CEN Neuro

  1. Flaccidity?
    no resistance to passive movement
  2. Hypotonia?
    little resistance to passive movement
  3. Hypertonia?
    increased muscle resistance to passive movement
  4. Spasticity?
    gradual increase in tone that causes increased resistance until tone is suddenly reduced
  5. Clonus?
    continued rhythmic contraction of a muscle after the stimulus has been applied
  6. 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
  7. Decorticate posturing?
    • arms flexed toward body
    • legs extended
    • indicates cerebral lesion
  8. Decerebrate posturing?
    • arms extended, wrists externally rotated
    • legs extended
    • midbrain or brainstem lesion
  9. opisthotonos?
    extension of arms and legs with arching of the back and neck

    may indicate brainstem injury
  10. Agnosia?
    inability to recognize objects through the special senses:  may be visual, auditory, or tactile or r/t body parts and their relationships
  11. Degrees of sensory loss: anesthesia, dyesthesia, and hyperesthesia?
    • anesthesia - loss of sensation
    • dysesthesia - impaired sensation
    • hyperesthesia - increased sensation
  12. Paresthesia?
    burning or tingling sensation
  13. Snellen chart use?
    20 ft from chart or pocket version 14 inches away

    record number on lowest line patient can read with 50% accuracy
  14. Ptosis may indicate cranial nerve ___ injury?
    • III
    • controls elevation of eyelids
  15. Normal pupil size?
    2-6 mm
  16. Clinically significant pupil size change?
  17. What can cause pinpoint and nonreactive pupils?
    pontine lesions, opiates, miotics (pilocarpine)
  18. What can cause midsize and nonreactive pupils?  (2-6mm)
    midbrain lesion
  19. What can cause unilateral >6mm pupils and nonreactive?
    brainstem lesion, medication:  parasympatholytics (atropine), sympathomimetic (EPI)
  20. Word that means unequal pupils?
  21. 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
  22. 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
  23. What may oval shaped pupil indicate?
    may precede dilated pupil as a sign of pressure on oculomotor nerve
  24. Abnormal extraocular movements indicates what?
    cranial nerve injury or isolated muscular dysfunction
  25. Indications of nystagmus?
    lesions of the vestibular system or the brainstem
  26. What may disconjugate gaze indicate?
    brainstem damage
  27. Decreased or absent corneal blink reflex?
    may indicate cranial nerve V injury

    may be decreased in contact wearers
  28. Asymmetry of facial muscle strength may indicate damage to what cranial nerve?
  29. 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

  30. Inability to taste indicates cranial nerve ___ injury.
  31. Oculocephalic reflex?
    • AKA Doll's eyes
    • turn head - eyes should go in opposite direction
    • abnormal indicates compression in the midbrain-pontine area
  32. Hoarseness indicates damage to what cranial nerve?
    damge to laryngeal branch of cranial nerve X
  33. Involuntary swallow or gag when palate is stroke indicates intactness of what cranial nerves?
    9 and 10
  34. Consultation needed if neuro pt fails water test?
    speech and language pathologist
  35. Interventions for patient with no gag reflex?
    • no fluids
    • position on side
    • suction equipment available
  36. Causes of hyporeflexia?
    hypocalcemia, hyperphosphatemia, hpomagnesemia or lower motor neuron lesions
  37. Causes of hyperreflexia?
    • high Ca, phosphate, or Mg
    • upper motor neuron lesions
  38. Babinskin reflex in adults indication?
    upper motor neuron lesion
  39. Battle sign?
    brusing of the mastoid (behind ear)

    indicates basal skull fracture
  40. Raccoon eyes?
    black eyes

    indicates basal skull fracture
  41. With what type of skull fracture may ottorhea or rhinorhea be seen?
    basal skull fracture
  42. Malocclusion?
    inability of teeth to fit together normally when mouth is closed or inability to close mouth
  43. 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
  44. Kernig sign?
    • flex thigh toward chest
    • inability to fully extend leg when thigh is flexed toward abd indicates irritation of meninges with infection/blood
  45. ICP poor prognosis?
    >50mmHg for >20 min
  46. ESR normal?
    15 - 20
  47. Dilantin therapeutic level?
  48. Normal serum glucose?

    When decreased?
    60% of serum glucose value

    decreased in bacterial meningities
  49. What will occur if ICP exceeds Map
    BF to brain will stop
  50. Consideration with older adults and alcoholics and brain bleeds?
    cerebral atrophy - increases risk of intracranial bleeds
  51. CPP?
    • pressure at which brain tissue is perfused
    • MAP-ICP = CPP
  52. Normal CPP
  53. CPP of >___ is considered minimum desirable CPP for pt with brain injuries
  54. Increased ____ and decreased ____ decrease cerebral BF.
    • ICP
    • CPP
  55. Cushings Triad?
    • 1. increased systolic BP
    • 2. widening pulse pressure
    • 3. bradycardia

    indicates impending herniation
  56. When may hyperthermia occur in pat with intracranial HTN?
    late as a result of pressure on thermoregulatory center in hypothalamus
  57. Parinaud syndrome?
    paralysis of the upward gaze
  58. 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
  59. Why is lumbar puncture contraindicated in intracranial HTN/ increased ICP?
    can cause downward cerebellar herniation with medullary herniation and death
  60. What test may show cause of intracranial HTN?
    cerebral angiography
  61. Positioning of patient with intracranial htn?
    on side to prevent aspiration if spine has been cleared
  62. Suction should be limited to ____ seconds.
  63. Positive pressure mechanical ventilation effect on ICP?
    increases ICP

    use lower tidal volumes and PEEP with intracranial HTN and increased ICP
  64. What fluids should be avoided with intracranial HTN and increased ICP?
    hypotonic - dextrose 5%, D5W
  65. 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
  66. 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
  67. Concussion?
    brief alteration in the level of consciousness/rticular activation system that causes brief loss of awareness
  68. Contrecoup injuries?
    impact occurs on one side whch causes brain to move and hit opposite side of skull and injuring opposite side of brain
  69. Diffuse axonal injuries?
    extensive generalized damage to white matter of brain
  70. Focal injury?
    lg enough that it can be id'd macroscopically
  71. Diffuse injury
    diffuse microscopic damage
  72. S/S of TBI specific to infants?
    • bulging fontanel
    • if retinal hemorrhages - abuse possible
  73. S/S of brain contusion?
    • altered LOC >6h
    • memory loss
  74. CT head with brain contusion?
    may initially be normal
  75. 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
  76. 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
  77. 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
  78. What may occur with linear fractures of the temporal and parietal bones?
    tear middle meningeal artery and lead to epidural hematoma
  79. what may occur with linear Fx of the occipital bone?
    tear occipital artery and lead to epidural hematoma
  80. 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
  81. 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
  82. Subdural hematoma?
    collection of blood in subdural space
  83. Epidural hematoma?
    collection of blood b/t skull and dura mater
  84. Intracerebral hematoma?
    bleeding directly into brain tissue
  85. Subdural hematoma predisposing factors?
    • 1. may be spontaneous - esp. with coagulation disorder or anticoagulants
    • 2. older adults and alcoholics
  86. Epidural hematoma often associated with what type of skull fractures?
    linear skull fractures that cross major vascular channels
  87. Patho of subdural hematoma?
    • usually venous bleed
    • acute:  onset within 48 hours of  injury
    • subacute:  within 2 wks
    • chronic:  weeks to months after injury
  88. Epidural hematoma patho?
    usually arterial
  89. Causes of intracerebral hemorrhage?
    missile inury or severe accel-decel force
  90. 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
  91. 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
  92. S/S intracerebral hemorrhage?
    varies with area of brain involved

    may or may not show s/s of increased ICP
  93. When is LP contraindicated with brain injuries?
    increased ICP and intracranial htn
  94. Hemorrhagic stroke?
    interruption of BF to brain as a result of vessel rupture
  95. 90% of ruptured aneurysms are associated with ____
  96. What bleeding causes meningeal irritation?
    blood leakage into subarachnoid space that comes in contact with meninges
  97. ______can develop as a result of the obstruction of CSF outflow through the arachnoid villi.
  98. What may occur as a clot around an aneurysm is broken down by body's natural firinolytic processes?
  99. 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
  100. What electrolyte imbalance may occur with aneurysm rupture?
    hyponatremia r/t SIADH or cereral salt wasting
  101. When may LP be performed with aneurysm?
    if CT is ondiagnostic and no indication of intracranial htn
  102. ECG with subarachnoid hemorrhage?
    • flat, peaked, or inverted T wave
    • prominent U
    • prolonged QT
    • dysrhythmias esp. torsades
  103. What is the purpose of transcranial dopplar?
    dx of vasospasm
  104. 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
  105. In CVA brain edema develops over first ____ h.

    What effect does this have?
    72 hours

    progressive damage to penumbra
  106. When do thrombotic strokes usually occur?
    at night - wake up with s/s
  107. When do embolic strokes usually occur?
    when active
  108. CT goals with CVA patient?
    noncontrast CT within 25 min of entering ED doors and read within 20 min of procedure
  109. With CVA, maintain systolic BP ____ and diastolic BP ____.
    • <185
    • <110
  110. Drugs used for HTN in CVA?
    • labetalol mainly
    • nitroprusside, hydralazine, nicardipine
  111. 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
  112. 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
  113. Platelet aggregation inhibitors and fibrinolytics?
    contraindicated for 24 hours after IV fibrinolytics
  114. What should be done if pt experiences change in LOC during fibrinolytic infusion?
    stop infusion and have immedicate repeat CT
  115. Complications of CVA?
    • 1. fibrinolytic complications
    • 2 persistent neurologic trauma
    • 3. brain edema
    • 4. seizures
    • 5. fluid/electrolyte imbalances:  DI & SIADH
  116. Risk factors for traumatic SC injuries?
    • 1. male
    • 2. age 16-30
    • 3. alcohol & drug use
  117. Hyperflexion SC injury?
    • chin forced to chest
    • usually C5 and C6
    • from sudden decceleration
  118. Hyperextension SC injury?
    • head thrown backward
    • usually cervical area
    • forces of acceleration and decel
  119. SC rotation injury?
    all parts of vertebral column affected
  120. 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
  121. High and low cervical injuries affect on breathing?
    • high:  affects breathing
    • low:  affects ability to take deep breath, cough, and sigh
  122. When does edema develop with SC injury
    within an hour after injury
  123. Spinal shock?

    loss of neurologic function below level of injury

    • 1. flaccid paralysis
    • 2. areflexia
    • 3. loss of sensation
    • 4. loss of autonomic function (sweating)
  124. BP and HR that may occur with SC injuries?
    hypotension and bradycardia
  125. Spinal shock may be seen with ___ and ____ injuries.
    cervical and high thoracic
  126. C1 - C2 SC lesion?
    ventilatory cessation and immediate death
  127. C3-C5 SC lesion?
    quadriplegia with total loss of ventialatory function

    • depend on ventilator
    • C3, 4, and 5 keep the diaphragm alive
  128. C5-C6 SC lesion?
    • quadriplegia with gross arm mvmts
    • diaphragm spared:  diaphragmatic breathing with no accessory/abd assistance to cough
  129. 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
  130. C7-C8 SC lesion?
    • quadriplegia with triceps and biceps intact but no function of hand muscles
    • diaphragmatic breathing
    • no intercosta/abd for cough
  131. T1-L2 SC lesion?
    paraplegia with loss of varying amnt of intercostal and abd muscle
  132. Below L2 SC lesion?
    cauda equina injury:  mixed picture of motor and sensory loss with bowel and bladder dysfunction
  133. Complete SC lesion?
    • loss of sensory and motor function below level of lesion - irreversible
    • flaccid paralysis
    • areflexia
    • urinary retention or priapism
  134. Incomplete syndromes of SC?
    varying degrees of paralysis and sensory loss below level of injury with varying degrees of bowel and bladder dysfunction
  135. When does spinal shock occur after injury and how long does it last?
    within minutes

    several days to months
  136. 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
  137. 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
  138. 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
  139. 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
  140. 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
  141. 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
  142. 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
  143. If suspect SC injury in children 8 and under with no radiographic evidence what is intervention?
    immobilize for 1 to 3 wks
  144. 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
  145. What type of fluids should be avoided with SC injury?
  146. How should pt with SC injury be moved?
    log roll
  147. Interventions to help with venous return in SC injury pt?
    • elevate legs
    • TEDs
  148. 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
  149. Contraindications for steroid / methylprednisolone with SC injury?
    • 1. injury >8 h
    • injury below L2
    • 3. injury to cauda equina
  150. Autonomic dysreflexia?
    BP with spinal cord injury above T6 becomes excessively high as a result of overactivity of autonomic NS
  151. Interventions for autonomic dysreflexia?
    • 1. eliminate noxious stimuli - full bladder/bowel
    • 2. admin antihypertenisve agens
  152. Neurogenic bladder?
    nerves supposed to carry msgs from brain to bladder don't work
  153. Intervention for neurogenic bladder?
    intermittent bladder preferred to use of Foley cath
  154. Status epilepticus?
    seizure activity of >/= 30 minutes caused by a single seizure or series of seizures with no return of consciousness b/t seizures
  155. What induces a seizure with elevated body temp?
    not temp but how fast it rises

    rapid increase in temp >102
  156. Age of febrile seizures?
    6months to 3 years
  157. ___ % risk of developing seizures after major head trauma
  158. 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
  159. What occurs with prolonged generlized seizures?
    may deplete brain of O2 and glucose -> hypoxia and neuronal death
  160. 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
  161. Electrolyte imbalances with seizure?
    hyperkalemia with prolonged seizures
  162. glucose levels with seizures?
    increased early and decreased late
  163. Creatinine kinase with seizure?
    increased esp if prolonged
  164. ABG with seizure?
    may have hypercapnia or hypoxemia
  165. Urine with seizure?
    may show myoglobinuria esp if prlonged
  166. Airway mngmt with seizures and decreased LOC?
    may need oral or nasopharyngeal airway to hold tongue
  167. UDS for seizures?
    screen for barbituarates, alcohol, tricyclic antidepressants, cocaine
  168. Contributing factors that lower seizure threshold and need to be corrected?
    • 1. hypoxemia
    • 2. acid-base imbalances
    • 3. electrolyte imbalance
    • 4. hyperthermia
    • 5. hypermetabolism
  169. Consideration with seizure activity r/t alcohol?
    thiamine and D5W
  170. Why is thiamine given with D5W?
    to prevent Wernicke Encephalopathy
  171. 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
  172. Tonic phase?
    prolonged muscle contraction
  173. Clonic phase?
    rapid succession of alternating contractions and partial relaxations
  174. 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
  175. Tension HA?
    tight pressure around the head  - no throbbing

    usually starts in occipital area and moves toward frontal area

    may have neck tension
  176. Migraine?
    • often unilateral and throbbing
    • may have aura
    • NV
    • photophobia
    • speech difficulties may occur
  177. 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
  178. LP with HA?
    r/o meningitis

    CT first to r/o subarachnoid hemorrhage
  179. 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
  180. Tx of  cluster HA?
    • 100% O2 for up to 15 minutes
    • - intranasal lidocaine 4% topical or 2% viscous
    • - Ca channel blockers
  181. Guillain-Barre syndrome?
    acute, rapidly progressing symmetrical demyelinating polyneuropathy in which body's immune system attacks part of the peripheral NS
  182. 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
  183. 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
  184. Peak effects of Guillain-Barre weakness?
    peak effects occur b/t 1 and 4 wks
  185. What electrolyte imbalance occurs with Guillain Barre?
    hypercalcermia seen with immobilization
  186. What is seen in LP of guillain Barre?
  187. Postioning of pt with Guillain-Barre
    elevated HOB
  188. Complications of Guillain-Barre?
    • 1. DVT
    • 2. PE
    • 3. urinary retention
    • 4. acute respiratory failure
  189. 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
  190. Multiple sclerosis?
    progressive demyelination of the CNS
  191. Parkinson disease?
    progressive dgeneration of the neurons in the motor area of the brain
  192. Myasthenia gravis?
    progressive disorder of the peripheral NS that affects the transmission of nerve impulses to the voluntary muscles
  193. Neonatal myasthenia?
    can occur when fetus acquires antibodies from a mother who is affected with myasthenia gravis
  194. Predisposing factors of ALS?
    • more common in men
    • average age at Dx 55
  195. Who is more prone to multiple sclerosis?
    • affects women more than men
    • age of onset is 20 to 40 years
  196. Predisposing factors for myesthenia gravis?
    family Hx of autoimmune disorder

    seen in adult women <40 and men >60
  197. Patho of ALS?
    progressive neurodegnerative disease that affects nerve cells in the brain and spinal cord
  198. Patho of MS?
    immune system attacks protective myelin sheaths that surround the nerve cells of the brain and spinal cord
  199. 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
  200. 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
  201. 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
  202. Hallmark sign of ALS?
    muscle weakness in arms, legs, and chest (trouble breathing)
  203. Dx of ALS?
    high-resolution serum protein electrophoresis, thyroid and parathyroid levels

    urine - 24h collection for heavy metals
  204. 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
  205. CSF with multiple sclerosis?
    increased total protein and immu noglobulin G levels
Card Set
CEN Neuro
CEN neuro