Neuro Test #3

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Author:
em1277
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247617
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Neuro Test #3
Updated:
2013-11-21 10:20:07
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Chapters 49 50
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Patients with cerebroascular disorders Peripheral nervous system disorders
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  1. TIA
    • Temporary blockage of blood in the brain that causes brief neurologic impairment
    • 1/3 of patients will go on to have a stroke
  2. Penumbra
    Area of brain tissue surrounding damage from a stroke that may be revived if reperfused quickly
  3. Ischemic stroke
    • Most common - 87% of all strokes
    • Blood supply to the brain is blocked or slowed
    • 2 types: Thombotic, Emobolic
  4. Thrombotic stroke
    • [Ischemic]
    • Blood clot that traels until it becomes trapped in small vessel
  5. Hemorrhagic stroke
    • Less common - 13% of strokes
    • Caused by rupture of cerebral blood essel
    • 2 types: Subarachnoid, Intracerebral
  6. Subarachnoid hemorrhage
    • [Hemorrhagic stroke]
    • Occurs on surface of brain
    • Most often occurs as a result of ruptured cerebral aneurysm
    • *Often fatal*
  7. Intracerebral hemorrhage
    • [Hemorrhagic stroke]
    • Occurs in deeper tissues of brain
    • Usually caused by uncontrolled hypertension
    • May go undetected for a long time
    • Maintain lower BP
  8. Non-modifiable risk factors for stroke
    • ↑ age
    • More common in men
    • Heredity
    • Prior stroke or MI
  9. Modifiable risk factors for stroke
    • High BP
    • Smoking
    • Diabetes
    • CD
    • Afib
    • Sickle cell anemia
    • Obesity
    • Excessive alcohol
    • Poor diet
    • Inactivity
    • Postmenopausal hormone therapy
  10. 5 warning signs of stroke
    • *Sudden*:
    • Numbness or weakness of face, arm, leg, especially on one side
    • Confusion
    • Visual disturbances
    • Loss of balance/coordination
    • Severe headache
  11. Signs of stroke - FAST
    • Facial droop
    • Arm drift (eyes closed)
    • Speech (difficulty with) - Dysphasia
    • Time (any symptoms, 911 immediately)
  12. Ataxia
    Poor balance or a stumbling, staggering gait
  13. CT for stroke
    • Identifies if hemorrhagic or ischemic
    • Ischemic strokes won't be visible until several days later
  14. Thrombolytic therapy (tPA)
    • Clotbuster medication that dissolves clot
    • Can only be given within 3 hours of symptom onset
    • Risk of hemorrhage
  15. Permissive hypertension
    • After stroke, if thrombolytic is not to be given
    • It helps blood travel through redundant blood vessels in brain to reach damaged tissue
  16. Meds for CVA
    • tPA
    • Aspirin
    • Plavix
    • Aggrenox
    • Warfarin
    • Heparin
    • Statins
  17. Long term effects of stroke
    • Impaired motor function
    • Impaired sensation
    • Dysphagia
    • Aphasia
    • Emotional instability
    • Impaired judgement
    • Unilateral neglect
  18. Which side of body is affected after stroke
    Opposite the side of the cerebral infarct (contralateral)
  19. If stroke affects temporal lobe region, what will be affected?
    • Speech
    • Learned social behaviors
  20. Cerebral aneurysm
    • Weakness in the wall of a cerebral artery
    • If aneurysm ruptures, the result is often subarachnoid hemorrhage
    • Most often occur in circle of Willis
    • Most common site: bifurcation of artery
  21. Subarachnoid hemorrhage
    Collection of blood beneath the arachnoid mater
  22. S/S of a rupture of aneurysm
    • Sudden, severe headache
    • Photophobia
    • May: Nuchal rigidity
    • Most common affected cranial nerves are III & IV (enlarged pupil or abnormal gaze)
  23. Dx of aneurysm
    • CT to identify and locate hemorrhage
    • Precise diagnosis requires cerebral angiogram
  24. Therapeutic measures for subarachnoid hemorrhage
    • BP carefully monitored
    • With high BP: ↑ chance of rerupture
    • Low BP: Assoc with ischemia
    • Systolic s/b between 120-160

    May clamp a berry aneurysm
  25. Diplopia
    Double sight
  26. Why do you monitor glucose in stroke patient?
    Elevated glucose is assoc with worsening infarct and hemorrhage

    Report >140
  27. Constraint therapy
    Restrains the unaffected side to force the use of affected side
  28. Feeding with swallowing disorders
    • No straw
    • Hemiplegic - may be better to turn head toward weak side
  29. Multiple sclerosis
    • Myelin sheath breaks down
    • More common in women
    • CSF shows ↑ IgG
    • No cure
    • Permanent loss of muscle function
    • Avoid stressful situations and extreme heat
    • ACTH to treat symptoms
  30. S/S of MS
    • Muscle weakness/paralysis
    • Tingling/numbness
    • Visual disturbances (one eye)
    • Faitgue
  31. Plasmapheresis
    • For MS and MG who don't respond to steroids
    • Used to remove antibodies from blood that are attacking myelin
    • Periods of exacerbation and remission of symptoms
  32. Myasthenic crisis
    • MG
    • Not enough medication causes 
    • S/S - Ptosis, difficulty swallowing/speaking, dyspnea, weakness
  33. Cholinergic crisis
    • MG
    • Too much anticholinterase drugs
    • S/S: ↑ muscle weakness, dyspnea, salivation, miosis (constriction of pupils), ↑ in bronchial secreations
  34. Tensilon
    • An anticholinesterase drug
    • Used to test for MG.  Injected IV and if muscle strength improves dramatically, MG is diagnosed
  35. Myasthenia gravis
    • Weakness of muscles
    • Mask-like face
    • Increased muscle weakness during activity and improved muscle strength at rest.
    • Ptosis test & tensilon test to diagnose
    • No cure
  36. Therapeutic measures for MG
    • Schedule anticholinterase drugs so peak is at times when muscle strength is needed
    • Plasmapheresis
    • Steroids
  37. Amyotrophic lateral sclerosis (Lou Gehrig's disease)
    • Affects motor neurons responsible for voluntary movement
    • Genetic predisposition
    • S/S: progressive muscle weakness and ↓ coordination.  Emotional outbursts
    • Death usually from respiratory complications
    • Intact mind, deterioration of body
    • Quinine & Rilutek to treat
  38. Guillain-Barre syndrome
    • AKA polyneuropathy (nerves disease)
    • Viral
    • Abrupt onset of weakness that progresses to paralysis
    • Protein in CSF
    • 3 stages:
    • 1. Ascending paralysis: 24 hours-3 wks
    • 2. Plateau stage: most severe symptoms, progression stopped
    • 3. Recovery stage: 6-24 mo
  39. 4 variants of GBS
    • 1: Ascending GBS - begins in legs and moves up (most common)
    • 2: Descending GBS - Brainstem down
    • 3: Miller fisher syndrome - profound ataxia, paralysis - no respiratory compromise
    • 4: Pure motor GBS - milder form of ascending GBS
  40. Complications of GBS
    • Respiratory failure* (patients may deny respiratory difficulty because of fear of intubation)
    • Infection (pneumonia & UTIs)
    • Depression
  41. Trigeminal Neuralgia
    • 5th sensory nerve
    • S/S: Pain on one side of face (sudden, intense)
    • Sensitive to temp, sensitive to talking or chewing
    • Compl: Corneal damage, poor nutrition, depression
    • Anticonvulsants relieve nerve pain
    • Avoid touching face, and protect against cool breezes
  42. Bell's Palsy
    • 7th motor nerve
    • S/S:  Loss of motor control, paralysis on one side, facial droop
    • Prednisone, heat, facial sling to treat
    • Eye drops, eye patch, warm compresses, facial massage

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