Chapter 34-Chronic and Neurodegenerative Disorders (Davis)

A nurse is caring for a patient diagnosed with tension headaches. Which signs and symptoms would you expect? Select all that apply. -Bilateral pain -Mild to moderate pain -Rhinorrhea -Stabbing pain -Headache preceded by an aura

-Bilateral pain -Mild to moderate pain

David is a retired football player who has been recently diagnosed with a neurological disorder. The first signs and symptoms included weakness of his extremities and speech changes. David's disease is progressing; he now experiences dysphagia and muscle spasticity. His treatment plan is designed to manage his symptoms, as there is no cure. What disorder does David have?

Amyotrophic lateral sclerosis CORRECT. ALS is a progressive neurodegenerative disorder involving both the upper and lower neurons. It causes gradual loss of control of the muscles. Signs and symptoms include muscle weakness, atrophy, and dysphagia. Sensation remains intact. There is no cure; care is supportive.

What is the cause of multiple sclerosis? -Lack of dopamine production -Sudden discharge of electrical activity in brain -Autoimmune attack of myelin sheath of neurons -Autoimmune attack of acetylcholine receptors

Autoimmune attack of myelin sheath of neurons

Kathy arrives at the physician's office with a primary complaint of headaches that awaken her at night. With further questioning, Kathy states that she also experiences headaches during the day. The pain is dull and throbbing, but she has noticed whenever she bends over to pick something up, the headache worsens. When the physician conducts a cranial nerve assessment, an abnormality in cranial nerve V on the right side of the face was noted. What condition may Kathy be experiencing?

Brain tumor headache CORRECT. Although signs and symptoms of brain tumors may vary, a headache like Kathy described can be a primary symptom. Brain tumors can also compromise cranial nerve function.

The production of which neurotransmitter is disrupted in Parkinson's disease? -Dopamine -Acetylcholine -Serotonin -GABA

Dopamine

Which condition is associated with seizures? -Myasthenia gravis -Epilepsy -Parkinson's disease -Multiple sclerosis

Epilepsy

Several months ago, Julianne had gastroenteritis. Since that infection resolved, she has been healthy until a few days ago when she started having weakness in her extremities. She is now having difficulty walking. After running diagnostic tests, her physician expects her to fully recover. What disorder does Julianne most likely have?

Guillain-Barré syndrome CORRECT. Guillain-Barré syndrome is a postinfectious disease with resulting neuropathy that manifests with ascending paralysis. Treatment is largely supportive as full recovery is expected.

The pathophysiology of Maggie's condition occurs in stages: neural hyperexcitability, cortical spreading depression, trigeminovascular complex activation, and continued sensitization of the trigeminovascular complex. She experiences throbbing pain, usually on the right side of her head. While in pain, she lays down in a dark, quiet room to not exacerbate the pain. What disorder causes Maggie's pain?

Migraine CORRECT. Current theories on the pathophysiology of migraines propose four stages: prodrome (neural hyperexcitability), aura (cortical spreading depression), pain (trigeminovascular complex activation), and postdrome (continued sensitization of the trigeminovascular complex). Pain is often described as throbbing and occurs on one side of the head. The pain may be accompanied by nausea, vomiting, photophobia, and phonophobia.

Which neurodegenerative disorder is due to an autoimmune response? -Alzheimer's disease -Epilepsy -Parkinson's disease -Multiple sclerosis

Multiple sclerosis

Claire's diagnosis was confirmed after imaging studies showed the appearance of lesions of demyelination and cerebrospinal fluid tested positive for immunoglobulins. Her autoimmune disorder causes motor and sensory weakness. Claire is experiencing problems with her vision and is having trouble with balance. What disorder does Claire have?

Multiple sclerosis CORRECT. MS is a progressive, autoimmune, demyelinating disorder. It causes damage to myelin and cells within the CNS and ANS. Signs and symptoms include motor and sensory weakness, visual problems, balance issues, and gait problems. It cannot be diagnosed based on symptoms. Confirmation requires evidence of demyelination on imaging studies.

Amber is surprised at how tired she has been feeling recently. Even the smallest activities appear to drain her energy. Lately, commuting to work is exhausting. She has even noted she has difficulty keeping her eyes open while reading. Amber makes an appointment with her physician. Her physician is especially concerned about Amber's complaint of not being able to keep her eyes open. The physician orders antibody tests. What condition does the physician suspect?

Myasthenia gravis CORRECT. Myasthenia gravis is an autoimmune condition, in which antibodies are produced that attack acetylcholine receptors on skeletal muscle. As receptors are destroyed, acetylcholine is no longer able to stimulate the muscle to contract efficiently, leading to a sensation of severe fatigue.

Make the connection. For each patient, you will be given pieces of the puzzle. Consider the pathophysiology, clinical manifestations, and treatment and how they relate. Drag and drop the disorder that matches the patient data. Michael's disorder initiates in substantia nigra of basal ganglia. His disorder causes slow movements and muscle rigidity. He often experiences a pill-rolling tremor. He is currently on dopamine replacement therapy. What disorder does Michael have?

Parkinson's disease CORRECT. Parkinson's disease results from disrupted dopamine production in the basal ganglia. Depletion of dopamine results in an imbalance of acetylcholine (which stimulates muscle movements) and dopamine (which inhibits muscle movements). This causes a triad of symptoms: tremors, bradykinesia, and muscle rigidity. Treatment is mainly focused on dopamine replacement therapy.

Dan, age 27, visits his primary care provider about a recent history of headaches. He says that when he gets a headache, he feels "restless" and the pain feels like an ice pick. He sometimes has a stuffy nose and notices that his right eye gets red. He never vomits. What disorder is consistent with Dan's signs and symptoms?

Trigeminal autonomic cephalgia CORRECT. Trigeminal autonomic cephalgia is caused by activation of the trigeminovascular system. Activation causes pain that is often described as an "ice pick." The person may be unable to sit quietly. Pain may be accompanied by rhinorrhea, tearing, and ipsilateral redness in the eye. Cluster headaches, a form of trigeminal autonomic cephalgia, most often affect males between the ages of 25 and 50.