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Neurological Conditions and Emergencies Flashcards

1
Q

What are important questions/assessments for suspected neurological emergencies?

A

-Headache, dizziness, visual disturbances (blurred, black, lights, stars, etc.)
-Nausea, vomiting
-Any altered LOA/GCS (obtain a baseline)
-Pupillary assessment (size, reactivity, equality), H test
-Stroke assessment (grips, gas pedals, smile, arm/leg drop)
-Incontinence

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2
Q

What causes a migraine?

A

-When a migraine occurs, cranial nerve V (trigeminal) is activated and likely releases
mediators that trigger an inflammatory response in the meningeal vasculature - causing pain
-Many people with chronic migraines have hormonal or dietary triggers

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3
Q

What are the clinical manifestations of a migraine?

A

-Migraine Aura - reversible symptoms that precede (warn) the onset of a migraine headache
-Visual disturbances (flickering lights, spots or lines)
-Partial or complete loss of vision (blackness/ blurred)
-Pins and needles, numbness
-Speech disturbances
-Pulsatile, throbbing, unilateral headache that may last 1-2 days and is aggravated by routine physical activity
-Commonly associated with nausea, vomiting and photophobia (light sensitivity)
-Patients without aura may experience unexplained fatigue or irritability preceding the
onset

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4
Q

What is a tension headache?

A

-The most common type of headache and usually not severe enough to interfere with daily activities
-Exact mechanism isn’t known but may be a result of sustained tension of the muscles of the
scalp and neck
-May also be caused by stress, anxiety, depression, or caffeine

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5
Q

What are the clinical manifestations of a tension headache?

A

-Dull, aching and diffuse headaches located in a “hatband” distribution around the head
-Typically, not worsened by activity and not associated with nausea/vomiting

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6
Q

What is a stroke?

A

-An acute focal neurologic deficit from a vascular disorder that injures brain tissue
-Classified as either ischemic (87% of all strokes) or hemorrhagic
-Hemorrhagic strokes have a much higher fatality rate

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7
Q

What is an ischemic stroke?

A

Caused by cerebral vascular obstruction by thrombosis or emboli

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8
Q

What is the penumbra?

A

-During the evolution of a stroke there is usually a core of dead or dying cells (due to disrupted blood flow) surrounded by an ischemic band of minimally perfused cells
-Cells in the penumbra can survive provided there is a timely return of adequate circulation
-Should cerebral blood flow not return, the core of dead cells grows, and the penumbra grow

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9
Q

What is a thrombotic ischemic stroke?

A

A thrombus is the most common cause of ischemic stroke, usually occurring in
atherosclerotic blood vessels, resulting in infarction

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10
Q

What is a thrombus?

A

stationary mass of clotted blood or other formed elements

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11
Q

What is atherosclerosis?

A

buildup of fats, cholesterol and other substances in and on the walls of an artery (buildup is called plaque) - narrows the vessel

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12
Q

What is infarction?

A

necrosis or death of tissues due to local ischemia resulting from obstruction of blood flow

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13
Q

What is an embolic ischemic stroke?

A

-An embolic stroke presents the same as a thrombotic stroke, but the obstruction
originates in another region of the body
-The most common origin of an embolic stroke is from a thrombus in the left side of the heart
-May also originate in atherosclerotic carotid arteries

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14
Q

What is an embolus?

A

a mass of clotted blood or other formed elements (calcium fragments, air bubbles, loose tissue), that circulates in the blood until it becomes lodged
in a vessel, obstructing circulation

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15
Q

What is a transient ischemic attack (TIA)?

A

-A temporary disturbance in focal cerebral blood flow that reverses before infarction occurs
-Causes of TIA are similar to ischemic stroke (atherosclerosis, emboli)
- A TIA can be seen as a warning sign of an impending stroke
-10-15% of patients with TIA have a stroke within 3 months - 50% of those occur within 48hours
-only way to diagnose the difference between a stroke, clinically, is if the symptoms resolve

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16
Q

What is a hemorrhagic stroke?

A

-Result of a ruptured cerebral blood vessel, often during physical or emotional exertion
-The hemorrhage can cause a focal hematoma, edema, compression of brain contents and spasm of adjacent blood vessel
-Ruptured aneurysms and arteriovenous malformations are the origins

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17
Q

What is an aneurysm?

A

outpouching or dilation in the wall of a blood vessel

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18
Q

What is an AV malformation?

A

a tangle of malformed arteries and veins linked by fistulas, lacking a capillary bed and with a deficient muscularis layer

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19
Q

What are symptoms of a CVA?

A

-Unilateral arm/leg weakness or drift
-Slurred speech or inappropriate words or mute
-Unilateral facial droop
-Vision loss in one eye, language disturbance (aphasia, dysarthria), imbalance, hemineglect, apraxia, agnosia or ataxia

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20
Q

What is aphasia?

A

-varying inability to comprehend, integrate and express language
-caused by the stroke affecting the speech center in the brain
-can be receptive (comprehension of speech or written words) or expressive (communication using speech or writing)

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21
Q

What is dysarthria?

A

-imperfect articulation of speech sounds or changes in voice pitch or quality
-caused by stroke affecting the muscles in the larynx or any part of the airway related to speech

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22
Q

What is apraxia?

A

loss of ability to carry out familiar, purposeful acts or to manipulate objects

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23
Q

What is ataxia?

A

inability to coordinate voluntary muscle movement

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24
Q

What is agnosia?

A

inability to recognize and identify objects

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25
What is hemineglect?
-inability to attend and react to stimuli from the contralateral side -may not visually track or reach to the affected side
26
What are the clinical manifestations unique to a hemorrhagic stroke?
-Many patients describe an acute “thunderclap” headache - sudden and severe -Some patients describe hearing or feeling a “pop” in their head that precedes the headache -Following the onset of symptoms there can be a rapid deterioration to unconsciousness and death - timeline varies with size and location of ruptured vessel
27
What is meningitis?
Meningitis is an inflammation of the meninges, specifically the pia mater, arachnoid mater and subarachnoid space
28
What is bacterial meningitis?
-Bacterial meningitis spreads easily with close contact but people are at higher risk if they are immunocompromised -Bacteria replicate and release endotoxins into the CSF that initiates a release of inflammatory mediators -The infiltration of inflammatory cells produces a cloudy purulent exudate and damage to the nearby vessels -Impaired CSF flow and tissue infarction is possible
29
What are the clinical manifestations of bacterial meningitis?
-Fever, chills, nausea, and vomiting -Headache, stiff neck, back/abdominal/extremity pain -Seizures and other focal cerebral symptoms are also possible
30
What is viral meningitis?
-Viral meningitis is very similar to bacterial, but the clinical course and CSF findings are typically less severe -Treatment is usually symptom oriented as the virus is self-limiting -Many different viruses can cause viral meningitis
31
What is encephalitis?
-Generalized infection of the brain or spinal cord parenchyma -Usually caused by a virus but may be caused by bacteria, fungi and other organisms -Common origins include: Mosquito bites, rabid animal bites, and viral ingestion -Local necrotizing hemorrhage, which becomes generalized, and cerebral edema
32
What are the clinical manifestations of encephalitis?
-Fever -Headache -Nuchal rigidity -Other neurological disturbances - lethargy, seizures, disorientation, delirium, etc
33
What is Guillain-Barre Syndrome?
-An acute immune-mediated polyneuropathy (simultaneous malfunction of many peripheral nerves) -Caused by the demyelination of spinal roots (usually motor, but may be sensory and motor) -Onset of symptoms may be rapid and severe or a slow insidious process -There is no known cure, however, if symptoms are treated quickly and appropriately patients often recover completely within months
34
What are the clinical manifestations of Guillain-Barre Syndrome?
-Progressive ascending muscle weakness of the limbs (legs to arms), producing a symmetric flaccid paralysis -If respiratory muscles become affected, the patient may require a ventilator -ANS involvement may cause: postural hypotension, arrhythmias, facial flushing, abnormalities of sweating and urinary retention -Pain, paresthesia and numbness -Cranial nerve involvement may cause facial or oculomotor disruption
35
What is a neoplasm (tumour)?
an abnormal mass of tissue that forms when cells grow and divide more than they should or do not die when they should
36
What does benign mean?
Non-cancerous
37
What does malignant mean?
Cancerous
38
What are the clinical manifestations of a brain tumour?
-Vary depending on the area of brain tissue affected -Blood vessel disruption -Brain swelling/compression -Edema -Increased ICP
39
What is a hemangioma?
-A hemangioma is a benign (non-cancerous) vascular tumour caused by an excessive growth of blood vessels -In the brain, they typically develop in the cerebellum or spinal cord -They do not spread and are not life threatening
40
What are the clinical manifestations of a hemangioma?
(dependent on area of brain effected) -Seizures -Blurred vision -Facial droop -Unsteady gait -Unilateral weakness -Headaches -Dizziness -Tinnitus -Impaired speech
41
What is a seizure?
A seizure represents the abnormal behavior caused by an electrical discharge from neurons
42
What is a generalized seizure?
-The most common type of seizure - classified when clinical signs, supporting symptoms and EEG changes indicate involvement of both hemispheres -Symptoms include unconsciousness and bilateral degrees of symmetric motor responses -Two categories of generalized seizures include motor and non-motor
43
What are tonic-clonic seizures (grand mal)?
-Tonic and clonic muscle contractions followed by a period of unconsciousness called the “post- ictal” period (seizure activity typically lasts 30-90 seconds) -Urinary and/or fecal incontinence is common as is cyanosis due to respiratory muscle contraction -Post-ictal Phase - time and presentation vary drastically from patient to patient (5-45 minutes). It is common for patients to be confused, amnesic and combative
44
What is a tonic muscle contraction?
sustained contractions of muscle fibers
45
What is a clonic muscle
alternating contraction and relaxation of a muscle
46
What is a myoclonic seizure?
-Brief, involuntary muscle contractions -Bilateral jerking of muscles, generalized or confined to the face, trunk or extremity
47
What is a clonic seizure?
Initial unconsciousness and hypotonia followed by limb jerking that may or may not be symmetrical
48
What is a tonic seizure?
A sudden onset of increased tone maintained in the extensor muscles
49
What is an atonic seizure?
Sudden loss of muscle tone leading to a slackening of the jaw, drooping of the limbs and falling to the ground
50
What is a non-motor seizure?
-generalized non- convulsive seizures expressed mainly as disturbances in consciousness -aka absence seizures (petit mal seizures) -often occur in children and cease in adulthood or progress to generalized motor seizures
51
What are the clinical manifestations of a non-motor seizure?
-Blank stare -Motionless -Unresponsive -Automatisms (lip smacking, mild clonic movements in the eyelids or hands) -Usually only last a few seconds to a minute
52
What is a focal seizure?
-Origin of a seizure in a specific focal area of one hemisphere -Can be classified as with or without impairment of consciousness or awareness
53
What are the clinical manifestations of a focal seizure without impairment?
-Symptoms depend on the focal area of the brain involved -May include motor or sensory impairment/ hyperactivity on the contralateral side of the body -Patient remains conscious and aware throughout the seizure
54
What are the clinical manifestations of a focal seizure with impairment?
-Symptoms depend on the focal area of the brain involved but may rapidly spread to both hemispheres -May initially present with focal symptoms but progress to tonic-clonic activity -Automatisms are also common -Patient does not remain conscious and aware throughout the seizure
55
What is a febrile seizure?
-A form of generalized motor seizure occurring mainly in young pediatric patients -Can be due to a very high sustained fever (>39) but more commonly occurs when the fever spikes rapidly -Febrile seizures are self limiting and typically do not cause harm to the patient -Treatment should be directed at the underlying cause of the fever and reassuring the family
56
What is status epilepticus?
A- seizure that does not stop spontaneously or reoccurs without recovery (minimal to no post-octal phase) -A true emergency and may lead to respiratory failure and death -Treatment includes: Management of life support (ventilators support), identification and treatment of the underlying cause, medications to stop the seizure (midazolam - ACPs)
57
What is an upper motor neuron disorder?
-Involve neurons that are fully contained within the CNS -This includes the motor neurons arising in motor areas of the cortex and their fibers as they project to the anterior horn of the spinal cord
58
What is a lower motor neuron disorder?
Involve the nerve fibers travelling from the anterior horn of the spinal cord to the associated effectors (muscles)
59
What is Amyotrophic Lateral Sclerosis (ALS) aka Lou Gehrig disease?
-A neurological disorder that selectively affects motor function -ALS is a mixed disorder of UMN and LMN that mainly affects males in their 50s -Affects the LMNs of the spinal cord, motor nuclei of the brain stem and the UMNs of the cerebral cortex -Disease process is more severe in the distal parts of the affected nerves than the proximal parts -Sensory neurons, regulatory mechanisms that control coordination and intellect are not affected -Death of LMNs leads to enervation, shrinkage of musculature and muscle fiber atrophy (amyotrophy)
60
What are the clinical manifestations of ALS?
-Weakness, spasticity or stiffness and impaired fine motor control -Dysphagia, dysarthria, and dysphonia (hoarse voice) -Fasciculations, weakness, muscle atrophy, hyporeflexia -Muscle cramps in the distal legs is often an early warning sign -Common clinical progression is a slow but progressive weakness and atrophy of the distal muscles of one upper extremity followed a regional spread of the illness -Facial, neck and respiratory muscle involvement can make eating impossible and aspiration a common complication -When the cranial nerves and respiratory muscles become severely involve, death usually occurs
61
What is cerebral palsy (CP)?
-An abnormal development of the brain or damage to the developing brain that affects a child’s ability to control his/or muscles (usually occurs during pregnancy but may also develop during, or shortly after, delivery) -A common cause is fetal hypoxia -Symptoms are non-progressive and permanent
62
What are the clinical manifestations of CP?
-Abnormal muscle tone, reflexes, motor development or coordination -Problems with sensation, vision, hearing, and speaking -Seizures and cognitive deficiencies -Unequal growth between tendons and bones can lead to bone and joint deformities, often leads to significant alterations in gait
63
What is multiple sclerosis (MS)?
-Inflammation and destruction of the myelin sheath in the CNS (brain, spinal cord and optic nerve) - PNS is unaffected -Typical onset is 20-30yrs old and more common in females -Likely an immune-mediated response occurring in genetically susceptible people -MS lesions consist of demyelinated patches mostly in the white matter of the CNS and are distributed throughout the CNS
64
What are the clinical manifestations of MS?
Common initial presentations include: -Acute episodes of paresthesia -Optic neuritis (pain with eye movement, vision loss) -Diplopia (double vision) -Gaze paralysis (difficulty tracking or looking a certain way) Physical Symptoms: -Paresthesia (numbness, tingling, burning, itching, pressure) -Abnormal gait, bladder and sexual dysfunction -Vertigo -Nystagmus (“dancing eyes”) -Speech disturbances Psychological Symptoms: -Depression -Mood swings -Euphoria -Loss of memory -Apathy -Inattentiveness -Fatigue
65
What is the clinical course of MS?
-Can occur as periods of remission and relapsing with near stable recovery between episodes -Can be a gradually worsening progression without periods of remission -MS is incurable but the severity of the disease varies drastically, and the treatment is directed at managing symptoms and delaying progression of the disease
66
What is muscular dystrophy?
-A genetic disorder that produces progressive deterioration of muscles due to a mix of muscle cell hypertrophy, atrophy and necrosis -This is a primary muscular system disease that likely doesn’t involve the nervous system, however, the most common form of the disease is a genetic deficiency
67
What causes muscular dystrophy?
-The genetic disorder causes an abnormality in a plasma protein called dystrophin -Dystrophin forms a link between the actin filaments and the extracellular connective tissue -Dystrophin abnormalities can compromise the integrity of the plasma membrane of a muscle cell -Increases muscle fiber fragility, can cause an excessive influx of Ca2+ ions and a release of muscle enzymes -This process leads to necrosis of muscle fibres with subsequent repair and fibrosis of muscle tissue -Eventually, the affected skeletal muscles become replaced with fibrous, fatty connective tissue
68
What are the clinical manifestations of muscular dystrophy?
-Muscle weakness and frequent falls are typically noted by age 2 or 3 -Distal muscle function is often preserved enough for certain motor skills -Respiratory muscles are affected: Weak cough, frequent RTIs, decreased respiratory reserve -Cardiac muscles are affected: not always coinciding with the severity of skeletal muscle involvement
69
What is Parkinson's disease?
A degenerative disorder of the basal ganglia function that results in variable combinations of tremor, rigidity, akinesia/bradykinesia, and postural changes
70
What is akinesa?
loss or impairment of voluntary movement
71
What is bradykinesa?
slowness of movement and speed
72
What is the basal ganglia?
a group of nerve cells responsible for: control of voluntary movements, eye movements, and coordination of automatic movements. They are also involved in cognitive and perceptual function
73
What are the clinical manifestations of Parkinson's?
-Tremors- rhythmic, alternating flexion and contraction movements -Rigidity (resistance to flexion and extension) -Akinesia/bradykinesia -Facial and throat rigidity produce drooling and difficulty speaking ANS involvement: -Sweating -Sebaceous gland hyperactivity -Dysphagia -Orthostatic hypotension -Thermal regulation -Constipation -Impotence -Urinary incontinence -Cognitive dysfunction, such as dementia, is common late in the progression of the disease
74
What is polio?
-A life-threatening disease caused by the polio virus that, in severe cases, can cause paralysis -Can be a mild, asymptomatic cause or severe causing permanent paralysis or death -Most cases result in basic flu-like symptoms as the virus replicated in the GI tract and lymphatic system -If it spreads to the CNS it can either cause self-limiting inflammation to the meninges or permanent destruction of nerve fibres
75
What is a neurocognitive disorder?
A NCD is a term for a decline in mental function severe enough to interfere with a person’s ability to perform usual daily activities and is NOT a normal part of the aging process
76
What are the clinical manifestations of Alzheimer's disease?
Follows an insidious and progressive course lasting approximately 8-10 years, hallmark symptoms are: -Loss of memory -Difficulty with language, -Changes in behavior -Depression, agitation and sleep disorders

Patho (9 decks)

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