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(ions accompany an occipital cortex locus). Seizures can occur as a

complication of CVA, head trauma, meningitis, at sutgety. Febrile

state, hypoxia, hyper- or hypoglycemia, hyponatremja, severe uremia

or hepatic encephalopathy, drug overdose, and drug or alcohol wirhdrawal are also associated with seizure.41 Seizures are classified as partial (originating in a focal region of one hemisphere) or gelleralized

(originating in both hemispheres or from a deep midline focus).

Types of partial seizures include the following":

• Simple partial seizures are partial seizures withour loss of consciousness.

•

Complex partial seizures involve a brief loss of consciousness

marked by motionless staring.

•

Partial seizures with secondary generalization involve a progression to seizure activity in both hemispheres.

Types of generalized seizures include the following4 ' :

•

TOllic seizures are characterized by sudden flexor or extensor

rigidity.

•

TOllic-clonic seizures are characterized by sudden extensor rigidity followed by Aexor jerking. (This type of seizure may be accompanied by incontinence or a crying noise owing to rigidity of the truncal muscles.)

•

Clollic seizures are characterized by rhythmic jerking muscle

movementS without an initial tOnic phase.

•

Atonic seizures are characterized by a loss of muscle tOne.

•

Absellce seizures are characterized by a very brief period (seconds) of unresponsiveness with blank staring and the inability to complete any activity at the time of the seizure.

•

Myoclonic seizures are characterized by local or gross rapid,

non rhythmic jerking movements.

Seizures are of acute onset, with or without any of the following:

aura, tremor, paresthesia, sensation of fear, gustatory hallucinations,

lightheadedness, and visual changes. Medical management of seizures

involves the treatment of causative factor (if possible) and antiepilep-

3 1 8 ACUTE CARE HANDBOOK FOR PHYSICAL THERAPISTS

tic drugs. Surgical management for seizure refractOry to medical management may consist of the resection of the seizure foclls or the implantation of a vagal nerve stimulatOr:n

Terms related to seizure include the following 14.41 :

Epilepsy or seizure disorder. Refers to recurrent seizures.

Status epilepticus. More than 30 minutes of continuous seizure activity or two or more seizures witham full recovery of consciollsness between seizures. Generalized tOnic-clonic status epilepricus is a

medical emergency marked by the inability to susrain spontaneous

ventilation with the potential for hypoxia requiring pharmacologic

and life support.

Prodrome. The signs and symptoms (e.g., smells, auditory hallucinations, a sense of deja vu) that precede a seizure by hours.

Aura. The signs and symptoms (as above) that precede a seizure by

seconds or minutes.

Postictal state. The period of time immediately after a seizure.

Clinical Tip

Establish the seizure history, including prodrome or aura

(if any), for the patient with a recent seizure or epilepsy by

either chart review or interview to be as prepared as possible to assist the patient if seizure activity should occur.

SYllcope

Syncope is the transient loss of consciousness and postural tOne secondary to cerebral hypoperfusion, usually accompanied by bradycardia and hypotension." Syncope can be any of the following43:

•

Cardiogenic syncope, resulting from drug toxicity; dysrhythmias,

such as atrioventricular block or supraventricular tachycardia; cardiac tamponade; atrial stenosis; aortic aneurysm; pulmonary hypertension; or pulmonary embolism

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• Neurologic syncope, resulting from benign positional vertigo,

cerebral atherosclerosis, seizure, spinal cord lesions, or peripheral

neuropathy associated with diabetes mellitus or with degenerative

diseases, such as I'D

•

Reflexive syncope, resulting from carotid sinus syndrome, pain,

emotions, or a vasovagal response after eating, coughing, or defecation

•

Orthostatic syncope, resulting from the side effects of drugs,

volume depletion, or prolonged bed rest

Syncope is diagnosed b)' clinical histOry, ECG, Holter or continuous-loop

event recorder, or tilt-table testing. cr and MRJ are only performed if

new neurologic deficits are found.43 The management of syncope, dependent on the etiology and frequency of the syncopal episode(s), may include treatment of the causative factor; pharmacologic agents, such as

beta-adrenergic blockers; or cardiac pacemaker placement.

NCI/roill(ectiol/s Diseases

Sec Chapter 1 0 for a description of encephalitis, meningitis, and

poliomyelitis.

Common Degenerative Central NerooHs System Diseases

Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS), or Lou Gehrig disease, is the progressive degeneration of upper and lower motor neurons, primarily the motor cells of the anterior horn and the corticospinal tract. The etiology

of ALS is unknown except for familial cases. Signs and symptOms of ALS

depend on the predominance of upper or lower mOtor neuron involvement and may include hypcr-reflcxia, muscle atrophy, fasciculation, and weakness, which result in dysarthria, dysphagia, respiratory weakness,

and immobility'" ALS is diagnosed by clinical presentation and EMG.'

Owing to the progressive nature of ALS, management is typically supportive or palliative, depending on the disease state, and may include pharmacologic therapy Relutek (Riluzole) spasticity control, bronchopulmonary hygiene, and nutritional and psychosocial supporr.34