Glossary of Neuro Part 2
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- What are some neurological clinical manifestions of stroke?
- Flaccid paralysis - loss of all muscle tone - lasts up to 48 hours.
Brainstem stroke - swallowing effected > aspiration risk.
Incontinence of both bladder/bowel.
- Can bladder/bowel be retrained following stroke?
- Yes, if only one hemisphere is affected and had continence before stroke.
- Which hemisphere is dominant for language in all right-handed people and most left-handed people?
- Left hemisphere.
- Which hemisphere strokes affect communication most?
- Aphasia -
- absence of language communication. Can be global - nothing understood or communicated.
- Receptive Aphasia
- Words - spoken and written - are not comprehended. Speech is inappropriate jargon, sounds. Can't write words.
- What area of the brain is the auditory speech center?
- Wernick's area: involves interpretation and memory.
- Where is Wernicke's area?
- Center of brain. Overrides temporal and parietal lobe - supplied by anterior cerebral artery.
- Repeat what you say > picture board
- Expressive aphasia
- Involves formation of words. Words are usually comprehended; speech is garbled, nonsense syllables, perhaps inappropriate words.
Don't lose profanity.
Can read but may not be able to write words > picture board.
- A stroke in what area of the brain would be associated with expressive aphasia?
- Middle cerebral artery stroke - surface area of brain.
- Dysarthria -
- Difficulty articulating; a problem with motor control for pronunciation of words.
Comprehension not a problem
Speech is slurred
Communicate well by writing
- What area is dysarthria associated with?
- problem with post cerebral artery > brainstem stroke.
- What is a persons affect or emotional status after a stroke?
- emotionally labile; depression common.
- What emotional changes occur following anterior cerebral artery strokes
- Peronality changes > limbic system. May be more outgoing or more quiet.
- How can intellect be affected?
- Left hemisphere - dominant for language, memory, judgement, reasoning. Actions become slow and conscious.
Right hemisphere - dominant for spiritually nonverbal communication, spacial perception. Pt. tends to be impulsive in actions.
- How is spatial perception affected?
- Right hemisphere infarct causes most problems and results in pt. who is indifferent to or ignores a body part so that he neglects that side . left sided neglect.
- What are some other effects of spacial-perception problems.
- Can't tell up from down, left from right.
- can't recognize objects by sight, sound, touch.
- Can't carry out sequential learned behavior (tie shoes)
- Homonymuos hemianopia
- loss of half the visual field, same half in both eyes due to lesions in optic chiasm before fibers cross.
- When is homonymous hemianopia especially a problem?
- when it is combined with left sided neglect.
- What is medical management of stroke?
- dx problems and potential risks
- Will a CT show necrotic tissue?
- No, MRI will.
- What could blood in CSF indicate?
- What can be done to prevent strokes?
- #1 is control of reversible factors in pts. at risk:
Control Diabetes - contributes to HTN and Artherosclerosis
Cardiac problems - dig, plavix, aspirin - for prevention of clots.
- What is the #2 treatment for prevention of strokes?
- Surgery - endarterectomy for TIAs.
- What is endarterectomy?
- Ream out vessels with a lot of plaque. Wait until it's 80-90% occluded. Surgery must out weigh riks.
- What is the risk involved with an endarterectomy?
- Surgery can cause emboli.
- What are the signs of an emboli?
- Change in LOC, change in VS, weakness.
- Where will most emboli go?
- To middle cerebral artery.
- What management of pt. should be done following an endarterectomy?
- Monitor BP; check for occult blood - hemorrhage would be at site of occlusion. Hematoma under skin could block airway - respiratory problems.
- If there are problems from an endarterectomy when will they usually occur?
- Diring 1st 24 hours.
- What is involved with acute management of stroke?
- Maintain patent airway
Monitor Neurological changes so treatment can be adjusted as needed.
Prevent further Damage.
- What is involved with maintaining a patent airway?
- Oral airway, NT tube, suctioning management, when ICP not an issue. HOB elevated, not on side.
- What is involved with circulation mangagement?
- When BP lowered, brain not perfused as well. Make sure pt. has enough fluids to be normotensive for that pt.
SIADH - Anterior cerebral artery
Diabetes Insipidus - anterior cerebral artery.
- What medication is given for thrombotic strokes?
- Anticoagulants - Heparin, TPA - treat as quickly as possible.
- What is a hemorrhagic stroke?
- Vessel has problem with vasospasms to decrease perfusion.
- What med can be used to treat hemorrhagic strokes?
- Antifibrolytic - Amicar
- How does Amicar work?
- Allows blood to clot so doesn't break down. Use fluid to keep vessel open. The pressure of fluid in vessel keeps vessel open.
- How can further damage from stroke be prevented?
- Decrease edema
Decrease cerebral metabolism
Increase cerebral blood flow but control IICP.
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