What cause changes in consciousness?
infection
vascular abnormality
neoplasm
trauma
congenital defect
hypoxia
electrolyte disturbances
drugs
What are signs of changes in consciousness?
irregular breathing pattern
pupillary changes
altered eye movement
altered movement
vomiting
What are some abnormal motor responses?
decorticate
decerebrate
seizure
a sudden, explosive discharge of cerebral neurons that contributes to altered levels of consciousness
what is another term to describe a person who gets frequent seizures?
epilepsy
status epilepticus
when an epileptic person has a prolonged seizure lasting more than 5 min
What are some causes of seizure disorders?
cerebral lesions/ cancer
congenital malformation
genetic predisposition
injury
trauma
infection
fever
drug/ alcohol abuse
What are the different types of seizure disorders?
partial seizures (simple/ complex)
generalized seizures
absence seizures
myoclonic
tonic-clonic
unclassified
partial seizures
localized seizure
simple- no change in level of consciousness
complex- loss of consciousness
generalized seizures
systemic seizures throughout the whole body
absence seizures
looks like the patient is absent (just stare)
myoclonic
jerking and twitching on either side of the body
tonic-clonic
muscle contaction and jerking, loss of bladder control
What are the phases of a seizure?
aura
prodromal period
seizure
postictal phase
aura
feelings of warning signs (Ex: sees spots)
prodromal period
headache, not feeling good (can happen for several days)
postictal phase
time that a person should rest after a seizure
What diagnostic test can be used for seizures?
EEG
What is acute confusional state associated with?
infection/ febrile illness
chronic disease
head injury
anesthesia
drugs/ alcohol
What causes cerebral dysfunction?
decreased neuronal metabolism
decreased nerve conduction
decreased neurotransmitter function
What are the clinical manifestations of acute confusional states?
abrupt onset
decreased concentration
restlessness
irritability
insomnia or lethargy
poor appetite
tremors
dementia
progressive failure of cerebral functions
Alzheimer's Disease
loss of neuromuscular stimulation by choline acetyltransferase
What are some causes of Alzheimer's disease?
altered (decreased) function of apolipoprotein E
familial Alzheimer dementia
chromosomal mutations
accumulation of amyloid
nuerofibrillary tangle
What are the clinical manifestations of Alzheimer's Disease?
progressive forgetfulness (remember past but not recent things)
memory loss
decreased concentration
decreased judgment and problem solving
dyspraxia (lose ability to take care of themselves)
anxiety
depression
emotional lability
rigidity
propulsion and re
What are causes of Parkinson's disease?
degenerative
starts after age 40 peaks 50-60
genetic, viral, and environmental toxins are possible contributors
lack or dopamine
What is the pathophysiology of Parkinson's disease?
inadequate dopamine levels due to failure of the dopaminergic system in the substantia nigra
loss of neurons
degeneration of neurons
lack of dopamine
relative excess of acetylcholine
What are the clinical manifestations of Parkinson's disease?
resting tremor
rigidity
bradykinesia/ akinesia: slow movement
stoop posture, festinating gait
masked facies
dysarthia
dysphagia
sleep disturbances
decreased concentration
progressive dementia
What are some of the causes of Huntington's disease?
autosomal dominant
starts at age 50
excess dopamine
what is the pathophysiology of Huntington's disease?
degeneration of the basal ganglia
depletion of GABA
relative excess of dopamine
What are the clinical manifestations of Huntington's disease?
abnormal movement (chorea)
progressive dementia
slow thinking
apathy
restlessness
irritability
eventually lose ability to walk, talk and move
meningitis
infection of the meninges (lining around the brain)
What are the types of meningitis?
bacterial (worst)
viral (aseptic)
fungal (more chronic)
what are the types of bacterial meningitis?
pneumococcal (onset: age 40)
meningococcal (onset: college kids/ teens)
What are the meningeal signs of meningitis?
severe, throbbing headache
photophobia
nuchal rigidity (move one thing and everything else moves too)
Kernig and Brudzinski signs
What are the infectious signs of meningitis?
fever
tachycardia
petechial/ purpural rash
What are the neurologic signs of meningitis?
decreased consciousness
neurologic deficits (hemiparesis, ataxia)
seizures
increased intracranial pressure
projectile vomiting
papilledema
delirium
What is the pathophysiology of meningitis?
blood borne pathogen--> enter choroid plexus--> bacteria causes irritation and inflammation in the meninges, CSF, and ventricles--> increased blood vessel permeability--> neutrophils migrate to subarachnoid space--> exudate thickens CSF--> increased infla
What are the different types of stroke?
ischemic, hemorrhagic, and global hypoperfusion
ischemic stroke
(lack of blood flow due to clot) thrombotic
embolic (clot somewhere else and travels to brain)
transient ischemic attack (TIA)
reversible ischemic neurologic deficit (RIND)
hemorrhagic stroke
cerebral aneurysm
arteriovenous malformation
severe hypertension
Global hypoperfusion stroke
not enough blood getting to the brain
shock
What are some risk factors for developing a stroke?
HTN
diabetes
insulin resistance
heart disease
hypercholesterolemia
hypercoaguable states
atrial fibrilation
male
obesity
smoking
heredity
race (predominantly black)
trauma
artherosclerosis
What is the pathophysiology of cerebral ischemia?
vascular occlusion/ embolus/ artherosclerosis/ thrombus--> hypoxia--> inflammation--> tissue necrosis, edema, mushy disintegration
What is the pathophysiology of cerebral hemorrhage?
HTN--> artherosclerosis--> aneurysm rupture--> bleeding compresses brain tissue--> ischemia, edema, increased intracranial pressure
What are the clinical manifestations of a stroke?
headache
mental changes (confusion, disorientation, memory impairment)
aphasia
respiratory problems (decreased neuromuscular control)
decreased cough/ swallow reflex
incontinence
seizures
hemiparesis or hemiplegia
emotional lability
visual change
agnosia
What are diagnostic assessments for stroke?
CT
CTA
MRI
Possible cardiac workup