Neurological Pathologies

• Stroke

  sudden + rapid developing signs of focal/global disturbance of cerebral fuctions which lasts longer than 24 hrs

  brain has an interruption of blood flow/supply, causing a loss of oxygen to brain cells, causes cell death

  2 main types - ishemic (blood clot, accounts for majority of cases) + haemorrhagic (bleeding/burst blood vessel, minority of cases)
• Causes of Ischaemic Stroke - Arteries Occlusion

  arteries r occluded by thrombus or fatty material from an atherosclerotic plaque (elevated cholesterol in arteries) or a clot in a large artery or heart (often as a complication of atrial fibrilation or atherosclerosis of the carotid arteries
• Causes of Ischaemic Stroke - Cranial/Haematological Diseases

  intracranial/extracranial vessels disease - disection, vasculitis, venous thrombois

  haematological conditions - sickle cell anaemia, hypercoagulable states
• Intracerebral Haemorrhage

  10% of stroke cases

  most intracerebral haemorrhages occur in the abscense of vascular malformations, aneurysm or other structural causes

  presumed to be due to diseases affecting small cerebral vessels

  commonest cause is high blood pressure
• Subarachnoid Haemorrhage

  5% of stroke cases

  rupture of an intracranial saccular aneurysm accounts for 80% of cases of non-traumatic subarachnoid haemorrhage

  remaining 20% = ateriovenous malformations, arterial disections, use of anticoagulants + other rare conditions
• Brain Aneurysms

  aneurysm formation may be due to structural abnormalities of cerebral vessels due to an inflammatory process

  this may be influenced by smoking, hypertension + alcohol abuse
• Rarer Causes of Stroke - Cerebral Venous Thrombosis

  cerebral venous thrombosis occurs due to thrombosis of the dural venous sinus (thrombosis = blood clot)

  more likely in ppl w a prothrombotic tendency - pregnancy, infection, dehydration or malignancy
• Rarer Causes of Stroke - Carotid Artery Dissection

  tends to occur in younger ppl + may be preceded by neck trauma
• FAST

  Face - face falling to one side, ability to smile

  Arms - ability to raise + hold arms in air

  Speech - speech slurred

  Time - call 999 to any one of these signs
• Clinical Presentation of Stroke

  sudden onset

  wide range of subtle/obv neuro dysfunction depending on region of brain affected

  weakness, sensory changes, co-ordination changes, speech + swallow changes, cognitive dysfunction

  other symptoms - dizziness, headache, blurred vision/visual changes, unsteady gait + confusion
• Initial Stroke Medical Management - CT Head

  CT head to determine if clot/bleed, MRI head, ECG, carotid doppler

  bloods, neuro observation, swallow screen, treatment of any other infections, control, control intracranial pressure if applicable
• Initial Stroke Medical Management - Thromectomy/Thrombolysis

  may require thrombectomy, thrombolysis or decompressive cranitotomy depending on time of symptoms, severity of neuro impairment + appropriateness for each treatment
• Subjective Assessment for Stroke

  PMH, HPC, SH, DH

  look at med notes + diagnosis/imaging + ongiong med management

  physiological/vital signs stability - HR, BP, RR, SpO2, AVPU, blood sugars + NEWS

  observation of patient at bedside - pos, facial weakness/drooping, alignmen, alertness, attachments etc...
• Objective Assessment for Stroke

  orientation, visual screen

  ROM, muscle tone + power

  sensation, propioception, co-ordination

  bed mobility, sitting balance, standing balance, trasfers + mobility
• Evidence-Based Practice Guidelines for Stroke

  3 hrs of therapy a day per 5/7 days for those w motor impairment

  greater amounts of physical therapy (dose) r associated w better recovery

  motor learning is best accomplished w challenging, motivating tasks + variable training schedules

  content of therapy is also important - effectiveness, dosage + intensity
• Treatment Suggestions for Stroke

  positioning, strengthening, task specific practice

  sitting = standing balance

  neuromuscular stimulation, moility practice - orthotics, aids

  care of the limbs, pt, family + carer education

  minimising secondary complications - pressure sores, contractures, pain
• Parkinson's Disease

  progressive neurodegenerative disease

  loss of nerve cells in part of the brain = substantia nigra

  dopamine plays a vital role in regulating the movement of the body

  exactly what causes the loss of nerve cells = unclear

  possible combo of genetic + eviro factors
• Population Affected by Parkinson's

  most ppl start to develop when theyre over 50, some may first experience symptoms under 40

  men r slightly more likely to have it than women
• Parkinson's - Dopamine

  dopamine = brain hormone

  symptoms appear when dopamine levels become too low

  = cos brain cells that produce dopamine have stopped working
• Medical Treatment for Parkinson's

  the drugs will do one or more of the following:

  increase the amount of dopamine in the brain

  act as a dopamine substitute, stimulating the parts of the brain where dopamine works

  block the action of other factors (enzymes) that break down dopamine
• Parkinson's - Signs & Symptoms

  develops gradually + r mild at first

  motor symptoms - affecting movement + balance, inc tremor, stiffness + slowness of movement

  tremor at rest, rigidity, bradykinesia (slow movement) + postural instability = cardinal signs of PD

  non-motor symptoms - pain, sleep problems + mental health issues
• Multiple Scelrosis

  causes damage to the myelin sheath in nerves along the CNS - brain + spinal cord

  sclerosis = scarring, multiple = can happen in more than one place

  3 times more common in women than in men
• MS - Pathophysiology

  immune system directs repeated inflammatory attacks on the CNS, which cause damage to the myelin sheath, the nerve fibres themselves + the cells that make myelin

  when myelin is damaged, impulses dont pass along ur nereves as efficiently

  = these areas of damage = lesions that cause the symptoms
• Relapsing-Remitting MS

  most common type

  characterised by periods of disease activity (relapses) followed by periods of remission where symptoms may improve or stabilise

  Relapses can cause new or worsening symptoms, and remissions can last for weeks, months, or even years
• Secondary Progressive MS

  a form of multiple sclerosis that develops after an initial period of relapsing-remitting MS  

  It's characterized by a steady worsening of symptoms and disability, without the typical relapses and remissions seen in RRMS

  In SPMS, the severity and frequency of relapses decrease or stop altogether, but the level of permanent changes in symptoms increases over time