Spinal Cord Injury

Common to highly educated person

Common in July

Cause: vehicular accident, violence, sports related injuries  eg diving

Areflexia- absence of reflexes after injury

stroke

-sudden neuro deficit

Diagnosis: Right CVA – left hemapheresis

                   Left CVA – Right hemapheresis

40% - thrombotic

30% -embolic

          Lacunar

           Hemorrhagic – devastating

*prone to depression

*prevent depression – family support

2 common cause in depression

1.       Acquired

2.       Side effects of drugs

Stages of Recovery:

1.       Flaccidity

2.       Spasticity begin

3.       Spasticity continues

4.       Peak spasticity 

5.       Spasticity declines

6.       Spasticity disappear – normal recovery

Risk Factors:

Lifestyle, obesity, diabetes mellitus, increase serum cholesterol, age, black people

Management:

1.       Drug – anti – coagulant (heparin)

2.       Carotid endarterectomy – surgical removal of plaques ; side effects – alzheimer’s disease

Bacillar artery affected = death

Pontine artery affected = doll’s eye phenomenon (oculo cephalic reflex)

Complication: immobility, contractures, sexual dysfunction

**prevent footdrop contractures – wear high tennis shoes

multiple sclerosis

Multiple Sclerosis

-myelin sheath- conducts impulses from brain to another

3 theories : 1. Demyelination, 2. Auto immune, 3. Virus

Manifestations:

1.       Blurring of vision (unilateral blindness)

2.       Weakness/ fatigue

3.       Spasticity

4.       Scanning speech

5.       Bowel/bladder incontinence

6.       Sexual dysfunction – due to decrease vaginal lubricant

7.       Euphoria(mood swings)

Drugs of choice: Baclofen

Mgt: live life actively

myasthenia gravis

Myasthenia Gravis

-decrease in acethylcholine

1^st manifestation: ptosis (drooping eyes)

Fatal complication: myasthenia crisis (dyspnea, dysphagia, difficulty talking)

Test: edrophonium chloride through IV

Crisis should subside – 3-5minutes/ 5-10minutes

Nsg. Mgt: live life actively

Tay- Sach's Disease

Tay – sachs Disease

-common in jewish family

-decrease hexosaminidase A( brain function; intelligence)

-Neuro deterioration

-lead to coma = death

-onset 3-6months

Manifestations: weakness, fever, cherry red macula (lead to blindness)

Mumps

Mumps

-paramyxo virus; common during winter and spring

-uni or bilateral

-downward, forward formation of swelling

Fatal complications: orchitis

scarlet fever

Scarlet fever

-strawberry tongue

-group A beta hemolytic strep

Manifestation: fever, pharyngitis, fatigue

Kawasaki disease

Kawasaki disease – from korea

Strawberry tongue; 5 days = white tongue

baby shaken syndrome

Baby shaken syndrome

-child abuse

-retinal hemorrhage

Reye's Syndrome

Reye’s Syndrome

-accumulation of fats in liver; aspirin toxicity

-below 10 years old

-use Tylenol instead (widely used analgesic)

2 posture associated with neuro disorder

1.       Decorticate- cortex (basal ganglia)

2.       Decerebrate – pons (rate, depth of respiration)

Manifestations: lethargic, tinnitus, neuro disorder

Tumor

Tumor

-space occupying lesions

2 types of tumor in brain: 1. Glioblastoma – adult

                                                    2. medullablastoma – children

Mgt: Surgery

a.       Craniotomy – opening of skull

b.      Craniectomy – part of skull removed

Nsg priority: SAFETY (wear helmet)

Drug: steroid ( decrease edema), NSAIDS

Note: prolonged use of steroids causes osteoporosis; if asthmatic weight gain