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History of the Neurologic System
Terms in this set (100)
What are some common complaints concerning the Neurologic System?
- Gait Dysfunction
- Loss of coordination
- Changes in Mental Status
What are the different types of seizures/convulsions?
- Petit Mal
- Grand Mal
- Myoclonic Seizure
- Febrile Seizure
What is another term for a petit mal seizure?
Which type of seizure is sudden, brief (10-30 sec.), has no warning, no motor component, and no recall?
In what age group do Petit Mal seizures occur in?
Children (5-15 y/o)
(they are rare in adulthood)
What is the difference between convulsions and seizures?
Convulsions more often indicate a grand mal seizure while the general term seizure is a more all encompassing term.
What does Ictal mean?
relating to the seizure
What type of seizure can be described by the following:
They tend to stare off into space; they either stop blinking or have excessive blinking; has no motor component where they just stop what they are doing.
Petit Mal seizures
What is another name for a grand mal seizure?
What type of seizure is described as Sudden, violent, having a pre-ictal period, two phases, and a post-ictal phase?
What is the first phase of a Grand Mal seizure and what happens during it?
the TONIC PHASE which has a significant increase in muscle tone (The patient becomes rigid and develops a flexed posture; from the flexed posture they go into a rigid extended posture; at this point in the tonic phase they can become apneic; there can be a degree of cyanosis; the eyes are usually open and either staring off or have severe lateralization of gaze)
What is the second phase of a Grand Mal seizure?
The CLONIC PHASE. (the patient has involuntary muscle contractions and a lot of muscle shaking; this phase is associated with loss of bladder and bowel control; there is excessive salivation; the eyes roll into the back of the head but the eyelids stay open. It is very common for the patient to bite their tongue at this point.
How long can a grand mal seizure last for?
The entire thing can last a few seconds to a minute or more depending on severity
What is characteristic of a post-ictal state of a grand mal seizure?
In the post-ictal state, the patient can be almost completely unresponsive because of fatigue. Some patients may be confused and fatigued but awake. The exhaustion can last for minutes to days. Muscle pain and headache are common; they are at risk for aspiration and secondary head trauma
Which type of seizure has minor motor involvement, a jacksonian march, and no loss of consciousness?
What is the Jacksonian march
a phenomenon where a simple partial seizure spreads from the distal part of the limb toward the ipsilateral face (on same side of body). They involve a progression of the location of the seizure in the brain, which leads to a "march" of the motor presentation of symptoms.
What age group can febrile seizures be seen in?
Children <6 y/o
How long can febrile seizures last?
less than 10 minutes
What type of seizures present similarly to a febrile seizure?
Grand Mal seizures (in a febrile setting)
The younger the child greater chance of recurrence. (True/False)
What part(s) of the body is/are most commonly affected in myoclonic seizures?
face and the upper extremities
At what temperature would you be concerned about a febrile seizure?
A child who has had a febrile seizure is more likely to develop another febrile seizure in the future. (True/False)
What is the condition/disease in which the patient has seizures without any underlying cause?
What are the different types of Headaches?
- Cluster Headache
- Space occupying lesions
What is the most common type of Headache?
What is the most common prodrome complaint of patients who have migraines?
Aura (this could be a wavy or misty appearance or it could be colors or a fuzzy swirling it could be flashing lights or changes in color)
Which type of headache occurs when the prodrome fades, is classically unilateral, described as a constant pulsating pain, and can have a trigger?
What can be used to treat a migraine?
Caffeine (Excedrin) can be used to treat the migraine as long as it is not the trigger. Aspirin Tylenol and caffeine is basically Excedrin.
What affect does alcohol have on migraines?
makes migraines worse
Migraines usually have a familial component. (True/False)
What is characteristic of a post-migraine period?
- all senses bother them
Which gender are migraines more common in?
What might you need to rule out with a migraine headache?
Which type of headaches occur in clusters with asymptomatic periods, typically with an intense, sharp, almost boring type pain in the periorbital region?
What gender are cluster headaches more common in?
males (specifically middle aged)
What is the most common trigger for a cluster headache?
What are some of the associated symptoms of cluster headaches?
(all on the ipsilateral side of the headache)
- runny nose
- ipsilateral ptosis
- nasal congestion
- injections and swelling of the conjunctiva
What time of day do cluster headaches typically occur?
How long can a cluster headache last for? (just one not the group)
from a half hour to two or three hours
What is the most helpful treatment for a cluster headache?
What causes a tension headache?
Muscle tension in scalp, neck, or the shoulder area, and occasionally upper back (could be from pulling the hair back too tight)
Can you reproduce the pain from a tension headache?
usually can be reproduced when palpating and pressing down on the affected muscles
How is the pain from a tension headache described?
tight and constant; bilateral; the patient may be able to feel spasms of the affected muscles.
What can relieve the pain from a tension headache?
anti-inflammatories and Tylenol
How is a subarachnoid headache described?
"Worst Headache of my life"
(caused by hemorrhage)
How is the pain from a hypertensive headache described?
throbbing; corresponds to a pulse
What are the symptoms associated with a hypertensive headache?
- blurred vision
- chest pain
- loss of consciousness
What could hypertensive headaches be a precursor to?
an intracranial bleed (hemorrhagic stroke)
How is the pain from a space occupying lesion described?
vague headaches that are fairly constant and progressively get worse (usually affects the cranial nerves)
What are the different types if gait dysfunction?
- Corticospinal Tract lesion
- Spinal Cord lesion
- Parkinsonian gait
What type of gait dysfunction includes Joint/tendon/ligament/muscle/bone and is described as limping?
What is one of the most common gait dysfunctions?
What are the symptoms of a cardiovascular gait dysfunction?
(affects gait stamina not pattern)
Which type of gait dysfunction causes the patient to lose balance, become unsteady, need to hold on to things, and falls (due to changes in terrain)?
Which type of gait dysfunction is characterized by spastic weakness of the contralateral leg causing the foot to be dragged; the body appears stiff and extended.
Corticospinal Tract lesion
What is associated with corticospinal tract lesions?
CVA or degenerative disease
Which type of gait dysfunction is characterized by a spastic paralysis; it is a slow, stiff gait with small steps?
Spinal Cord lesion
Which type of gait dysfunction can be described as quick shuffling steps with the patient stooped over?
What are examples of loss of coorination/ataxia?
- Unsteadiness in upright position
- Disruption of vestibular-ocular-cerebellar control mechanism (Required for equilibrium)
- Sensory ataxia
- Motor ataxia
What is the sense of self in space?
What results with a loss of proprioception?
the patient has a persistent unsteady gait especially in the upright position.
What are the three things needed to maintain proprioception?
- vestibular mechanisms
- ocular mechanisms
- cerebellar mechanisms
What type of ataxia occurs as a result of the patient not being able to feel things such as the ground beneath them?
What things could cause sensory ataxia?
- tertiary syphilis
- vitamin B12 deficiency
- multiple sclerosis
(all cause severe disease of posterior column dysfunction)
What stance is associated with sensory ataxia?
a wide based stance
(improves if they can see their feet)
What causes motor ataxia?
abnormalities in the cerebellum and central vestibular pathways
What stance is associated with motor ataxia?
an irregular wide based stance (The patient lurches and almost has to lift their entire body up so as to not lose the wide stance)
What is the difference between proximal and distal muscle weakness?
- Proximal: tends to be more of a myopathy (patients have a harder time lifting their hands over their head)
- Distal: tends to be more of a neuropathy (patients have a harder time with extension/flexion of the hips, fine motor skills, or gait problems)
How can paresthesias be described by the patient?
- pins and needles
- feels like my arm fell asleep
What could cause paresthesias?
it could be neuropathic or vascular (arterial)
it indicates irritation over the nerve
What is the difference between paralysis and anesthesia?
Paralysis: loss of motor function
Anesthesia: loss of sensation or feeling
What could cause paralysis?
central from the spinal cord or peripheral from within the extremity
Paralysis and Anesthesia don't have to occur together. (True/False)
What are involuntary movements of the extremities that tend to be rhythmic in nature?
How can tremors be differentiated/classified?
High or Low frequency
What is the term for a tremor that improves with intention/movement?
What is the term for a tremor that is only present or gets worse with movement?
What diseases/conditions are an intention tremor associated with?
- Multiple Sclerosis
- chronic liver or kidney disease
What is the involuntary gross movement of the legs at rest?
Restless leg syndrome
How is neuropathic pain described?
A burning, searing, stinging type pain; it follows a nerve root distribution
What is the term for a stroke in which the signs and symptoms are transient and there are no residual effects of the stroke? (symptoms last 24 hours and go away without treatment)
Transient Ischemic Attack (TIA)
What are the symptoms of a TIA?
- sudden onset
- facial drooping
- numbness (of an extremity)
- difficulty seeing or talking
What does a TIA put you at risk for?
A cardiovascular accident (CVA)
What is an ischemic stroke also referred to as?
A dry stroke
Which type of stroke cuts off blood to a specific area of the brain and can be more focal in symptoms and signs?
In which type of stoke does the patient seem to be aware of what is going on and have symptoms that are unilateral and painless?
Which type of stroke has a longer evolution?
What is a hemorrhagic stroke also referred to as?
a wet stroke
Which type of stroke is caused by bleeding into the brain ans results in more global neurologic symptoms that are painful?
What could cause an ischemic stroke?
Patients with what conditions/diseases tend to develop hemorrhagic strokes?
- severe HTN
- aneurysmal disease
- bleeding disorders
WHich type of stroke tends to be more lethal?
a hemorrhagic stroke will not be a TIA. (True/False)
What should be in your differential for neurologic symptoms that come on in minutes or hours?
What should be in your differential for neurologic symptoms that progress over hours to days?
- metabolic disorders
What should be in your differential for neurologic symptoms that progress over weeks to months?
- multiple sclerosis (MS)
- Myasthenia Gravis (MG)
- ALA malignancies
- chronic infections (syphilis & HIV)
What is a side effect of the aminoglycosides?
ototoxic (deafness and vestibular dysfunction)
What is a side effect of narcotics?
drowsiness and alterations in consciousness
What is the only drug that can be lethal if you withdrawal from it?
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