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What are the early signs of ICP?
- Decreasing level of consciousness
- Severe HA
- Vomiting
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What are signs of more advanced ICP?
- Cerebral ischemia
- Vasoconstriction
- Slowing of HR
- Decreased RR
- Leads to more ischemia
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What are the etiologies of nerve damage?
- Blunt: poor posture, fracture, injury
- Penetrating: wound or surgery
- Acute compression
- Electrical Burn
- Chronic Causes:
- -Tight nerve passages
- -Tumors
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clinical S/S of peripheral nerver injury
- Paralysis with no tone changes
- Muscular atrophy
- Contractures
- Sensation and proprioception loss
- Localized hair loss
- Inablilty to perspire
- Local poor wound healing
- Skin and nail changes
- Loss of reflexes
- Loss of movement and/or sensation
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What are the components of an upper neuro exam?
- Posture
- ROM
- Myotomes
- Reflexes
- -0: absent
- -1+: decreased
- -2+: normal
- -3+: hyperactive
- -4+: hyperactive + clonus
- Dermatome
- Cranial nerve exam
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What are the components of a lower neuro exam?
- Posture
- ROM
- Myotomes
- Reflexes
- -Patella
- -Achilles
- Dermatomes
- -L2-S3
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What are the 5 levels of arousal?
- Alert
- lethargic
- obtunded
- stupor
- coma
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What does lethargic mean?
appears drowsy, can respond to questions but falls asleep easily
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What does obtunded mean?
responds slowly and is confused, decreased interest in environment
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What does stupor mean?
Only aroused from sleep with painful stimulus
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What does coma mean?
cannot be aroused and no response to external stimuli or environment
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What do the numbers on the Glascow coma scale indicate?
- less than or equal to 8: severe brain injury
- 9-12: moderate brain injury
- 13-15: milde brain injury
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What type of damage is associated with a decorticate posture?
corticospinal tract
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What type of injury is associated with a decerebrate posture?
damage to brainstem
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What is Wallerian degeneration?
- When peripheral nerve is cut or crushed; degeneration of the axon follows
- Myelin sheath remains intact, resulting in growth within the sheath
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What is neuropraxia?
- Peripheral nerve injury causing short term compression, short term damage
- localized to area of injury
- reversible
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What is axonotomesis?
- Peripheral nerve injury causing a damaged but still intact myelin sheath
- complete abscence of sensorymotor activity for days to weeks
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What is neurotmesis?
- Total disruption of the axon and nerve sheath
- NO conduction below level of lesion again
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What is the treatment for peripheral nerve injury?
- Increase circulation
- Sensory Re-education
- Motor Re-education
- Functional Training
- Protection
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What are the risk factors associated with CVA?
- Cardiac disease: atherosclerosis, hypertension, etc.
- Diabetes
- Smoking, alcohol and drug use
- TIA’s
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What are the S/S of CVA?
- Sudden numbness or weakness of the face, arm, or leg
- Sudden confusion or trouble speaking or understanding others
- Sudden trouble seeing in one or both eyes
- Sudden dizziness, trouble walking, or loss of balance/coordination
- Sudden severe HA with no known cause
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What impairments are associated with CVA?
- Loss of or impaired sensation
- Pain – headache, neck, and face
- Visual changes
- –Including neglect
- **Alterations in motor function
- –Weakness, alterations in tone, abnormal synergy patters,
- abnormal reflex, altered coordination, bowel/bladder changes, and altered motor programming
- Impairments in postural control
- Impairments of speech, language, and swallowing
- Perception and cognition
- Changes in emotional status
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What defecits are associated with Posterior cerebral artery occlusion?
- Affect vision and thought
- Pain and temperature sensory loss
- Contralateral hemiplegia
- Altered mental status
- Impaired memory
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What are the neurological defecits associated with middle cerebral artery occlusion?
- Contralateral hemiparesis
- ipsilateral hemianopsia
- gaze towards the side of the lesion
- receptive or expressive aphasia
- *weakness of the arm and face is usually worse than lower limb
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What defecits are associated with anterior cerebral artery occlusion?
- Altered mental status
- impaired judgment
- neglect
- contralateral hemiplegia
- bowel and bladder incontinence
- behavioral changes
- possible aphasia
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