Neurological Disorders: Past Paper Notes PDF
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These notes provide an overview of neurological disorders, including information on hyperventilation, ketogenic diets, seizures, vaccines, and anti-epileptic drug management. The notes cover both early and late signs of conditions and related treatments used for patients. Information is presented in a concise format, making it ideal for quick reference, and covers topics such as intracranial pressure, seizure types, and common treatments.
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# Neurological Disorders ## Hyperventilation - Hyperventilation helps decrease intracranial pressure by causing vasoconstriction. - Decreases PaCO2, causes vasoconstriction, decreases IICP. ## Ketogenic Diet - Ketogenic diet - ↑ fat, ↑ protein, ↓ carbs to help = seizure disorder. ## Seizures...
# Neurological Disorders ## Hyperventilation - Hyperventilation helps decrease intracranial pressure by causing vasoconstriction. - Decreases PaCO2, causes vasoconstriction, decreases IICP. ## Ketogenic Diet - Ketogenic diet - ↑ fat, ↑ protein, ↓ carbs to help = seizure disorder. ## Seizures - If seizure lasts more than 5 minutes, patients should receive diazepam (Ativan) and call paramedics. - Chiari malformation - most common is type 2. - What’s supposed to be inside the brain is protruding down the cervical canal. - S/Sx: weak cry, stridor, apnea. ## Vaccines - Vaccines that prevent bacterial meningitis: Hib, pneumococcal, meningococcal. - Only way to develop Reye-syndrome: use of aspirin and a virus. ### Early Signs - Headache - Vomiting (projectile) - Visual changes - Dizziness - Decreasing HR and respirations - Changes in pupil reactions - Sunset eyes - Changes in LOC - Seizures - Bulging fontanel and increasing head circumference (infants) ### Late Signs - Decreased LOC - Depressed motor, sensory responses - Bradycardia - Irregular respirations - Cheyne-Stokes respurations - Decerebrate/decorticate postures - Fixed and dilated pupils ## First Anti-Seizure Medication - First anti-seizure medication used in neonatal seizures is phenobarbital. ## Seizures - Seizures can be either partial or generalized. - **Partial** seizures affect one part of the brain and are further divided into: - **Simple partial:** Can affect sensory motor, psychic, or autonomic symptoms. The person remains aware. - **Complex partial:** Altered awareness. May appear dazed and confused. - **Absence:** Blank stare, lasts less than 10 seconds. Starts and ends abruptly. Awareness is imparied during the activity. - **Generalized** seizures involve both hemispheres of the brain, with the most common types being: - **Tonic-Clonic:** Two phases: tonic and clonic. - Tonic phase: crying out, loss of awareness, muscles stiffen, fall as consciousness is lost. - Clonic phase: convulsions, jerking and twitching in all four limbs. - **Myoclonic:** Sudden jerk in arm/leg. The person may fall. - **Atonic:** Loss of muscle tone, falling down, dropping objects, head nodding involuntarily. ## Seizure Management - **Tonic** phase of seizures is often when a patient falls to the ground with arms and legs stiffly extended. - **Clonic** phase is a series of rhythmic jerking movements in the arms and legs. | Assessment | Seizure Management | |---|---| | Onset | Maintain patient’s airway | | Body part affected | Protect from harm | | LOC | Do not restrain | | Muscle tone | Do not place objects inside mouth | | Pupils | Observe and record event | | Cyanosis | | | Altered salivation| | | Incontinence | | ## ICP - Intracranial Pressure - Causes of ICP: head trauma, birth trauma, hydrocephalus, infection, brain tumors. - s/sx: ↑ BP, ↓ pulse, VRR. - Mannitol is a good medication to give. - **Early vs. late signs of ICP** - **Early signs** are often missed as they can be subtle. - **Late signs** are more obvious and indicate that the brain is under significant pressure. ## Decorticate & Decerebrate - **Decorticate:** Extremities flexed, cerebral cortex damage. “Better to have.” - **Decerebrate:** Extremities extended/pronated, brain stem damage. “Worse to have”. ## Things to Focus on for Quizzes: - Score of 8 for pediatric GCS scale: intubate. - If patient looks straight during doll’s eye maneuver, there is damage to the midbrain or pons. ## Anti-epileptic Drugs - Diagram shows **commonly used anti-epileptic drugs and side effects:** - **Phenytoin (Dilantin)**: selective inhibition of sodium channels. *Side Effects:* gingival hyperplasia, bradycardia, rash. - **Carbamazepine (Tegretol)**: suppresses high-frequency neuronal discharge. *Side Effects:* visual problems, leukemia, anemia, thrombo-cytopenia. - **Valproic Acid (Depakene)**: blocks sodium and calcium channels to prevent neuron firing. *Side Effects:* GI upset, hepatotoxicity, pancreatitis. - **Noncompliance is frequently responsible for treatment failure**. - **Drug levels need to be monitored.** - **Caution: High voltage**. *Management of tonic-clonic and partial seizure activity.*
