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TIA
- Transient Ischemic Attack
- a temporary localized reduction of blood flow in the brain. Recovery occurs within 24 hours, generally 1-2hours
- "Little Stroke"
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Anencephaly
Congenital birth Defect where baby is born without a brain
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TIA S&S and Dx
- S&S:
- numbness, paresthesias (burning, foot going to sleep) weakness, visual disturbance(tunnel vision)
Dx: CT scan, MRI/MRA(angiography injecting dye looking at blood vessels, neuro exam , ECG
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CVA and Causes
- Cerebrovascular Accident
- 1. Thrombosis (atherosclerosis, blood clot) arteries leading to the brain
- resulting in occlusion of the vessel.
- 2. Hemorrhage- blood vessel, such a cerebral artery breaks and bleeding occurs
- (aneurysm, A-V malformation)
- 3. Embolus- travels to cerebral arteries and occluded a small vessel (fat, blood clot)
- 4. Brain Abscess
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CVA S&S, Dx, Trx
- S&S: loss of consciousness, cognitive and motor deficiencies
- Dx: history of syncope, numbness, H&P, neuro exam, CT scan, MRI/MRA, cerebral angiography
- Trx: Tissue Plasminogen Activator, Carotid Endarterectomy
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Carotid Endarterectomy
removal of the atherosclerotic plaque along with the inner lining of the affected carotid artery
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Concussion
Brief LOC, Severe could lead to coma
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Epidural Hematoma
- Arterial bleed caused by head injury.
- Between Skull and dura as result of ruptured meningeal artery
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Epidural Hematoma SS, Dx, Trx
- S&S: puplis dilated, unconsciousness, increased ICP- intracranial pressure
- Dx: neuro exam, CT exam, MRI/MRA
- Trx: Craniotomy or Burr Holes
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Subdural Hematoma
- tearing of veins between the dura and arachnoid membranes
- Blunt Trauma
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Benign Tumors
Meninginoma and Schwanoma
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Malignant Tumors
Gliobastoma, Astrocystoma, Medullablastoma, Oligodendroglimo
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Tumors SS, Dx, Trx
- SS: Insidious Onset, Increased Intracranial Pressure, visual disturbances, N&V, vertigo
- Dx: Neuro exam, CT exam, MRI/MRA
- Trx: Craniotomy and Biopsy of tumor, SHUNT!
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Seizures
- Causes: H&P, description of seizure, CT scan, MRI/MRA, EEG, r/o underlying disease process and treat if found, neuro exam
- Trx: anticonvulsant drugs like topamax and dilantin
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Seizures-Aura
Clam before storm, Dizziness, numbness, and visual disturbances
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Seizures- Tonic Clonic/Grand Mal
- Sudden LOC
- Falling Down and convulsing
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Parkinsons
- Degeneration of neurons in the basal ganglia occurring in later life and leading to tremors, weakness of muscles, and slowness of movement
- Loss of dopamine (neurotransmitter) made by cells in the basal ganglia
- Motor disturbances include stooped posture, shuffling gait, muscle stiffness, and often a tremor of the hands
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Parkinsons SS, Dx, Trx
- S&S: bradykinesia, tremor, rigidity (facial), shuffling gait, sweating, drooling, dementia in advanced stages
- Trx: medication- dopamine (levodopa, sinemet), cogentin, parlodel
- Surgery-deep brain stimulation, implant of fetal brain tissue
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Alzheimers-Causes, Dx, SS
- Causes: Atrophy of the cortex and loss of neurons in the frontal and temporal lobes.
- Dx: a diagnosis of exclusion via testing-cognitive tests, CT scan, MRI, H&P, neuro exam, r/o metabolic disorders
- S&S: insidious onset of memory loss, distorentation, abstract thinking is impaired, all symptoms become progressively worse
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Alzheimers- Trx
patient and family education, support groups, medications- aricept, memantine
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Graves Disease
because metabolism is faster; the condition is marked by an increase in heart rate (with irregular beats), higher body temperature, hyperactivity, weight loss, and increased peristalsis (diarrhea occurs).
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Graves- SS, Dx, Trx
- SS: nervousness, heat intolerance, weight loss, tremor, tachycardia, thyromegaly (goiter), hair loss, exophthalmos protrusion of the eyeballs
- Dx: Serum TSH, T3, T4, Thyroid Scan, Ultrasound of thyroid, fine needle aspiration
- Trx: Radiation and Thyroidectomy
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Hypothyroidism SS, Dx, Trx
- S&S: cold intolerance, bradycardia, cardiomegaly, lethargic, weight gain, thyromegaly
- Dx: Serum TSH will be up, T3, T4
- Trx: thyroid replacement
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Type 1 Diabetes SS, Dx, Trx
- S&S: acute and sudden onset of polyuria, polydipsia, polyphagia, weight loss, ketosis, coma
- Dx: FBG- Fasting Blood Glucose over 126 mg/dl on more than one test (normal is less than 100mg/dl), glucose tolerance test (2-3 GTT)
- Trx: Insulin- types rapid acting ( 10 minutes onset), short acting (regular insulin- 30 minutes onset) Intermediate acting (1-4 hours onset) Long acting (1-5 hours 24 hours)
- Drugs-Humo, Nuvo
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Type 2 Diabetes-SS, Trx, Dx
- S&S: Insidious Onset-developing in a gradual manner, polyuria, polydipsia, blurred vision, fatigue, paresthesias
- Dx: same at Type 1
- Trx: antidiabetic drugs: metformin (glucophage), diabinese, orinase, actose, avandia, prandin, byetta, januvia, insulin if necessary
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Ketoacidosis-SS, Dx, Trx
- increase in ketones when insulin is decreased and fat is
- being burned
- S&S: 1-2 days of polyuria, n&v, stupor, coma, hyperglycemia of 250-1000, serum pH, bicarb and K+ are all out of balance
- Trx: low dose insulin, replace electrolytes
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