-
Flaccidity?
no resistance to passive movement
-
Hypotonia?
little resistance to passive movement
-
Hypertonia?
increased muscle resistance to passive movement
-
Spasticity?
gradual increase in tone that causes increased resistance until tone is suddenly reduced
-
Clonus?
continued rhythmic contraction of a muscle after the stimulus has been applied
-
Spastic paralysis?
chronic condition in which muscles are affected by persistent spasms and exaggerated tendon reflexes because of damage to motor nerves of the CNS
-
Decorticate posturing?
- arms flexed toward body
- legs extended
- indicates cerebral lesion
-
Decerebrate posturing?
- arms extended, wrists externally rotated
- legs extended
- midbrain or brainstem lesion
-
opisthotonos?
extension of arms and legs with arching of the back and neck
may indicate brainstem injury
-
Agnosia?
inability to recognize objects through the special senses: may be visual, auditory, or tactile or r/t body parts and their relationships
-
Degrees of sensory loss: anesthesia, dyesthesia, and hyperesthesia?
- anesthesia - loss of sensation
- dysesthesia - impaired sensation
- hyperesthesia - increased sensation
-
Paresthesia?
burning or tingling sensation
-
Snellen chart use?
20 ft from chart or pocket version 14 inches away
record number on lowest line patient can read with 50% accuracy
-
Ptosis may indicate cranial nerve ___ injury?
- III
- controls elevation of eyelids
-
Normal pupil size?
2-6 mm
-
Clinically significant pupil size change?
1mm
-
What can cause pinpoint and nonreactive pupils?
pontine lesions, opiates, miotics (pilocarpine)
-
What can cause midsize and nonreactive pupils? (2-6mm)
midbrain lesion
-
What can cause unilateral >6mm pupils and nonreactive?
brainstem lesion, medication: parasympatholytics (atropine), sympathomimetic (EPI)
-
Word that means unequal pupils?
anisocoria
-
What will occur with injury to parasympathetic fibers of the oculomotor nerve?
Sympathetic fibers of the oculomotor nerves?
parasympathetic: ipsilateral (same side) pupil dilation
sympathetic: ipsilateral pupil constriction
-
Horner syndrome?
- interruption of sympathetic nerve fibers of oculomotor nerve
- 1. pupil constriction
- 2. partial ptosis
- 3 loss of hemifacial sweating
caused by CVA, injury to carotid artery, migraine, or tumor
-
What may oval shaped pupil indicate?
may precede dilated pupil as a sign of pressure on oculomotor nerve
-
Abnormal extraocular movements indicates what?
cranial nerve injury or isolated muscular dysfunction
-
Indications of nystagmus?
lesions of the vestibular system or the brainstem
-
What may disconjugate gaze indicate?
brainstem damage
-
Decreased or absent corneal blink reflex?
may indicate cranial nerve V injury
may be decreased in contact wearers
-
Asymmetry of facial muscle strength may indicate damage to what cranial nerve?
5
-
S/S of Bell's Palsy?
What cranial nerve is affected?
- 1. assymmetry of facial expression
- 2. loss of nasolabial fold
- 3. eye remaining open when trying to close
VII
-
Inability to taste indicates cranial nerve ___ injury.
7
-
Oculocephalic reflex?
- AKA Doll's eyes
- turn head - eyes should go in opposite direction
- abnormal indicates compression in the midbrain-pontine area
-
Hoarseness indicates damage to what cranial nerve?
damge to laryngeal branch of cranial nerve X
-
Involuntary swallow or gag when palate is stroke indicates intactness of what cranial nerves?
9 and 10
-
Consultation needed if neuro pt fails water test?
speech and language pathologist
-
Interventions for patient with no gag reflex?
- no fluids
- position on side
- suction equipment available
-
Causes of hyporeflexia?
hypocalcemia, hyperphosphatemia, hpomagnesemia or lower motor neuron lesions
-
Causes of hyperreflexia?
- high Ca, phosphate, or Mg
- upper motor neuron lesions
-
Babinskin reflex in adults indication?
upper motor neuron lesion
-
Battle sign?
brusing of the mastoid (behind ear)
indicates basal skull fracture
-
Raccoon eyes?
black eyes
indicates basal skull fracture
-
With what type of skull fracture may ottorhea or rhinorhea be seen?
basal skull fracture
-
Malocclusion?
inability of teeth to fit together normally when mouth is closed or inability to close mouth
-
Brudzinski sign?
- c-spine must be clear
- chin to chest and head brought forward
neck pain and involuntary adduction and flexion of legs with attempt to flex neck indicates irritation of meninges by infectoin or blood
-
Kernig sign?
- flex thigh toward chest
- inability to fully extend leg when thigh is flexed toward abd indicates irritation of meninges with infection/blood
-
ICP poor prognosis?
>50mmHg for >20 min
-
-
Dilantin therapeutic level?
10-20
-
Normal serum glucose?
When decreased?
60% of serum glucose value
decreased in bacterial meningities
-
What will occur if ICP exceeds Map
BF to brain will stop
-
Consideration with older adults and alcoholics and brain bleeds?
cerebral atrophy - increases risk of intracranial bleeds
-
CPP?
- pressure at which brain tissue is perfused
- MAP-ICP = CPP
-
-
CPP of >___ is considered minimum desirable CPP for pt with brain injuries
60
-
Increased ____ and decreased ____ decrease cerebral BF.
-
Cushings Triad?
- 1. increased systolic BP
- 2. widening pulse pressure
- 3. bradycardia
indicates impending herniation
-
When may hyperthermia occur in pat with intracranial HTN?
late as a result of pressure on thermoregulatory center in hypothalamus
-
Parinaud syndrome?
paralysis of the upward gaze
-
S/S of intracranial HTN in infants?
- 1. bulging fontanels
- 2. high-pitched cry
- 3. "setting sun" sign: looks like eyes are sinking into lower lids and there is visible sclera above irises
- 4. persistent vomiting
-
Why is lumbar puncture contraindicated in intracranial HTN/ increased ICP?
can cause downward cerebellar herniation with medullary herniation and death
-
What test may show cause of intracranial HTN?
cerebral angiography
-
Positioning of patient with intracranial htn?
on side to prevent aspiration if spine has been cleared
-
Suction should be limited to ____ seconds.
10
-
Positive pressure mechanical ventilation effect on ICP?
increases ICP
use lower tidal volumes and PEEP with intracranial HTN and increased ICP
-
What fluids should be avoided with intracranial HTN and increased ICP?
hypotonic - dextrose 5%, D5W
-
Tx of intracranial HTN?
- aimed at reducing one of 3 components of ICP
- 1. CSF - drain if have intraventricular catheter present
- 2. blood volume: hyperventilation may be used in dire circumstances b/c alkolosis causes vasoconstriction
- 3. brain mass: osmotic diuretics: mannitol, fluid restriction, corticosteroids
-
Ways to decrease metabolic demands of the brain?
- 1. prophylactic anticonvulsants
- 2. normothermia or therapeutic hypothermia: antipyretics, cooling therapies
- 3. sedatives, paralytics, and barbiturates
- 4. calm, quiet environment
-
Concussion?
brief alteration in the level of consciousness/rticular activation system that causes brief loss of awareness
-
Contrecoup injuries?
impact occurs on one side whch causes brain to move and hit opposite side of skull and injuring opposite side of brain
-
Diffuse axonal injuries?
extensive generalized damage to white matter of brain
-
Focal injury?
lg enough that it can be id'd macroscopically
-
Diffuse injury
diffuse microscopic damage
-
S/S of TBI specific to infants?
- bulging fontanel
- if retinal hemorrhages - abuse possible
-
S/S of brain contusion?
- altered LOC >6h
- memory loss
-
CT head with brain contusion?
may initially be normal
-
Diffuse axonal injury?
- immediate LOC that takes >6 hours to resolve if it resolves ever
- amnesia, confusion, behavior changes, may have brainstem damage s/s
-
Complications of TBI?
- 1. secondary brain inury: edema, ischemia
- 2 intracerebral hematoma/hemorrhage
- 3. subarachnoid hemorrhage with contusion
- 4. fluid and electrolyte imbalance
- 5. ADH imbalance: DI, or SIADH
-
Discharge instructions with concussion and brain contusion?
return if HA, NV confusion, s/s ICP
may need to wake pt every 2-4 h and assess orientation at home
-
What may occur with linear fractures of the temporal and parietal bones?
tear middle meningeal artery and lead to epidural hematoma
-
what may occur with linear Fx of the occipital bone?
tear occipital artery and lead to epidural hematoma
-
s/s of basal skull fracture?
- anterior fossa: rhinorrhea (lasts 2-3 days), racoon sign (tks 3-4 h to occur), may have cranial nerve 1 damage and anosmia
- middle fossa: otorrhea or rhinorrhea, CSF/blood behind tympanic membrane, hearing deficit, Battle sign (4-6 h to occur), may have cranial nerve injuries
- posterior fossa: may have epidural hematoma -> intracranial HTN, cerebellar/brainstem/cranial nerve signs
-
Tx of rhinorrhea or otorrhea?
- 1. Don't obstruct flow - mustache dressing
- 2. elvate HOB 30
- 3. discourage sneezing, blowing nose, valsalva, breathe out while turning, cough with mouth open
- 4. do not put anything in nose
-
Subdural hematoma?
collection of blood in subdural space
-
Epidural hematoma?
collection of blood b/t skull and dura mater
-
Intracerebral hematoma?
bleeding directly into brain tissue
-
Subdural hematoma predisposing factors?
- 1. may be spontaneous - esp. with coagulation disorder or anticoagulants
- 2. older adults and alcoholics
-
Epidural hematoma often associated with what type of skull fractures?
linear skull fractures that cross major vascular channels
-
Patho of subdural hematoma?
- usually venous bleed
- acute: onset within 48 hours of injury
- subacute: within 2 wks
- chronic: weeks to months after injury
-
Epidural hematoma patho?
usually arterial
-
Causes of intracerebral hemorrhage?
missile inury or severe accel-decel force
-
S/S of subdural hematoma?
- 1. HA
- 2. increasing irritability progressing to confusion then decreased LOC
- 3. ipsilateral oculomotor paralysis
- 4. contralateral hemiparesis or hemiplegia
-
S/S of epidural hematoma?
- 1. short period of unconsciousness followed by lucid interval then rapid dterioration - lucid period may be absent if significant blow
- 2. HA
- 3. ipsilateral oculomotor paralysis
- 4. contralateral hemiparesis/hemiplegia
-
S/S intracerebral hemorrhage?
varies with area of brain involved
may or may not show s/s of increased ICP
-
When is LP contraindicated with brain injuries?
increased ICP and intracranial htn
-
Hemorrhagic stroke?
interruption of BF to brain as a result of vessel rupture
-
90% of ruptured aneurysms are associated with ____
htn
-
What bleeding causes meningeal irritation?
blood leakage into subarachnoid space that comes in contact with meninges
-
______can develop as a result of the obstruction of CSF outflow through the arachnoid villi.
hydrocephalus
-
What may occur as a clot around an aneurysm is broken down by body's natural firinolytic processes?
rebleeding
-
S/S of brain aneurysm?
- Aneurysm:
- 1. atypical HA occuring days or weeks prior to rupture
- 2. sudden/severe HA, radiates to neck/back
- 3. weakness
- 4. ptosis diplopia, blurred vision
- 5. NV
Arteriovenous malformation: hearing contant swishing sound in head with each heartbeat, dizziness/syncope
restlessness progressing to altered LOC
-
What electrolyte imbalance may occur with aneurysm rupture?
hyponatremia r/t SIADH or cereral salt wasting
-
When may LP be performed with aneurysm?
if CT is ondiagnostic and no indication of intracranial htn
-
ECG with subarachnoid hemorrhage?
- flat, peaked, or inverted T wave
- prominent U
- prolonged QT
- dysrhythmias esp. torsades
-
What is the purpose of transcranial dopplar?
dx of vasospasm
-
What drugs are used to maintain BP in aneurysm rupture?
What is target BP?
maintain within 10% of prehemorrhage levels
alpha and beta blockers, vasodilators, vasopressors, Ca channel blockers to prevent/reduce vasospasm
-
In CVA brain edema develops over first ____ h.
What effect does this have?
72 hours
progressive damage to penumbra
-
When do thrombotic strokes usually occur?
at night - wake up with s/s
-
When do embolic strokes usually occur?
when active
-
CT goals with CVA patient?
noncontrast CT within 25 min of entering ED doors and read within 20 min of procedure
-
With CVA, maintain systolic BP ____ and diastolic BP ____.
-
Drugs used for HTN in CVA?
- labetalol mainly
- nitroprusside, hydralazine, nicardipine
-
Contraindications for TPA?
- 1. waking with s/s
- 2. seizure at onset
- 3. age >75
- 4. NIHS >22
- 5. hypodensities on CT
- 6. subacute bacterial endocarditis
- 7. H of hemorrhagic stroke, intracranial neoplasm, atrioventricular malformation, or aneurysm
- 8. known bleeding disorder
- 9. suspected aortic aneurysm
- 10. systolic BP <200 or diastolic <120
- 11. prolonged >10min or traumatic CPR
- 12. pregnancy
- 13. streptokinase: not if have received it or had stre infection in last 6-9 months
-
Alteplase dosing?
- activase
- 0.9mg/kg IV with max dose of 90mg
admin 10% of dose as bolus over 1minute. Infuse remaining amnt over 60 minutes
-
Platelet aggregation inhibitors and fibrinolytics?
contraindicated for 24 hours after IV fibrinolytics
-
What should be done if pt experiences change in LOC during fibrinolytic infusion?
stop infusion and have immedicate repeat CT
-
Complications of CVA?
- 1. fibrinolytic complications
- 2 persistent neurologic trauma
- 3. brain edema
- 4. seizures
- 5. fluid/electrolyte imbalances: DI & SIADH
-
Risk factors for traumatic SC injuries?
- 1. male
- 2. age 16-30
- 3. alcohol & drug use
-
Hyperflexion SC injury?
- chin forced to chest
- usually C5 and C6
- from sudden decceleration
-
Hyperextension SC injury?
- head thrown backward
- usually cervical area
- forces of acceleration and decel
-
SC rotation injury?
all parts of vertebral column affected
-
SC vertical compression injury?
- falling or jumping and landing directly on feet or head
- feet: Fx of low thoracic and lumbar vertabrae
- head: Fx of cervical vertabrae
-
High and low cervical injuries affect on breathing?
- high: affects breathing
- low: affects ability to take deep breath, cough, and sigh
-
When does edema develop with SC injury
within an hour after injury
-
Spinal shock?
S/S?
loss of neurologic function below level of injury
- 1. flaccid paralysis
- 2. areflexia
- 3. loss of sensation
- 4. loss of autonomic function (sweating)
-
BP and HR that may occur with SC injuries?
hypotension and bradycardia
-
Spinal shock may be seen with ___ and ____ injuries.
cervical and high thoracic
-
C1 - C2 SC lesion?
ventilatory cessation and immediate death
-
C3-C5 SC lesion?
quadriplegia with total loss of ventialatory function
- depend on ventilator
- C3, 4, and 5 keep the diaphragm alive
-
C5-C6 SC lesion?
- quadriplegia with gross arm mvmts
- diaphragm spared: diaphragmatic breathing with no accessory/abd assistance to cough
-
C6-C7 SC lesion?
- quadriplegia with biceps muscles intact but no function of intrinsic hand muscles
- diaphragmatic breathing with no intercostal/abd help with cough
-
C7-C8 SC lesion?
- quadriplegia with triceps and biceps intact but no function of hand muscles
- diaphragmatic breathing
- no intercosta/abd for cough
-
T1-L2 SC lesion?
paraplegia with loss of varying amnt of intercostal and abd muscle
-
Below L2 SC lesion?
cauda equina injury: mixed picture of motor and sensory loss with bowel and bladder dysfunction
-
Complete SC lesion?
- loss of sensory and motor function below level of lesion - irreversible
- flaccid paralysis
- areflexia
- urinary retention or priapism
-
Incomplete syndromes of SC?
varying degrees of paralysis and sensory loss below level of injury with varying degrees of bowel and bladder dysfunction
-
When does spinal shock occur after injury and how long does it last?
within minutes
several days to months
-
S/S of spinal shock?
- 1. loss of all motor, sensory, and reflex responses
- 2. bradycardia, hypotension
- 3. loss of autonomic control
- 4. trasient reflex depression below level of injury
- 5. flaccid paralysis of all skeletal muscles below injury
- 6. urinary and fecal retention
- 7. impairment of temp regulation *vasodilation, inability to shiver), poikilothermia
- 8. priapism may occur
-
Central cord syndrome motor/sensory loss and type of injury?
- motor: weakness of all extremities but greater motor loss in upper extremities
- sensory: varies depending on number of undamaged SC tracts
- hyperextension injury
-
Brown-Sequard syndrome motor/sensory loss and type of injury?
- motor: ipsilateral motor loss below the lesion
- sensory: isilateral loss of position and vibratory sense, contralateral loss of pain and temp sensation
- rotational with dislocation of Fx fragements, penetrating, tumor
-
Anterior cord syndrome motor/sensory loss and type of injury?
- complete motor loss below lesion
- sensory: loss of pain and temp sensation below lesion, sparing of proprioception, vibratory sense, and touch
- hyperflexion
-
Psterior cord syndrome motor/sensory loss and type of injury?
- motor: function intact
- sensory: loss of touch, vibratory sense, and proprioception below lesion
- hyperextension or disease processes
-
Cauda equina syndrome motor/sensory loss and type of injury?
- motor: varying amnt of motor loss in LE, bowel and bladder probs
- sensory: varying amnt of loss in LE
- indirect trauma to peripheral nerves associated with Fx
-
Spinal cord injury without radiographic abnormality accounts for up to 2/3 of severe cervical injuries in what group of ppl?
children <8 years old
-
If suspect SC injury in children 8 and under with no radiographic evidence what is intervention?
immobilize for 1 to 3 wks
-
Fluid admin with SC injury?
How is BP managed?
pt hypotensive with normal fluid volume - increased fluids can increase SC edema
careful fluid admin
may manage hypotension with pressors
-
What type of fluids should be avoided with SC injury?
hypotonic
-
How should pt with SC injury be moved?
log roll
-
Interventions to help with venous return in SC injury pt?
-
Methylprednisolone admin after SC injury?
- 30mg/kg over 15 min pause 45min
- maintanance dose 5.4mg/kg/h X23 hours
- infuse X24h if Tx within 3 h of inury
- infuse 48 h if Tx within 3-8 h of injury
-
Contraindications for steroid / methylprednisolone with SC injury?
- 1. injury >8 h
- injury below L2
- 3. injury to cauda equina
-
Autonomic dysreflexia?
BP with spinal cord injury above T6 becomes excessively high as a result of overactivity of autonomic NS
-
Interventions for autonomic dysreflexia?
- 1. eliminate noxious stimuli - full bladder/bowel
- 2. admin antihypertenisve agens
-
Neurogenic bladder?
nerves supposed to carry msgs from brain to bladder don't work
-
Intervention for neurogenic bladder?
intermittent bladder preferred to use of Foley cath
-
Status epilepticus?
seizure activity of >/= 30 minutes caused by a single seizure or series of seizures with no return of consciousness b/t seizures
-
What induces a seizure with elevated body temp?
not temp but how fast it rises
rapid increase in temp >102
-
Age of febrile seizures?
6months to 3 years
-
___ % risk of developing seizures after major head trauma
50%
-
Causes of seizures?
- 1 major head trauma
- 2. stroke
- 3. CNS infection
- 4. brain tumors
- 5. encephalopathy
- 6. Electrolyte imbalance: hyponatremia, hypocalcemia, hypomagnesemia
- 7. drug toxicity: lidocaine, demerol, theophylline, salicylates, tricyclic antidepressants, cocaine
- 8. sepsis
- 9. perinatal problems: anoxia or hypoglycemia at birth
-
What occurs with prolonged generlized seizures?
may deplete brain of O2 and glucose -> hypoxia and neuronal death
-
What occurs after 25-30 min of seizure?
- 1. cerebral BF unable to keep up with cerebral demands
- 2. bradycardia, hypotension, dysrhythmias, and hypoglycemia
- 3. marked dlevations of creatine kinase and K
- 4. Vfib may occur
- 5. rhabdomyolysis-induced renal failure
-
Electrolyte imbalances with seizure?
hyperkalemia with prolonged seizures
-
glucose levels with seizures?
increased early and decreased late
-
Creatinine kinase with seizure?
increased esp if prolonged
-
ABG with seizure?
may have hypercapnia or hypoxemia
-
Urine with seizure?
may show myoglobinuria esp if prlonged
-
Airway mngmt with seizures and decreased LOC?
may need oral or nasopharyngeal airway to hold tongue
-
UDS for seizures?
screen for barbituarates, alcohol, tricyclic antidepressants, cocaine
-
Contributing factors that lower seizure threshold and need to be corrected?
- 1. hypoxemia
- 2. acid-base imbalances
- 3. electrolyte imbalance
- 4. hyperthermia
- 5. hypermetabolism
-
Consideration with seizure activity r/t alcohol?
thiamine and D5W
-
Why is thiamine given with D5W?
to prevent Wernicke Encephalopathy
-
Seizure meds time until seizure stops and duration of anticonvulsant effect?
ativan, diazepam, phenytoin sodium, fospheytoin/cerebyx, phenobarbital
- lorazepam: 6-10min/12-24h
- diazepam: 1-3 min/30min
- phenytoin sodium: 30min/24h
- fosphenytoin/cerebyx: 15min/24h
- phenobarbital: 20-30 min/48h
-
Tonic phase?
prolonged muscle contraction
-
Clonic phase?
rapid succession of alternating contractions and partial relaxations
-
Characteristics of HA that is likely to have a serious cause?
- 1. sudden onset with rapid worsening
- 2. no previous Hx of similar HA
- 3. fever
- 4 altered LOC
- 5. indications of meningeal irritation
- 6. age >50
- 7. immunosuppression
-
Tension HA?
tight pressure around the head - no throbbing
usually starts in occipital area and moves toward frontal area
may have neck tension
-
Migraine?
- often unilateral and throbbing
- may have aura
- NV
- photophobia
- speech difficulties may occur
-
Cluster HA?
- 1. cyclic HA
- 2. unilateral
- 3. periorbital or temporal
- 4. describied as severe, sharp, burning, or boring
- 5. patting or rubbing affected area may relieve some of the discomfort
-
LP with HA?
r/o meningitis
CT first to r/o subarachnoid hemorrhage
-
Drugs for migraine?
alpha adrenergic blockers: dihydroergotamine - constricts cerebral blood vessels - may cause reflex tachycardia and HTN, contraindicated in pregnancy
imitrex- cranial vasoconstriction - tingling and hot sensations are common - caustious in pt with CAD
-
Tx of cluster HA?
- 100% O2 for up to 15 minutes
- - intranasal lidocaine 4% topical or 2% viscous
- - Ca channel blockers
-
Guillain-Barre syndrome?
acute, rapidly progressing symmetrical demyelinating polyneuropathy in which body's immune system attacks part of the peripheral NS
-
Predisposing factors Guillian-Barre?
- 1. viruses: cytomegalovirus, varicella-zoster virus, and Epstein-Barr virus
- 2. Bacteria: campylobacter jejuni, and mycoplasma pneumoniae
- 3. vaccines: rabies and H1N1 influenza
- 4. trauma or surgery
-
S/S of Guillain-Barre?
- 1. Hx of recent illness
- 2. sudden weakness and mild sensory disturbances of legs - progressses in symetrical ascending manner - evolves days to wks
- 3. paresthesia
- 4. muscle cramping or ache in hips, thighs, or back
- 5. dyspnea
- 6. dysphagia
- 7. wide blood pressure changes: may have orthostatic changes
- 8. respiratory distress
- 9. tachycardia progressing to bradycardia
- 10. facial flushing
- 11. loss of sweating or episodic profuse diaphoresis
- 12. bell palsy or facial paresis
- 13. symmetric proximal and distal weakness
- 14. areflexia or decreased depp tendon reflexes
- 15. no muscle atrophy
-
Peak effects of Guillain-Barre weakness?
peak effects occur b/t 1 and 4 wks
-
What electrolyte imbalance occurs with Guillain Barre?
hypercalcermia seen with immobilization
-
What is seen in LP of guillain Barre?
protein
-
Postioning of pt with Guillain-Barre
elevated HOB
-
Complications of Guillain-Barre?
- 1. DVT
- 2. PE
- 3. urinary retention
- 4. acute respiratory failure
-
Amyotrophic Lateral sclerosis (Lou Gehrig disease)?
progressive neurodegenerative disease of upper and lower motor neurons of the cerebral cortex, brainstem, and spinal cord that results in total paralysis
-
Multiple sclerosis?
progressive demyelination of the CNS
-
Parkinson disease?
progressive dgeneration of the neurons in the motor area of the brain
-
Myasthenia gravis?
progressive disorder of the peripheral NS that affects the transmission of nerve impulses to the voluntary muscles
-
Neonatal myasthenia?
can occur when fetus acquires antibodies from a mother who is affected with myasthenia gravis
-
Predisposing factors of ALS?
- more common in men
- average age at Dx 55
-
Who is more prone to multiple sclerosis?
- affects women more than men
- age of onset is 20 to 40 years
-
Predisposing factors for myesthenia gravis?
family Hx of autoimmune disorder
seen in adult women <40 and men >60
-
Patho of ALS?
progressive neurodegnerative disease that affects nerve cells in the brain and spinal cord
-
Patho of MS?
immune system attacks protective myelin sheaths that surround the nerve cells of the brain and spinal cord
-
Patho of Parkinson disease?
breakdown of the nerve cells in the motor area of the brain which results in a shortage of dopamine
deficiency of dopamine in basal ganglia affects regulation of body movements
-
Patho of myasthenia gravis?
- acetylcholine receptor antibodies are present in 80to 90% of pt with generalized form of myasthenia gravis
- immunoglbulin G autoantibodies prevent acetyl-choline from binding with receptor at the neuro-muscular junction
-
S/S of ALS?
muscle weakness and stiffness is earliest sign
muscle weakness in arms, legs, or chest (trouble breathing) is hallmark sign
twitching and cramping of muscles - impairment of the use of arms and legs
muscle twitches, thick speech, difficulty projecting the voice,
advanced stages: probs with breathing and swallowing
-
Hallmark sign of ALS?
muscle weakness in arms, legs, and chest (trouble breathing)
-
Dx of ALS?
high-resolution serum protein electrophoresis, thyroid and parathyroid levels
urine - 24h collection for heavy metals
-
MS S/S?
- 1. visual disturbances: diplopia, blurred vision
- 2. muscle weakness, numbness, prickling sesations, and ataxia
- 3. facial hypesthesia and paresthesias
- 4. memory and concentration probs
- 5. charcot triad: nystagmus, intention tremor, and scanning speech
- 6. abnormal reflexes: increased deep tendon reflexes, positive Hoffman sign, positive Babinski sign, and decreased cremateric reflex
- 7. Lhermitte sign: when pt laing down, flexion of the neck causes electrical shock radiates bilat down arms, back, and trunk
- 8. high steppage gait and scissors gait
- 9. decreased vibration and position sense
- 10. ataxia
- 11. decreased muscle stregth and paralysis
-
CSF with multiple sclerosis?
increased total protein and immu noglobulin G levels
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