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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.
Homonymous hemianopia
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
Lumbar puncture
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 HTN
Control Diabetes - contributes to HTN and Artherosclerosis
Cardiac problems - dig, plavix, aspirin - for prevention of clots.
Lower Cholesterol
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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