Pathophysiology- Neurologic Alterations: CND disorders

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