This document provides an overview of neurosurgical patient management and diagnostic tools. It discusses the anatomy of the brain and spinal cord. It describes different pathologies that can be seen on imaging like CT and MRI such as tumors, hemorrhages, and infarcts. It also reviews diagnostic scales for altered mental status, muscle strength, and facial nerve function. Key diagnostic and management principles for conditions like stroke, hydrocephalus, and increased intracranial pressure are summarized.
The document discusses common entrapment neuropathies including carpal tunnel syndrome, pronator syndrome, anterior interosseous nerve syndrome, cubital tunnel syndrome, and Guyon's canal syndrome. It provides details on the anatomy, etiology, symptoms, diagnostic studies including electrodiagnostic studies, ultrasound findings, and treatments for each of these conditions. The treatment typically involves initially trying conservative measures such as splinting, steroid injections, and activity modification. Surgery is considered if conservative treatments fail or if there is evidence of nerve damage on electrodiagnostic studies.
This document discusses epilepsy surgery evaluation and outcomes. It notes that about one-third of epilepsy patients have seizures that cannot be controlled with medication. For these patients, surgical therapy can be an important treatment option. The goals of presurgical evaluation are to localize the epileptogenic zone and assess risk to brain functions from surgery. Evaluations may include brain imaging, video-EEG monitoring, neuropsychological testing, and in some cases invasive monitoring. Common indications for surgery include mesial temporal lobe epilepsy and lesions. Seizure freedom rates after surgery range from 50-90% depending on the specific diagnosis and evaluation findings. Outcome measures also consider cognitive and quality of life impacts.
Compression neuropathy: pathophysiology, history, diagnosis, and treatment (including the management of carpal tunnel syndrome, and cubital tunnel syndrome).
The document discusses stroke, including its causes, risk factors, symptoms, classifications, assessments, and rehabilitation management. Some key points:
- Stroke is caused by an abnormality in cerebral circulation, cutting off blood flow to the brain.
- Risk factors include smoking, obesity, lack of exercise, infection, and psychological stress.
- Symptoms can include weakness, numbness, difficulty speaking, and headaches.
- Assessments include patient history, observations of impairments, range of motion, motor function, and imaging tests.
- Rehabilitation in the acute stage focuses on positioning, respiratory/circulation exercises, and prevention of pressure sores and deconditioning. Later stages address flexibility,
Refractory Status epilepticus: A Time TravelWafik Bahnasy
Status Epilepticus is a condition resulting from failure of the mechanisms responsible for seizure termination or the initiation of mechanisms, which leads to abnormally prolonged seizures (time point, T1) that might have long-term consequences (time point T2), including neuronal death, neuronal injury, and alteration of neuronal networks, depending on the type and duration of seizures.
1) The document discusses the challenges of differentiating between central and peripheral causes of vertigo. Examination of nystagmus characteristics, including direction and response to positional testing, can be helpful in making the distinction.
2) The HINTS examination, including the head impulse test, observation of nystagmus patterns, and test of skew, provides a quick bedside assessment that is more sensitive than early MRI for detecting stroke as the cause in acute vestibular syndrome.
3) Peripheral causes of vertigo like vestibular paroxysmia or Meniere's disease produce distinctive nystagmus patterns and symptoms, whereas central causes like stroke may require additional neurological assessment to identify
Pupil size and reactivity are tested clinically to evaluate the eye and brain. The normal pupil constricts to light (direct and consensual response) and accommodation. Pupil size is controlled by the iris sphincter and dilator muscles innervated by the parasympathetic and sympathetic nervous systems. Pupillary reflexes like the light and accommodation reflexes are tested to localize lesions. Abnormal pupil size or reactivity can indicate conditions like Horner's syndrome or third nerve palsy. An afferent pupillary defect detected by the swinging flashlight test indicates optic nerve dysfunction. Pharmacologic testing can further localize lesions in the pupillary pathway.
The pupil is a circular opening located in the center of the iris that controls the amount of light entering the eye to ensure optimal vision. Key characteristics of a normal pupil include being equal in size and round between both eyes. Abnormal pupils can be too small (miosis) or too large (mydriasis) and may be caused by medical conditions, drugs, or neurological disorders. Doctors examine the pupil's size, shape, equality, reaction to light, and accommodation to evaluate for any abnormalities.
The document discusses common entrapment neuropathies including carpal tunnel syndrome, pronator syndrome, anterior interosseous nerve syndrome, cubital tunnel syndrome, and Guyon's canal syndrome. It provides details on the anatomy, etiology, symptoms, diagnostic studies including electrodiagnostic studies, ultrasound findings, and treatments for each of these conditions. The treatment typically involves initially trying conservative measures such as splinting, steroid injections, and activity modification. Surgery is considered if conservative treatments fail or if there is evidence of nerve damage on electrodiagnostic studies.
This document discusses epilepsy surgery evaluation and outcomes. It notes that about one-third of epilepsy patients have seizures that cannot be controlled with medication. For these patients, surgical therapy can be an important treatment option. The goals of presurgical evaluation are to localize the epileptogenic zone and assess risk to brain functions from surgery. Evaluations may include brain imaging, video-EEG monitoring, neuropsychological testing, and in some cases invasive monitoring. Common indications for surgery include mesial temporal lobe epilepsy and lesions. Seizure freedom rates after surgery range from 50-90% depending on the specific diagnosis and evaluation findings. Outcome measures also consider cognitive and quality of life impacts.
Compression neuropathy: pathophysiology, history, diagnosis, and treatment (including the management of carpal tunnel syndrome, and cubital tunnel syndrome).
The document discusses stroke, including its causes, risk factors, symptoms, classifications, assessments, and rehabilitation management. Some key points:
- Stroke is caused by an abnormality in cerebral circulation, cutting off blood flow to the brain.
- Risk factors include smoking, obesity, lack of exercise, infection, and psychological stress.
- Symptoms can include weakness, numbness, difficulty speaking, and headaches.
- Assessments include patient history, observations of impairments, range of motion, motor function, and imaging tests.
- Rehabilitation in the acute stage focuses on positioning, respiratory/circulation exercises, and prevention of pressure sores and deconditioning. Later stages address flexibility,
Refractory Status epilepticus: A Time TravelWafik Bahnasy
Status Epilepticus is a condition resulting from failure of the mechanisms responsible for seizure termination or the initiation of mechanisms, which leads to abnormally prolonged seizures (time point, T1) that might have long-term consequences (time point T2), including neuronal death, neuronal injury, and alteration of neuronal networks, depending on the type and duration of seizures.
1) The document discusses the challenges of differentiating between central and peripheral causes of vertigo. Examination of nystagmus characteristics, including direction and response to positional testing, can be helpful in making the distinction.
2) The HINTS examination, including the head impulse test, observation of nystagmus patterns, and test of skew, provides a quick bedside assessment that is more sensitive than early MRI for detecting stroke as the cause in acute vestibular syndrome.
3) Peripheral causes of vertigo like vestibular paroxysmia or Meniere's disease produce distinctive nystagmus patterns and symptoms, whereas central causes like stroke may require additional neurological assessment to identify
Pupil size and reactivity are tested clinically to evaluate the eye and brain. The normal pupil constricts to light (direct and consensual response) and accommodation. Pupil size is controlled by the iris sphincter and dilator muscles innervated by the parasympathetic and sympathetic nervous systems. Pupillary reflexes like the light and accommodation reflexes are tested to localize lesions. Abnormal pupil size or reactivity can indicate conditions like Horner's syndrome or third nerve palsy. An afferent pupillary defect detected by the swinging flashlight test indicates optic nerve dysfunction. Pharmacologic testing can further localize lesions in the pupillary pathway.
The pupil is a circular opening located in the center of the iris that controls the amount of light entering the eye to ensure optimal vision. Key characteristics of a normal pupil include being equal in size and round between both eyes. Abnormal pupils can be too small (miosis) or too large (mydriasis) and may be caused by medical conditions, drugs, or neurological disorders. Doctors examine the pupil's size, shape, equality, reaction to light, and accommodation to evaluate for any abnormalities.
Autonomic innervation of ocular strucures and Pupillary reflexesDhanyasree Nair
The document discusses the autonomic innervation of ocular structures and pupillary reflexes. It notes that the autonomic nervous system innervates structures like the iris, ciliary muscle, eyelids, blood vessels and lacrimal gland. The sympathetic system prepares the body for emergencies and supplies structures like the iris dilator and parasympathetic restores resting state and supplies the iris sphincter. Pupillary reflexes like light, near and darkness are discussed along with their pathways. Abnormalities in afferent pathways can cause total or relative afferent defects while efferent defects affect the light reflex. Conditions like Adie's tonic pupil and Argyll Robertson pupil that cause diss
1. The document discusses the pupil, normal pupil reactions, and various abnormalities of the pupil.
2. It describes tests like direct light response, swinging flashlight, and accommodation response that are used to assess the pupil.
3. Abnormalities are categorized based on whether they cause isocoria (equal pupil size) or anisocoria (unequal pupil size). Disorders causing isocoria include Argyll Robertson Pupil and Parinaud Oculoglandular Syndrome. Disorders causing anisocoria include Complete Oculomotor Palsy, Tonic Pupil, and Horner Syndrome.
The document provides an overview of the visual pathway, including its anatomy and physiology. It describes the main components of the visual pathway - the optic nerve, optic chiasm, optic tracts, lateral geniculate bodies, optic radiations, and visual cortex. It then discusses lesions that can occur along the visual pathway and their associated signs and symptoms. Finally, it covers pupillary reflexes like the light reflex and near reflex, as well as abnormalities in pupillary reactions.
Chapter 14 The Human Eye Lesson 3 - The 2 Mechanisms of the Eye 1) Accommodat...j3di79
The document summarizes two key mechanisms of the eye: 1) the pupil reflex which controls the amount of light entering the eyes by enlarging or constricting the pupil in response to light intensity, and 2) accommodation, where the lens becomes more or less convex to focus on near or distant objects by contracting or relaxing the ciliary muscles. It also discusses stereoscopic vision and includes some optical illusions to demonstrate how perception is not always reality.
This document discusses various pupil abnormalities and anomalies. It defines the pupil and normal pupil size ranges. It then describes several types of pupil disorders including microcoria (small pupil), megalocoria (large pupil), anisocoria (unequal pupil size), polycoria (multiple pupils), and corectopia (eccentric pupil position). It provides details on specific pupil anomalies such as Argyll Robertson pupil, Adie's tonic pupil, Horner's syndrome, Marcus Gunn pupil, amaurotic pupil, and hippus (irregular pupil oscillations). Differential diagnoses and causes are mentioned for several of the disorders.
The document discusses pupil function and abnormal pupil reactions. It covers:
1. The physiology of pupil constriction and dilation which is controlled by the parasympathetic and sympathetic nervous systems respectively.
2. How to examine pupils including observing size and shape, light reflex testing, swinging flashlight test, and near reflex testing.
3. Various diseases and conditions that can cause abnormal pupil reactions like Horner's syndrome, third nerve palsy, Adie's tonic pupil, and Argyll Robertson pupils.
4. Drugs that can cause mydriasis or miosis by affecting the parasympathetic or sympathetic pathways.
The document discusses normal and abnormal pupillary reflexes. It describes the anatomy and physiology behind the light reflex and near reflex. The light reflex involves transmission of signals from the retina through the optic pathway to the Edinger-Westphal nucleus which controls the iris sphincter and dilator muscles. The near reflex involves a triad of accommodation, convergence, and pupillary constriction. It also discusses various pupil abnormalities that can occur due to lesions in the afferent or efferent pathways as well as pharmacologic agents that cause miosis or mydriasis. Specific conditions mentioned include Horner's syndrome, Adie's tonic pupil, and Argyll Robertson pupil.
The pupil is a circular opening located in the center of the iris that controls the amount of light entering the eye. It constricts (miosis) and dilates (mydriasis) under autonomic nervous system influence. The iris contains two sets of muscles - the sphincter pupillae contracts the pupil in response to parasympathetic stimulation while the dilator pupillae dilates it with sympathetic stimulation. Abnormal pupils may be unequal in size (anisocoria), irregularly shaped, or have abnormal reactions to light. Various diseases and drugs can affect the pupils.
The document provides an overview of the pupillary pathway, including its anatomy, physiology, and clinical aspects. It describes:
- The afferent and efferent pathways that control the pupillary light reflex and near response.
- Clinical tests to evaluate the pupillary light reflex, including for anisocoria, RAPD, and other defects.
- Causes and features of different types of pupillary defects affecting the afferent pathway (e.g. optic nerve lesions) or efferent pathway (e.g. Horner's syndrome, Adie's tonic pupil).
This document discusses the pupil and its abnormalities. It covers:
1. The pupil light reflex involves a four neuron arc from the retina to muscles controlling the pupil.
2. Horner's syndrome causes miosis, ptosis, and anhydrosis due to disruption of the sympathetic pathway.
3. Adie's pupil is characterized by a dilated, poorly reactive pupil due to ciliary ganglion denervation.
The document discusses the neurological examination process. It describes the various components that are assessed which include levels of consciousness, mental status, cranial nerve function, motor skills, sensation, cerebellar function, and reflexes. Nurses play an important role in conducting and documenting the neurological examination to evaluate the presence of any disease in the nervous system.
The Glasgow Coma Scale (GCS) is a neurological assessment tool used to determine the severity of brain injury or dysfunction. It assesses three factors: eye opening, verbal response, and motor response, with scores ranging from 3 to 15. Lower scores indicate more severe brain injury. The GCS aids in classifying brain injuries as mild, moderate, or severe and helps identify potential causes of decreased consciousness like hypoxemia or hypotension. Signs of increased intracranial pressure include deteriorating consciousness, headache, pupil abnormalities, and motor or sensory deficits. The GCS is a widely-used assessment for monitoring acute medical and trauma patients.
This document discusses the management of neurotrauma, including head injuries. It begins by describing the case of a 36-year-old male who presented with a possible head injury after being arrested for intoxication and fighting. It then provides details on various types of head injuries like extradural hematomas, subdural hematomas, intracerebral hemorrhages, and diffuse axonal injuries. The document outlines the importance of initial assessment, transport, and treatment of neurotrauma patients. It discusses monitoring of intracranial pressure, investigations like CT scans, and various treatment modalities including surgical options. Nursing care is also highlighted as being critical for good patient outcomes in neurotrauma.
This document provides an overview of neurologic and neurosurgical emergencies that may present in the intensive care unit (ICU). It discusses altered consciousness, increased intracranial pressure, neurogenic respiratory failure, status epilepticus, acute stroke, intracerebral hemorrhage, subarachnoid hemorrhage, head trauma, and spinal cord injury. For each topic, it describes evaluations, potential causes, and management strategies.
This document provides an overview of stroke, including its definition, epidemiology, etiology, risk factors, symptoms, pathophysiology, diagnosis, management, recovery, prognosis, and the role of physiotherapy. Some key points:
- Stroke is defined as a sudden loss of neurological function due to interrupted blood flow to the brain. It is a leading cause of death and disability worldwide.
- Risk factors include hypertension, diabetes, cardiac disorders, age, smoking, obesity, diet, alcohol consumption, and high cholesterol.
- Symptoms can include numbness, weakness, confusion, vision issues, dizziness, and headaches. Diagnosis involves medical history, exams, and imaging tests.
Antiepilepticdrugs(Harbhusan Gain, Student, Dept. of Pharmacy,World Universit...University of Dhaka
The document discusses antiepileptic drugs and provides information on the history and classification of epilepsy. It defines what epilepsy is and describes different types of seizures including generalized seizures like tonic-clonic, absence and myoclonic seizures. It also covers partial or focal seizures and status epilepticus. The document discusses experimental models used to study epilepsy and potential causes. It provides a classification of antiepileptic drugs and describes mechanisms of seizure and how various drugs work, including by modifying ion conductance and increasing GABAergic transmission. Specific drugs like phenobarbital, phenytoin, ethosuximide and valproate are also covered in terms of their pharmacological properties, mechanisms of action, adverse effects
This document discusses syncope, which is a brief loss of consciousness caused by transient global cerebral hypoperfusion. It is a common symptom but not a diagnosis. The document summarizes the prevalence, causes, evaluation, and management of syncope. The most common causes are neurally-mediated (50%), cardiac arrhythmias (11%), and orthostatic hypotension (6%). Evaluation involves history, physical exam, ECG, echocardiogram, tilt table testing, carotid sinus massage, and long-term cardiac monitoring depending on the suspected cause. Management depends on the underlying cause but may include lifestyle changes, medications, pacemakers, or treating any identified structural heart issues.
The document discusses spinal injuries, describing stable injuries that do not displace or endanger the spinal cord versus unstable injuries that may further displace and cause deformity or pain. It outlines the primary injury caused by the initial trauma and secondary injury from hemorrhage and ischemia. Various types of spinal injuries are described based on the mechanism of trauma. Evaluation involves assessing neurological function, location of injury, and determining if the injury is complete or incomplete. Imaging like CT and MRI can further characterize injuries. Treatment goals are preserving neurological function, relieving compression, stabilizing the spine, and rehabilitation.
This document provides information on carpal tunnel syndrome (CTS), including its anatomy, etiology, diagnosis, and treatment options. Some key points:
- CTS is caused by compression of the median nerve as it passes through the carpal tunnel in the wrist. Symptoms include pain, numbness, and tingling in the hand.
- Diagnosis is primarily clinical through tests like Tinel's sign and Phalen's maneuver. Electrodiagnostic tests like nerve conduction studies can help assess severity.
- Conservative treatments include splinting, injections, and exercises. Surgery (open or endoscopic release) is recommended if conservative options fail.
- The goals of any surgical technique are to completely
The document summarizes key aspects of death and brain death from a medicolegal perspective. It defines death and outlines the vital systems that cease to function at death. It discusses the presumption of death and survivorship under Indian law. The document then examines the historical definitions of death and milestones in determining brain death. It provides details on the anatomy of the normal brain and causes, mechanisms, and conditions distinct from brain death. The neurological examination for determining brain death and confirmatory testing are described. The key provisions of the Transplantation of Human Organs Act of 1994 and its amendment in 2009 are summarized.
Autonomic innervation of ocular strucures and Pupillary reflexesDhanyasree Nair
The document discusses the autonomic innervation of ocular structures and pupillary reflexes. It notes that the autonomic nervous system innervates structures like the iris, ciliary muscle, eyelids, blood vessels and lacrimal gland. The sympathetic system prepares the body for emergencies and supplies structures like the iris dilator and parasympathetic restores resting state and supplies the iris sphincter. Pupillary reflexes like light, near and darkness are discussed along with their pathways. Abnormalities in afferent pathways can cause total or relative afferent defects while efferent defects affect the light reflex. Conditions like Adie's tonic pupil and Argyll Robertson pupil that cause diss
1. The document discusses the pupil, normal pupil reactions, and various abnormalities of the pupil.
2. It describes tests like direct light response, swinging flashlight, and accommodation response that are used to assess the pupil.
3. Abnormalities are categorized based on whether they cause isocoria (equal pupil size) or anisocoria (unequal pupil size). Disorders causing isocoria include Argyll Robertson Pupil and Parinaud Oculoglandular Syndrome. Disorders causing anisocoria include Complete Oculomotor Palsy, Tonic Pupil, and Horner Syndrome.
The document provides an overview of the visual pathway, including its anatomy and physiology. It describes the main components of the visual pathway - the optic nerve, optic chiasm, optic tracts, lateral geniculate bodies, optic radiations, and visual cortex. It then discusses lesions that can occur along the visual pathway and their associated signs and symptoms. Finally, it covers pupillary reflexes like the light reflex and near reflex, as well as abnormalities in pupillary reactions.
Chapter 14 The Human Eye Lesson 3 - The 2 Mechanisms of the Eye 1) Accommodat...j3di79
The document summarizes two key mechanisms of the eye: 1) the pupil reflex which controls the amount of light entering the eyes by enlarging or constricting the pupil in response to light intensity, and 2) accommodation, where the lens becomes more or less convex to focus on near or distant objects by contracting or relaxing the ciliary muscles. It also discusses stereoscopic vision and includes some optical illusions to demonstrate how perception is not always reality.
This document discusses various pupil abnormalities and anomalies. It defines the pupil and normal pupil size ranges. It then describes several types of pupil disorders including microcoria (small pupil), megalocoria (large pupil), anisocoria (unequal pupil size), polycoria (multiple pupils), and corectopia (eccentric pupil position). It provides details on specific pupil anomalies such as Argyll Robertson pupil, Adie's tonic pupil, Horner's syndrome, Marcus Gunn pupil, amaurotic pupil, and hippus (irregular pupil oscillations). Differential diagnoses and causes are mentioned for several of the disorders.
The document discusses pupil function and abnormal pupil reactions. It covers:
1. The physiology of pupil constriction and dilation which is controlled by the parasympathetic and sympathetic nervous systems respectively.
2. How to examine pupils including observing size and shape, light reflex testing, swinging flashlight test, and near reflex testing.
3. Various diseases and conditions that can cause abnormal pupil reactions like Horner's syndrome, third nerve palsy, Adie's tonic pupil, and Argyll Robertson pupils.
4. Drugs that can cause mydriasis or miosis by affecting the parasympathetic or sympathetic pathways.
The document discusses normal and abnormal pupillary reflexes. It describes the anatomy and physiology behind the light reflex and near reflex. The light reflex involves transmission of signals from the retina through the optic pathway to the Edinger-Westphal nucleus which controls the iris sphincter and dilator muscles. The near reflex involves a triad of accommodation, convergence, and pupillary constriction. It also discusses various pupil abnormalities that can occur due to lesions in the afferent or efferent pathways as well as pharmacologic agents that cause miosis or mydriasis. Specific conditions mentioned include Horner's syndrome, Adie's tonic pupil, and Argyll Robertson pupil.
The pupil is a circular opening located in the center of the iris that controls the amount of light entering the eye. It constricts (miosis) and dilates (mydriasis) under autonomic nervous system influence. The iris contains two sets of muscles - the sphincter pupillae contracts the pupil in response to parasympathetic stimulation while the dilator pupillae dilates it with sympathetic stimulation. Abnormal pupils may be unequal in size (anisocoria), irregularly shaped, or have abnormal reactions to light. Various diseases and drugs can affect the pupils.
The document provides an overview of the pupillary pathway, including its anatomy, physiology, and clinical aspects. It describes:
- The afferent and efferent pathways that control the pupillary light reflex and near response.
- Clinical tests to evaluate the pupillary light reflex, including for anisocoria, RAPD, and other defects.
- Causes and features of different types of pupillary defects affecting the afferent pathway (e.g. optic nerve lesions) or efferent pathway (e.g. Horner's syndrome, Adie's tonic pupil).
This document discusses the pupil and its abnormalities. It covers:
1. The pupil light reflex involves a four neuron arc from the retina to muscles controlling the pupil.
2. Horner's syndrome causes miosis, ptosis, and anhydrosis due to disruption of the sympathetic pathway.
3. Adie's pupil is characterized by a dilated, poorly reactive pupil due to ciliary ganglion denervation.
The document discusses the neurological examination process. It describes the various components that are assessed which include levels of consciousness, mental status, cranial nerve function, motor skills, sensation, cerebellar function, and reflexes. Nurses play an important role in conducting and documenting the neurological examination to evaluate the presence of any disease in the nervous system.
The Glasgow Coma Scale (GCS) is a neurological assessment tool used to determine the severity of brain injury or dysfunction. It assesses three factors: eye opening, verbal response, and motor response, with scores ranging from 3 to 15. Lower scores indicate more severe brain injury. The GCS aids in classifying brain injuries as mild, moderate, or severe and helps identify potential causes of decreased consciousness like hypoxemia or hypotension. Signs of increased intracranial pressure include deteriorating consciousness, headache, pupil abnormalities, and motor or sensory deficits. The GCS is a widely-used assessment for monitoring acute medical and trauma patients.
This document discusses the management of neurotrauma, including head injuries. It begins by describing the case of a 36-year-old male who presented with a possible head injury after being arrested for intoxication and fighting. It then provides details on various types of head injuries like extradural hematomas, subdural hematomas, intracerebral hemorrhages, and diffuse axonal injuries. The document outlines the importance of initial assessment, transport, and treatment of neurotrauma patients. It discusses monitoring of intracranial pressure, investigations like CT scans, and various treatment modalities including surgical options. Nursing care is also highlighted as being critical for good patient outcomes in neurotrauma.
This document provides an overview of neurologic and neurosurgical emergencies that may present in the intensive care unit (ICU). It discusses altered consciousness, increased intracranial pressure, neurogenic respiratory failure, status epilepticus, acute stroke, intracerebral hemorrhage, subarachnoid hemorrhage, head trauma, and spinal cord injury. For each topic, it describes evaluations, potential causes, and management strategies.
This document provides an overview of stroke, including its definition, epidemiology, etiology, risk factors, symptoms, pathophysiology, diagnosis, management, recovery, prognosis, and the role of physiotherapy. Some key points:
- Stroke is defined as a sudden loss of neurological function due to interrupted blood flow to the brain. It is a leading cause of death and disability worldwide.
- Risk factors include hypertension, diabetes, cardiac disorders, age, smoking, obesity, diet, alcohol consumption, and high cholesterol.
- Symptoms can include numbness, weakness, confusion, vision issues, dizziness, and headaches. Diagnosis involves medical history, exams, and imaging tests.
Antiepilepticdrugs(Harbhusan Gain, Student, Dept. of Pharmacy,World Universit...University of Dhaka
The document discusses antiepileptic drugs and provides information on the history and classification of epilepsy. It defines what epilepsy is and describes different types of seizures including generalized seizures like tonic-clonic, absence and myoclonic seizures. It also covers partial or focal seizures and status epilepticus. The document discusses experimental models used to study epilepsy and potential causes. It provides a classification of antiepileptic drugs and describes mechanisms of seizure and how various drugs work, including by modifying ion conductance and increasing GABAergic transmission. Specific drugs like phenobarbital, phenytoin, ethosuximide and valproate are also covered in terms of their pharmacological properties, mechanisms of action, adverse effects
This document discusses syncope, which is a brief loss of consciousness caused by transient global cerebral hypoperfusion. It is a common symptom but not a diagnosis. The document summarizes the prevalence, causes, evaluation, and management of syncope. The most common causes are neurally-mediated (50%), cardiac arrhythmias (11%), and orthostatic hypotension (6%). Evaluation involves history, physical exam, ECG, echocardiogram, tilt table testing, carotid sinus massage, and long-term cardiac monitoring depending on the suspected cause. Management depends on the underlying cause but may include lifestyle changes, medications, pacemakers, or treating any identified structural heart issues.
The document discusses spinal injuries, describing stable injuries that do not displace or endanger the spinal cord versus unstable injuries that may further displace and cause deformity or pain. It outlines the primary injury caused by the initial trauma and secondary injury from hemorrhage and ischemia. Various types of spinal injuries are described based on the mechanism of trauma. Evaluation involves assessing neurological function, location of injury, and determining if the injury is complete or incomplete. Imaging like CT and MRI can further characterize injuries. Treatment goals are preserving neurological function, relieving compression, stabilizing the spine, and rehabilitation.
This document provides information on carpal tunnel syndrome (CTS), including its anatomy, etiology, diagnosis, and treatment options. Some key points:
- CTS is caused by compression of the median nerve as it passes through the carpal tunnel in the wrist. Symptoms include pain, numbness, and tingling in the hand.
- Diagnosis is primarily clinical through tests like Tinel's sign and Phalen's maneuver. Electrodiagnostic tests like nerve conduction studies can help assess severity.
- Conservative treatments include splinting, injections, and exercises. Surgery (open or endoscopic release) is recommended if conservative options fail.
- The goals of any surgical technique are to completely
The document summarizes key aspects of death and brain death from a medicolegal perspective. It defines death and outlines the vital systems that cease to function at death. It discusses the presumption of death and survivorship under Indian law. The document then examines the historical definitions of death and milestones in determining brain death. It provides details on the anatomy of the normal brain and causes, mechanisms, and conditions distinct from brain death. The neurological examination for determining brain death and confirmatory testing are described. The key provisions of the Transplantation of Human Organs Act of 1994 and its amendment in 2009 are summarized.
This document provides an overview of coma, including its anatomical and physiological bases, definition, causes, evaluation, and management. Coma requires dysfunction of the pontine reticular activating system and/or bilateral cerebral hemispheres. Common causes include drug overdose, metabolic derangements, head trauma, anoxia, and stroke. Evaluation involves assessing ABCs, looking for signs of increased intracranial pressure, and performing tests to identify potential causes. Management priorities are supporting ABCs, treating potentially reversible causes like hypoglycemia, and controlling intracranial pressure if elevated.
This document provides information about carpal tunnel syndrome (CTS), including its anatomy, etiology, pathogenesis, diagnosis, and treatment options. Some key points:
- CTS is caused by compression of the median nerve as it passes through the carpal tunnel in the wrist. Symptoms include numbness, tingling, and pain in the hand.
- Physical exam techniques like Tinel's sign, Phalen's test, and nerve compression tests help diagnose CTS clinically. Electrodiagnostic tests can confirm diagnosis and assess severity.
- Risk factors include repetitive wrist motions, obesity, pregnancy, and certain medical conditions. Conservative treatments include splinting, injections, and exercises. Surgery is considered if conservative
Brain death refers to the irreversible loss of all brain function. It is diagnosed through examinations showing the absence of brainstem reflexes and apnea during an oxygen challenge. Organ donation from brain dead donors provides organs for transplantation but there is a shortage due to misperceptions about the process. The document discusses the criteria for determining brain death in adults and children, confirmatory tests, organ donation laws in India, and efforts to increase donation rates.
Hippocrates first suggested epilepsy was a brain disorder in 400 BC. It is defined as brief episodes of loss of consciousness due to abnormal brain neuron firing. Seizures can be focal or generalized. Common seizure types include generalized tonic-clonic, absence, myoclonic, complex partial, and simple partial. Antiepileptic drugs work by modifying ion conductances like sodium channels, increasing GABA effects, or blocking glutamate receptors. Common antiepileptic drugs include phenytoin, carbamazepine, valproic acid, ethosuximide, and phenobarbital. Adverse effects and drug interactions must be monitored with long-term antiepileptic treatment.
CEREBROVASCULAR STROKE for nursing student.pdffkzp4kn8tm
1. Cerebrovascular stroke is caused by a sudden disruption of blood flow to the brain, resulting in the loss of neurological function.
2. The two main types of stroke are ischemia, caused by blockage of a blood vessel, and hemorrhagic, caused by bleeding in the brain.
3. Risk factors for stroke include age, hypertension, diabetes, smoking, and high cholesterol. Symptoms vary depending on the affected brain region but may include weakness, confusion, trouble speaking, and loss of vision.
Management of patient with Epilepsy involves treating acute seizures, identifying and removing underlying causes, and long-term antiepileptic drug therapy. Seizures are classified as partial or generalized based on origin in one brain region or both hemispheres. Evaluation includes thorough history, physical exam, EEG and imaging to diagnose epilepsy and guide treatment. Management focuses on controlling seizures through medications while also addressing psychosocial needs through rehabilitation. Surgery may be considered for drug-resistant epilepsy localized to one brain region.
History and examination of nervous system- Part II.pptAkshatagrahari2
This document provides guidance on performing a neurological examination, including the equipment needed and aims. It describes examining various parts of the nervous system like higher mental functions, cranial nerves, motor and sensory systems, and reflexes. For each section, it lists the specific tests and assessments to perform, what they examine, and potential abnormalities. The goal is to systematically examine the nervous system to confirm clinical findings.
1. Spinal shock is a temporary loss of spinal reflex activity below the level of spinal cord injury that occurs immediately after severe spinal cord injury.
2. It is demonstrated by a loss of muscle tone, reflexes, and sensation below the level of injury and can last from hours to weeks depending on the severity and level of injury.
3. Spinal shock results from the loss of descending facilitation from the brain to the spinal cord below the level of injury and goes through phases of areflexia, initial reflex return, hyperreflexia, and eventually spasticity as the spinal cord recovers over time.
Alteration of consciousness can result from diminished alertness due to widespread brain abnormalities or reduced activity of the reticular activating system. Confusion is characterized by impaired attention/concentration and disorientation, while delirium involves additional symptoms like agitation, hallucinations, and convulsions. Levels of consciousness range from alert to comatose. Confusion can be caused by medical/surgical diseases, infections, drugs, or nervous system disorders and is evaluated through history, exam focusing on attentiveness/orientation, and controlling underlying illnesses. The Glasgow Coma Scale assesses eye, motor, and verbal responses to determine coma depth.
Alteration of consciousness can result from diminished alertness due to widespread brain abnormalities or reduced activity of the reticular activating system. Confusion is characterized by impaired attention/concentration and disorientation, while delirium involves additional symptoms like agitation, hallucinations, and convulsions. Levels of consciousness range from alert to comatose. Confusion can be caused by medical/surgical diseases, infections, drugs, or nervous system disorders and is evaluated based on history, exam focusing on attentiveness/orientation, and aim to control underlying illness. The Glasgow Coma Scale assesses eye, motor, and verbal responses to determine coma depth.
20. Diagnostic Tool
Indications of use of CT
`Hounsfield number(Bone>>> lipid>air)
`fisrt line in evaluation of a change in mental status
`Test of choice for those with implantable devices
`shows acute and sub acute blood(ICH/SAH,SDH)
`Bony abnormalities,i.e Trauma or Fracture
`Edema/mass effect
`Abnormalities in size and shape of structures
(brain atrophy,gyri effacement with swelling)
`Hydrocephalus
`Ischemic stroke
21. Diagnostic Tool
Indications of use of MRI
`Use with caution with people with claustrophobia,implantable
devices or programmable shunts
`Provide better soft tissue differentiation than CT
`Tumor
`Abscess
`Edema/mass effect
`Stroke
`Hydrocephalus
`Stereotactic surgical planning
26. How things appear on a CT
Acute blood/Calcifications -White
Chronic blood collection -Low density
black to gray as increasing density
CSF/Air-Black
White matter- Less dense than gray matter
Ischemia-lower density and therefore will be
darker and may not appear for 12hours
27.
28. Types of MRI
Gadilinium enhancement(tumor/infection)
T1/T2
Diffusion- can assess an acute infarct within the last 2 weeks
MRV-Assess patency,stenosis or occlusion of the venous system
MRA
Flair/Echo gradient-Similar studies(Echo gradient may see a smaller
bleed clearer
Functional MRI-Asked to do sensory,motor and cognitive tasks.
Shows increasing signals with cerebral activity
29. MRI overview (T1/T2)
T1
CSF appears black
White matter brighter than gray matter
T2
CSF apperars white
60. Spinal cord injury
Methylprednisolone(Within 8hrs)
1.concentration:62.5mg/ml
2.bolus:30mg/kg initial bolus over
15minutes
3.followed by a 45 minutes pause
4.maintenance:then 5.4 mg/kg/hr
if<3hrs:23hrs, >3~8hrs:47hrs
61. Spinal cord injury
(Frankel Scale)
Grade Description
1(A) complete motor and sensory paralysis below lesion
2(B) Complete motor paralysis,but some residual sensory
perception below lesion
3(C) Residual motor function,but of no practical use
4(D) Useful but subnormal motor function below lesion
5(E) normal
62. Glasgow coma scale(≥4yrs)
Points Eye opening verbal motor
6 - - obeys
5 - oriented Localizes pain
4 Spontaneou Confused Withdrawals to pain
s
3 To speech Inappropriate Flexion
2 To pain Incomprehesible Extenson
1 None None none
63. Glasgow coma scale(≤4yrs)
Points Eye opening verbal motor
6 - - obeys
5 - Smile,interact Localizes pain
s
4 Spontaneous Consolable , Withdrawals to
inappropriate pain
3 To speech moaning Flexion
2 To pain Inconsolable, Extenson
restless
1 None None none
66. Vegetative state
Preservation of autonomic function and
primitive reflex.
No meaingful interaction for external
stimuli.
67. Locked in syndrome
A state quadriplegia with preservation of
cognition
Consciousness,vertical eye
movements,eyelid blinking
Destructive lesions in the ventral pons or
ventral midbrain
Reemergence of horizontal movement
(within 4weeks):Predictive of improved
recovery
69. Muscle strength
Grade Strength
0 No contraction
1 Flickering
2 Movement with gravity eliminated
3 Movement against gravity
4 Against resistance(4-,4 ,4+)
5 normal
79. Facial weakness
H-B(House-Brackmann grade)
Grade Description
1 Normal function in all areas
2 Slight weakness on close inspection
3 Obvious but not disfiguring
4 Obvious weakness and/or disfiguring
asymmetry
5 Barely perceptible motion
6 No movement
85. Acute medical management of
ischemic stroke
Effective therapy for stroke
-Reduce degree of ischemic change
-Minimize effect of reperfusion injury
*penumbra:
Target of
neuroprotective therapy
86. Thrombolytic agents
Plasminogen to plasmin
Degradation of fibrin
Canal recanalization
* t-PA:only drug approved by FDA
87. t- PA administration
Inclusion
-18yr older
-Signs of measurable neurological deficit
-Onset≤3hrs
88. t- PA administration
Exclusion
-Hemorrhage
ICH,SAH,active internal bleeding
Platelet count<100,000/mm 3
Heparin within48hrs,PT>15sec
Recent lumbar or arterial puncture
GI bleeding within 21 days
89. t- PA administration
Exclusion
-Minor or rapidly improving symptoms
-Uncontrolled HTN (SBP>180,DBP<110)
-abnormal blood glucose(<50 or >400)
-Post myocardial infarction
-Seizure at time stroke onset
90. t- PA administration
Monitor BP every 15min for 2hrs
Recommneded goal of BP
-less than 185/100
Aggressive blood pressure reduction
might precipitate further ischemic injury
91. Pain-sensitive structure
Venous sinuses
Cortical veins
Artery
Dura mater
Scalp vessels and muscle
92. Classfication(Headache)
Sinusits
Migrane
Cluster headache
Post traumatic
Drug-induced HA
Menigitis
Hydrocephalus
Tension HA
Cervicalgia
Hemorrhage
93. History taking
Character,site,mode of onset
Frequently duration
Timing
Associated symptoms
Precipitating factors