Neuro 101 - Amazon Web Servicesnursingnetwork-groupdata.s3.amazonaws.com/AMSN/... · Eventually...
Transcript of Neuro 101 - Amazon Web Servicesnursingnetwork-groupdata.s3.amazonaws.com/AMSN/... · Eventually...
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Ischemic ▪85 – 90% of strokes ▪Can be subdivided into embolic or thrombotic Hemorrhagic ▪10-15% of strokes
Thrombotic
1. atherosclerotic plaque formation
2. occludes cerebral vessels
3. ischemia and infarction of tissues
supplied by vessels
Embolic
1. formation of a thrombus
2. most often originate in heart
Weakened vessel ruptures and bleeds into surrounding brain tissue
Two types
1. intracerebral
2. subarachnoid
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Smoking
Hypertension
Diabetes
Atrial fibrillation
Age
Gender
Ethnicity
Heredity
Abuse of amphetamines, cocaine
Inactivity
Previous TIA or stroke
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Sudden numbness or weakness of the face, arm or leg
Sudden confusion or trouble speaking or understanding speech
Sudden trouble seeing from one or both eyes
Sudden trouble walking, dizziness or loss of balance or coordination
Sudden severe headache with no known cause
If you notice any of these signs and
symptoms, call 911
Make note of the time the signs and
symptoms began
ACT F - A - S - T
Rapid recognition of the signs and symptoms of stroke
Rapid activation of EMS
Rapid EMS transport and notifying the hospital ahead of time
Rapid start of pre-hospital care during EMS transport
Rapid diagnosis and treatment at the hospital
Right Gaze Preference
Left Hemiparesis
Left Hemisensory Loss
Left Hemi-inattention (Neglect)
Left Visual Field Deficit
Due to pathology
– if right
hemisphere
stroke (left
muscles become
paralyzed)– so
only muscles
working are the
right.
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Aphasia
Left Gaze Preference
Right Hemiparesis
Right Hemisensory Loss
Right Visual Field Deficit
Hemiparesis: weakness or partial paralysis
Hemiplegia: paralysis
Due to pathology
– if left
hemisphere
stroke (right
muscles become
paralyzed)– so
only muscles
working are the
left.
Cerebellar strokes cause unilateral or bilateral upper or lower extremity incoordination May be accompanied by dizziness and nausea Brainstem strokes cause generalized weakness, disconjugate eye movements,dizziness, nausea and vomiting
Ipsilateral (same side) Limb Ataxia (dyscoordination)
Truncal or Gait
Ataxia (imbalance) Tremors, or Limb Ataxia, result from
lack of coordination of opposing muscle groups
(flexors vs. extensors), causing the muscle groups to
fight each other
Quadriparesis
Sensory Loss in
All 4 Limbs
“Locked In
Syndrome”
Cranial Nerve
Signs
Crossed Signs
(1 side of face and
contralateral body)
Hemiparesis
Hemisensory Loss
Oropharyngeal Weakness:
Dysarthria (speaking), Dysphagia (swallowing)
Eye Movement Abnormalities:
Diplopia
Dysconjugate Gaze
Gaze Palsy (horizontal gaze deficit or gaze
preference)
Decreased LOC
Nausea, Vomiting
Hiccups, Abnormal Respirations
Vertigo, Tinnitus
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Assessment of airway, breathing and circulation is a priority
Focused neuro assessment including the NIHSS
Time last known well Brief medical history/physical
assessment Diagnostic testing such as CT scan or
MRI Treatment with fibrinolytic therapy, if
eligible
Conscious cranial nerve assessment 11 item exam – perform in 7 minutes Focused on focal/neuro deficits Valid, reliable tool. Standardized training Moves from easy to most difficult Score is based on first attempt Easy to communicate to other clinicians
Level of Consciousness (1a, 1b, 1c) Visual (2, 3) Motor (4, 5a, 5b, 6a, 6b) Cerebellar (7) Language (9, 10) Inattention (neglect) (11)
Bonus Cranial Nerves – Optic (II), Oculomotor (III), Abducens (VI), Facial (VII)
Limited ability to assess the posterior circulation
Limited cognitive measurement
Left hemisphere infarcts are over-scored due to language deficits
0 = normal exam, no neurological deficits
>15-20 = indicates a more severe stroke
42 = maximum score, the higher the score the more severe the stroke
Level of consciousness
a. alert, drowsy, stuporous, coma
b. 2 questions – age, month
c. 2 commands
Best Gaze – eyeballs must cross midline
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Visual Fields
▪4 fields in each eye
▪No visual loss, partial hemianopia,
complete or bilateral hemianopia
Facial palsy
▪tests the mouth, teeth and eyebrows for
symmetrical movement
Motor Arm
Checks both arms for drift and effort
Motor Leg
▪extends leg to test for strength,
effort against gravity, in supine
position
Ataxia
▪finger to nose, heel to shin for any
presence of ataxia
Sensory
▪checking for the presence of
sensations on body parts (sharp
and dull)
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Best Language
1.checking for fluency, recall, and
reading ability using a picture
2.identifying objects in picture
3.reading sentences
Dysarthria
1.articulation of speech
2.repeating words
Best Language
–You know how. –Down to earth.
–I got home from work.
–Near the table in the dining room.
–They heard him speak on the radio last
night
Dysarthria
–Mama –Tip-Top
–Fifty-Fifty –Thanks
–Huckleberry –Baseball Player
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Extinction and Inattention
▪neglect, not understanding or
realizing body part or system does
not work
Restore blood flow to the brain by:
removing the clot
dissolving the clot
disrupting the blockage that is occurring in one or more vessels in the brain
Clot-dissolving medications Anticoagulants
Antiplatelet medications
Endovascular treatment recommended for some patients with ischemic stroke
Endovascular surgery- minimally invasive method of treating disease by accessing the blood vessels of the brain and other areas of the body.
Several methods are available including MERCI retriever and Penumbra System
First interventional device cleared by FDA for acute ischemic stroke patients – 8/2004
Performed in over 500 U.S. hospitals
Over 9,000 patients have been treated world-wide
Used in the larger vessels of the brain
Tiny corkscrew-shaped device
Works by wrapping around clot and trapping it
Clot is then retrieved and removed from the body
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MERCI Retriever
FDA Approval in 2007
Breaks up the clot and aspirates the fragments
Designed to remove thrombus or emboli within a large vessel
3 Parts : reperfusion catheter, separator and thrombus-removal ring
FDA Approved 2008
Medical treatment
▪treatment depends on cause of
bleeding
Surgical treatment
▪surgical clipping
▪endovascular coiling
May be used when caused by ruptured aneurysm in the subarachnoid space
Also used to keep aneurysms from rupturing
Must be done with craniotomy
Blood flow to aneurysm is blocked by applying a metal clip to the base where it connects to the blood vessel
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Newer, much less invasive technique
Used to treat certain types of aneurysms
Involves catheter being inserted in femoral artery and navigated through vascular system into the head and into the aneurysm
Tiny platinum coil is threaded through the catheter and deployed into the aneurysm
Keep HOB elevated 30 degrees to reduce ICP
Assess for swallowing dysfunction
Avoid hyperglycemia in all stroke patients
Early mobilization
Skin care
VTE prophylaxis
Definition: neoplasms associated with neural, neuroglial, meningeal or vascular tissue in the brain
Classification
1. primary vs. metastic
2. intra-axial vs. extra-axial
3. malignant vs. benign
Clinical manifestations
1. headache
2. weakness
3. clumsiness
4. difficulty walking
5. seizures
6. alterations in sensation/motor
function
Acquired autoimmune disease
Characterized by weakness of
skeletal muscles and fatigability
Two peaks of onset
1. early : 20-30 years, women more
than men
2. late : after age 50, men more than
women
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Clinical manifestations
1. muscle weakness
a. increase with sustained muscle
contraction
b. least in morning, worst in evening and after exertion
c. usually greater in upper than lower limbs
Progressive degenerative disease
Commonly characterized by relapses and remissions
Affects more than 400,000 people in
the U.S. in early to middle adulthood
Women twice as often as men
Diagnostic methods
1. Neurologic exam
2. MRI
3. MTI
4. VEP
5. cerebrospinal fluid analysis
6. EEG
Treatment
1. Corticosteroids
2. Use of disease-modifying
treatments to reduce progression
a. interferons
3. Regular exercise
Progressive, degenerative disease
Eventually fatal because of respiratory
muscle weakness
Slightly more common in men than
women
Can be familial or sporadic
Goals of treatment: supportive; no
known cure
Potential complications include:
1. pneumonia/respiratory failure
2. urosepsis
3. immobility-related problems
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Syndrome involving degeneration of
dopamine neurons in midbrain
One of most common neurologic
disorders
Average age of onset: 60 years
1.5 times more common in men
Believed to be caused by combination
of genetic and environmental factors
4 cardinal signs
1. tremor
2. muscle rigidity
3. dyskinesia
4. postural instability
Other clinical manifestations include mood disturbances, fatigue, sleep
disturbances, dementia in 15-30%
Acquired, chronic, progressive,
degenerative disease of CNS
Results in profound cognitive,
intellectual and behavioral impairment
Affects 1 in 8 individuals over age 65
Every 70 seconds in the U.S., someone
develops the disease
Can be classified into 2 types
1. familial (early onset)
2. sporadic (late onset)
3 stages
1. early stage
2. intermediate stage
3. late stage
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