Demyelinating Degenerating & Motor Neuron Disorders

    Cards (23)

    • Multiple Sclerosis
      An autoimmune condition where the body attacks the myelin of brain & spinal cord resulting in demyelination of destruction of myelin
      • W/O myelin - it creates gaps in insulation
    • MS Assessment
      Initial Episode: double vision, blurred vision
      • Pt may have nystagmus
      Pt can experience muscle weakness, impairment of pain, temp, touch senses
      • Ataxia, intention tremors, sexual dysfunction, depression, euphoria, fatigue, cognitive abnormalities
      • Lhermitte sign: electric sensation down spine/extremities when head is flexed forward
    • MS Management
      Supportive
      Pt among - 20-50 yo
    • Guillain-Barré syndrome
      A rare disease where the immune system attacks portions of nervous system - cause is unclear
      • Pt report minor respiratory or GI infection prior to weakness
      • Infectious agent attacks body - agent is similar to myelin structure so body attacks myelin thinking it is the agent
    • Guillain-Barré Syndrome Assessment
      Starts as weakness & tingling sensations in legs
      • Weakness moves up legs & starts to affect thorax & arms - may lead to paralysis
      • This can take few hours
      • Pt are prone to severe swings in PR & BP
    • Guillain-Barré Syndrome Management

      Prehospital includes protecting airway & ventilating
      Monitor ECG & VS
      Established IV - be prepared to administer fluids
    • Parkinson Disease
      A neurologic condition where environmental & genetic factors can place pt at risk for damage to certain neurons
      • Substania nigra is responsible for dopamine (neurotransmitter needed among other things) production if damaged or overused disease can result
    • Parkinson Disease Assessment
      Gradual onset of symptoms over mo. to yrs
      1. Tremor: rest tremors & postural tremors common
      2. Postural instability: pt have stiff posture where they are stoped over & alters their gait - stiffness makes pt unsteady when walking
      3. Rigidity: causes pt to move in fits & starts
      4. Bradykinesia: slowing down of routine motions
      5. classic type of gait - shuffles in a straight line with feet close together
      6. Dementia, difficulty swallowing (aphagia), fatigue, dystonia
      7. Foot & leg contractions - leg arched or arm flexed across chest & abdomen
    • Parkinson Disease Management
      Pre-hospital management is supportive - reorient pt if needed
      If pt has trauma, manage it
    • Amyotrophic Lateral Sclerosis (ALS)

      AKA Lou Gehrig disease that strikes voluntary motor neurons
      • Cause is unclear & condition is more common in middle-aged men of any race
    • ALS Assessment
      Fatigue, general weakness of muscle groups, fasciculations (muscle twitching), & difficulty doing routine activities
      • Pt may have difficult speaking - as condition progresses a loss of ability to walk, move arms, eat
      • Pt last 3-5yrs
      • Pt die from respiratory infections or other immobility complications
    • ALS Management
      Monitor airway
      Pt may be on several devices such as ventilators or feeding pumps - IV ports - ask pt family abt them
    • Bell Palsy
      Paralysis of facial muscles due to inflammation of the facial nerve (cranial nerve 7)
      • Episode is sudden & can easily be confused w/ stroke - one sided
      • S&S: eyelid ptosis, facial droop or weakness, excessive salivation, loss of ability to taste - episode can last up to 2wks to 2mo
      • Management: corticosteroid to reduce inflammation in addition to analgesics
    • Dystonia
      Severe, abnormal muscle spasms that cause bizarre contortions, repetitive motions or postures
      • Can be a sign of another condition or be a condition itself
      • Doesn't impact pt's LOC
      • Primary happen for unknown reason
    • Dystonia Assessment

      Spasms are involuntary & are often painful
    • Dystonia Management
      Prehospital care is focused on ruining out other conditions - seizures, strokes or reactions to psychiatric medications
      • if it's a reaction to an antipsychotic medication then Benadryl 25mg (diphenhydramine) - ineffective in primary dystonia
      • Pain management may be appropriate
    • Encephalitis
      Inflammation of brain
      Presentation: fever, HA, N/V, & general malaise
      • As condition progresses - changes in LOC, include behavioral & personality changes, stiff neck, photophobia, confusion, lethargy
    • Meningitis
      Inflammation of the meninges - the outer covering of the CNS
      • Bacterial: upper respiratory infection, as it progresses pt has HA, still neck, fever, chills, seizures, inc. ICP
      • Infants: bulging fontanelles. high-pitched cry
      • Viral: similar to bacterial except inc. ICP is not seen
    • Encephalitis & Meningitis Management

      Prehospital care is supportive
      • Meningitis: place a mask over mouths
    • Abscesses
      Caused by infectious agent within the brain or spinal cord - destroys tissue.
      • Immune system tries to kill pathogen - if not body created a wall to prevent pathogen from spreading
    • Abscesses Assessment & Management
      • Look for a low- or high-grade fever, persistent HA, drowsiness, confusion, generalized or focal seizures, N/V, hemiparesis, stiff neck
      • Manage S&S - pay attention to inc. ICP, seizures
      • Manage temp
    • Poliomyelitis & Postpolio
      A viral infection transmitted by fecal oral route - vaccine developed, so pt with it have no been immunized
      • S&S: happen after 1wk of exposure - sore throat, N/V, stiff neck, diarrhea, muscle weakness, or paralysis
      • Management: Hydration, ventilation, airway support
    • Peripheral Neuropathy
      A group of conditions where nerves leaving spinal cord damaged. Signals moving to or from the brain become distorted
      • Causes: trauma, toxins, tumors, metabolic disorders. autoimmune attacks
      • Assessment: loss of sensation, numbness, burning, pain, muscle weakness, paresthesia (sensation of tingling, skin-crawling)
      • Management: Supportive
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