Neurological Disorders

• Basic Functions of the Nervous System (NS)

  • Two divisions: Central Nervous System (CNS) and Peripheral Nervous System (PNS)

  • CNS includes brain, spinal cord, blood supply, and blood-brain barrier (BBB)

  • Reticular Activating System (RAS) plays a role in arousal and consciousness

Blood Supply to the Brain

• Key arteries include:

  • Anterior cerebral artery

  • Middle cerebral artery

  • Posterior cerebral artery

  • Basilar artery

• Branches from internal and vertebral arteries supply the brain

Altered Mental State (AMS)

• Definition: Changes in an individual's normal mental state

• Identification tools: Physical exams, history taking

Concussion

• Description: Fully reversible brain injury without structural damage

• Symptoms: Brief loss of consciousness (LOC), temporary disturbance of function, potential mild retrograde amnesia

• Important to note that a concussion does not worsen over time

Causes of Unconsciousness

• Broad causes of AMS include:

  • Blood oxygenation problems

  • Blood circulation issues

  • Metabolic disturbances

  • Central Nervous System conditions

The Greedy Brain

• Requires glucose and oxygen for functioning

Common Causes of AMS**

• A: Alcohol

• E: Epilepsy

• I: Insulin issues

• O: Overdose/Oxygen deprivation

• U: Urinary/Uraemia issues

• T: Trauma/temperature issues

• I: Infection

• P: Poisoning/Psychosis

• S: Stroke/Shock/Structural problems

Case Scenario: Older Male

• 79-year-old male collapsed; assessment involves checking airway, breathing, circulation

• Use primary survey to gather information about the patient's condition

Stroke Types

• Ischaemic Stroke (80% of strokes):

  • Caused by blockage, often from a thrombus or embolus

• Haemorrhagic Stroke:

  • Caused by arterial rupture leading to bleeding in or around the brain

Differentiating Between CVA and TIA**

• Transient Ischaemic Attack (TIA) typically resolves quickly without lasting effects

• Importance of hospital referral for proper diagnosis and treatment

Serious Headache Causes**

• Brain tumors, meningitis, hypertension, stroke, depression, etc.

Management of Headaches**

• Symptomatic treatment is vital, including comfort measures and continuous monitoring

Seizures**

• Status Epilepticus: medical emergency defined by prolonged seizure activity (over 5 minutes)

• Treatment involves airway management and protecting the patient from dangers

Febrile Seizures**

• Common in children due to high fever; typically do not indicate epilepsy

Syncope (Fainting)**

• Temporary loss of consciousness due to reduced blood flow to the brain

• Symptoms can include sweating, pallor, nausea, palpitations, etc.

The Syncope Mnemonic**

• P: Pressure (vasovagal, orthostatic)

• A: Arrhythmias

• S: Seizure

• S: Sugar (hypoglycemia)

• O: Output (cardiac issues)

• U: Unusual conditions (anxiety, hyperventilation)

• T: Transient Ischaemic Attack/CVA

Review Summary**

• Covered key topics: Neurological anatomy, pathophysiology, neurological conditions (CVA/TIA, headaches, seizures, syncope)

Neurological Disorders Case Scenarios

Concussion: A 25-year-old male college football player experiences a brief loss of consciousness after a tackle during a game. He shows signs of temporary confusion and amnesia about the preceding plays. His coach recognizes the symptoms and immediately removes him from the game for evaluation.

Stroke (Ischaemic): A 70-year-old female presents to the emergency department with sudden weakness in her right arm and difficulty speaking. Her family reports that she was perfectly fine until she suddenly slurred her speech while having breakfast. A CT scan reveals a blockage in the right middle cerebral artery.

Stroke (Haemorrhagic): A 65-year-old male with a history of hypertension suddenly collapses while gardening. Family members find him unresponsive and call emergency services. Upon arrival, paramedics notice he has a severe headache and signs of neurological impairment. Imaging shows blood in the cranial cavity due to a ruptured artery.

Transient Ischaemic Attack (TIA): A 59-year-old male experiences sudden weakness on his left side and difficulty speaking for about 20 minutes before his symptoms resolve. He seeks medical attention, where doctors explain that these symptoms were likely caused by a TIA and require further investigation to prevent a potential stroke.

Serious Headaches: A 45-year-old female goes to the clinic reporting excruciating headaches that have increased in frequency and intensity. She describes these headaches as unlike anything she has experienced before, accompanied by nausea and visual disturbances. The physician considers a brain tumor as a potential cause after initial examination.

Status Epilepticus: A 32-year-old male with a known history of epilepsy experiences a seizure that lasts over 10 minutes. Friends call for help, and paramedics rush him to the hospital, where he receives immediate airway management and medication to stop the seizure and prevent further neurological damage.

Syncope: A 22-year-old female faints while standing in line at a grocery store. Witnesses report that she appeared pale and sweaty beforehand. Upon recovery, she explains she hadn’t eaten all day and had been feeling anxious. She is evaluated for possible vasovagal syncope.

Febrile Seizures: A 3-year-old child has a high fever due to an ear infection and experiences a seizure lasting a couple of minutes. The parents call for help, worried about their child's health, but the doctor reassures them that febrile seizures are common in children and typically do not lead to further epilepsy.