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Step one in neuro assessment
look for psycho-social explanations (depression, anxiety)
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Step two in neuro assessment
Asses time frame, acuity, family history and change (recent or long standing)
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Step three in neuro assessment
assess for medical involvement, especially sleep, diet, exercise, respiratory, circulatory, meds, and endocrine
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Step four is neuro assessment
hypothesize most obvious explanation and continue to explore
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most common type of neuro assessment?
trauma, followed by vascular
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Three types of TBI
- Mild - receiving a lot of attention b/c of sports
- closed - the most common form
- open - the most dangerous
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Effects of TBI
- Tissue loss
- tissue swelling or edema
- epilepsy
- often leads to interpersonal problems
- often undetected
- often first seen as emotional changes
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Most common contributor to mTBI?
MVA
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Mechanism of mTBI
- concussion
- acceleration/deceleration
- shearing/diffuse axonal injury
- secondary swelling
- metabolic change
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Second impact syndrome
- prior concussion followed by another impact
- most common in athletes
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Diffuse Axonal Injury
- high speed injury with stretching or shearing of brain tissue
- cerebral swelling and elevations in intracranial pressure, coma likely
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mTBI criteria
- gasgow coma scale > 12
- loss of consciousness < 20 min
- hospitalization < 48 hours
- no obvious structural damage
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penetrating injuries
- most problematic because of infection
- brain does not have strong infection defense
- fever can reach 110 degrees
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Mechanisms of injury
- rotational acceleration
- linear acceleration
- carotid injuries (circle of willis)
- deceleration on impact
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Cerebrovascular accident characteristics
- caused by disease, life-style, and trauma
- very common and often undetected
- manifestation depends on location and degree
- very slow and hard to recover from
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Cerebrovascular accident - embolic
- sudden blockage of a vessel by some blood borne
- "cork"
- usually occur w/o warning
- associated with poor cardiovascular health
- onset of cognitive signs very rapid and obvious
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Cerebrovascular accident - thrombotic
- gradual blockage of a vessel by plaque or inflammation
- develop over long period of restricted blood flow
- associated with high cholesterol
- often manifest at periods of low blood pressure
- can produce transient ischemic attacks (TIA) that serve as warnings
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Cerebrovascular accident - aneurysm
- a ballooning of a weakened vessel
- frequently occur in chronically hypertensive people
- sudden and usually intensely painful onset
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Cerebrovascular accident - hemorrhagic
- a bleed due to a puncture or rupture of a vessel
- become more common with aging
- blood on brain = extremely dangerous
- seizures/convulsions often indicate bleed
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Cerebrovascular accident - arteriovenous malformation (AVM)
- an abnormal connection between an artery and a vein
- inefficient and often leaky these can cause gradual damage to cortical surfaces
- prone to rupture
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Warning signs of a Cerebrovascular accident
- sudden numbness or weakness of face, arm, or leg
- sudden confusion, trouble speaking or understanding speech
- sudden trouble seeing in one or both eyes
- sudden trouble walking, dizziness, loss of balance or coordination
- sudden, severe headache
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What kind of pathology does a transient ischemic attack herald?
Thrombotic CVA
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Migrane headaches can sometimes be confused with?
CVA
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Why to Dr's look at the retina after a TBI?
to look for a bulging optic disk
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The mantra of MSE
Results are valid and representative of the clients cognitive functioning
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After a shearing injury what causes confusion about the patients initial intactness?
some axons recover and others die off. takes about 2 weeks
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What accounts for confusions when a patient shows signs of damage to the opposite side of their injury?
expecting deficits at coup, not the contre coup
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what type of CVA is heralded by temporary, stroke like symptoms?
thrombus
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what type of tumor would you want?
slow-growing displacing tumor
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most likely cause of an aneurysm?
hypertension
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