neurological exam 3

early changes with acute brain disorders

glasgow coma scale

early changes with acute brain disorders

glasgow coma scale

what does decreased levels of loc inducate?

confusion or disorientation

memory loss

unresponsiveness to vertebral stimuli

difficulty in arousal

loss of consciousness or coma

what do the levels of reduced consciousness ay lead to what?

vegetative state

loss of awareness and mental capabilities

they still retain autonomic nervous system

locked in syndrome

individual is aware and capable of thinking bt is paralyzed and cannot communicate

brain death

cessation of brain function

absence of brain stem reflexes or responses

absence of spontaneous respirations or establishment of irreversible brain damage

no autonomic nervous system

motor dysfunction

damage to upper motor neurons

damage to lowe motor neurons

decorticate and decerebrate posutring

decorticate positioning

arms on the chest and toes pointed down

decerebrate

arms at the sides and hands turned out

toes pointed

sensory deficits

issue with sensory neurons

somatosensory cortex in the parietal lobe receives and localized basic sensory input

involves touch, pain ,temp, position

mapped by dermatomes

intracranial pressure

pressure insdie the skull

blood, brain tissue, and csf within the skill contribute to this

monro kellie hypothesis

monro-kellie hypothesis

body can compensate by adjusting one or two things to keep icp normal

blood csf, tissue itself: by regulating these three things we can regulate the pressure in our skull

obstruct blood flow

destroy brain cells, tissue

displace brain tissue

damage delicate brain structures., right in the middle of the brain

what can excessive icp lead to?

tumor

edema

bleeding

what are the common causes of increased icp?

decreased elvel of consciousness

severe headache

vomiting

what are the early manifestations of increased icp?

hypertension

bradycardia

decreased respirations

what are the late manifestations of increased icp?

brain herniation

increased icp pushed the brain out of position

brain tissue is compressed into the center of the brain, agaisnt bone or agaisnt rigid folds of the dura mater

head injury, stroke, tumor

skull fracture

may do down the brain stem

what is the cause of brain herniations?

headache

lethargy

loss of consciousness

dilated pupils

high blood pressure

irregualr slow pulse

respiratory or cardiac arrest

comatose

what are the manifestations of brain herniation?

stroke

cva

sudden impairment of cerebral circulation in one or more blood vessels supplying the brain

lack of o2=ischemia and necrosis

loosing tissue

ischemic stroke

hemorrhagic stroke

what are the two common types of CVA?

ischemic stroke

most common type of stroke

thrombus or emboli

TIA

hemorrhagic stroke

chronic, severe hypertension high morbidity, and mortality rate

rupture and now we are bleeding in tot he brain

hypertension is the underlying cause

age, gender, race, hereditary, htn, smoking, diabetes, heart disease, drug use, obesity, usally not one thing, multiple risk factors together

what are the risk factors for stroke?

depend on type and severity of stroke

aphasia

dysarthria

weakenss,paralysis,

visual changes, coma

fast

personality change

what are the manifestations of stroke?

cardiovascular stabilization

brain ct

what is the tx for stroke?

treatment aimed at minimizing infarct size and preserving neurological function

what is the tx for an ischemic stroke?

blood pressure management icp monitoring and mangement

what is the tx for hemorrhagic stroke?

aphasia recpetive/sensory

dependso nthe area of the brain affected

damage to wernicke’s area

inability to read or understand the spoken word

speech frequently meaningless

expressive/motor aphasia

depends on the area of the brain affected

damabe to the brocas area

imapired ability to speak or write fluently

mixed/global aphasia

damage to both area or to the fibers and tracts between them

aneurysms

localized dilation in the artery, thinning usually d/t controlled hypertension

common location is the circle of willis

commonly multiple and aggravted by uncontrolled hypertension

asymptomatic

visual distubances

headache and photophobia neck stiffness

increased icp

what are the manifestations of a aneuryms?

qwhat are the manifestations of a sudden rupture of an aneurysm?

increased blood pressure

when they do a spinal tap blood can be in it

vasospasm

surgical treatment before rupture clamp the aneurism

antihypertensive drugs

id detected and keep an eye on it if it is not causing issues

what are the tx for aneurysms?

meningitis

infection within the brain and spinal cord meninges

spreads quixckly d/t transmission within the csf

swelling cuases decreased blodo flow and increased icp

infants, children, and elderly people at highest risk

bacterial high risk one viral mild than bacterial or fungal

infeciton gains access throguh bloodstream-csf-spreads rapidly

usually secondary to another infection

what are the causes of meningitis

fever

severe ha

photophobia

tinnitus

neck stiffness

pain

projectile vomiting

decreased consciousness

what are the manifestations of meningitis?

postiive kernig and brudzinskl

deafness, paresis,paralysis,coma

what are the manifestations and complciations of meningitis?

encephalitis

infection of the connective tissue in the brain and spinal cord

necrosis and inflammation develop in tissue

can result in some perm. damage

usually of viral origin

severe headache, stiff neck

lethargy, vomiting

seizers, fever

muscle pain

rash

no positive kernig, bruskiinski

what are the manifestations of encephalitis?

guillian barrer syndrome

autoimmune degenerartion of nerve cell bodies

inflammation of peripheral nerves lead to demyelination

acute episode and we have degeneration of the nerve cell start to demyelinate

idiopathic origon

unknown, post infections immunologic mechanism is suspected

what is the cauess of guillian barrer syndrome ?

acute onset of motor paralysis

begins in legs and moves upward

muscle wekaness

incontinence

respiratory issues if severe

what are the manifestations of guillian barrer syndrome ?

fractures

hemorrhage and edema

direct injury to brain tissue

what are the types of head injuries?

concussion

minimal brain truama

immediate loos of consciousness and reflexes after a blow to the head to whiplash type injury

lasts less than 5 minutes

recovery 24 ours without perm. damage

post concussion syndrome

contusion

brusing of brain tissue, rupture of small blood vessels, and edema

cuased by blunt blow to the head, possible residual damage

contrecoup injury

whip lash

area of the brain contralateral to the site of direct damage is injured

may be secondary to acceleration or deceleration injuries

brain hits the side of the skull and hits the other side

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 injuries

involve fractures or penetration of the brain

depressed skull fractures

involve displacement of a peice of bone below the level of the skull

compression of the brain tissue

blood supply to area often impaired -pressure to brain

peice pushed inward

basilar fractures

occur at the base of the skull: around the eye sockets and ears

elakage of csf through the ears or nose back of throat is possible. constantly swallowing to see if seothing is drainign there

csf has sugar in it

may occur when forehead hits windshield

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

movmeent of lobes agaisnt each other

what are the affects of primary brain injuries?

progressie damage resulting form primary insult

cerebral edema, bleeding,

akes the primary worse

what are the affects of secondary brain injuries?

loss of function in part of body controlled by the area of brain

cell damage and bleeding lead to inflammaiton and vasospasm

what does trauma to brain tissue cause?

seixures

possible cranial nerve impairment

otorrhea or rhinorrhea

fever

euphoria

impaired congition

coma, paralyis, increased icp

what are the manifestations of head injuries?

epidural hematoma

injury to head results in the arterial bleed

rapid expansion of blood between dura mater and skull

increased icp

signs usually arise within few hours of injury

see smyptoms quickly

decreased loc with lucid states

headahce

vomiting

drowsiness

seizures

as a hemoatoma progresses s/s will include what?

subdural hematoma

bleed between arachnoid and dura mater

commonly associated with venous system

can be acute or chronic

acute/subacute subdural hematoma

develops within hours to weeks after injury

severe drowsiness

rapid onset

increased mortality

chronic subdural hematoma

slow accumulation may not see symtoms for 1 to severl weeks after injurt

headache

drowsiness

change in consciousness

pupillary and respiratory pattern changes

what are the manifestations of the subdural hematoma?

herniated intervertebral disk

involves protrusion of the nucleus pulposus

may occur suddenly or over time

sensory, motor, or autonomit function may be impaired

perople will let it go for a long time nad then they have perm. issue

depend on location and extent of protrusion

often unilateral

of pressure is prolonged, severe permanent damage may occur

what are the s.s of a herniated intervertebral disk?

central cord syndrome

usually associated with cervial spinal injuries

more motor impairment in upper body than lower body

variable sensory loss below the injury

anterior cord syndrome

hurt anterior part of the cord

associated with cervial spine injury

below injury level motor paralysis, loss pf pain and loss of temp sensation

brown sequard syndrome

common with cervical spine injury

loss of motor function on one side

on oppsosite side loss of sensation

posterior cordsyndrome

associated with cervical spine injury

below injury leel motor function retained

below injury level loss of sensation, pressure, postion, sense

all about sensation, pressure, positon, sensation loss

sudden loss, complete transestion of the spinal cord. body is shutting everytthing down until they firgure out what is going on

then move into what is acutally goign on

what is the first stage of spinal shock?

absence of all voluntary and reflex activity below the level of inujury, including loss of sensation

neurogenic chock can occur if severe

what are the manifestations of spinal shock?

second stage of spinal shock

recovry and recogniton

the body goes in to recovry

gradual return of

hyperreflexia

spastic paralysis

sensory deficits

bladder and howel dysfunction

what are the common symptoms of an SCI?

bell palsy

neuropathy of the facial nerve

paralysis of hte muscles on one side of the face

often self limiting with unknown cause

idiopathic cause

unilateral facial weakness

facia ldrop and diminished eye blink

hyperacusis

decreased lacrimation

what are the symptoms of bell palsy ?

seizures

sudden explosive discharge of neurons sudden transient alteration in brain function

spontaneous nerve firing on the brain

not a disease but a symtpoms of CNS dysfunction

affects all ages, races, ethnicities

provoked seizures

fever, electrolyte imbalance, hypoglycemia, infection

being provoked by something else

unprovoked seizures

epilepsy

we dont know why they happen

every test and everything looks normal but they still have seizures

tonic/clonic movements

tonguw biting

incontinence

blank stare

change in level of awareness

loss of postural tone

hat are the manifestations of a seizure?

prodrome

aura

what are the special manifestations of a seizure?

epilepsy

recurrent seizures, not provoked by other illnesses or circumstances

neurons hypersensative and easily activated

partial and generalized

partial and generalized

what are epilespy seizues classfiied?

partial epilepsy seizure

complex and simple

generalized epilepsy seizure

grand mal and petit mal

complex partial seizure

abnormal firing begins in one hemisphere and then spread to the other

consciousness affected, change in behavior

blank state then involuntary movement

starts at one side and moves over to the other side of the brain

simple partial seizure

only involves one hemisphere

consciousness unaffected, unusual emotions

uncontrolled movement in any body part, aura

unusual responses to the situations

grand mal seizre

type of generalized epilepsy seizures

involve both hemispheres with loss of consciousness

characterized by tonic clonic phases

prodromal-auras

might make sounds

petit mal seizure

type of generalized epilepsy seizure

involve both hemispheres with loos of consciousness

quiet seizure vacant starring facial or eye twitching

no prodromal/auras usually present

multiple sclerosis

progressive and chronic demyelination of neurons in the brain, spinal cord, and cranial nerves

different types of this and occurs between 20-40 more in women than men

idiopathic cause

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

describe the patho of MS

lesions

inflammatory response and demyelination occurs

what are the early s/s of MS?

larger areas of inflammation and demyelination

frequently next to the lateral ventricles, brainstem, optic nerve

plaques vary in size

what are the later s/s of MS?

initial inflammation may subside

neuronal function may reutrn to normal for a short period of time

over time neural degeenration becomes irreversible

each recurrance causes additional areas of the cns to become affected

want to keep them in remission

describe the recurrence of MS

blurred vision, weakness in legs

double vision

dysarthria

paresthesia

progressive muscle wekaness and paralysis extending to the upper limbs

loss of coordination, bladder and bowel and sexual dysfunction

reoccurance is very dibiltating

depression

what are the s/s of ms?

no definitive tests

mri for dx and monitoiring

go by the symptos and rule everything else out first

what are the diagnostic tests for ms?

parkinson’s disease

disorder involving the dopamine secreting pathway in the basal ganglia

chronic and progressive, degenerative

dysfunction of the extrapyramidal motor system

unknown

but could be scondary to enephaliits, trauma, vascular disease, drug use

what are the causes of parkinson’s disease

fatigue, muscle wekaness, muscle aching

decreased flexibility

less spontaneous changes in facial expression

tremors in the hands at rest

what are the early signs of parkinson’s ?

tremors affect hands, feet, face, tongue, lips

increased muscle regidity, slow movments

difficulty initiating movement

lack of associated involuntary movements

propulsive gait: tendency to lean forward

complex activities become slow and hard

what are the later signs and symptoms of parkinson’s disease?

low voice, dysarthria

chewing and swallowing become difficult

face might resemble a mask

autonomic dysfunction

orthostatic hypotension

uti

dementia develops late in course of disease

what are the other functions affected by parkinson’s disease?

medication aimed at restoring brain dopamine levels or activity by administration of dopamine precurcors, dopamine agonsits

antidepressants

therapy

surgical procedures

treating the symptoms

what is the treatment for parkinson’s disease?

ALS

progressive chronic disease affecting both upper and lower motor neurons

40-60

men>women

cognition impaired

uknown cuase