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Pathophysiology-Neurological

Terms in this set (39)

Lou Gehrig's Disease (Amyotrophic Lateral Sclerosis)
-Neurologically degenerative, rapidly progressive and fatal
-Weakness and wasting of muscles that are under voluntary control
-No accompanying sensory or cognitive changes
-Muscle atrophy results from motor neuron degeneration and sclerosis of the corticospinal tract in the lateral column of the spinal cord
Amyotrophy = without muscle nutrition or progressive muscle wasting/atrophy
ALS
-Death results in 2 to 5 years after onset of the manifestations
Usually due to respiratory failure
-Most common motor neuron disease in the US
-20,000 in US have ALS at one time with approximately 5,000 new cases diagnosed each year
-90-95% of cases occur randomly without associated risk factors
-5-10% of cases occur in what is termed familial ALS
-Most people diagnosed between 40-60 years of age
ALS cont
-Incidence is higher in men in the earlier ages
Incidence becomes equal with women after menopause
-Most health problems needing intervention r/t swallowing, managing secretions, communication, respiration
-During early stages, surviving motor neurons sprout new branches to reinnervate affected muscle fibers
Initially have weakness to muscles in body, then progresses to flaccid and/or spastic paralysis
-When more than ½ motor neurons affected, reinnervation fails and weakness is evidenced
Traumatic Brain Injury Assessment
Level of Consciousness
Pattern of Breathing
Size & Reactivity of pupils
Eye position and reflex response
Skeletal muscle motor responses
Abnormal Posturing
Decorticate
-Hemispheric damage above the midmbrain
Decerebrate
-Severe damage to diencephalon or midbrain
Symptoms of Brain Injury
-Highly variable
-Depends on area of brain injured
-Depends on extent of injury
-Coup/Countercoup injury
Coup = impact against object (head strikes a wall)
Countercoup = impact within skull (head rebounds from wall)
-Depends on type of injury
Focal = specific and grossly observable lesions
Diffuse = results from a "shaking" effect that produces strains and distortions in the brain; damage seen with a microscope
Spinal Cord Injuries
-Forces of trauma compress tissues, pull or exert tension on tissues, or shear tissues and affect the spinal cord
-Bones, ligaments, and joints of vertebral column may be damaged
Fracture, dislocation, or both
-Damage to the motor neuron
-Herniated intervertebral discs
-Partial or Complete severing of spinal cord
Much of injury can be due to cord ischemia
NEVER MOVE without stabilizing
Spinal cord injuries all have potential to result in....
Despite etiology, all have potential to result in
Loss of voluntary control
Flaccid paralysis
Decreased muscle tone
Muscle atrophy
Absent or decreased reflexes
Long term loss depends on....
Long term loss depends on
Level of injury and
Extent of transection
C2 - ventilator dependent; quadriplegic
C4 - move head, mouth, shoulders, diaphragm
C6 - weak hands, drive with hand controls
T1 - normal upper body; paraplegic
Neuroplasticity
-The brain's capacity for recovery from injury is far greater than previously thought.
-The brain has the ability to reorganize (i.e., neuroplasticity) after disease or injury
This phenomenon can be facilitated through activity-dependent processes including environmental enrichment, forced-use, complex skills training, and exercise.
-Most of our understanding of this activity-dependent plasticity is derived from studies of brain injury related to stroke and spinal cord injury.
-Dr. Pettinato's suggested reading: "The Brain that Changes Itself" by Norman Doidge
Bleeds
-Happen in response to injury
----Brain not anchored to skull - floating
----Sudden changes in motion can tear blood vessels
-Can happen in response to aneurysm or artery bursting as last stage of chronic HTN
-The skull is an enclosed compartment
-----Bleeds shift and distort brain
-----Bleeds may herniate brain tissue (push it out of its normal space)
-----Bleeds may compress blood vessels, leading to ischemia
Bleeds cont
-Within brain: Hemorrhagic Stroke
Generally arterial aneurysms bursting
-Epidural
Between skull and dura
Mostly ARTERIAL
-Subdural
Between the dura and the pia matter
Mostly VENOUS
-Subarachnoid and intracerebral
Between pia mater and the brain (into CSF) or brain tissue
Venous or arterial
Bleed S &S
-Severe headache
-Change in level of consciousness
Confused, Delirious, Lethargic, Obtunded (dulled), Stuperous, Comatose
-Glascow Coma Scale
Eye opening, Verbal response, Motor response
-Brain stem function
Pupillary response, corneal reflex
Seizures
-Sudden, explosive, disorderly discharge of brain neurons
-Produces a brief disruption of electrical function of the brain and alters brain function
Affects motor, sensory, autonomic, psychic systems
Affects level of consciousness
-May result in convulsive movement
Jerky, contract-relax (tonic-clonic) movement
Seizure caused by...
--Caused by sudden changes (paroxysmal depolarization) in the membrane potential of neurons
--Plasma membrane thought to be more permeable making them more sensitive
--Seizure Threshold may be lower in others; can trigger a seizure with
Hyperthermia, hypoxia, hypoglycemia, hyponatremia, repeated sensory information, emotional/physical stress, fatigue, lack of sleep
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