Patho Ch. 14 - Neurological 1

Front 1

Assesses level of consciousness
Three ares: eye opening, motor response, verbal response
15 Point Scale

Back 1

Glasgow Coma Scale

Front 2

Most critical clinical index of nervous system function

Back 2

Level of Consciousness

Front 3

Put in order:
Coma, Lethargy, Obtundation, Disorientation, Confusion, Stupor

Back 3

Confusion
Disorientation
Lethargy
Obtundation
Stupor
Coma

Front 4

Loss of ability to think rapidly and clearly
impaired judgement and decision making

Back 4

Confusion

Front 5

beginning loss of consciousness;
disorientation to time followed by disorientation to time followed by disorientation to place and impaired mamory;
lost last is recognition of self

Back 5

Disorientation

Front 6

Limited spontaneous movement or speech;
easy arousal with normal speech or touch;
may or may not be orientated to time, place, person

Back 6

Lethargy

Front 7

Mild to moderate reduction in arousal (awakeness) with limited response to the environment;
falls asleep unless atimulated verbally or tactilely;
answers questions with minimum response

Back 7

Obtundation

Front 8

A condition of deep sleep or unresponsiveness from which theperson may be aroused or caused to open eyes only by vigorous and repeatd stimulation;
response is often withdrawal or grabbing at stimulus

Back 8

Stupor

Front 9

no verbal response to the external environment or to any stimuli, noxious stimuli such as deep pain or suctioning do not yield motor movement

Back 9

Coma

Front 10

associated with purposeful movement on stimulation

Back 10

Light Coma

Front 11

associated with nonpurposeful movement only on stimulation

Back 11

Coma

Front 12

Associated with unresponsiveness or no response to any stimulus

Back 12

Deep Coma

Front 13

Helps evaluate level of brain dysfunction and coma

Back 13

Patterns of Breathing
(Rate, Rhythm, and Patern)

Front 14

Regulated by lower brain stem in response to changes in PaCO2

Back 14

Level of Consciousness

Front 15

Deep breathing pattern with apnea

Back 15

Cheyne-Stokes

Front 16

Increased ventilatory response to CO2;
Results in hypercapnia;
Decreased ventilatory stimulus

Back 16

Cheyne-Stokes

Front 17

Indicates the presence and level of brain stem dysfunction;
Altered by drugs

Back 17

Pupillary Changes

Front 18

Resting State
Spontaneous Reaction
Reflexive Eye Movements

Back 18

Varying Levels of Brain Dysfunction Effect

Front 19

Grasp Reflex
Snout Reflex
Palmomental Reflex
Suck Reflex

Back 19

Pathologic Reflexes

Front 20

Maintainenance of abnormal posture during contractions
Increased Muscle Tone
Fasciculations(Parkinson's)

Back 20

Dystonia

Front 21

Tremoring Muscles

Back 21

Fasciculations

Front 22

Flexion of arms, wrists, and fingers with adduction in upper extremities
Extension, internal rotation, and plantar flexion in lower extremities
Damage to brain stem above the pons

Back 22

Decorticate Response

Front 23

All four extremities in rigid extension, with hyperpronation of forearms and plantar extension of feet
Brain stem lesion below the pons

Back 23

Decerebrate Response

Front 24

Which is worse and why?
~Decorticate Response
~Decerebrate Response

Back 24

Decerebrate
The damage is lower on the brain the worse it is

Front 25

Hypothermia
Acid-base Imbalance
Internal Homeostasis is not maintained

Back 25

Symptoms of Brain Death

Front 26

Body works but the brain doesn't
Normal body temperature
Acid-Base Balance
Irreversible Coma
Permanenet Brain Damage
Internal Homeostasis is intact

Back 26

Cerebral Death

Front 27

Completion of all appropriate and therapeutic procedures
Unresponsive Coma (no motor or reflex movements
No spontaneous respiration
No ocular responses to head turning or caloric stimulation; dilated fixed pupils
Isoelectric (flat) EEG (electrocerebral silence)
Persistence of these signs for 30 minutes to 1 hour and for 6 hours after onset of coma and apnea
Confirming test indicating absence of cerebral circulation (Optional)

Back 27

Criteria for Brain Death (Box 14-1)

Front 28

A sudden, explosive, disorderly discharge of cerebral neurons
Sudden transient alteration of brain dysfunction

Back 28

Seizure

Front 29

Any disorder that changes neuro-response

Back 29

Seizure

Front 30

Jerky, contract-relax (tonic-clonic) movement of muscle associated with seizures
Side effect of a seizure

Back 30

Convulsion

Front 31

Seizure with no underlying cause

Back 31

Epilepsy

Front 32

Cerebral Lesions
Biochemical Disorders
Cerebral Trauma
Epilepsy

Back 32

Etiology of Seizures

Front 33

Hypoglycemia
Fatigue
Emotional or physical stress
Febrile Illness
Large amounts of water ingestion
Constipation
Drugs (Stimulants; Withdrawal of antidepressants)
Hyperventilation
Environmental Stimulus (Blinking Light, Loud Noises)

Back 33

Precipitating Factors of Seizures

Front 34

Siezures that begin locally

Back 34

Partial Seizures

Front 35

Without impairment of consciousness
With motor signs
With special sensory or somatosensory symptoms
With autonomic signs or symptoms
With psychic symptoms

Back 35

Simple Partial Seizure

Front 36

With impairment of consciousness
Simple partial onset followed by imparied consciousness
Impaired consciousness at onset - with or without automatisms

Back 36

Complex Partial Seizure

Front 37

Bilaterally symmetric and without local onset

Back 37

Generalized Seizures

Front 38

Partial onset evolving to generalized tonic-clonic seizures

Back 38

Secondarily Generalized Seizures

Front 39

Absence
Myoclonic
Clonic
Tonic

Back 39

Petit Mal Seizures

Front 40

Tonic-Clonic

Back 40

Grand Mal Seizures

Front 41

Atonic
Likely to receive injury

Back 41

Drop Attack

Front 42

Relaxed Muscles

Back 42

Myoclonic

Front 43

Periods of alternating Contraction and Relaxation of muscles
No Spasms

Back 43

Clonic

Front 44

State of muscle contraction with excessive tone
Spasms, Rigid Muscles

Back 44

Tonic

Front 45

Periods of alternating contraction and relaxation where the contractions are rigid

Back 45

Tonic-Clonic

Front 46

No muscular activity

Back 46

Atonic

Front 47

Partial seizure preceding onset of generalized seizure
Gustatory, Visual, or Auditory
Dizziness, Numbness, "Funny Feeling"

Back 47

Aura

Front 48

Early clinical signs and symptoms
Malaise, HA, sense of depression hours or days before onset of seizure

Back 48

Prodroma

Front 49

Time period immediately following the cessation of seizure activity
Respiratory status returns
Can last hours or days

Back 49

Postictal Phase

Front 50

Loss of past memories

Back 50

Retrograde Amnesia

Front 51

Inability to form new memories

Back 51

Anterograde Amnesia

Front 52

Inability to sustain attention
Inability to set goals
Recognize object meets a goal
Working Memory Deficit (instructions, etc.)

Back 52

Executive Attention Deficits

Front 53

Direct destruction by ischemia and hypoxia
Indirect destruction by compression
Toxins and chemical effects

Back 53

Patho of Executive Attention Deficits

Front 54

Recognition failure of objects: form and nature
Tactile, visual, or auditory

Back 54

Agnosia

Front 55

Alzheimer's Disease

Back 55

Agnosia

Front 56

Impairment of comprehension or production of language
Comprehension and use of symbols (written or verbal) is lost
Difficulty speaking or comprehending

Back 56

Dysphasia

Front 57

Loss of comprehension or production of language
Inability to speak

Back 57

Aphasia

Front 58

Expressive
Receptive
Transcortical

Back 58

Types of Dysphasia

Front 59

Nonfluent; cannot find words
Difficulty writing

Back 59

Expressive Dysphasia

Front 60

Fluent; meaningless inappropriate words
Unable to monitor language for correctness
Speech may be incomprehensible
Word Salad

Back 60

Receptive Dysphasia

Front 61

Echolalia (repeat)
Inability to read and write
Impaired comprehension

Back 61

Transcortical Dysphasia

Front 62

Leading cause of severe cognitive dysfunction in older adults

Back 62

Alzheimer Disease

Front 63

Diagnosis of exclusion; Based on clinical findings
Autopsy - only was to truly diagnose

Back 63

Diagnosis Criteria for Alzheimer's Disease

Front 64

Cortical atrophy and loss of neurons, particularly parietal and temporal lobes "senila plaques"
Presence of amyloid-containing neuritic plaques and "neurofibrillary tangles"
Associated decrease level of choline acetyltransferase activity
Protein in the neurons becomes distorted and twisted, forming a neurofibrillary tangle

Back 64

Patho of Alzheimer Disease

Front 65

Lasts 2 - 4 years
Memory loss, subtle personality changes, disorientation time & place

Back 65

Stage 1 Alzheimer Clinical Manifestations

Front 66

Confusion stage
Lasts several years
Impaired cognition, restlessness, agitation, irritability
Wandering; Sundowner's Syndrome
Repetitive Behavior

Back 66

Stage 2 Alzheimer Clinical Manifestations

Front 67

Terminal Stage
Lasts 1-2 years
Emaciation
Inability to Communication
Bowel and Bladder Incontinence
May have seizures
Disoriented
Wasting Syndrome

Back 67

Stage 3 Alzheimer Clinical Manifestations

Front 68

5 to 15 mmHg

Back 68

Normal Intracranial Pressure (ICP)

Front 69

Tumor growth, edema, excess CSF, hemorrhage

Back 69

Causes of ICP

Front 70

Subtle and transient; episodic confusion, restlessness, drowsiness, slight pupillary and breathing changes
Decreased levels of arousal, widened pulse pressure, bradycardia, pupils small and sluggish

Back 70

Clinical Symptoms of ICP

Front 71

Brain herniation into spinal cord

Back 71

Prolonged effect of ICP

Front 72

Weakness
Partial paralysis with incomplete loss of muscle power
Loss of fine motor skills

Back 72

Paresis

Front 73

Loss of complete motor function
Patients tend to forget the affected part of the body is there
Loss of motor function

Back 73

Paralysis

Front 74

Weakness on one side of the body

Back 74

Hemiparesis

Front 75

Paralysis on one side of the body

Back 75

Hemiplegia

Front 76

Paralysis of both upper or lower extremities

Back 76

Diplegia

Front 77

Paralysis of LOWER extremities

Back 77

Paraplegia

Front 78

Paralysis of all four extremities

Back 78

Quadriplegia

Front 79

First sign/symptoms after spinal cord injury

Back 79

Spinal Shock

Front 80

Complete cessation of spinal cord function belowe lesion

Back 80

Spinal Shock

Front 81

Characterized by:
Flaccid Paralysis
Absence of Reflexes
Marked disturbances of bowel and bladder

Back 81

Spinal Shock

Front 82

Hemiparesis
Hemiplegia
Diplegia
Paraplegia
Quadriplegia

Back 82

Upper Motor Neuron Syndromes

Front 83

Loss of voluntary movement despite preserved consciousness and normal peripheral nerve and muscle function

Back 83

Hypokinesia

Front 84

Decreased associated and voluntary movements

Back 84

Akinesia

Front 85

Slowness of voluntary movements

Back 85

Bradykinesia

Front 86

Expressionless Face, Statue-like Posture, Absence of Speech Inflection, Absence of Spontaneous Gestures

Back 86

CLinical Signs of Hypokinesia

Front 87

Excessive Movements

Back 87

Hyperkinesia

Front 88

Dyskinesias
Paroxysmal Dyskinesias
Tardive Dyskinesias

Back 88

Categories of Hyperkinesia

Front 89

Abnormal involuntary movements

Back 89

Dyskinesias

Front 90

Abnormal involuntary movements (spasms, tremors)

Back 90

Paroxysmal Dyskinesias

Front 91

Involuntary movement of trunk, face, extremities
Usually caused by side effect of prolonged phenothiazine drug therapy

Back 91

Tardive Dyskinesias