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Neurological Disorders Part 1

front 1 Cerebral Vascular Disease Definition? Different Types? What are some examples? Is the most frequently occurring neurologic disorder Is the fifth-leading cause of death in the United States Effects: can range from minimal to death	back 1 CVD is a abnormality in brain caused by pathologic process in the blood vessels Two types of cerebrovascular disorders: Ischemia with or without infarction Hemorrhage Examples Cerebrovascular accidents (CVAs) or strokes Transient ischemic attacks (TIAs) Aneurysms or malformations pathologic process categories: lesions of the vessel wall (e.g., aneurysm or malformations); occlusion of the vessel lumen by thrombus or embolus; rupture of the vessel; and alteration in blood quality, such as increased blood viscosity or clotting.
front 2 Cerebral Vascular Disease What is the greatest risk factor is CVA? What are the two different types?	back 2 Greatest risk factor: Hypertension Types Ischemic: inadequate blood supply to brain from obstruction in arterial blood flow to the brain (thrombus, hypoperfusion of blood flow, embolus associated with atherosclerosis) ischemia: inadequate cellular oxygen Hemorrhagic: Microaneurysms in these smaller vessels Because neurons surrounding the ischemic or infarcted areas undergo changes that disrupt plasma membranes, cellular edema results, causing further compression of capillaries.
front 3 Cerebral Vascular Disease Different Examples	back 3 Transient ischemic attacks Neurologic deficits are not permanent episodes of neurologic dysfunction lasting no more than 1 hour and resulting from focal cerebral ischemia Thrombotic stroke Arterial occlusions are caused by thrombi formed in the arteries that supply the brain or in intracranial vessels Is attributed to atherosclerosis and inflammatory disease processes Embolic stroke Fragments break from a thrombus that is formed outside of the brain usually in the heart, aorta, or common carotid artery. A second stroke usually occurs In ischemic infarcts, the affected area becomes pale and softens 6 to 12 hours after the occlusion (white infarct). Necrosis, swelling around the insult, and mushy disintegration appear by 48 to 72 hours after infarction.
front 4 Clinical Manifestations of CVA	back 4 S/S depends on the artery affected Contralateral weakness in arms, legs, and/or face Possible motor, speech, and/or swallowing problems Contralateral sensory and motor manifestations occur on the opposite side of the body from the location of the brain lesion because motor tracts originate in the cortex and most cross over in the medulla.

front 5 Cerebral Vascular Accident: Treatment of Embolic Stroke	back 5 Thrombolysis (tissue-type plasminogen activator) is administered within 3 hours and up to 4 ½ hours of symptom onset for embolic stroke Not a treatment for a hemorrhagic stroke Hypertension is NOT aggressively treated Acute ischemic stroke frequently presents with hypertension, but the systemic blood pressure should not be treated unless the systolic pressure is 150 to 220 mmHg or mean arterial pressure exceeds 150 mmHg. Overly aggressive treatment of hypertension can compromise collateral perfusion of the ischemic penumbra.
front 6 Cerebral Vascular Accident: Ischemic Stroke Treatment Medications/Surgery?	back 6 Pharmacologic Aspirin Systemic anticoagulation Thrombolysis Antiplatelet therapy and statins to decrease recurrence Surgery Endarterectomy- surgery to remove plaque Treatment of ischemic stroke is focused on: (1) restoring brain perfusion in a timeframe that does not contribute to reperfusion injury (2) counteracting the ischemic cascade pathways (3) lowering cerebral metabolic demand so that the susceptible brain tissue is protected against impaired perfusion (4) preventing recurrent ischemic events (5) promoting tissue restoration
front 7 Cerebral Vascular Accident Hemorrhagic Stroke Definition S/S Treatment	back 7 Hemorrhagic stroke Is spontaneous bleeding into the brain Clinical manifestations Focal neurologic deficits, altered consciousness, headache Treatment Needs to be initiated within 3–4 hours of symptom onset for reversibility of brain ischemia Limit hematoma enlargement by managing HTN Prevent or control seizures and cerebral edema Osmotic therapies (e.g., mannitol) are used for the treatment of IICP and cerebral edema in hemorrhagic stroke.
front 8 Subarachnoid Hemorrhage Definition? Greatest Risk Factor? Mortality Rate?	back 8 Blood escapes from defective or injured vasculature into the subarachnoid space Blood produces an inflammatory response Greatest risk factor is family history Mortality rate is 50%

front 9 Clinical Manifestations Leaked Vessel? Ruptured Vessel? Other S/S	back 9 Leaking vessels: episodic headache transient changes in mental status or level of consciousness focal neurologic defects including visual or speech disturbances stiff neck nausea or vomiting Ruptured vessel causes: A ruptured vessel causes a sudden throbbing, “explosive” headache accompanied by nausea and vomiting, visual disturbances, motor deficits, and loss of consciousness related to a dramatic rise in ICP. sudden throbbing “explosive” or “thunderclap” headache associated with nausea and vomiting visual disturbances motor deficits loss of consciousness meningeal irritation and inflammation neck stiffness (nuchal rigidity) photophobia, blurred vision, irritability, restlessness, and low-grade fever Positive Kernig sign and Brudzinski sign positive Kernig sign (straightening the knee with the hip and knee in a flexed position produces pain in the back and neck regions) and a positive Brudzinski sign (passive flexion of the neck produces neck pain and increased rigidity)
front 10 Subarachnoid Hemorrhage Treatment	back 10 Treatment Nimodipine (prevent vasospasm) Surgery: to clip the aneurysm
front 11 Seizures, Epilepsy, Convulsions Definition	back 11 Is a symptom of disease, not a specific disease Seizure: is a sudden, transient disruption in brain electrical function caused by abnormal excessive discharges of cortical neurons Epilepsy: is a recurrence of seizures and a disorder for which no cause can be found Convulsion: is tonic-clonic (jerky, contract-relax) movements associated with some seizures
front 12 What disease/conditions are associated with Seizure Disorders ?	back 12 Diseases and conditions associated with seizure disorders: Any condition that affects the CNS or neuronal environment Genetic predisposition Congenital malformations Perinatal injury Metabolic disorder Postnatal trauma Infection Brain tumor Vascular disease Drug/alcohol abuse

front 13 Different Types of Seizures?	back 13 Generalized seizures: affect neurons bilaterally Focal (partial) seizures: affect neurons unilaterally Epilepsy syndromes: genetic/developmental cause Unclassified epileptic seizures: etiology unknown Status epilepticus Is a medical emergency bc medical emergency because of the resulting cerebral hypoxia. Continuing/recurring seizures with incomplete recovery, unrelenting seizure activity that lasts 30 minutes or more
front 14 S/S of Seizures	back 14 Clinical manifestations Depends on the type of seizure With clonic-tonic movements, the seizure may have an aura or a prodrome
front 15 Seizure Sequence and Consequences	back 15 Seizure sequence Resting potential instability Seizure initiation Bursts of action potentials Tonic phase muscle contraction with increased muscle tone Clonic phase alternating contraction and relaxation of muscles Postictal state: follows the seizure Consequences Cerebral blood flow increases Cerebral oxygen consumption is increased by 60%. Glucose depletion Accumulation of lactate in brain tissues
front 16 Treatment of Seizures	back 16 Antiseizure medication Ketogenic diet for epilepsy Surgery; vagal nerve stimulation

front 17 Febrile Seizures Most common in what population? What age? Onset? How long does it last? What needs to be rules out? Is Epilepsy develop after?	back 17 Most common type of seizure in pediatric patients Usually develops within 24 hours of the onset of a fever (temp is usually >102) Usually develop between 6 months and 5 years of age Usually lasts less than 5 minutes Need to rule out meningitis by exam/testing Most children do not develop epilepsy after experiencing febrile seizures but a small percent can develop epilepsy
front 18 Vertigo	back 18 Sensation of spinning (NOT lightheadedness) occurs with inflammation of the semicircular canals or displacement of otoliths in the utricle and saccule of the semicircular canal system
front 19 Different Types of Vertigo	back 19 Peripheral Vertigo Benign paroxysmal positional vertigo (BPPV) Meniere disease Acute labyrinthitis and vestibular neuritis Central Vertigo Caused by strokes, tumors Medication-induced Anticonvulsants, salicylates, antibiotics
front 20 Benign paroxysmal positional vertigo (BPPV) Cause? Treatment Maneuvers	back 20 Benign paroxysmal positional vertigo (BPPV) calcium deposits or debris in the posterior semicircular canal Treatment Epley maneuvers- turning your head in a series of movements.

front 21 Meniere Disease Vertigo Cause? Treatment?	back 21 Increased volume of endolymph in the semicircular canals Also have S/S vertigo + tinnitus and hearing loss Treatment Benefit from a low sodium diet and should minimize use of alcohol and caffeine
front 22 Acute labyrinthitis and vestibular neuritis vertigo	back 22 Most often caused by inflammation from a viral infection
front 23 Central Vertigo	back 23 Caused by strokes, tumors
front 24 Medication Induced Vertigo	back 24 Anticonvulsants, salicylates, antibiotics

front 25 What are different types of Menegitis?	back 25 Bacterial meningitis Infection of pia mater, arachnoid villi, subarachnoid space, ventricular system, and cerebrospinal fluid (CSF) Viral meningitis virus enters the brain either directly or indirectly, through infected migrating leukocytes, and then infects vascular endothelial cells. The virus then enters the subarachnoid= meningitis Fungal meningitis Tubercular (TB) meningitis
front 26 Clinical Manifestations of Bacterial Meningitis	back 26 Bacterial Throbbing headache increasing in severity Increasing photophobia Nuchal rigidity Kernig sign Brudzinski sign Projectile vomiting
front 27 Clinical Manifestations of Viral Meningitis	back 27 Viral: Milder than bacterial meningitis Mild generalized throbbing headache Mild neck pain, stiffness Mild photophobia Fever, Malaise
front 28 Types of Multiple Sclerosis?	back 28 Most Common: Relapse-Remitting S/S develop & resolve in a few weeks to months, returns to baseline → as times goes on relapse become more frequent(classic characteristic) Least Common: Primary-progressive steady & gradual detetoriating w/o remission. gradual loss of power in the lower limbs that can be asymmetric, and bowel and bladder symptoms Secondary-progressive replase-remitting, gradual worsening of the symptoms between relapses Progressive- relapsing gradual deterioration, no remission, no return to baseline