Neurological disorders NS 216.txt

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tundrafox
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50121
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Neurological disorders NS 216.txt
Updated:
2010-11-17 00:32:09
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patho
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neurological disorders
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  1. Contusion (immediate M's)
    • loss of consciousness lasting < 5 minutes
    • loss of reflexes
    • transient cessation of respirations
    • brief period of bradicardia
    • decreased blood pressure
  2. Contusions (later M's)
    • vital signs stable and normal
    • reflexes and consciousness normal in minutes to days
  3. What type of bleeding results in an extradural hematoma?
    Arterial bleeding between the skull and the dura mater
  4. Epidural or extradural hematoma (M's)
    • loss of consciousness
    • headache
    • vomiting
    • drowsiness
    • confusion
    • seizure
    • hemiparesis (unilateral paralysis)
    • ipsilateral pupil dilation (same side as injury)
  5. What M is characteristic of a herniation of the uncus part of the temporal lobe?
    ipsilateral (same side as injury) pupil dilation
  6. What is an Uncal herniation?
    Where the lower part of the brain herniates down around the tentorium
  7. What type of bleeding results in a subdural hematoma?
    venous
  8. Subdural hematoma (initial acute M's)
    • headache
    • drowsiness
    • restless
    • agitation
    • slow cognition
    • confusion
  9. Subdural hematoma (later acute M's)
    • loss of consciousness
    • respiration changes
    • pupillary dilation
  10. Subdural hematoma (chronic M's)
    • chronic headaches
    • progressive dementia
  11. Intracerebral hematoma (M's)
    • decreased LOC
    • confusion
    • contralateral hemiplegia
    • temporal lobe herniation
    • coma
  12. Concussion (C's)
    • no loss of continuousness
    • no evidence of damage on physical or radiologic exams
  13. Concussion (M's)
    • short-lived confusion
    • amnesia for events preceding and immediately after trauma
  14. Classic cerebral concussion (M's)
    • immediate LOC lasting < 6 hrs
    • transient apnea, bradycardia, and hypotension
    • amnesia for events before and after trauma
    • head pain
    • nausea
    • fatigue
    • mood and affect (emotion) changes
  15. Diffuse Axon Injury (DAI) (Definition)
    • All axons fire at once
    • prolonged traumatic coma (> 6 hrs)
    • result of shaking and rotational acceleration
  16. Diffuse Axon Injury (DAI) (physical M's)
    • spastic paralysis
    • peripheral nerve injury
    • swallowing impairments
    • visual and hearing impairments
  17. Diffuse Axon Injury (DAI) (cognitive M's)
    • disorientation/confusion
    • short attention span
    • memory deficits
    • learning difficulties
    • poor judgement
  18. Diffuse Axon Injury (DAI) (behavioral M's)
    • agitation
    • impulsiveness
    • blunted affect
    • social withdrawal
    • depression
  19. CVA related to carotid artery (M's)
    • contralateral hemiparesis/hemiplegia (first flaccid, then spastic)
    • contralateral sensory impairment
    • visual field cuts (homonymous hemianopsia)
    • neglect syndrome (right CVA)
    • aphasia (expressive or receptive)
    • changes in consciousness
    • changes in cognition
    • dysphagia
  20. Differentiating M of right-side CVA related to carotid circulation?
    neglect syndrome (client ignores the side that doesn't work)
  21. Expressive aphasia (def & M's)
    • can receive, but not express
    • poorly articulated speech
    • sparse vocabulary
    • simple grammar
  22. Receptive aphasia (def & M's)
    • cannot receive or express
    • difficulty comprehending speech
    • use of jargon
    • work finding difficulties
  23. CVA in Broca's area results in ___ aphasia
    Expressive
  24. CVA in Wernicke's area results in ___ aphasia
    Receptive
  25. CVA related to basilar and vertebral arteries (M's)
    • ataxia
    • dysarthia/dysphagia
    • vertigo
    • diplopia
    • nausea/vomiting
  26. Pressure on the chemoreceptor trigger zone (CTZ) causes ___
    nausea or vomiting
  27. Hemorrhagic stroke (M's)
    • profound headache
    • photophobia
    • stiff neck
    • profound neurologic deficit with hemorrhage rupture
    • can cause communicating hydrocephalus
  28. A congenital weakening of the medial layer of cerebral arteries can lead to ___
    cerebral aneurysm
  29. Most common place to find a cerebral aneurysm
    circle of Willis
  30. Cerebral aneurysm (pre-rupture M's)
    severe headache
  31. Cerebral aneurysm (post-rupture M's)
    • Standard M's of a brain bleed:
    • increased ICP -> profound neurological deficits
    • vasospasm -> ischemia -> more neurogenic deterioration
    • communicating hydrocephalus
  32. Subarachnoid hemorrhage (slow leak M's)
    • headache
    • change in mental status
    • nausea/vomiting
    • focal neurologic deficits
  33. Subarachnoid hemorrhage (ruptured vessels M's)
    • sudden throbbing headache
    • nausea/vomiting
    • visual disturbances
    • motor deficits
    • loss of consciousness
    • stiff neck
  34. Communicating Hydrocephalus (def)
    reduced ability of arachnoid villi to absorb CSF from subarachnoid space
  35. Communicating Hydrocephalus (M's)
    increased intracranial pressure
  36. Non-communicating Hydrocephalus (def)
    • also known as Obstructive Hydrocephalus
    • usually a congenital defect resulting in an obstruction of CSF flow at the aqueduct of Sylvius between the 3rd and 4th ventricles
  37. Non-communicating Hydrocephalus (M's)
    • enlarging skull if bones are not yet fused
    • if untreated:
    • -- mental retardation
    • -- growth retardation
    • -- lack of development
  38. Normal Pressure Hydrocephalus (def)
    • increase in volume of CSF:
    • -- to compensate for loss of brain tissue (Alzheimers)
    • -- viral infections and neurotoxins
  39. Normal Pressure Hydrocephalus (M's)
    • declining memory
    • unsteady, broad based gait causing falls
    • apathy, inattentiveness, indifference
  40. Meningitis (def & spread by)
    • infection of the cerebrospinal fluid
    • spread via respiratory secretions
  41. Meningitis (M's)
    • nuchal rigidity, headache
    • photophobia
    • decreased LOC
    • fever, chills
    • nausea/vomiting
    • seizures
  42. Meningitis (Lab indicators)
    • Bacteria and protein in CSF
    • low CSF glucose
  43. Encephalitis (def)
    inflammation of the brain
  44. Encephalitis (M's)
    • enlarged lymph nodes
    • flu-like symptoms
    • coma
    • fever
    • headache
    • changes in mental status
  45. Brain abscess (def)
    a mass, lesion, or collection of pus in the brain that mimics a tumor
  46. Brain abscess (early M's)
    • headache
    • low-grade fever
    • neck pain and rigidity
    • drowsiness
    • confusion
  47. Brain abscess (late M's)
    • inattentiveness
    • memory deficits
    • decreased visual acuity
    • narrowed field of view
    • ocular palsy (tremors)
    • dementia
  48. Glioma (def)
    Brain tumor
  49. Astrocytoma (def)
    • most common glioma
    • develop from astrocytes
    • fast growing
  50. Early M's of an Astrocytoma
    • headache
    • seizures
  51. Primary glioma (def)
    intracerebral tumor that invades and destroys brain tissue causing compression -> ischemia -> edema -> increased intracranial pressure
  52. Types and def of atypical seizures
    • clonic - jerking movement
    • tonic - stiffening of muscle groups
  53. What are some seemingly unexpected causes of dementia?
    • renal failure
    • atherosclerosis
    • HIV infection of the CNS
  54. Multi-infarct dementia is caused by ___
    atherosclerosis
  55. Mutations on chromosomes 14, 19, & 21 are linked to ___
    early onset of Alzheimer disease
  56. Development of ___ and ___, and decreased ___ are a/w what?
    • neurofibrillary tangles of tau proteins
    • amyloid deposits forming senile plaques
    • acetylcholine syntesis
    • Alzheimer disease
  57. Parkinson disease (patho)
    lack of dopamine to balance out acetylcholine -> jerky muscle movement and poor coordination

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