Neurological Conditions and Injuries

These flashcards cover key definitions and concepts related to neurological conditions and injuries, including their symptoms, causes, and treatment approaches.

Intracranial Pressure (ICP)

Pressure inside the cranium, influenced by blood, brain tissue, and CSF.

Monro-Kellie hypothesis

The concept that the skull can compensate for changes in volume of blood, brain, or CSF to maintain normal ICP.

Increased ICP early manifestations

Decreased level of consciousness, severe headache, vomiting, decreased pupil response

Cushing reflex

A late sign of increased ICP characterized by hypertension, bradycardia, and decreased respirations.

Stroke (Cerebral-Vascular Accident)

Sudden impairment of cerebral circulation leading to potential brain injury.

Ischemia

Lack of oxygen causing tissue damage or necrosis.

Dysarthria

Motor speech disorder resulting in weakness or difficulty in speaking.

Seizures

Uncontrolled electrical disturbances in the brain leading to changes in behavior or consciousness.

Epidural hematoma

A hematoma that forms between the dura mater and skull, often due to arterial bleeding.

Subdural hematoma

Bleeding that occurs between the arachnoid layer and dura mater, typically associated with venous bleeding.

Spinal Cord Injury (SCI)

Damage to the neural elements of the spinal cord, often resulting in motor or sensory loss.

-Results from trauma, fractures, dislocations or subluxations

- Damage located within the vertebral column and cord

Complete SCI

No preservation of sensory or motor function below the level of injury.

Incomplete SCI

Some motor or sensory function remains below the level of injury.

Central Cord Syndrome

- Usually associated with cervical spinal injuries

- More motor inpairment in upper body than lower

- Variable sensory loss below the injury

Brown-Sequard Syndrome

-Common with cervical spine injury

- Loss of motor function (weakness/paralysis) on one side

- On opposite side loss of sensation

Bell Palsy

Neuropathy of the facial nerve causing unilateral facial weakness.

- Paralysis of the muscles on one side of the face

- Often self-limiting with unknow cause

Multiple Sclerosis (MS)

Chronic, progressive demyelination of neurons in the central nervous system.

- Different types of MS (severity and progression)

- Onset usually occurs between 20 to 40 years of age

Parkinson Disease

Disorder involving the dopamine secreting pathway in the basal gangia

- Chronic, progressive, degenerative

- Dysfunction of the extrapyramidal motor system

- Progressive degeneration in basal nuclei and reduction of dopamine

- Difficulty initiating, modulating, and completing movements

Amyotrophic Lateral Sclerosis (ALS)

Progressive disease affecting both upper and lower motor neurons, leading to muscle weakness and atrophy.

- Typically occurs between the ages of 40-60 years

- Affects more men than women

- Cognition often unimpaired

Myasthenia Gravis

A chronic autoimmune disease characterized by the gradual weakness of skeletal muscles.

-Gradual destruction of acetylcholine receptors

- An IgG antibody blocks receptor sites

- Acetylcholine important in causing muscle contractions

- Very rare

- Breakdown causes delayed communication between nerves and muscles

Alzheimer Disease

Progressive, degenerative disorder of the cerebral corteex, affecting memory and cognitive functions.

- Progressive, degenerative disorder of the cerebral cortex

- Slow, progressive deterioration in learning, recent, and remote memory, language, abstraction, problem sovling, and judgement skills over 5-12 years

Neurofibrillary tangles

Fibrous proteins on the neuron that accumulate inside neurons in Alzheimer's disease.

Amyloid plaques

Deposits of abnormal protein that build up in the brains of Alzheimer's patients.

Blackout symptoms

Inability to recognize family and friends in advanced stages of Alzheimer's.

Chronic autoimmune disease

A persistent condition where the immune system attacks the body's own tissues.

Hypotonia

Decreased muscle tone, commonly found in various neurological disorders.

Neuropathy

Any disease or dysfunction of the peripheral nerves.

Cerebral edema

Swelling of the brain due to excess fluid.

Herniated intervertebral disk

Protrusion of the nucleus pulposus, often found in the lumbar region, causing nerve pain.

Scotoma

An area of partial or total blindness in a visual field.

Diplopia

Double vision, often associated with neurological conditions.

Dystonia

Involuntary muscle contractions causing abnormal postures.

Akinesia

Loss or impairment of voluntary movement.

Bradykinesia

Slowness of movement, characteristic of Parkinson’s disease.

Post-concussion syndrome

Persistent symptoms such as headache and irritability following a concussion.

CSF leakage

Cerebrospinal fluid leaking from the ears or nose, often due to a skull fracture.

Somatic nervous system

The part of the peripheral nervous system responsible for voluntary movements.

Autonomic nervous system

The part of the peripheral nervous system that controls involuntary bodily functions.

Cognition

The mental process of acquiring knowledge and understanding through thought.

Nature of electrical disturbances

Uncontrolled electrical surges in the brain leading to seizures.

Risk factors for stroke

Age, hypertension, diabetes, smoking, obesity.

Mortality rate

The rate of death in a given population, often referenced in context of specific diseases.

Management of ICP

Includes monitoring and pharmacological interventions to prevent brain injury.

Neurological assessment

An evaluation of a person's nervous system, typically focusing on sensory and motor function.

Complications of strokes

Can include paralysis, speech difficulties, and cognitive impairments.

Functional consequences

Impact on daily living that results from neurological conditions or brain injuries.

Visceral functions

Involuntary functions controlled by the autonomic nervous system, such as heart rate.

Diagnostic imaging for strokes

CT scans are used to determine the type and location of a stroke.

Management of hemorrhagic stroke

Focuses on blood pressure stabilization and monitoring ICP.

Chronic fatigue

Persistent tiredness not alleviated by rest, often seen in MS.

Neurological rehabilitation

Therapeutic interventions aimed at helping patients recover from neurological conditions.

Cognitive decline

A decrease in cognitive functioning, often observed in Alzheimer's patients.

Muscle dystrophy

A group of disorders characterized by muscle weakness and degeneration.

Diagnosis of MS

No definitive test; MRI is often utilized for monitoring progression.

Long-term effects of head injuries

Can include cognitive impairment, personality changes, and increased susceptibility to further injury.

Therapeutic interventions for NV

Various medical and supportive measures to manage neurological conditions.

Dopaminergic pathway

Neural pathways in the brain that are primarily affected in Parkinson's disease.

Common causes of increased ICP

Tumor, edema, swelling, bleeding

Risk Factors for stroke

age, gender, race, hereditary, HTN, smoking, diabetes, heart disease, drug use, alcoholism, obesity

Manifestations of stroke

Depend on type and severity of stroke

- Aphasia

- Alterations in receiving and expressing speech

- Dysarthria

- Motor dysfunction affecting speech

- Weakness, paralysis, poor coordination

- Confusion, personality change

- Visual changes

- Coma

What is an ischemic stroke

It is the most common type of stroke; caused by thrombus or emboli.

What is a TIA

- Type of ischemic stroke

- Brief episode of paresis/paralysis d/t local ischemia not infarct

- Signal of issue

- Deficit short term, normal within 24 hours

What is hemorrhagic stroke

- Cause: chronic, severe hypertension

- High morbidity and mortality rate

Type of Aphasia: receptive/ sensory

- Damage to Wernicke’s area

- Inability to read or understand the spoken word

- Speech frequently meaningless

Type of aphasia: expressive/ motor

- Damage to Broca’s area

- Impaired ability to speak or write fluently or appropriately

Type of aphasia: mixed/global

Damage to both areas or to the fibers and tracts between them

Direct injury to brain tissue

-Bruising of the tissue

- Destruction of brain tissue

- Massive swelling of the brain

Concussion (minimal brain trauma)

- Immediate loss of consciousness and reflexes after a blow to the head or

whiplash-type injury

- Lasts less than 5 minutes

- Recovery within 24 hours without permeant damage

- Post concussion syndrome: persistent HA, irritability, insomnia,

poor concentration and memory

Contusion

- Bruising of brain tissue, rupture of small blood vessels, and edema

- Caused by blunt blow to the head, possible residual damage

Contrecoup injury

-Area of the brain contralateral to the site of direct damage is injured

- As brain bounces off the skull

- May be secondary to acceleration or deceleration injuries

Closed head injury

-Skull is not fractured in injury

- Brain tissue is injured and blood vessels may be ruptured

- Extensive damage may occur when head is rotated

Open head injury

Involve fracture or penetration of the brain

Depressed skull fracture

- Involve displacement of a piece of bone below the level of the skull

- Compression of brain tissue

- Blood supply to area often impaired— pressure to brain

Basilar fractures

-Occur at the base of the skull

- Leakage of CSF through ears or nose is possible

- May occur when forehead hits windshield

Effects of Head injuries on the brain: Primary Brain Injuries: direct insult

-Laceration or compression of brain tissue

- Rupture or compression of cerebral blood vessels

- Damage from rough or irregular inner surface of the skull

- Movement of lobes against each other

Effects of Head injuries on the brain: Secondary injuries: Progressive damage resulting from primary insult

Cerebral edema, hemorrhage, hematoma, cerebral vasospasm, infection,

ischemia related to systemic factors

Effects of Head injuries on the brain: Trauma to brain tissue causes:

-Loss of function in part of body controlled by that area of the brain

- Cell damage and bleeding lead to inflammation and vasospam

- Increased ICP, general ischemia, dysfunction

- Some recovery may occur— scar tissue formation

Manifestations: Head injuries

-Seizures

- Often focal but may be generalized

- Possible cranial nerve impairment

- Otorrhea or rhinorrhea

- Leaking of CSF from ear or nose

- Fever

- May be sign of hypothalmic impairment or cranial or systemic infection

- Euphoria, drowsiness

- Impaired cognition

- Severe: coma, increased ICP, paralysis

S/ Sx of epidural hematoma

- Decreased LOC with lucid states

- HA

- Vomiting

- Drowsiness and confusion

- Seizures

- If not reversed 100% mortality

acute subdural hematoma

-Usually develops within first 24 hours

- Severe drowsiness

- Rapid onset, increased mortality

chronic subdural hematoma

-Slow accumulation, develops over days/ weeks

- Occur often in elderly population

Manifestations of subdural hematoma

-Headache

- Drowsiness

- Change in consciousness

- Pupillary and respiratory pattern changes

Primary spinal cord injury

-Gray and white matter within the cord damaged by small hemorrhaging and

edema causing necrosis of neural tissue

- Occurs at time of insult, irreversible

secondary spinal cord injury

-Follows the injury, surrounding area of inital damage are affected

- Causes progressive neurological damage

- Can be temporary

Anterior Cord Syndrome

-Associated with cervical spine injury

- Below injury level motor paralysis, loss of pain and loss of temp.

sensation

- Below the injury touch sensation and position sense not affected

SCI Stages: Spinal Shock

First stage

- Sudden, complete transection of the spinal cord

- Initial injury

Manifestations of Spinal Shocl

-Absence of all voluntary and reflex activity below level of injury, includinf

loss of sensation

- Tetraplegia (quadriplegia): damage within the cervical spine

- Impairment: arms, trunk, legs, pelvic organs

- Paraplegia: damage within the thoracic, lumbar, or sacral spine

- Impairment: trunk, legs, pelvic organs (vary)

- Neurogenic shock can occur if severe

SCI stages: recovery and recognition

Second stage:

- Gradual return of reflex activity below the injury

symptoms of recovery and recognition SCI stage

-Hyperreflexia

- Spastic paralysis

- Sensory deficits

- Bladder and bowel dysfunction

symtoms of bell’s palsy

- Unilateral facial weakness

- Facial droop and diminished eye blink

- Hyperacusis

- Decreased lacrimation (tears)

Cause of MS

- May be an autoimmune disease, nutritional deficit, change in blood flow to

neurons

- May have genetic, immunological, and environmental components

Patho of MS

- Loss of myelin interferes with conduction of impulses in affected fibers

- May affect motor, sensory, or autonomic fibers

- Occurs in diffuse patches in the nervous system

- Early: lesions

- Inflammatory response and demyelination occurs

- Later: plaques

- Larger areas of inflammation and demyelination

- Frequently next to the lateral ventricles, brainstem, optic nerve

- Plaques vary in size

S/ Sx of MS

-Blurred vision, weakness in legs

- Diplopia, scotoma (spot in visual field)

- Dysarthia

- Paresthesia, areas of numbness, burning, tingling

- Pain

- Progressive weakness and paralysis extending to the upper limbs (fatigue)

- Loss of coordination, bladder, bowel and sexual dysfunction, chronic fatigue

- Depression

Cause of Parkinsons

• unknown

• Primary or idiopathic Parkinson’s disease

• Usually develops after age 60

early S/Sx of parkinsons

-Fatigue, muscle weakness, muscle aching

- Decreased flexibility

- Less spontaneous changes in facial expression

- Tremors in the hands at rest (pill rolling)

Later S/Sx of parkinsons

-Tremors affect hands, feet, face, tongue, lips

- Increased muscle rigidity, slow movements

- Difficulty initiating movements

- Lack of associated involuntary movements

- Characteristics standing posture is stooped, leaning forward

- Propulsive gait

- Complex activities become slow and difficult

Patho of ALS

-Atrophy of the muscle fibers due to denervation of motor neurons

- No indication of inflammation around nerves

Symptoms of ALS

-Hallmark: muscle weakness and wasting

- Impaired speech

- Swallowing

- Respiration difficulty

- Stiffness

- Irregular twitching

symptoms of myasthenia gravis

Gradual development of weakness

- From proximal too distal portions of body

- Early symptoms include diplopia and ptosis

- Other: difficulty chewing, swallowing, and talking

- Fatigue