What are the early signs of ICP?
- Decreasing level of consciousness
- Severe HA
What are signs of more advanced ICP?
- Cerebral ischemia
- Slowing of HR
- Decreased RR
- Leads to more ischemia
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
clinical S/S of peripheral nerver injury
- Paralysis with no tone changes
- Muscular atrophy
- 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
What are the components of an upper neuro exam?
- -0: absent
- -1+: decreased
- -2+: normal
- -3+: hyperactive
- -4+: hyperactive + clonus
- Cranial nerve exam
What are the components of a lower neuro exam?
What are the 5 levels of arousal?
What does lethargic mean?
appears drowsy, can respond to questions but falls asleep easily
What does obtunded mean?
responds slowly and is confused, decreased interest in environment
What does stupor mean?
Only aroused from sleep with painful stimulus
What does coma mean?
cannot be aroused and no response to external stimuli or environment
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
What type of damage is associated with a decorticate posture?
What type of injury is associated with a decerebrate posture?
damage to brainstem
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
What is neuropraxia?
- Peripheral nerve injury causing short term compression, short term damage
- localized to area of injury
What is axonotomesis?
- Peripheral nerve injury causing a damaged but still intact myelin sheath
- complete abscence of sensorymotor activity for days to weeks
What is neurotmesis?
- Total disruption of the axon and nerve sheath
- NO conduction below level of lesion again
What is the treatment for peripheral nerve injury?
- Increase circulation
- Sensory Re-education
- Motor Re-education
- Functional Training
What are the risk factors associated with CVA?
- Cardiac disease: atherosclerosis, hypertension, etc.
- Smoking, alcohol and drug use
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
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
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
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
What defecits are associated with anterior cerebral artery occlusion?
- Altered mental status
- impaired judgment
- contralateral hemiplegia
- bowel and bladder incontinence
- behavioral changes
- possible aphasia