Neural and Psychological Conditions - NCLEX-PN

Migraine headaches are commonly treated at first by over the counter (OTC) medications such as NSAIDS and acetaminophen. Other treatment options include triptans, antidepressants such as amitriptyline, and anti-hypertensives (beta blockers and calcium channel blockers).

Petasites hybridus (butterbur) is a flowering plant of the family asteraceae. It has been shown in studies to reduce the frequency of migraine headaches by as much as 68%. None of the other herbs listed have any significant medicinal benefit in migraine headaches.

One non-pharmaceutical intervention that has shown to provide relief for a significant number of individuals with cluster headaches is 100% oxygen, delivered via mask at a minimum of 12 liters per minute. Relief can be felt in as little as 15 minutes. None of the other interventions mentioned would be likely to improve symptoms of a cluster headache.

Bell's palsy is due to dysfunction of cranial nerve VII, the facial nerve. The facial nerve provides motor control to the musculature of the face and sensory innervation of taste, facial sensation, and parasympathetic innervation of the submandibular and sublingual glands.

While Bell's palsy is most frequently associated with prior infection with herpes simplex 1, is may also be associated with cytomegalovirus, Epstein Barr virus, and herpes zoster.

In the vast majority of cases Bell's palsy resolves within 1-6 months without medical intervention. Moistening of the affected eye (rather than nerve resection) is required during this period to prevent corneal damage. There is very little risk of permanent paralysis or loss of taste.

The most common causes of seizures include brain injury or tumor, genetic predisposition, medications, and infections such as meningitis. While marijuana may be a trigger for sensitive individuals with seizure disorders, it has not been known to cause seizures in a non-epileptic individual and has shown to reduce seizure incidence in some individuals with this condition when used in a medical setting.

The most commonly prescribed medication for absence seizures is Ethosuximide. Lamotrigine and valproic acid may also be used if seizures are unable to be controlled with ethosuximide. Carbamazepine, a common medication prescribed for simple and complex partial seizures, is specifically contraindicated in absence seizures.

Benzodiazepines are the mainstay of treatment for alcohol withdrawal. Anti-epileptic drug (AEDs) are not to be used during alcohol withdrawal, and are reserved for patients who have a true seizure disorder. The Clinical Institute Withdrawal Assessment for Alcohol (CIWA) protocol is used as symptom based therapy with benzodiazepines to prevent seizures and other complications from withdrawal.

Cauda equina syndrome is a serious condition in which the cauda equina is disturbed within the spinal cord, generally due to impingement, trauma, local lesion, or compression. The first-line treatment is surgical decompression. Neither physiotherapy nor muscle relaxants would address the cause of this condition, and chiropractic manipulation may actually exacerbate the symptoms.

The most common artery occluded in ischemic stroke is the middle cerebral artery, which supplies a large percentage of the frontal lobe and the lateral surface of the temporal and parietal lobes. Occlusion of this artery affects the motor and sensory areas of the face, throat, arm, hand and the areas for speech.

Hypertension is a leading etiology in intracerebral hemorrhagic stroke. Chronic hypertension can cause damage and stress to the blood vessel wall, leading to aneurism or increased risk of spontaneous rupture.

AVM, trauma, and medications such as blood thinners are all also responsible for a significant (though lesser) number of hemorrhagic strokes, or may be co-morbidities that increase the risk of a rupture in the presence of prolonged hypertension.

Hypogeusia is a condition of reduced sensitivity to taste. This may be due to various causes, including brain injury, viral infection, zinc deficiency, certain medications such as chemotherapeutic agents or antibiotics.

Dysgeusia and parageusia both describe alterations in the perception of taste. These conditions can have similar etiologies to hypogeusia. Ageusia is the total absence of taste perception.

Third nerve palsy (cranial nerve III, the oculomotor nerve) is the most common cranial mononeuropathy seen in diabetic patients. They will present with ptosis, dilated and fixed pupils, and an outward and slightly downward deviation of the eye. Bell's palsy involves unilateral facial paralysis as a result of damage to the facial nerve (cranial nerve VII). Cranial mononeuropathy VI is caused by damage to the abducens nerve (cranial nerve VI). Signs of damage include inability to laterally rotate the eye and/or double vision. Auditory neuropathy may be a result of damage to the vestibulocochlear nerve (cranial nerve VIII); the most pronounced symptom is loss of audition.

The symptoms of alcohol withdrawal may include confusion, disorientation, and anxiety. Hypersomnolence or excessive sleep is not associated with this condition. Additional symptoms may include agitation, hypervigilance, tremor, rapid and irregular heart beat, hypertension, seizure, and hallucinations (mostly visual).

Wilson's disease is characterized by a defect of copper excretion, leading to copper overload and feedback inhibition of ceruloplasmin synthesis. This results in copper accumulation, primarily in the liver and the brain. Signs and symptoms include liver failure, cognitive deterioration, clumsiness, and changes in behavior. Symptoms often start in adolescence, but can start any time between 6-20 years old. Aceruloplasminemia is a rare condition of iron accumulation in the basal ganglia, retina, and liver. Hereditary hemochromatosis is also a disorder of iron accumulation, often caused by mutations in the HFE gene. Huntington disease is a genetic neurodegenerative disease unrelated to any mineral storage disorders.

All of the answers given are possible causes of meningitis, but the most common (and least severe) etiology is viral. There is no vaccine for viral meningitis, but there are vaccines for three different organisms that cause bacterial meningitis:

• Neisseria meningitidis (meningococcus)
• Streptococcus pneumoniae (pneumococcus)
• Haemophilus influenzae type b (Hib)

Approximately 80% of strokes are ischemic, either caused by thrombus or emboli. Hemorrhagic strokes only account for approximately 15% of all strokes, but are significantly more lethal and account for 30% of all stroke deaths. They involve the rupturing of a weakened blood vessel in the brain and subsequent bleeding in the surrounding areas. Transient ischemic attacks are not considered true strokes, and are often referred to as "mini strokes."

These symptoms are evidence of autonomic dysreflexia, which is a sequela of spinal shock. It is a medical emergency and requires immediate intervention as it may lead to stroke, cardiac arrest, coma or death if untreated.