Neuro.pptx - Neurologic Pathophysiology and Disorders NURS 5315 Advanced Pathophysiology Mary Schira PhD RN ACNP-BC Neurologic Pathophysiologies

Neuro.pptx - Neurologic Pathophysiology and Disorders NURS...

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Neurologic Pathophysiology and Disorders NURS 5315 Advanced Pathophysiology Mary Schira PhD, RN, ACNP-BC
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Neurologic Pathophysiologies Introduction and Stroke
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Compare and contrast etiologies and manifestations of stroke. Objective
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Atherosclerosis, thrombus Inflammation and infection Neurotransmission “dysfunction” – transmitters insufficient vs uptake; receptor functions; synapse vs myoneural junction Integrity of myelin/myelin sheath function Effects of trauma – especially brain and spinal cord Most of neuro pathologies cross age ranges (e.g. stroke, infection, seizures) Pathophysiologic Concepts in Neurologic Pathologies
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Area of stroke has corresponding neurologic deficits Most common vessels Middle cerebral artery Parietal, temporal lobes; deficit depends on branch involved (rt. MCA = visual, sensory neglect left side body) Posterior cerebral artery Temporal, occipital lobes, upper brain stem; vision, depth perception Vertebral artery Posterior occipital lobe, cerebellum; swallow, speech, pain, temperature; muscle weakness, gait, balance Stroke
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Frontal Problem solving, perseveration, expressive aphasia, personality changes Temporal Receptive aphasia, recognizing faces, short term memory loss, aggressive behavior Parietal Object naming, rt/lt confusion, difficulty with tactile senses Occipital Visual field and color identification, word blindness Cerebellum Gross and fine motor movement, posture, tremor, speech Brainstem Temperature, heart rate, respiratory rate, swallow, balance Stroke – Areas Affected/Deficit
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Stroke Left Hemisphere Right Hemisphere Right sided hemiplegia Language Expressive dysphasia Receptive dysphasia Right visual field deficit Slow, deliberate, disorganized Left Sided hemiplegia Language not affected Left visual field deficit Impulsive behavior, distractible Unaware of deficits
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Transient ischemic event (“previous TIA”) Deficits sudden; most common is unilateral weakness and limb paresthesia Reverses in < 60 min. No evidence infarct – highest risk stroke in 48 hrs; 45- 60% risk of stroke within 3mo. Reversible ischemic neurologic deficit (RIND) Deficits sudden; reverse > 24 hrs Lacunar Deficits may progress 24-36 hrs. Small lesions in penetrating arterioles Motor hemiplegia, hemisensory deficit, dysarthria, ataxia Link to vascular dementia Stroke
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“5Ps”: parenchyma, pipes, perfusion, penumbra, prevent complications General: FAST (Face, Arm, Speech, Time) Thrombotic (atherosclerosis; hypertension, DM) Deficit tends progress over time Usually large vessel Cardioembolic (atrial fibrillation, mechanical valve) Deficit maximum at onset Most common site mid-cerebral artery Cryptogenic (underlying cause unknown) Most likely = atrial fibrillation, patent foramen ovale, clotting disorder Stroke - Ischemic
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Subarachnoid Bleeding into space between arachnoid membrane & pia mater
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  • Fall '15
  • david,mary
  • Intracranial pressure, Traumatic brain injury, Headaches, Middle cerebral artery, posterior cerebral artery

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