Neurologic Disorders Lecture Notes

Introduction

• Part one of the series on neurologic disorders.
• Today's focus: disorders of the neurologic system.

Basic Concepts

• The Skull as a Box:

  • The skull is a rigid, bony box with no stretch.
  • Contains the brain, blood, and cerebrospinal fluid (CSF).
  • Each has an allotted space; imbalance leads to pressure issues.

• Intracranial Pressure (ICP):

  • Pressure inside the skull.
  • Must be balanced to allow proper blood flow and oxygenation to the brain.
  • Measured by cerebral perfusion pressure, related to oxygenation.

• Consequences of Imbalance:

  • Increase in ICP can decrease cerebral perfusion (oxygenation).
  • Could be caused by brain edema, brain tumors, or increased blood/CSF.

Brain Attacks (Strokes)

• Definition: Interruption of arterial blood supply to the brain causing ischemia or necrosis.

• Causes:

  • Atherosclerosis, hypertension, aneurysms, cardiac issues.
  • Risk factors: aging, family history, diabetes, smoking.

• Types of Strokes:

  • Ischemic:
    • Caused by artery narrowing/blockage (thrombotic or embolic).
    • Embolic events, often related to atrial fibrillation.
  • Hemorrhagic:
    • Caused by blood leakage from vessels.
    • Factors: hypertension, aneurysms, vascular malformations.

• Transient Ischemic Attacks (TIAs):

  • Temporary blockages, symptoms last less than 24 hours.
  • Warning signs for potential full strokes.

Stroke Assessment

• Autonomic Status:

  • Evaluate involuntary functions like vital signs.
  • Changes could indicate brain stem issues.

• Level of Consciousness (LOC):

  • First indicator of neurologic events or worsening conditions.
  • Monitored by orientation questions.

• Sensory-Motor Assessment:

  • Above the Shoulders:
    • Governed by cranial nerves (focus on CN II, III, VII).
    • Issues show as facial droop (CN VII), vision problems (CN II).
  • Below the Shoulders:
    • Assessed by corticospinal and spinothalamic tracts.
    • Contralateral rule: right brain affects left body and vice versa.

• Reflexes:

  • Peripheral Reflexes:
    • Deep tendon reflexes like patellar reflex.
  • Central Reflexes:
    • Involuntary reflexes like cough, swallow, gag.
    • Babinski reflex: abnormal if toes fan out in adults, indicates neurological issue.

Conclusion

• Intracranial events require careful assessment.
• Continuous monitoring of reflexes and LOC for changes.

Resources

• Visual resources such as videos for further understanding.

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These notes summarize the important aspects of neurological disorder presentations, focusing on the balance of intracranial pressure and understanding brain attacks (strokes) and their assessments.