the blood filled tissue is a lighter shade of grey.
67
How does a hemorrhagic stroke appear on a CT scan?
The hemorrhage will show up as white.
68
Cerebellar and brainstem strokes generally occurs as a result of pathology in which arteries? (2)
Vertebral artery
| Basilar artery
69
When edema in the cerebellum or brainstem occur the patient is at high risk for brainstem ________ and ________.
hernitation, compression
70
Herniation of the brainstem may cause what 3 things?
1) Rapid LOC
2) Apnea - temporary cessation of breathing
3) Death
71
What functions do the cerebellum and brainstem control? (3)
1) Coordination
2) Swallowing
3) breathing
72
What is an UNCAL herniation
A pushing of the brain down through the foramen magnum. Can lead to rapid death from respiratory distress.
73
What are signs of cerebellar or brainstem involvement in a stroke?
- Gait of limb ataxia
- vertigo of tinnitus
- nausea/ vomiting
- hemeparesis or quadriparesis
- eye movement abnormalities - diplopia or nystagmus
- Oropharyngeal weakness of dysphagia
74
The posterior column transmit what information?
Cerebellar functions: coordination.
75
What is the most frequent cause of a clinically significant subarachnoid hemorrhage?
Rupture of a berry (saccular aneurysm)
76
What is a berry aneurysm? Where is it located?
A thing wall outpouching from an area on the CIRCLE OF WILLIS.
77
How big are berry aneurysms?
a few millimeter to 2-3 cm
78
What is the very characteristic symptom of a berry aneurysm rupture?
Thunderclap headache!!! - may also be sever nausea and projectile vomiting
79
What is the most common type of clinically significant vascular malformation?
Arteriovenous malformation (AVM)
80
What is the most common location of an AVM?
Middle cerebral artery - particularly its posterior branches
but AVMs can occurs in any area of the brain.
81
True of false: When AVMs hemorrhage they do so with a large amount of blood loss
False: When they hemorrhage, they usually do so with a limited amount of blood loss, unlike the hypertensive hemorrhages of other stroke patients. Loss of neurologic function depends on both the location of the AVM and the amount of bleeding.
82
What are the 4 principle groups of vascular malformations?
1) Arteriovenous malformations (AVMs)
2) cavernous hemangiomas (where a collection of dilated blood vessels form a benign tumor. Because of this malformation, blood flow through the cavities, or caverns, is slow. Additionally, the cells that form the vessels do not form the necessary junctions with surrounding cells. Also, the structural support from the smooth muscle is hindered, causing leakage into the surrounding tissue. It is the leakage of blood, known as a hemorrhage)
3) Venous hemangiomas (represent congenital anatomically variant pathways in the normal venous drainage of an area of the brain. )
4) Capillary telangiectasias (Capillary telangiectasias (CTSs) are small areas of abnormally dilated capillaries within otherwise normal brain tissue.)
83
What are arteriovenous malformations?
When there is an abnormal connection between arteries and veins, bypassing the capillary system.
84
What is acute hypertensive encephalopathy?
A syndrome arising in a hypertensive patient characterized by diffuse cerebral dysfunction including: headaches, confusion, vomiting, convulsions, and possible coma.
85
Postmortem examination of a brain effected by hypertensive encephalopathy may show what? (2)
- edematous brain with or without transtentorial or tonsillar herniation.
- Petechiae and fibrinoid necrosis of arterioles in the grey and white matter may be seen microscopically
86
What are the factors of greater significance in CNS trauma?
1) anatomical location of the lesion
| 2) limited capacity of the brain for functional repair
87
The physical forces associated with head injury may result in what three things?
1) Skull fractures
2) Parenchymal injury
3) Vascular injury
And all three can coexist
88
Why is it important to palpate the head during the workup of a head injury?
If step-off fracture is present, send to the ER.
89
What might you find in a PERRLA examination of a patient with history of head trauma?
anisochoria
90
What is important physical exam is important in the workup of a head trauma?
Well documented and thorough neurological exam.
91
What is the characteristic neurological picture of a concussion? (4 things)
Instantaneous onset of transient neurological dysfunction including:
- LOC
- Temporary respiratory arrest
- Loss of reflexes
- amnesia of the event typically persists
92
Does any structural brain damage occur in a concussion?
No. Symptoms are cause primarily by temporary biochemical changes in neurons
93
Unequal pupil size is called ___________ and it is associated with a brain injury that is more serious than a concussion.
Anisocoria
94
Anisocoria can be benign when?
If the patient has had a past trauma and the yes stayed that way, or if they were born with it.
If there is a new onset on anisocoria, send to the ER!
95
What is the difference between a coup injury and contra coup injury?
Coup injury occurs under the site of impact with an object, and a contrecoup injury occurs on the side opposite the area that was hit. (like whiplash)
96
A fall from LOC typical appear with trauma on which aspect of the body?
Frontal. You typically won't see frontal injuries from a fall with a conscious person people they would be able to protect themselves with outstretch arms.
97
Fall from people who are awake typically present with injuries on which aspect of the body?
back side - the occiput.
98
Nonpalpable skull fractures are typically ______ fractures
Linear
99
A fracture in which bone is displaced into the cranial gravity by a distance greater than the thickness of the bone is called a _________ skull fracture.
displaced
100
Basal skull fractures are a type of ______ fractures extending through the _______ portion of the _______ bone.
linear, petrus, temporal
101
What is the characteristic finding in a person with a basal skull fracture?
CSF leaking for the ear or nose.
There may be associated hearing loss, instability of gait, vertigo.
102
What is Battle's sign?
What does it indicate?
Mastoid ecchymosis. (Purple behind the ear)
Basilar fracture
103
What are Raccoon eyes characteristic of in an unconscious patient or a pt with hx of head trauma?
Raccoon's eyes = bilateral periorbital ecchymosis
Suspect basilar skull fracture
104
Which artery is most vulnerable to an injury in a skull fracture?
Middle meningeal artery
105
What is an epidural hematoma?
An accumulation of arterial blood between the dura and the skull usually cause by a rupture of a meningeal artery from a skull fracture.
106
Is an epidural hematoma a venous or arterial bleed?
arterial
107
Where meningeal artery bleeds located?
Between the dura and the skull.
108
What typically causes an epidural hematoma (meningeal artery bleed)
Skull fracture
109
Where are sub-dural hematoma located
Subdural! -between the dura and the arachnoid
110
How do you differentiate between a traumatic arterial bleed and a traumatic venous bleed in the skull?
Arterial bleed are often due to a skull fracture and are epidural.
Venous bleed are often much slower and are subdural.
111
Are epidural hemorrhage typical unilateral or bilateral?
Unilateral. Epidural hemorrhages do not cross cranial sutures.
112
What is the common cause of a subdural hematoma?
Torn bridging veins between the brain and the superior sagittal sinus.
Usually due to falling and stoking one's head
113
What location of the brain are sub-dural hemorrhages most like found?
fronto-parietal regions of the cerebral hemisphere.
114
What does blood do when its not in a vessel.
It irritates the surrounding tissue!
115
What is meningitis?
Acute inflammation of the meninges, the protective membranes covering the brain and spinal chord.
116
What are the most common symptoms of meningitis? (3)
What are some other possible symptoms? (5)
1. fever
2. headache
3. neck stiffness (nuchal rigidity)
Other:
1: confusion
2. altered consciousness
3. vomiting
4. intolerance of light
5. intolerance of loud noises.
117
Severe headache occurs in almost 90% of cases of _________ meningitis.
Nuchal rigidity occurs in 70% of _________ meningitis in adults
bacterial, bacterial
118
What is Kerning's sign?
The person lying supine, with the hip and knee flexed to 90 degrees. In a person with a positive Kernig's sign, pain limits passive extension of the knee.
119
What is Brudzinski's sign?
Flexion of the neck causes involuntary flexion of the knee and hip.
120
What is nuchal rigidity and how does it differ from painful neck flexion?
Nuchal rigidity is the inability to flex the neck forward due to rigidity of the neck muscles. (As if head and shoulders are one unit)
If flexion of the neck is present, but full range of motion is present, than the term nuchal rigidity is less applicable.
121
A ______ _______ diagnoses and exclused meningitis, but it is important to do a ___ beforehand because their might be edema in the brain.
spinal tap, CT
122
Young children with meningitis often exhibit only nonspecific symtoms such as: (3)
1. irritability
2. drowsiness
3. lack of appetite
123
Meningitis caused by which bacterium causes a petechial rash?
Neisseria meningitidis
124
CSF that is _______(clear, cloudy) is a bad sign.
Cloudy
125
What is unique about meningitis caused by neisseria meningitides?
it causes a petechial rash that DOES NOT BLANCH.
126
How are petechiae different from purport and ecchymosis?
Petechiae are by definition less than 3 mm. The term is almost always used in the plural, since a single lesions is seldom noticed or significant.
127
Which disease with a petechial rash can cause death within 48 hours?
Meningococcemia.
128
Which three may present with a petechial rash?
Meningococcemia, leukemia, thrombocytopenia.
...can also be from a physical trap,a such as a sever bout of laughing, crying or vomiting.
129
In premature babies and newborns up to 3 months of age, what is the TWO most common bacteria that cause meningitis?
E. Coli (normally inhabits the GI tract)
Group B strep (normally inhabits the vagina)
130
Which bacteria may be transmitted by the mother before birth and may cause meningitis in a newborn?
Listeria monocytogenes
131
Older children are common get bacterial meningitis from which 2 bacteria?
Neisseria meningitidis
| Streptococcus pneumoniae
132
Children under 5 are most common to get bacterial meningitis from which bacteria?
Haemophilus influenza type B (in countries that don't offer vaccination)
133
Which two bug cause the majority of adult cases of bacterial meningitis?
Neisseria meningitidis
| Streptococcus pneumoniae
134
Risk of infection with which bug is increased in individuals over 50 years of age?
Listeria monocytogenes
135
Bacterial meningitis cause by recent skull trauma, allowing bacteria to enter the meningeal space is typically caused by gram-_________ bacteria including ________ and ________
Negative
Staphylococci
Pseudomonas
136
Which kind of meningitis has the highest WBC counts?
Viral
137
What are some virus than can cause meningitis?
1) enterovirus
2) herpes simplex virus
3) varicella zoster virus
4) mumps virus
5) measles virus
6) West Nile virus
7) HIV
138
Which virus causes the majority of cases of viral meningitis in the US?
enteroviruses
139
What are some non-infectious causes of meningitis?
1) Spread of cancer to the meninges
2) certain drugs (mainly NSAIDs, antibiotics, and intravenous immunoglobins)
3) sarcoidosis
4) SLE
5) vasculitis
