REPASO NEUROLOGIA ENARM
Short Description
Repaso Neuro Enarm...
Description
NEUROLOGIA RUTH GPE. GONZÁLEZ ALVARADO ALVARADO
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COMA
SRA
LOS NIVELES DE CONCIENCIA DEPENDEN DE LA ACTIVACIÓN DE LOS HEMISFERIOS CEREBRALES POR GRUPOS NEURONALES LOCALIZADOS EN EL SRA.
HEMISFERIOS Localiza en la formación reticular comprendida entre la porción rostral de
COMA
Mecanismos : 1-lesiones estructurales
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CAUSA MAS FRECUENTE -Los
trastornos metabólicos. Sin signos de focalidad con función tronco encefálica intacta
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SIGNOS DE VALOR LOCALIZADOR Respiración de Cheyne-Stoke
Hiperventilación con periodos mas cortos de apnea Hiperventilación Neurógena
PATRON RESPIRATORIO
-Respiración Apnéustica
Inspiración mantenida, seguida de espiración y pausa
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El patrón respiratorio de Cheyne-Stokes; pueden aparecer también también en uremia y en la insuficiencia cardiaca congestiva. El patrón respiratorio de kussmaul;
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La forma, tamaño, simetría y respuesta a la luz son de valor localizador en la función función troncoencefa troncoencefalica lica o del III par
Mióticas Mióticas reactiv reactivas as Midriáticas arreactivas
PUPILAS
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Pupilas midriáticas
Lesión Mesencefálica
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MOVIMIENTOS OCULARES -Reflejo corneal
-Movimientos oculares espontáne espontáneos os
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Oftalmoplejia internuclear lesión del
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POSTURAS REFLEJAS
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Estados de pseudocoma Falta de respuesta psicógena
En la escala de Glasgow la respuesta motora es, a su vez, el
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CORRELACIÓN CORRELACIÓN ANATOMO ANATOMO CLINICA DE LAS DEMENCIAS CORTICALES ANATOMIA
CLINICA
SUBCORTICALES
-Corteza de lóbulos frontales, temporales y parietales -Hipocampo
-Núcleos grises profundos del diencéfalo
-Afasia -Apraxia -Agnosia -Acalculia
-Retardo psicomotor -Movimientos anormales -Disartria -Alteraciones posturales
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DIAGNOSTICO °CLÍNICO °ANALÍTICA °ANALÍTICA COMPELTA: COMPELTA: -BH,ES,QS, -BH,ES,QS, PFH, PFT -NIVELES DE B12 -SEROLOGÍA PARA PARA VIH Y SÍFILIS. ° RM CARACTERISTICO;
ESTUDIOS NEUROLÓGICOS: -Minimental test; SE CALIFICA DE 0 A 30 PUNTOS *Memoria - NORMA ORMALL = 27 A 30 P *Orientaciontemporoespacial - DETE DETERI RIOR ORO O COGNIT COGNITIV IVOL OLIG IGER ERO O *Lenguaje 24 A 27 P *Escritura - DEME DEMENC NCIA IAPO PORR DEB DEBAJ AJO O DE DE LOS LOS *Lectura 24 P *Calculo *Praxis visuoespaciales visuoespaciales e ideomotoras ideomotoras
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DEMENCIA SENIL -CAUSA MAS FRECUENTE DE DEMENCIA -INICIO DE LOS SINTOMAS 65 AÑOS - PRESENTAC PRESENTACION ION FORMA FORMA HEREDITARIA 5 A 10% AFECCION AP; DEGENERACIÓN PROGRESIVA Y SELECTIVA -CÓRTEX ENTORRINAL -HIPOCAMPO -CORTEZAS TEMPORAL, FRONTAL Y
Solo un 5% de los casos se debe a mutaciones: La mayoría de los casos son esporádicos y debutan tardíamente; FR asociados; -Vulnerabilidad -Vulnerabilid ad genética: presencia del alelo E4 de la apoliprot apoli proteina eina E C19 C19 -Edad; incidencia y prevalencia se
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HISTOLOGICAMENTE HISTOLOGICAMEN TE : OVILLOS O MADEJAS NEUROFIBRILARES PROTEINAS -TAU (HIPERFOSFORILACION) -UBIQUITINA -PLACA DE AMILOIDE (placas seniles o neuríticas) Hipocampo y lóbulo temporal Acúmulos Acúmul os de proteína proteína B- amilo amiloide. ide. Frecuentes en el hipocampo y lóbulo temporal.
Inicio incidioso y progresión Inicio progresión lenta: Clínica: evolución media de unos 8 o10 año de inicio hasta la muerte Periodo preclínico: errores puntuales de memoria, capacidad de la memoria reciente FASE INICIAL -Capacidad de aprendizaje -Recuperación de episodios lejanos -Alteración del lenguaje EA Progresiva : alteración nominación, perdida de la capacidad para reconocer objetos, personas o lugares. FASE MEDIA -Apatía
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DIAGNOSTCO CRITERIOS ( DIANOSTICO Y ESTADISTICAS , MANUAL DE DESORDENES MENTALES )
0 1 Déficit Cognitivo Cognitivo E I A-a1Déficit de la memoria C a2 Deterioro Al menos uno de; afasia, apraxia, , V I agnosia B- Déficit Déficit Cognitivo Cognitivo del apartado apartado A causan Mun deterioro significativo laboral y social S C- El comienzo comienzo es gradual gradual y el curso curso D continua
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SOLO RECOMENDADA RECOM ENDADA PARA PARA DX DIFERENCIALES DE OTRAS DEMENCIAS
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RECUERDA Lass pse La pseudo udodem demenc encias ias son
La principal diferencia entre
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DEMENCIA FRONTOTEMPORAL
•
Histológicamente; datos caracteristicos
1 NEURONAS DE PICK; Neuronas tumefactas, pálidas y localizadas en los
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DEMENCIA
Diagnostico; 3 elementos -Pérdida de función
ESCALA -Inicio súbito
2
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Meningismo con deterioro cognitivo y focalidad neurológica es indicativo de encefalitis.
RECUERDA
La presencia de abundantes hematíes en el LCR orienta a encefalitis necrohemorrágica por herpes simple.
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ENFERMEDADES NUTRICIONALES Y METABOLICAS DEL SISTEMA NERVIOSO ENCEFALOPATIA DE WERNICKE: ETIO: Pacientes alcohólicos, y malnutridos debido a un déficit de vit B1. CC: Triada Triada de oftalmopareci axia
ENERMEDADE NEUTOLOGICAS
PRUEBAS COMPLEMENTARIAS: LCR; es normal o muestra una mínima elevación de proteínas. EEG: Actividad lentificada en forma difusa.
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DEGENERACION SUBAGUDA COMBINADA DE LA MÉDULA -Se produce por déficit de vitamina B12 Incapacidad para absorber vitamina de la dieta -Debido a la ausencia de factor intrínseco en la secreción de gastrina -Presente; anemia megaloblástica
CC: sintomatología neurológica; Inicia: parestesias distales en miembros Clínica secundaria: secundaria: afección de los cordones posteriores (perdida de la sensibilidad vibratoria MI) cordones laterales de la medulares(paraparesia medulares(parapar esia espástica) Marcha atáxica y post
PELAGRA Producida por deficiencia de niacina o acido nicotínico Manifestaciones sistémicas : - 3 D; DE DERM RMA ATI TITI TISS, DIARREA Y DEMENCIA -Manifestaciones Neurológicas;
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TEST DE SCHILLING Primera Fase: Se administra cobalamina cobalamina marcada, y se cuantifica su excreción en orina. Los pacientes afectados afectados por mala absorción apenas elimina un 2% de la cantidad total ingerida. (Debido (Debido al déficit de factor intrínseco no se absorbe, por lo que no pasa a circulación sanguínea) Segunda Fase: Se administra Cobalamina marcada además de factor intrínseco. intrínseco. Si se padece de mala absorción, al
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RECUERDA: ENVEFALOPATIA DE WERNICKE Triada clásica (oftalmoparesia, ataxia y síndrome confusional ) las manifestaciones aparecen y desaparecen en el mismo orden. Antes de administrar solución glucosada a un paciente alcohólico, hay que administrar
para el diagnostico de déficit de b12, no es necesario q existan alteraciones en sangre periférica.
El déficit de niacina produce pelagra, la
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CEFALEAS
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MIGRAÑA
SUBTIPOS CLINICOS : Migraña con aura aura o migraña migraña clásica;
COMPLICACIONES: MIGRAÑA CRONICA: Más de 15 episodios al
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CRITERIOS DIAGNÓSTICOS SIMPLIFICADOS PARA LA MIGRAÑA CON O SIN AURA Migraña sin aura
Al menos 5 episodios, cumpliéndolos siguientes criterios .Duración del episodio de 2-72hrs (sin tx o tratada sin éxito)
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Preventivo (si la frecuencia es superior a dos episodios al mes)
T R
Ataques leves moderados: AINES ( AAS, naproxeno, o ibuprofeno
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NEUROCIRUGIA
ETIO: -Traumatismos cráneo encefálico: Hematoma epidural
PIC ; Dx: monitorización de la PIC; Sensores colocados intraparenquimatosos, intraventricular, epidural o
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