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HCC Neurologic
HCC Neurologic Disruptions
| Question | Answer |
|---|---|
| Quadriplegia | Paralysis of all four extremities, usually caused by a lesion of the cervical spinal cord. |
| Hemiplegia | Paralysis of one half of the body. Either left or right. |
| Paraplegia | Paralysis of the lower portion of the body and of both legs. |
| Contralateral | Originating in or affecting the opposite side of the body, as opposed to homolateral and ipsilateral. |
| Hemianopia | Loss of half of the visual field in one or both eyes. |
| Agnosia | Inability to recognize objects. Visual, tactile, and or auditory. |
| Apraxia | Inability to carry out motor patterns, such as dressing, drawing. Nothing to do with strength or coordination. |
| Neglect syndrome/Unilateral Neglect | Disorder of attention. Cannot use perceptions from affected side of the body. Can be severe. Nothing to do with strength or coordination. More common in R hemisphere CVA. |
| Aphasia | Inability to use or understand language. |
| Expressive Aphasia | Brocca's aphasia. Motor speech problem. Can understand but can't respond. Sometimes can respond with one word or short phrases. Frustrating, angry. |
| Receptive Aphasia | Wernicke's aphasia. Sensory speech problem. Can't understand spoken or written word. When they speak usually doesn't make sense in conversation. |
| Mixed or Global Aphasia | Mix of expressive & receptive. |
| Dysarthria | Disturbance in muscle control of speech. |
| Emotional Lability | Laughing or crying inappropriately. |
| Hemiparesis | Weakness of one half of the body. Left or right. |
| Flaccidity | Absence of muscle tone. Hypotonia. Contralateral. |
| Spasticity | Increased resistance to the stretching of an extremity as it is stretched further. Resistance increases as stretch increases. |
| Rigidity | Increased resistance to the stretching of an extremity that is uniform througout the stretch. |
| Unilateral | On, having, or confined to only one side. ONE SIDE |
| Bilateral | Having or formed of two sides; two-sided. BOTH SIDES |
| Dopamine | A monoamine neurotransmitter formed in the brain by the decarboxylation of dopa and essential to the normal functioning of the central nervous system. A reduction in its concentration within the brain is associated with Parkinson's disease. Also called 3- |
| Bradykinesia | Extreme slowness in movement. Kinetic = movement |
| Akinesia | A slowness or loss of normal motor function resulting in impaired muscle movement. |
| Dyskinesias | An impairment in the ability to control movements, characterized by spasmodic or repetitive motions or lack of coordination. |
| Parkinsonian Tremor/Resting Tremor | Resting tremor seen in parkinsonism, consists of slow regular movements of hands and sometimes legs, neck, face, or jaw; typically stops upon voluntary movement of the part and is intensified by stimuli such as cold, fatigue, and strong emotions. |
| Acetylcholine | The acetic acid ester of choline, which is a neurotransmitter at cholinergic synapses in the central, sympathetic, and parasympathetic nervous systems. |
| Amyloid | A hard, waxy deposit consisting of protein and polysaccharides resulting from the degeneration of tissue. |
| Dementia/DAT | A loss of mental ability severe enough to interfere with normal activities of daily living, lasting more than six months, not present since birth, and not associated with a loss or alteration of consciousness. Dementia Alzheimer's Type. |
| SDAT | Senile dementia–Alzheimer type |
| Presenile Dementia | that occurring in younger persons, usually age 65 or younger |
| Apraxia | Inability to perform purposeful movements and use objects appropriately. |
| Astereognosis | Inability to recognize objects by touch. |
| Agraphia | Inability to write. |
| Anomia | A form of aphasia characterized by the inability to name objects. Comprehension and repetition are unaffected. |
| Prosopagnosia | Inability to recognize faces due to damage to the underside of both occipital lobes. |
| Paraphasia | Language deficit in stage 2. Saying the wrong word. |
| Echolalia | Repitition of words or phrases. Scanning speech-searching for the right words, eventually leads to aphasia which causes frustration and depression. |
| Sundowning | Late afternoon to early evening, increased on gray overcast days. Increased agitation, wandering, and time disorientation. |
| Antiplatelets | Inhibit platelet adhesion and aggregation by blocking receptor sites on the platelet membrane, preventing platelet interactions or with other clotting chemicals. |
| Low-dose Aspirin/salicylates/asa | Antiplatelet, Antipyretics, nonopioid analgesics. Decreases platelet aggregation. Decreased incidence of transient ischemic attacks and MI. |
| Persantine/dipyridamole | Antiplatelet agents, platelet adhesion inhibitors. In combo w/Warfarin to prevent thromboembolism in clients w/artificial heart valves, CAD, angina. |
| Ticlid/ticlopidine | Antiplatelet agents, platelet aggregation inhibitors. Prevention of stroke in clients w/TIA's. |
| Trental/pentoxifylline | Blood viscosity reducing agents. Mngmnt of symptomatic peripheral vascular disease(intermittent claudication). |
| Plavix/clopidogrel | Antiplatelet agents, platelet aggregation inhibitors. Reduce risk of MI acute coronary syndrome, stroke, and PVD. |
| Coumadin/warfarin | Anticoagulants, coumarins. Prophylaxis and treatment of embolism. |
| Heparin/Hep- | Anticoagulants, antithromotics. Prophylaxis and treatment of thromboembolic disorders. |
| Thrombolytics | Medications that dissolve a clot that is blocking blood flow to a tissue/organ. Stimulates conversion of plasminogen to plasmin which breaks down fibrin threads. |
| Abbokinase/urokinase | Thrombolytics, plasminogen activators. Breaks down clots by converting plasminogen to plasmin. |
| streptokinase/Streptase | Thrombolytics, plasminogen activators. Breaks down clots by converting plasminogen to plasmin. |
| Activase/tissue plasminogen activator(tPA)/alteplase | Thrombolytics, plasminogen activators. Breaks down clots by converting plasminogen to plasmin. |
| Calcium Channel Blockers | Prevent the movement of calcium into the cardiac and smooth muscle cells when the cells are stimulated. |
| Nimotop/nimodipine | Subarachnoid hemorrhage therapy agents, calcium channel blockers. Inhibits the transport of calcium into vascular smooth muscle cells, resulting in inhibition of excitation-contraction coupling and subsequent contraction. Potent peripheral vasodilator. |
| Decorticate Posturing (Flexor Posturing) | Hold themselves very rigid, internal rotation & abduction of arms, flexion of elbows, wrist, fingers due to lesions at or above brain stem. |
| Decerebrate Posturing (Extensor Posturing) | Loss of control of spinal reflexes. MORE OMINOUS. Obstruction in midbrain and brain stem. Arms very stiff extended/hyperextended, plantar flexion of the feet. |
| WHO's Definition of Dementia | A chronic or progressive disease of the brain with losses in cortical functioning. |
| Three types of CVA | T.I.A., Cerebral Thrombosis/Embolus, Cerebral Hemorrhage |
| T.I.A. | Transient Ischemic Attacks. Brief period of localized cerebral ischemia. Deficits lasting seconds, minutes, hours, UP TO 24HRS. |
| Warning sign of CVA | 30% of CVA patients report TIA's prior to attack. |
| TIA Manifestations | Contralateral numbness and/or weakness of the hand, forearm, and corner of the mouth. Aphasia, visual (blurring) disturbances. |
| Thrombotic Stroke | 50+ y.o. while resting or sleeping due to low pressure not able to push blood thru. Occurs at bifurcation. 50% of all CVA's are thrombotic. |
| Bifurcation | A "Y" branch in a blood vessel |
| Most common location of thrombi | Internal carotid arteries, vertebral arteries, junction of vertebral and vascular. Affects 1 region supplied by 1 artery. |
| Stroke in Evolution | Progresses slowly, worsens during 1-2 day period. |
| Complete Stroke | Maximum neurologic deficit. Can't get any worse. Usually 3 days. |
| Embolic Stroke | Younger than 50 while awake and active. 30% of CVA's are embolic. At bifurcation. |
| Most common location of emboli | Carotid and middle cerebral arteries. |
| Causes of Embolic Stroke | Carotid artery atherosclerosis, bacterial endocarditis, recent MI, *fat emboli from long bone fx, rheumatic heart disease. |
| Hemorrhagic Stroke | 10% of all CVA's. Typically older adult with long term poorly controlled HTN. |
| Causes of Hemorrhagic Stroke | Most common cause is HTN. Aneurysm, tumors, anticoagulant therapy, liver disease(clotting factors), blood disorders, and Arterial Venous malformations. |
| Internal Carotid Artery | Contralateral and sensory deficit of arm, leg, and face. If dominant hemisphere is affected-aphasia. Nondominant-apraxia, agnosia, unilateral neglect. |
| Middle Cerebral Artery | Drowsiness, stupor, coma. Contralateral hemiplegia and sensory deficits of arm & face. If dominant-global aphasia, hemianopia. |
| Anterior Cerebral Artery | Contralateral hemiplegia or hemiparesis and sensory deficits of toe, foot, and/or leg. Loss of decision making or ability to act voluntary. Urinary incontinence. |
| Vertebral Artery | Pain of face(numbness of face), nose, eyes. Numbness/weakness on contralateral side. Gait problems, dysphasia, dysarthria. |
| CT (CAT) Scan | Computed tomography. Show presence of hemorrhage, tumors, aneurysms, brain ischemia, cerebral edema, tissue necrosis. Shows shift of intercranial contents-indicator of increased ICP. Differentiate Ischemic or Hemorrhagic. |
| Arteriography | Picture of cerebral vessicles, structure abnormalities, vasospasm. |
| Transcranial Ultrasound Doppler (TCD) | Evaluate blood flow through carotid arteries-obstruction info. |
| Magnetic Resonance Imaging (MRI) | Intracranial contents. |
| Positron Emission Tomography (PET) and Single-Photon Emission Computed Tomography (SPECT) | Eval cerebral blood flow distribution and metabolic activity. |
| PET | Determine location and size of CVA/Stroke. |
| SPECT | Image of metabolic activity and blood flow of affected tissue. |
| Lumbar Puncture | To obtain CSF. May see frank blood in CSF with hemorrhagic CVA. NOT PERFORMED IF HAD/AT RISK FOR INCREASED ICP=BRAIN TISSUE HERNIATION. |
| Alzheimer's Dementia (AD) | 2/3 of clients w/dementia have alzheimer's. Typically occurs after 65 y.o. |
| AD Stage I | Lasts Approx 2-4 years. Appear physically healthy, alert, can go undetected. Subtle changes of forgetting every day activities. |
| AD Stage II | Lasts Approx 2-12 years. More apparent, less able to cover up. May get lost in own home. Periods of lucidity. Unable to handle stress as well. |
| AD Stage III | Lasts Approx 2-4 years. Decreased independence, inability to communicate, increased incontinence, pneumonia, dehydration, malnutrition. |
| EEG | May show slowed brain wave patterns(only in later stages of AD). |
| MRI & CT Scan | Shows shrinkage of hippocampus and brain tissue atrophy in AD. |
| PET Scan | Visualize activity, interaction of parts of brain in AD. Engaged in cognitive activity during this test. |
| Psychometric Evaluation | A tool to reflect loss of memory and function over time. Repeated and compared to baseline to determine deterioration. |
| Cholinesterase Inhibitors | Treat mild to moderate dementia in AD. Acetylcholine deficiency in early stages of AD. Inhibit breakdown of acetylcholine. |
| Cognex (tacrine) | Very first Cholinesterase inhibitor. anti-Alzheimer's agents, cholinergics. Increases levels of acetylcholine in CNS by inhibiting its breakdown. |
| Aricept (donepezil) | anti-Alzheimer's agents, cholinergics. Increases levels of acetylcholine in CNS by inhibiting its breakdown. |
| Exelon (rivastigmine) | anti-Alzheimer's agents, cholinergics. Increases levels of acetylcholine in CNS by inhibiting its breakdown. |
| Nemenda (memantine) | anti-Alzheimer's agents. Binds to CNS N-methyl-D-aspartate(NMDA) receptor sites, preventing binding of glutamate, an excitatory neurotransmitter. Improves cognition. |
| Antidepressants | SSRI's. Inhibit the reuptake of serotonin and result in decreased depression. |
| Zoloft (sertraline) | Antidepressants, SSRI's. Inhibits neuronal uptake of serotonin in the CNS. |
| Luvox (fluvoxamine) | Antidepressants, antiobsessives, SSRI's. Inhibits reuptake of serotonin in CNS. |
| Prozac (fluoxetine) | Antidepressants, SSRI's. Selectively inhibits the reuptake of serotonin in CNS. |
| Celexa (citalopram) | Antidepressants, SSRI's. Selectively inhibits the reuptake of serotonin in CNS. |
| Tricyclic Antidepressants | Elavil, Tofranil, Sinequan |
| Elavil (amitriptyline) | Antidepressants, tricyclic antidepressants. Potentiates the effect of serotonin and norepinephrine in CNS. Has significant anticholinergic properties. |
| Tofranil (imipramine) | Antidepressants, tricyclic antidepressants. Potentiates the effect of serotonin and norepinephrine in CNS. Has significant anticholinergic properties. |
| Sinequan (doxepin) | Antianxiety agents, antidepressants, antihistamines(topical), tricyclic antidepressants. Prevents reuptake of norepinephrine and serotonin by presynaptic neurons. Has significant anticholinergic properties. |
| Antipsychotics | Treat behavioral changes in AD. |
| Haldol (haloperidol) | Antipsychotics, butyrophenones. Alters the effects of dopamine in the CNS. Also has anticholinergic and alpha-adrenergic blocking activity. Improved behavior. |
| Risperdal (risperidone) | Antipsychotics, mood stabilizers, benzisoxazoles. Act by antagonizing dopamine and serotonin in the CNS. |
| Zyprexa (olanzapine) | Antipsychotics, mood stabilizers, thienobenzodiazepines. Antagonizes dopamine and serotonin type 2 in CNS. Also has anticholinergic, antihistaminic, and anti-alpha1, adrenergic effects. |
| Seroquel (quetiapine) | Antipsychotics, mood stabilizers. CNS. Also has anticholinergic, antihistaminic, and anti-alpha1, adrenergic effects. |
| Benzodiazepines | Antianxiety, sedative/hypnotics. |
| Ativan (lorazepam) | Anesthetics adjuncts, antianxiety agents, sedative/hypnotics, benzodiazepines. Depresses CNS, inhibitory neurotransmitter. Sedation, decreased seizures. |
Created by:
mande747
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