Chapter 29

Chapter 29: Neurology
Nervous System Central Nervous System (CNS) o Sensory Input (Afferent) o Motor Output (Efferent) Peripheral Nervous System o Afferent Division (Sensory) o Efferent Division (Motor) Autonomic Nervous System (involuntary/visceral) Peripheral Neuropathy- any malfunction or damage of the peripheral nerves. Results may include muscle weakness, loss of sensation, impaired reflexes, and internal organ malfunctions. Sympathetic Division (fight or flight) Parasympathetic Division (feed or breed) Somatic Nervous System (voluntary) Altered Mental Status (AMS) is the hallmark sign of CNS injury or illness. Coma- a state of unconsciousness from which the patient cannot be aroused. Patient Mental Status A- Pt. is Alert and aware of his surroundings V- Pt. responds to Verbal stimuli P- Pt. responds to Pain stimuli U- Pt. is Unresponsive. Cerebral Functioning Mood Thought Perception Judgment Memory & Attention Determine the pattern of respirations Kussmauls respirations- deep, slow or rapid, gasping breathing. Associated w/ diabetic ketoacidosis Cheyne-Stokes respirations- progressively deeper, faster breathing alternating gradually w/shallow, slower breathing, indicating brain stem injury. Ataxic/Biots respirations- irregular pattern of rate and depth w/ sudden, periodic episodes of apnea, indicating increased ICP. Central neurogenic hyperventilation- deep, rapid respirations, indicating increased ICP. Apneustic respirations- breathing characterized by a prolonged inspiration unrelieved by expiration attempts, seen in patients w/damage to the upper part of the pons. Posturing
Decorticate posture- characteristic posture associated w/a lesion at or above the upper brainstem. The patient presents w/the arms flexed, fists clenched, and legs extended. Decerebrate posture- sustained contraction of extensor muscles of the extremities resulting from a lesion in the brainstem. The patient presents w/stiff and extended extremities and retracted head. Glasgow Coma Scale (GCS) Eye Opening- 1-4 Verbal response- 1-5 Motor response- 1-6 Total= 15> Cushings reflex- a collective change in vital signs associated w/increasing Intracranial pressure (ICP). B/P, temp. pulse and respirations Wernickes syndrome- condition characterized by loss of memory and disorientation, associated w/chronic alcohol intake and a diet deficient in thiamine. Korsafoffs psychosis- psychosis characterized by disorientation, muttering delirium, insomnia, delusions, and hallucinations. Symptoms include painful extremities, bilateral wrist drop, bilateral foot drop, and pain on pressure over the long nerves. Stroke/CVA (cerebrovascular accident)- caused by either ischemic or hemorrhagic lesions to a portion of the brain, resulting in damage or destruction of brain tissue. TIA (transient ischemic attack)- temporary interruption of blood supply to the brain. Seizure- a temprotary alteration in behavior due to the massive electrical discharge of one or more groups of neurons in the brain. Seizures can be clinically classified as generalized or partial. Types of Seizures Generalized Seizures- seizures that begin as an electrical discharge in a small area of the brain but spread to involve the entire cerebral cortex, causing widespread malfunction. o Tonic-clonic seizures- characterized by rapid loss of consciousness and motor coordination, muscle spasms, and jerking motions. o Absence- sudden onset, characterized by a brief loss of awareness and rapid recovery. Partial Seizures- seizures that remain confined to a limited portion of the brain, causing localized malfunction. Partial seizures may spread and become generalized. o Simple partial seizures- involves local motor, sensory, or autonomic dysfunction of one area of the body. There is no loss of Consciousness. o Complex partial seizures- originating in the temporal lobe characterized by an aura and focal findings such as alterations in mental status or mood. Status Epilepticus- series of 2 or more generalized motor seizures without any intervening periods of consciousness. Is a life-threatening emergency. Syncope/Fainting- transient loss of consciousness due to inadequate flow of blood to the brain w/rapid recovery of consciousness upon becoming supine. If a patient does not
regain consciousness within a few moments, it is NOT syncope, but something more serious. Neoplasm- literally meaning new form; a new or abnormal formation; a tumor. Supportive therapy. Brain abscess- a collection of pus localized in an area of the brain. Degenerative neurological disorders- a collection of diseases that selectively affect one or more functional systems of the CNS. Alzheimers disease- a degenerative brain disorder; the most common cause of dementia in the elderly. Muscular dystrophy- a group of genetic diseases characterized by progressive muscle weakness and degeneration of the skeletal or voluntary muscle fibers. Multiple Sclerosis (MS)- disease that involves inflammation of certain nerve cells followed by demyelination, or the destruction of the myelin sheath, which is the fatty insulation surrounding nerve fibers. Dystonias- a group of disorders characterized by muscle contractions that cause twisting and repetitive movements, abnormal postures, or freezing in the middle of an action. Parkinsons disease- chronic and progressive motor system disorder characterized by tremor, rigidity, bradykinesia, and postural instability. Central Pain Syndrome- condition resulting from damage or injury to the brain, brainstem, or spinal cord characterized by intense, steady pain described as burning, aching, tingling, or a pins and needles sensation. Bells palsy- one-sided facial paralysis with an unknown cause characterized by the inability to close the eye, pain, tearing of the eyes, drooling, hypersensitivity to sound, and impairment of taste. Amyotrophic Lateral Sclerosis (ALS)/Lou Gegrigs disease- progressive degeneration of specific nerve cells that control voluntary movement characterized by weakness, loss of motor control, difficulty speaking, and cramping. Myoclonus- temporary, involuntary twitching or spasm of a muscle or group of muscles. Spina Bifida (SB)- a neural defect that results from the failure of one or more of the fetal vertebrae to close properly during the first month of pregnancy. Polio (poliomyelitis)- infectious, inflammatory viral disease of the CNS that sometimes results in permanent paralysis.

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Chapter 29: Neurology

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