Neuro Slides 1

Front 1

Tremor

Back 1

-slow, unilateral resting tremor present in 75% at DX of Parkinson's. Disappears with purposeful movement. Rhythmic, slow turning motion. Present while at rest and increases when walking, concentrating or feeling anxious.

Front 2

Rigidity-

Back 2

resistance to passive limb movement. Passive movement may cause jerky movements (cogwheeling). Invol stiffness increases when another extremity is vol moving.(Parkinsons)

Front 3

Bradykinesia-

Back 3

most commonsymptom of Parkinson's. Refers to the overall slowing of active movement. Takes longer to complete activities and has difficulty initiating movement. (getting up)

Front 4

Postural Instability

Back 4

-loss of postural reflexes; stands with head bent forward and walks with a propulsive gait. Shuffling gait; walks faster/faster trying to move the feet forward. Difficulty pivoting causes loss of balance and a risk of falling.(Parkinsons)

Front 5

Parkinsons
Complications

Back 5

Risk for:
–Respiratory and Urinary tract infections
–Skin breakdown and injury from falls
•Side effects from Meds:
–Dyskinesia or orthostatic hypotension

Front 6

Levodopa

Back 6

-most effective and the mainstay of treatment. Levodopa is converted to dopamine in the basal ganglia, producing sym relief.

Front 7

Anticholinergic:
Parkinson's tx

Back 7

are effective in controlling tremor and rigidity. May be used in with Levodopa. Counteract the action of acetylcholine. Side effects: blurred vision, flushing, rash, constipation, urinary retention, & acute conf state. Poorly tol. Monitor pts with glaucoma and BPH.

Front 8

Antiviral:
parkinsons tx

Back 8

to reduce rigidity, tremor, bradykinesia and postural chgs. Acts by releasing dopamine from neuronal storage sites, exact mech is unknown. Side effects: low. Psych (mood chg, confusion, dep, hall), LE edema, nausea, epi distress, urinary retention, headache, & visual impairment.

Front 9

Pergolide

Back 9

is 10x more potent, no therapeutic advantage.
Used for post poning levodopa or after it loses effectiveness
–Side effects: nausea, vomiting, diarrhea, lightheadedness, hypotension, impotence and pshych effect.

Front 10

Monoamine Oxidase Inhibitors:

Back 10

Eldepryl (seleglinie) promising development. Inhibits dopamine breakdown and is thought to slow down the progression of disease. Currently used in combination with dopamine agonist to delay the use of carbidopa/levodopa. Side effects similar to Levodopa.

Front 11

Catechol-O-methyltransferase Inhibitors:

Back 11

clinical trials suggest little effect when given alone but can increase the duration of action of carbidopa or levodopa block and enzyme that metabolizes levodopa making more available for conversion to dopamine. Entacapone (Comtan) and Tolcapone (Tasmar). These meds reduce motor fluctuations in advanced disease.

Front 12

Antidepressants:

Back 12

tricyclics ex: Amitriptyline hcl (Elavil) typically prescribed because of its anticholinergic and antidepressant effects. Serotonin reuptake inhibitors (Prozac or Wellbutrin), are effective but may aggravate sym of parkinson’s.

Front 13

Antihistamines:

Back 13

Benadryl (diphenhydramine hcl), Banflex (orphenadrine citrate), and Neo-Synephrine (phenindamine hcl) have mild central anticholinergic and sedative effects and may reduce tremors.

Front 14

Huntington’s Disease
def

Back 14

•A chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary choreiform movement and dementia.

Front 15

Huntington’s Disease
Clinical Manifestations

Back 15

•Most prominent chorea (abnormal invol movements), intellectual decline and often emotional disturbance.
•Progresses to a constant writhing, twisting, uncontrollable movement may involve entire body.
•Motions are devoid of purpose or rhythm.
•Face: tics and grimaces
•Speech: slurred, hesitant, explosive, to unintelligible.
•Chewing and swallowing difficulty; risk of choking and aspiration.
•Gait: disorganized to impossible
•Eventually w/c to bed bound
•Lost Bladder and Bowel control
•Cognitive: first personality changes to uncontrollable anger, profound depression to suicidal. Judgment and memory are impaired, eventual dementia.

Front 16

Amyotrophic Lateral Sclerosis
Def

Back 16

•Known as ALS or Lou Gehrig’s disease
•Unknown cause
•Loss of motor neurons in the anterior horns of the spinal cord and the lower brain stem.
•Motor neurons cells die, the muscle fibers they supply atrophy.
•Neuronal degeneration may occur in both the upper and lower motor neuron systems

Front 17

ALS
Clincal Manifestations

Back 17

Chief symptoms: fatigue, progressive muscle weakness, cramps, fasciculations, and incoordination of motor neurons in the anterior horns of the spinal cord results in progressive weakness and atrophy of the muscles of the arms, trunk or legs.
•Spasticity and the deep tendon stretch reflexes become brisk and overactive.
•Anal and bladder sphincters remain intact, spinal nerves are spared in this area.

Front 18

ALS
Nusing Interventions

Back 18

•Challenge to guide the patient in use of moderate intensity, endurance-type exercises for the trunk and limbs to help reduce spasticity.
•Facilitate communication
•Reduce risk of aspiration
•Decrease pain secondary to muscle weakness
•Decrease risk of injury related to falls
•Provide diversional activities such as reading and companionship.
•Family support

Front 19

Menigitis
Clinical manifestations

Back 19

Key: fever, severe headache, nausea, vomiting and nuchal rigidity
•Others: positive Kernig’s/brudzinski’s, photophobia, decreased LOC and signs of increased ICP.

Front 20

Meningitis
Complications

Back 20

•Increased ICP most common
•Residual neurologic dysfunction
•Hearing loss may be permanent; related to CN (VIII) irritation
•Hemiparesis, dysphasia and hemianopsia should resolve unless an ongoing infection is present.
•Waterhouse-Friderichsen syndrome: manifested by petechiae, DIC, adreanl hemorrhage and circulatory collapse. Associated with meningococcemia.

Front 21

Meningitis
Management

Back 21

Bedrest
•IV fluids
•Antibiotics IV; PCN/amp, cephalosporin
•Codeine for headache
•Dexamethasone
•Acetaminophen or asa for fever (T >100.4/38
•Hypothermia
•Phenytion IV
•Mannitol
•Clear liquids as desired or tolerated
•Vaccination preventative***

Front 22

Viral Meningitis
s/s

Back 22

Presents with a headache, fever, photophobia and nuchal rigidity.
–Moderate to high fever
Dx test: CSF exam by LP

Front 23

Encephalitis
clincal manifestations

Back 23

•Onset; usually nonspecific, with fever, headache, nausea and vomiting.
•Encephalitis can be acute or subacute.
•Onset day two or three and symptoms may vary.
•Minimal alterations in mental status to coma
•Virtually any CNS abnormality can occur including:
–Hemiparesis, tremors, seizures, cranial nerve palsies, personality changes, memory impairment, amnesia and dysphasia.

Front 24

Assessing for Brain Abscesses
•Frontal Lobe s/s

Back 24

–Hemiparesis
–Aphasia (expressive)
–Seizures
–Frontal headache

Front 25

Assessing for Brain Absess
•Temporal Lobe s/s

Back 25

–Localized headache
–Changes in vision
–Facial weakness
-Aphasia

Front 26

Assessing for
Cerebellar Abscess s/s

Back 26

–Occipital headache
–Ataxia (inability to coordinate movements)
–Nystagmus (rhythmic, involuntary movements of the eye)

Front 27

Alzheimer’s disease and Dementia
Overview

Back 27

•Alzheimer’s is a chronic, progressive, degenerative disease of the brain.
•Dementia is a syndrome characterized by dysfunction or loss of memory, orientation, attention, language, judgement, and resoning.

Front 28

Warning signs AD

Back 28

1.Memory loss that affects job skills
2.Difficulty performing familiar tasks
3.Problems with language
4.Disorientation to time and place
5.Poor or decreased judgment
6.Problems with abstract thinking
7.Misplacing things
8.Changes in mood or behavior
9.Changes in personality
10.Loss of initiative

Front 29

Clinical manifestations-Dementia

Back 29

•Depending on the cause the onset of symptoms may be insidious and gradual or more abrupt.
•Neurologic degeneration: gradual/progressive
•Vascular: abrupt
•Further classified as mild, moderate, severe
•Mild: forgetfulness beyond normal
•Mod: impaired ability to recognize family
•Sev: little memory, u/a to process new in

Front 30

Spinal Cord Injury
A = Complete:

Back 30

No motor or sensory function is preserved in the sacral segments S4-S5.

Front 31

Spinal Cord Injury
B = Incomplete:

Back 31

Sensory but not motor function is preserved below the neurologic level, and includes the sacral segments S4–S5.

Front 32

Spinal Cord Injury
C = Incomplete:

Back 32

Motor function is preserved below the neurologic level, and more than half of key muscles below the neurologic level have a muscle grade less than 3.

Front 33

Spinal Cord Injury
D = Incomplete:

Back 33

Motor function is preserved below the neurologic level, and at least half of key muscles below the neurologic level have a muscle grade of 3 or greater.

Front 34

Spinal Cord Injury
E = Normal:

Back 34

Motor and sensory function are normal.

Front 35

Spinal Cord Injury
Injury above C4:

Back 35

total loss of respiratory muscle function

Front 36

Spinal Cord Injury
Below C4:

Back 36

results in diaphragmatic if the phrenic nerve is functioning though edema or hemorrhage can affect function.
Cervical and thoracic injuries can cause paralysis of abdominal muscles and often intercostal inhibiting ability to cough.

Front 37

Spinal Cord Injury
Any injury above T6;

Back 37

decreases the influences of the sympathetic nervous sys
•Bradycardia, periph vasodilation results in hypotension. Reduces venous return and subsequently decreases cardiac output
•EKG monitoring essential
•RX: IV fluids, vasopressors

Front 38

Spinal Cord Injury
Injury above T5:

Back 38

ypomotility; paralytic ileus and gastric distension.
•Stress ulcers possible, if undiagnosed inability to diagnose due to lack of subjective symptoms.
•Less voluntary neurologic control over the bowel results in a neurogenic bowel. Need a good bowel regimen.

Front 39

Spinal shock:
Def

Back 39

represents a sudden depression of reflex activity in the spinal cord below the level of injury. Loss of sensation and motor.

Front 40

Neurogenic shock:

Back 40

due to loss of autonomic function below the level of injury. Vital organs affected; HR & B/P decrease. Loss of sympathetic causes a variety of other; decrease in CO, venous pooling in ext, and periph vasodilation.

Front 41

spina bifida
overview

Back 41

•Occurs during the 4thweek of gestation when ventral induction of the neural tube fails to occur.
•Degree of impairment corresponds to the level of the defect and size.

Front 42

Spina Bifida
Results:

Back 42

paralysis, partial paralysis, or varying sensory defects.
•Clubfeet, scoliosis and contracture and dislocation of the hips may also be associated with lesions

Front 43

Cerebral palsy
overview

Back 43

•Also known as; static encephalopathy
•Chronic, nonprogressive disorder of posture and movement.

Front 44

Cerebral palsy
Characterized by

Back 44

difficulty in controlling the muscles because of an abnomality in the extrapyramidal or pyramidal motor system (motor cortex, basal ganglia, cerebellum)
•Co-morbidities: cognitive, hearing, and visual impairments as well as seizures are common.

Front 45

Hydrocephalus

Back 45

•A result of an imbalance between the production and absorption of CSF
•Excess CSF accumulates in the ventricular system, causing dilation and compression of brain tissue against the skull
•Results in enlargement of the skull if sutures are open
•Results in s/s of increased ICP if sutures are fused.

Front 46

Pedi Differences in neuro dysfunction

Back 46

Papilledema rarely occurs because open fontanels and sutures can expand with ICP
•Primitive reflexes may reappear with neurologic disease. Ex: grasp, rooting (present @ birth then disappear by 5 months)

Front 47

Clinical Manifestations of ICP
•Infant:

Back 47

poor feeding, or vomiting
–Irritability or restlessness
–Lethargy
–Bulging fontanel
–High-pitched cry
–Increased head circumference
–Separation of cranial sutures
–Distended scalp veins
–Eyes deviated downward (“setting-sun” sign)
–Increased or decreased response to pain

Front 48

Clinical Manifestations of ICP
Child:

Back 48

headache
–Diplopia
–Mood swings
–Slurred speech
–Papilledema (after 48hrs)
–Altered level of consciousness
–Nausea and vomiting, especially in the morning

Front 49

Papilledema

Back 49

swelling of the optic disk

Front 50

Postconcussion syndrome:

Back 50

2 seeks to 2 months after the injury. Sym: persistent headache, lethargy, personality/behavioral changes, shortened attention span and memory, and changes in intellectual ability.

Front 51

Myasthenia Gravis
Exacerbations

Back 51

can be precipitated by emotional stress, pregnancy, trauma, various drugs; antibiotics, psychotropic's, beta blockers and neuromuscular blocers

Front 52

Waterhouse-Friderichsen syndrome:

Back 52

manifested by petechiae, DIC, adreanl hemorrhage and circulatory collapse. Associated with meningococcemia.

Front 53

encephalitis

Back 53

HSV encephalitis is the most common cause of acute non-epidemic viral encephalitis.
•Cytomegalovirus encephalitis is one of the most common complications in patients with AIDS.

Front 54

Medulla Oblongata

Back 54

Heart rate
Blood pressure
Respiration rate
reflexive digestive movements

Front 55

Pons

Back 55

a. Helps medulla in regulating respiration rate
b. Tracts between spinal cord and brain as well as brain to brain

Front 56

Midbrain

Back 56

a. Cranial somatic reflex for eye, head and neck muscles to visual stimuli
b. Cranial somatic reflex for trunk muscles to auditory stimuli
these are the so called "startle" responses

Front 57

Thalamus -- functions

Back 57

a. Sensory hub for incoming sensory impulses (except olfaction) to various regions of cerebral cortex
b. Interprets some sensory impulses (pain, light touch, pressure)

Front 58

Hypothalamus -mostly gray matter

Back 58

a. Controls body temperature
b. Thirst center (determines amount of water in blood)
c. Hunger centers (determines amount of glucose in blood)
d. Metabolism
e. Growth
f. Sex drive
g. Rage and aggression

Front 59

. Pituitary gland

Back 59

a. regulates metabolism, growth, osmotic pressure of blood, blood sugar (controlled by hormones from hypothalamus).
b. regulates body temperature, birth, lactation (controlled by nervous impulses from hypothalamus

Front 60

Cerebellum

Back 60

posture and coordination-allows smooth movements. Propioreception (muscle sense or position) comes from muscle spindle and tendon organ receptors to provide these functions.

Front 61

Cerebral cortex (gray matter)

Back 61

a. Sensory functions

Front 62

prefrontal lobe

Back 62

1) Memory
2) Judgement
3) Personality
4) Intelligence