UNIT 10 - ALTERATIONS IN NEUROLOGICAL FUNCTIONS Flashcards by rachel kozlow

Q

4 REGIONS OF THE BRAIN

A

Cerebrum
Cerebellum
Brain stem
Neuron

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Q

CEREBRUM

A

THINKING PROCESS

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Q

CEREBELLUM

A

BALANCE

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Q

BRAIN STEM

A

VITAL FUNCTIONS SUCH AS BREATHING, BP

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Q

NEURON

A

BASIC FUNCTIONAL UNIT OF THE BRAIN

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Q

PROTECTIVE SURFACES OF THE BRAIN

A

BRAIN
PIA MATER
SUB-ARACHNOID SPACE
ARACHNOID MATER
SUBDURAL SPACE
DURA MATER
EPIDURAL SPACE
SKULL

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Q

glued to brain like wallpaper. Soft layer.

A

PIA MATER

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Q

Space between pia mater and arachnoid mater
o Contains cerebral spinal fluid
o Lubricates brain, provides a little cushioning

A

SUB-ARACHNOID SPACE

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Q

looks like spiderweb. On top of pia mater.

A

ARACHNOID MATER

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Q

space between Arachnoid mater and dura mater

A

Subdural space

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Q

On top of Arachnoid mater. Protective layer

A

Dura mater – (tough mother)

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Q

Between dura mater and skull

A

Epidural space

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Q

SPINAL CORD IS PROTECTED BY THREE LAYERS CALLED THE __________________.

A

MENINGES

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Q

ALTERED ____________ ____ ______________ (AROUSAL AND AWARENESS) IS THE SINGLE MOST IMPORTANT INDICATOR FOR NEUROLOGICAL DYSFUNCTION

A

LEVEL OF CONSCIOUSNESS

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Q

CONFUSION, DISORIENTATION, STUPOROUS, LETHARGY, OBTUNDED

A

CLINICAL MANIFESTATIONS OF ALTERED LEVEL OF CONSCIOUSNESS IN NEUROLOGICAL DYSFUNCTION.

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Q

CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION

MEMORY LOSS IS EITHER _______________ OR
_____________ AMNESIA

A

RETROGRADE

ANTEROGRADE

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Q

CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION.

RETROGRADE AMNESIA

A

CANNOT REMEMBER BEFORE INJURY

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Q

CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION.

ANTEROGRADE AMNESIA

A

CANNOT FORM NEW MEMORIES. SINCE INJURY THEY CANNOT REMEMBER

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Q

CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION.

AGNOSIA

A

CANNOT RECOGNIZE FAMILIAR OBJECTS

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Q

CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION.

DYSPHASIA

A

LANGUAGE DIFFICULTIES

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Q

CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION.

DISORDER OF AWARENESS.
o TEMPORARY STATE*
o CAN OCCUR BECAUSE OF DRUGS, INFECTION OR TRAUMA

A

ACUTE CONFUSIONAL STATE

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Q

CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION.

DECLINE OF COGNITIVE FUNCTION
o PROBLEMS WITH ORIENTATION, PROBLEM SOLVING, DECISION MAKING
o BEHAVIOURAL ALTERATIONS MAY OCCUR
o CAN RESULT FROM VARIETY OF DISEASES

A

DEMENTIA

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Q

CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION.

HEADACHE, NAUSEA & VOMITING

A

CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION.

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Q

CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION.

PUPILLARY CHANGES & ALTERED BREATHING PATTERNS ARE ____________ ____________OF NEUROLOGICAL DYSFUNCTION

A

LATE SIGNS

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CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION. EYES DO NOT MOVE TOGETHER (LIZARD EYES)

DISCONJUGATE EYE MOVEMENTS

CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION INVOLUNTARY EYE MOVEMENTS

NYSTAGMUS

CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION – BODY SENSE (YOU KNOW WHERE YOUR BODY PARTS ARE)

SENSORY DYSFUNCTION: | LOSS OF PROPRIOCEPTION

CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION DIFFICULTY WITH MOVEMENT

MOTOR DYSFUNCTION: | DYSKINESIA

CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION CANNOT BEND OR EXTEND JOINTS IN A SMOOTH MANOR

MOTOR DYSFUNCTION: | COGWHEEL RIGIDITY

CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION GAIT WHERE THEY TEND TO LEAN FORWARD

MOTOR DYSFUNCTION: | PROPULSIVE GAIT

CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION GAIT WHERE THEY TEND TO LEAN BACKWARD

MOTOR DYSFUNCTION: | RETROPULSIVE GAIT

CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION UNCOORDINATED GAIT

MOTOR DYSFUNCTION: | ATAXIA

CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION * FLACCID VS SPASTIC (INCREASE IN MUSCLE TONE CAUSING RIGIDITY) * IPSILATERAL (SAME SIDE OF BRAIN/SPINAL CORD LESION) VS CONTRALATERAL (OPPOSITE SIDE OF BRAIN/SPINAL CORD LESION)

MOTOR DYSFUNCTION: | WEAKNESS/PARALYSIS

CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION ABNORMAL FLEXION OF EXTREMITIES TOWARD BRAIN

MOTOR DYSFUNCTION: | DECORTICATE

CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION ABNORMAL EXTENSION OF EXTREMITIES AWAY FROM BRAIN

MOTOR DYSFUNCTION: | DECEREBRATE POSTURING

CLINICAL MANIFESTATIONS OF NEUROLOGICAL DYSFUNCTION SUDDEN, EXPLOSIVE DISORDERLY DISCHARGE OF NEURONS

SEIZURES NEURONS USUALLY FIRE IN AN ORDERLY PATTERN. WITH SEIZURES THEY FIRE AT AN ABNORMAL RATE AND PATTERN.

SEIZURES STARTS IN ONE AREA OF THE BRAIN (FOCAL AREA), THEN SPREADS TO OTHER AREAS.

EPILEPTOGENIC FOCUS

SEIZURES ___________ (TEMPORARY) ALTERATION IN BRAIN FUNCTION o ALTERED LEVEL OF AROUSAL o SENSORY AND MOTOR MANIFESTATIONS

TRANSIENT

DRUGS, TOXINS, HEAD INJURY, BRAIN TUMORS, INFECTION, HYPOGLYCEMIA ARE ___________ OF SEIZURES

CAUSES

________ EPILEPSY – UNSURE OF CAUSE

IDIOPATHIC

WHICH TYPE OF SEIZURE? ABNORMAL ACTIVITY IS ORIGINATING IN ONE PART OF THE BRAIN SIMPLE OR COMPLEX

PARTIAL

WHICH TYPE OF SEIZURE? NO LOSS OF CONSCIOUSNESS OR AWARENESS  MAY HAVE MOTOR DISTURBANCES  SHAKING OR TREMORS STARTING IN TIPS OF FINGERS AND TOES. BEGINS DISTALLY AND WORKS IT WAS PROXIMALLY.  MAY HAVE SENSORY DISTURBANCES  AREN’T AS VISIBLE AS MOTOR SYMPTOMS  MAY FEEL BUGS CRAWLING UP ARM, HEAR RINGING IN EARS, VISUAL DISTURBANCES

SIMPLE PARTIAL

WHICH TYPE OF SEIZURE? NO LOSS OF CONSCIOUSNESS, BUT MAY BE A LOSS OF AWARENESS.  AUTOMATISMS – PERSON MAKE REPEATED, NON-PURPOSEFUL MOVEMENTS

COMPLEX PARTIAL

WHICH TYPE OF SEIZURE? INVOLVES BOTH CEREBRAL HEMISPHERES OF BRAIN

GENERALIZED SEIZURES

TYPE OF GENERALIZED SEIZURE  BEGINS WITH AURA (MAY SEE LIGHTS FLASHING, ODD TASTE IN MOUTH, RINGING IN EARS)  LOSS OF CONSCIOUSNESS. TONIC PHASE – BECOMES RIGID  CLONIC PHASE – SHAKING  ALTERNATES BETWEEN RIGID AND SHAKING. CAN FROTH AT MOUTH, BECOME INCONTINENT, EYES ROLL BACK.  POST-ICTAL – COMPLETELY FLACCID, UNABLE TO MOVE.

TONIC-CLONIC – AKA GRANDE MAL.

TYPE OF GENERALIZED SEIZURE ______________ SEIZURES: EPISODES OF COMPLETE LOSS OF AWARENESS  OCCURS IN CHILDREN. THEY CAN GROW OUT OF IT, OR IT CAN PROGRESS TO TONIC-CLONIC SEIZURES.

ABSENCE

TYPE OF GENERALIZED SEIZURE ____________ SEIZURES: INVOLUNTARY MUSCLE CONTRACTION (TWITCHING)  LOSS OF CONSCIOUSNESS AND BRIEF MUSCLE CONTRACTION

MYOCLONIC

TYPE OF GENERALIZED SEIZURE ___________SEIZURES: LOSS OF TONE. OCCURS WHEN SOMEONE SUDDENLY LOSES MUSCLE TONE AND DROP TO THE GROUND.  CALLED DROP ATTACKS.  HELMETS MAY BE WORN TO PROTECT THEIR HEAD.

ATONIC

_____________ _________________: PROLONGED SEIZURE o CAN RESULT IN BRAIN DAMAGE, AS THE BRAIN IS DEPRIVED OF OXYGEN FOR SOME TIME

STATUS EPILEPTICUS

SEIZURES NORMALLY DO NOT LAST LONGER THAN ___ ________ ______________

A FEW MINUTES

* EEG MUST BE DONE TO DETERMINE THE DIFFERENCE BETWEEN ______________ & _____________ _____________ SEIZURES BECAUSE SYMPTOMS ARE SIMILAR. * USED TO EVALUATE SEIZURES AND BRAIN FUNCTION.

ABSENCE AND COMPLEX PARTIAL

* MILD: 14 – 15 * MODERATE: 9 – 13 * SEVERE: 3 – 8

GLASGOW COMA SCALE – TEST TO EVALUATE NEUROLOGICAL FUNCTION

CATEGORIES OF NEUROLOGICAL ____________ ``` • TRAUMA • CEREBROVASCULAR DISEASE • INFECTION • DEGENERATIVE NEUROLOGICAL DISEASE • TUMORS • DEVELOPMENTAL ERRORS o CEREBRAL PALSY ```

CATEGORIES OF NEUROLOGICAL DISEASES

TRAUMA - BRAIN INJURY (ATLS) • MECHANISM OF INJURY o BLUNT - define

SKIN IS NOT BROKEN

TRAUMA - BRAIN INJURY (ATLS) • MECHANISM OF INJURY o PENETRATING - define

SKIN AND TISSUE UNDERNEATH IS BROKEN

SEVERITY OF BRAIN INJURIES IS BASED ON _____________ ________ _____________ (<8 = POOR OUTCOME)

GLASGOW COMA SCALE (T A SMILEY FACE WITH A HAT. ITS SERIOUS.

MORPHOLOGY

SHAPE

WITH A SKULL FRACTURE, DAMAGE TO ________ TISSUE IS THE MAIN CONCERN

BRAIN

MORPHOLOGY: SKULL FRACTURE •VAULT (TOP, ROUND SECTION THAT IS COVERED BY HAIR) o OPEN VS CLOSED

OPEN (SCALP IS TORN & DURA IS EXPOSED) CLOSED (SCALP IS INTACT)

MORPHOLOGY: SKULL FRACTURE •VAULT (TOP, ROUND SECTION THAT IS COVERED BY HAIR) o LINEAR VS DEPRESSED

LINEAR (HAIRLINE FRACTURE – LOOKS LIKE A LINE) DEPRESSED (BONE FRAGMENTS ARE COMPRESSING AGAINST BRAIN TISSUE)

MORPHOLOGY: SKULL FRACTURE •___________ ___________ (BASE FORMS FLOOR OF BRAIN AND ROOF OF NOSE – FRACTURE OF CRIBIFORM PLATE) – SERIOUS HEAD INJURY

BASILAR FRACTURE

MORPHOLOGY: SKULL FRACTURE •BASILAR FRACTURE o WITH/WITHOUT:  PERIORBITAL ECCHYMOSIS - DEFINE

BRUISING AROUND EYES (RACCOON EYES) CAUSED BY BLEEDING INTO THE BRAIN. IT TRICKLES DOWN AND SETTLES AROUND THE EYES

MORPHOLOGY: SKULL FRACTURE •BASILAR FRACTURE o WITH/WITHOUT:  MASTOID ECCHYMOSIS - DEFINE

BRUISING BEHIND THE EAR.

MORPHOLOGY: SKULL FRACTURE •BASILAR FRACTURE o WITH/WITHOUT:  VII NERVE PALSY - which nerve?

FACIAL NERVE. LOOK FOR FACIAL DROOPING

MORPHOLOGY: SKULL FRACTURE •BASILAR FRACTURE o WITH/WITHOUT:  CSF LEAK - DEFINE

(CLEAR, WATERY DRAINAGE)  RHINORRHEA – DRAINAGE IN NOSE  OTORRHEA – DRAINAGE IN EARS

TRAUMATIC BRAIN INJURY CAN OCCUR BECAUSE OF A BLOW _____________ TO THE BODY

ANYWHERE

TRAUMATIC BRAIN INJURY WHERE DOES COUP DAMAGE THE BRAIN?

DAMAGE TO BRAIN IS AT SITE OF IMPACT

TRAUMATIC BRAIN INJURY WHERE DOES CONTRECOUP DAMAGE THE BRAIN?

DAMAGE IS AT SITE OF IMPACT AS WELL AS OPPOSITE SIDE OF BRAIN

TRAUMATIC BRAIN INJURY WHERE DOES FOCAL BRAIN DAMAGE OCCUR?

IN ONE AREA OF THE BRAIN

TRAUMATIC BRAIN INJURY WHERE DOES DIFFUSE BRAIN DAMAGE OCCUR?

WIDESPREAD

TRAUMATIC BRAIN INJURY _____________ HEMORRHAGE: FOCAL INJURY. BLEEDING IN A SPECIFIC AREA OF THE BRAIN.

CEREBRAL

TRAUMATIC BRAIN INJURY _____________ HEMATOMA: BLEEDING INSIDE OF THE ENCLOSED, EPIDURAL SPACE

EPIDURAL

MIDDLE ___________ ARTERY TEARS CAN CAUSE THE EPIDURAL HEMATOMA. THE BLOOD HAS NOWHERE TO GO SO THE PRESSURE BUILDS UP INSIDE THE BRAIN.

MENINGEAL

EPIDURAL HEMATOMA CAUSES RAPID ________________ DETERIORATION

NEUROLOGICAL

__________ HEMATOMA: | TEARING OF BRIDGING VEINS BETWEEN DURA AND BRAIN (VEINS FEED BRAIN TISSUE)

SUBDURAL HEMATOMA

SUBDURAL HEMATOMAS ARE A _________ BLEED THAN EPIDURAL BECAUSE IT INVOLVES VEINS INSTEAD OF ARTERIES

SLOWER

BRAIN MATTER SHRINKS AS WE BECOME ELDERLY, MAKING BRAIN MORE MOBILE. INCREASES LIKELIHOOD OF______________ TO THOSE BRIDGING VEINS BETWEEN DURA & BRAIN.

DAMAGE

_________________ HEMORRHAGE: | BLEEDING INTO THE SPACE BETWEEN THE ARACHNOID MATER AND PIA MATER – SUBARACHNOID SPACE

SUBARACHNOID HEMORRHAGE

SUBARACHNOID HEMORRHAGE CAN OCCUR WITHOUT TRAUMA IF _____________ BURSTS

ANEURYSM

``` • RISK FACTORS OF _______________ HEMORRHAGE o HYPERTENSION o ANEURYSM – POUCHING OF BLOOD VESSEL. o AVM – WEAK BLOOD VESSELS o TRAUMA ```

SUBARACHNOID HEMORRHAGE

INCREASED INTRACRANIAL PRESSURE: THE _____________ THE AMOUNT OF BLEEDING IN THE BRAIN, THE ______________ THE AMOUNT OF INTRACRANIAL PRESSURE.

GREATER | GREATER

INCREASED INTRACRANIAL PRESSURE: AS THE PRESSURE ________________, THE BRAIN TISSUE IS BEING SQUISHED AND BEGINS TO HERNIATE (SQUISHED BACK DOWN THE SPINAL CORD).

INCREASES

INCREASED INTRACRANIAL PRESSURE: AS HERNIATION PUSHES AGAINST THE BRAINSTEM (RETICULAR ACTIVATING SYSTEM – PART OF BRAIN THAT KEEPS US AWAKE) IT CAUSES LOSS OF ___________________.

CONSCIOUSNESS

HERNIATION IS A RESULT OF _____________ INTRACRANIAL PRESSURE. THE BRAIN TISSUE BEGINS TO PROTRUDE _______________ TOWARD THE BRAIN STEM.

INCREASED | DOWNWARD

``` CLINICAL MANIFESTATIONS OF INCREASED INTRACRANIAL PRESSURE _________ signs • IRRITABILITY, RESTLESSNESS • CHANGES IN COGNITION • DISORIENTATION, VOMITING • IMPAIRED MOTOR FUNCTION • VITAL SIGNS Within Normal Limits ```

EARLY SIGNS

``` CLINICAL MANIFESTATIONS OF INCREASED INTRACRANIAL PRESSURE _______ signs • COMA • DECORTICATE (ARMS ARE POSITIONED TOWARDS BRAIN) OR DECEREBRATE (ARMS AWAY FROM BRAIN) POSTURING • FIXED AND DILATED PUPILS • CUSHING TRIAD o INCREASED SYSTOLIC BP o WIDENING PP o BRADYCARDIA ```

LATE SIGNS

CONCUSSION IS A ___________ INJURY

DIFFUSE

* TEMPORARY DISRUPTION OF NEURON TRANSMISSION IN THE BRAIN * DAMAGE IS DONE AT THE CELLULAR LEVEL. NEURONS ARE NOT FIRING IN AN ORDERLY FASHION AS THEY ARE SUPPOSED TO BE. THE NEURONS BECOME SWOLLEN AND THIS INTERFERES WITH NERVOUS IMPULSES.

CONCUSSION

S&S OF CONCUSSION MAY NOT BE _______________

IMMEDIATE

CONCUSSIONS HEALING RATE IS __________. AS LONG AS THE PERSON IS _____________, THEY SHOULD REST THEIR BRAIN.

VARIABLE | SYMPTOMATIC

PERSONS WHO HAVE REPEATED CONCUSSIONS AND HAVE NOT HAD A CHANCE TO HEAL, AND GET ANOTHER CONCUSSION. INCREASES RISK FOR _________ ________ OF __________

EARLY ONSET OF DEMENTIA

CONCUSSION DAMAGE IS NOT A VISIBLE AS ________ INJURY

FOCAL

_____________ CLINICAL MANIFESTATIONS OF CONCUSSION o LOSS OF CONSCIOUSNESS (MAY OR MAY NOT OCCUR) o POOR COORDINATION o SLOW COGNITION o TROUBLE FOLLOWING DIRECTIONS o TROUBLE CONCENTRATING, READING, PROCESSING o HEADACHE o DIZZINESS o NAUSEA o DO NOT FEEL RIGHT o AMNESIA

PHYSICAL

______________ CLINICAL MANIFESTATIONS OF CONCUSSION o MEMORY DISTURBANCES o TROUBLE UNDERSTANDING

COGNITIVE

``` ______________ CLINICAL MANIFESTATIONS OF CONCUSSION o MAY HAVE OUTBURST o INSOMNIA o DEPRESSION o MOODY ```

EMOTIONAL

SET OF SYMPTOMS THAT MAY CONTINUE FOR WEEKS, MONTHS, OR OCCASIONALLY A YEAR OR MORE AFTER A CONCUSSION

POST-CONCUSSION SYNDROME

ENCEPHALOPATHY (PERMANENT DAMAGE TO BRAIN) AND STRUCTURAL BRAIN DAMAGE FROM REPEATED CONCUSSIONS.

DEMENTIA PUGLISTICA

* GRADING SYSTEMS (GRADES 1 – 4) | * SPORTS CONCUSSION ASSESSMENT TOOL – 3RD EDITION

ASSESSMENT OF CONCUSSION

MOST SERIOUS GRADE OF CONCUSSIONS ACCORDING TO THE GRADING SYSTEM (GRADES 1-4)

grade 4

SPINAL NERVES: | C1-C8 CERVICAL SPINE SUPPLIES - 4

UPPER ARMS, HEAD, NECK & DIAPHRAGM

SPINAL NERVES: | T9-T12 THORACIC SPINE SUPPLIES - 2

CHEST AND ABDOMINAL MUSCLES

SPINAL NERVES: | L1-L5 LUMBAR SUPPLIES - 1

LOWER LEGS

SPINAL NERVES: | S1-S5 SACRAL – INNERVATES - 2

THE PERINEUM, BLADDER

SPINAL CORD IS COVERED BY THE SAME 3 LAYERS OF MENINGES THAT COVER THE ____________

BRAIN

SPINAL CORD INJURY CAN BE THE RESULT OF ___________ OR ___________

INJURY OR DISEASE

POINT AT WHICH SPINAL CORD IS DAMAGED IS CALLED A _____________

LESION

SPINAL CORD INJURY: | CONTUSION VS TRANSECTION

CONTUSION - BRUISING | TRANSECTION - CORD HAS BEEN CUT (VERY RARE)

SPINAL CORD INJURY: AT TIME OF INJURY, IF THERE IS PARALYSIS IT IS CONSIDERED A __________ INJURY.

COMPLETE INJURY | .

SPINAL CORD INJURY: ______________ INJURY – PERSON STILL HAS SOME SENSORY FUNCTION. INITIALLY, THERE IS LOSS OF FUNCTION. CHANCE OF RETURN OF NORMAL FUNCTION ONCE THE INFLAMMATION AND BRUISING GOES DOWN

INCOMPLETE INJURY

______________ IS MOST VULNERABLE BECAUSE IT IS THE MOST MOBILE.

C-SPINE

_____________ SPINAL CORD INJURY • HYPERFLEXION – HEAD IS FORCED FORWARD. DAMAGE TO POSTERIOR LIGAMENTS THAT KEEP SPINAL CORD IN ALIGNMENT. • HYPEREXTENSION – HEAD IS FORCED BACKWARD. DAMAGE TO ANTERIOR LIGAMENTS. • COMPRESSION – WHEN SPINAL CORD IS COMPRESSED. CAN SHATTER BONES OF VERTEBRAE, THE FRAGMENTS ARE SHARP AND THEY RUN THE RISK OF TRANSECTING THE CORD. • ROTATION – HEAD SPINS. CAN DAMAGE THE SPINE AS WELL.

PRIMARY

_____________ SPINAL CORD INJURY BODY TRIES TO REPAIR THE DAMAGE THROUGH INFLAMMATION WHICH CAUSES SECONDARY DAMAGE. 1. OXIDATIVE STRESS – NEUTROPHILS CREATE FREE RADICALS THAT CAN DAMAGE SPINAL CORD 2. CYTOKINES – MATURE HELPER T CELLS & MACROPHAGES (TYPE OF CYTOKINE) WILL CAUSE FURTHER DAMAGE 3. EXCITOTOXICITY – GLUTAMATE, A NEUROTRANSMITTER, AND ALTERS SODIUM & POTASSIUM PUMP WHICH CAN CAUSE FURTHER DAMAGE TO THE SPINAL CORD.

SECONDARY

TYPES OF SHOCK IN NEUROLOGICAL SECTION (2)

SPINAL NEUROGENIC *MORE DETAIL FOR SHORT ANSWER*

WHICH SPINAL CORD INJURY • HYPERREFLEXIA • OVERACTIVITY OF THE AUTONOMIC NERVOUS SYSTEM CAUSED BY AN IRRITANT BELOW THE LEVEL OF THE LESION. MOST COMMON IN PEOPLE WITH INJURIES ABOVE T6. **REQUIRES PROMPT ATTENTION

AUTONOMIC DYSREFLEXIA

``` CLINICAL MANIFESTATIONS OF _____________ ___________________ HYPERTENSION HEADACHE FLUSHED FACE DIAPHORESIS ABOVE THE LEVEL OF INJURY GOOSE FLESH BELOW LEVEL OF INJURY ```

AUTONOMIC DYSREFLEXIA

AUTONOMIC DYSREFLEXIA CAN RESULT IN BURST ______ __________ IN BRAIN

BLOOD VESSEL

AUTONOMIC DYSREFLEXIA CAN OCCUR BECAUSE OF ____________ ___________ OR _________________

URINARY RETENTION OR CONSTIPATION

WHICH CEREBROVASCULAR DISEASE ? DISEASE OF CEREBRAL BLOOD VESSELS RESULTING IN IMPAIRED CEREBRAL PERFUSION (DISORDER OF BLOOD VESSELS THAT DAMAGES THE BRAIN TISSUE)

CEREBROVASCULAR ACCIDENT (CVA)

CEREBROVASCULAR ACCIDENT (CVA) _______ _________: o FAMILY HISTORY, AGE o SMOKING, DYSLIPIDEMIA o HYPERTENSION, DIABETES

RISK FACTORS

80% OF CVA'S ARE _____________

ISCHEMIC

TYPES OF ____________________ ____________ ISCHEMIA HEMORRHAGIC TRANSIENT ISCHEMIC ATTACK (TIA)

CVA

WHICH TYPE OF CVA? o BLOOD CLOT OCCLUDES BLOOD VESSEL OF BRAIN. ALL TISSUE DISTAL DOES NOT RECEIVE OXYGEN. IT BECOMES ISCHEMIC AND DIES. o SYMPTOMS ARE PERMANENT

ISCHEMIC CVA

WHICH TYPE OF CVA? BLOOD VESSEL HAS BURST CAUSING BLEEDING INTO THE BRAIN. o EX. SUBARACHNOID HEMORRHAGE. o SYMPTOMS ARE PERMANENT

HEMORRHAGIC CVA

``` TYPE OF CVA? TEMPORARY REDUCTION OF BLOOD FLOW TO THE BRAIN o TEMPORARY SYMPTOMS & RESOLVES SHORTLY  HEADACHE  ONE SIDED WEAKNESS, DIZZINESS  FACIAL DROOPING  SLURRED SPEECH o CAN BE A WARNING STROKE IS IMMINENT ```

TRANSIENT ISCHEMIC ATTACK (TIA)

ETIOLOGY OF _____________ STROKE: •LARGE VESSEL DISEASE o ATRIAL FIBRILLATION CAN CAUSE STROKE o CARDIOEMBOLISM o ATHEROSCLEROSIS – PLAQUE IN BLOOD VESSELS •SMALL VESSEL DISEASE (LACUNAR INFARCT) – VESSELS DEEP IN VEINS

ISCHEMIC STROKE

DEFINITION - STROKE THAT OCCURS IN YOUNG PERSONS WITH NO RISK FACTORS

CRYPTOGENIC

DEFINITION - AREAS OF CELLS THAT ARE STILL ALIVE AND VIABLE IN REFERENCE TO STROKE.

PENUMBRA

____________ STROKE IS CHARACTERIZED BY ACUTE ISCHEMIA IN AREA OCCLUDED BY THROMBUS/EMBOLUS SURROUNDED BY VIABLE CELLS (PENUMBRA)

ISCHEMIC

PENUMBRA REMAINS VULNERABLE AS IT WILL DIE WITH FURTHER _______________

DEOXYGENATION

TREATMENT OF ____________ STROKE: TISSUE PLASMINOGEN ACTIVATOR (T-PA) WHEN ADMINISTERED WITHIN 4.5 HOURS FROM WHEN “LAST SEEN NORMAL” o DISSOLVES CLOT

ISCHEMIC

ISCHEMIC STROKE | TISSUE PLASMINOGEN ACTIVATOR (T-PA) WHEN ADMINISTERED WITHIN _____ HOURS FROM WHEN “LAST SEEN NORMAL”

4.5

HEMORRHAGIC STROKE - ____________ INTO THE BRAIN

BLEEDING

ETIOLOGY OF HEMORRHAGIC STROKE: | _______________ – BLOOD VESSEL BURSTS LEADS TO BRAIN BLEED

PRIMARY

ETIOLOGY OF HEMORRHAGIC STROKE: _______________ – UNDERLYING VASCULAR ABNORMALITIES (DISORDERS OF BLOOD VESSELS THAT CAN LEAD TO BLEEDING INTO THE INFARCTED SITE)

SECONDARY

_________________ IS THE MOST COMMON CAUSE OF PRIMARY HEMORRHAGIC STROKE!

HYPERTENSION (75%)

TREATMENT OF ____________ STROKE: | TO DO CAT SCAN, HAVE NEUROSURGEON SEE IT, AND SEE IF THEY CAN REPAIR IT.

HEMORRHAGIC *CANNOT GIVE CLOT BUSTING MEDS, IT WILL MAKE BLEEDING WORSE

DEFINITION – PARALYSIS IS ON OPPOSITE SIDE BRAIN IS AFFECTED. DYARTHRIA, DYSPHAGIA, SEIZURES, VISUAL IMPAIRMENT, HEADACHES, ETC…

CONTRALATERAL PARALYSIS

Signs & Symptoms OF ____________ * dysarthria * dysphagia * paralysis * seizures * hemiplegia: paralysis on one-side of body (usually opposite side of lesion)

STROKE

_______________ OF STROKE: * effects of stroke are permanent * effects of TIA are not permanent but can be a warning sign * paralysis * skin breakdown * loss of speech

Complications

INFECTION: ____________________ • INFLAMMATION OF THE LEPTOMENINGES & SUBARACHNOID SPACE • MAY OCCUR SECONDARY TO PARANASAL SINUS OR EAR INFECTION

MENINGITIS

INFECTION: _________________ - CLINICAL MANIFESTATIONS: o HEADACHE o FEVER o PHOTOPHOBIA o NUCHAL RIGIDITY – STIFF NECK, o BRUDZINSKI’S SIGN – WHEN NECK IS FLEXED FORWARD THE HIP AND KNEE AUTOFLEX o KERNIG’S SIGN – PERSON IS LYING ON THEIR BACK WITH HIPS FLEXED WHEN TRYING TO EXTEND LEG IT CAUSES MORE PAIN, AND CEREBRAL DYSFUNCTION o TACHYPNEA o SEIZURES o CRANIAL NERVE INVOLVEMENT

MENINGITIS

EVALUATION OF MENINGITIS IS DONE VIA ______________ ______________

LUMBAR PUNCTURE

TREATMENT OF MENINGITIS INVOLVES __________________ & ________________

ANTIBIOTICS, CORTICOSTEROIDS

``` ____________________ OF MENINGITIS: o HYDROCEPHALUS o HEADACHE o SEIZURES o DEAFNESS o PERSONALITY CHANGES o LANGUAGE DEFICITS o MOTOR WEAKNESS o ENDOCARDITIS o PNEUMONIA o DISSEMINATED INTRAVASCULAR COAGULOPATHY (DIC) ```

COMPLICATIONS

IF MENINGITIS IS LEFT UNTREATED A PERSON CAN HAVE _______________ & ______

SEIZURES & DIE

DEFINITION -- INFLAMMATION OF THE BRAIN

ENCEPHALITIS

_______ ________ VIRUS is a form of encephalitis

West Nile Virus

WHICH INFECTIVE NEUROLOGICAL DYSFUNCTION: S&S o FEVER, HEADACHE, NAUSEA o USUALLY SELF-LIMITING BUT CAN PROGRESS TO COMA AND DEATH o INCREASED RISK IN ELDERLY & THOSE WITH CHRONIC ILLNESS

ENCEPHALITIS

________________ NEUROLOGICAL DISEASES ``` ALZHEIMER'S HUNTINGTON'S DISEASE PARKINSON'S DISEASE AMYOTROPHIC LATERAL SCLEROSIS GUILLAIN BARRE SYNDROME MULTIPLE SCLEROSIS ```

DEGENERATIVE

``` DEMENTIA IS NOT A DISEASE, IT IS A _______________ IN MEMORY & COGNITIVE SKILLS SUCH AS: o MEMORY o COMMUNICATION AND LANGUAGE o ABILITY TO FOCUS AND PAY ATTENTION o REASONING AND JUDGMENT o VISUAL PERCEPTION ```

DECLINE

DEMENTIA CAN SOMETIMES BE ______________

REVERSIBLE

TYPES OF ______________: o ALZHEIMER'S DISEASE o VASCULAR DEMENTIA

DEMENTIA

DEFINITION - DISEASE THAT LEADS TO DEMENTIA

ALZHEIMER’S DISEASE

ALZEIMER'S DISEASE IS NOT ______________ & IS NOT PART OF NORMAL AGING.

REVERSIBLE

TWO MAJOR FEATURES OF ALZEIMER’S o _________________ TANGLES o ________ DEPOSITS

NEUROFIBRILLARY | PLAQUE

PATIENTS WITH ALZHEIMER’S HAVE ABNORMAL ____ PROTEIN. IT ACCUMULATES AS DEPOSITS OF PLAQUE.

TAU

``` RISK FOR ___________ DISEASE o AGE o GENETICS o FEMALE GENDER o CARDIOVASCULAR DISEASE o DIABETES o DOWN SYNDROME o HEAD INJURY o OTHER ```

ALZHEIMER'S

WHICH DEGENERATIVE NEUROLOGICAL DISEASE? | AUTOSOMAL DOMINANT TRAIT – GENETIC DEFECT ON CHROMOSOME 4 (INHERITED DISEASE)

HUNTINGTON’S DISEASE

HUNTINGTON'S DISEASE INDIVIDUAL HAS A _____% CHANCE OF INHERITING THE GENE FROM THEIR PARENTS. IF THEY INHERIT THE GENE THEY WILL GET THE DISEASE

50%

CLINICAL MANIFESTATIONS OF HUNTINGTON'S DISEASE MOVEMENT DISORDER  HUNTINGTON’S _________ – MOVING IN A RHYTHMIC TYPE OF FASHION

CHOREA

CLINICAL MANIFESTATIONS OF ___________ DISEASE o DEMENTIA o IRRITABLE, ANGRY o EMOTIONAL DISTURBANCES o TELL PEOPLE OFF

HUNTINGTON'S

HUNTINGTON'S DISEASE DEATH USUALLY OCCURS YOUNG AS A RESULT OF _____________ INFECTION

SECONDARY

DOPAMINE PLAYS A ROLE IN ____________

POSTURE

DOPAMINE DEFICIENCY CAUSES RESTING ________ AND ______________ GAIT

TREMORS | SHUFFLING

``` CLINICAL MANIFESTATIONS OF ____________ DISEASE o RIGIDITY, TREMOR, STOOPED POSTURE, o COGWHEEL RIGIDITY, BRADYKINESIA, o PROPULSIVE/RETROPULSIVE GAIT, o MASKLIKE FACIAL EXPRESSION, o DYSARTHRIA, DYSPHAGIA ```

PARKINSON'S DISEASE

PROGRESSIVE DEGENERATION OF UPPER MOTOR NEURONS IN CEREBRAL CORTEX AND LOWER MOTOR NEURONS IN BRAIN STEM AND SPINAL CORD. DEATH USUALLY OCCURS WITH 3-5 YEARS • occurs in CENTRIPETAL DIRECTION (FINGERS TO ARMS) • PROGRESSIVE MUSCLE WASTING AND ATROPHY OF HANDS, ARMS AND LEGS • PATIENTS MAINTAIN SENSORY AND COGNITIVE FUNCTION

AMYOTROPHIC LATERAL SCLEROSIS | AKA LOU GEHRIG’S DISEASE

WHICH DEGENERATIVE NEUROLOGICAL DISORDER? CAN OCCUR AFTER A VIRAL INFECTION. IMMUNE SYSTEM ATTACKS ITSELF AND CAUSES DEMYELINATION IN PNS. • FOLLOWS VIRAL INFECTION

GUILLAIN BARRE SYNDROME

WHICH DEGENERATIVE NEUROLOGICAL DISORDER? • CHARACTERIZED BY ASCENDING PARALYSIS • PARESTHESIA (PINS & NEEDLES) BEGINS IN FEET WORKS ITS WAY UP LEGS, ATAXIA, BLURRED VISION, DYSPHAGIA, DYSPNEA, RESP FAILURE • CAN BE REVERSIBLE IF TREATED EARLY & AGGRESSIVELY BUT RECOVERY TAKES SOME TIME (SEVERAL MONTHS) o TREATED WITH IMMUNOGLOBINS TO FIGHTS ANTIGENS THAT ARE TRYING TO DAMAGE PNS

GUILLAIN BARRE SYNDROME

WHICH DEGENERATIVE NEUROLOGICAL DISORDER? * PROGRESSIVE DEMYELINATION OF THE CNS – SLOWS NEURONS SIGNAL * CAN BE AUTOIMMUNE AS WELL * ONSET: 20-40 YEARS; FEMALES>MALES; TEMPERATE CLIMATE; 15% HAVE AFFECTED RELATIVE; ABNORMAL IMMUNE RESPONSE

MULTIPLE SCLEROSIS

WHICH DEGENERATIVE NEUROLOGICAL DISORDER? * CHARACTERIZED BY REMISSIONS & EXACERBATIONS * CLINICAL MANIFESTATIONS: FATIGUE, DIPLOPIA, ATAXIA, IMBALANCE, UNCOORDINATED GAIT, BLURRED VISION, PROGRESSIVE PARALYSIS * VARIES DEPENDING ON INDIVIDUALS

MULTIPLE SCLEROSIS

WHICH DEGENERATIVE NEUROLOGICAL DISORDER? • CHRONIC DISEASE WITH FLAIR UPS SUCH AS: o PAROXYSMAL ATTACKS • EVALUATION AND TREATMENT o NO CURE o LIMIT EXTENT OF DAMAGE AND SLOW DISEASE PROGRESSION

MULTIPLE SCLEROSIS

DEVELOPMENTAL ERRORS: | • NONPROGRESSIVE, PERMANENT ENCEPHALOPATHY OCCURRING PRENATALLY, PERINATALLY, OR POSTNATALLY

CEREBRAL PALSY

ALL TYPES OF CEREBRAL PALSY EFFECTS _______ FUNCTION

MOTOR

CEREBRAL PALSY CAN CAUSE SEVERE MENTAL _________ OR NONE AT ALL

DEFICITS

HYDROCEPHALUS – ACCUMULATION OF ______________ INSIDE VENTRICLES IN BRAIN

WATER

HYDROCEPHALUS CAN DEVELOP AFTER ________________

MENINGITIS

THE AQUEDUCT THAT NORMALLY DRAINS CEREBRAL SPINAL FLUID BECOMES _________ & COLLECTS FLUID CAUSING HYDROCEPHALUS.

BLOCKED

TREATMENT OF HYDROCEPHALUS: • A _________ IS INSERTED TO DRAIN THE VENTRICLES INTO THE PERITONEAL CAVITY. o MUST BE CAREFUL NOT TO DEVELOP HEAD INJURY o MAY DEVELOP SEIZURES

SHUNT

WHEN NECK IS FLEXED FORWARD THE HIP AND KNEE AUTOFLEX

o BRUDZINSKI’S SIGN –

PERSON IS LYING ON THEIR BACK WITH HIPS FLEXED WHEN TRYING TO EXTEND LEG IT CAUSES MORE PAIN, AND CEREBRAL DYSFUNCTION

o KERNIG’S SIGN –