Neuro patho

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Neuro patho
2013-03-26 15:23:18
BC Boston College CRNA patho

BC Boston College CRNA patho
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  1. Name some examples of neurotransmitters and where they act in the body.
    • Acetylcholine
    • Norepinephrine
    • GABA
    • Seratonin
    • Dopamine
  2. What is TBI?
    Blow or Jolt to the head or a penetrating head injury that disrupts the function of the brain.
  3. Are TBI's confined to a specific set of symptoms?
    no, they have a broad spectrum of disabilities and symptoms.
  4. What tool is used to classify TBI?
    glasgow coma scale
  5. What are the two types of TBI?
    • Primary or direct
    • Secondary (caused by swelling, hypoxia, etc)
  6. What is tetrapelgia?
    Lesions involving 1 of the cervical segments dysfunction of both arms, both legs, bowel and bladder
  7. What is parapelgia?
    Lesion involving the thoracic lumbar or sacral results in dysfunction of the lower extremities bowel or bladder
  8. What is meant by complete lesion?
    Implies total loss of sensation and voluntary muscle control
  9. What is implied by an incomplete lesion?
    Preservation of sensory or motor fibers or both below lesion are classified according to area of damage: central, lateral, anterior, or peripheral
  10. If someone is a quadraplegic what the level of their injury?
  11. If someone is a paraplegic what the level of their injury?
  12. If the level of injury is at T1 where is the expected paralysis?
  13. Name some examples of primary TBI.
    • diffuse axonal injury
    • focal lesions of laceration
    • contusion
    • hemorrhage
  14. Name some examples of secondary TBI.
    • Diffuse or multifocal
    • concussion
    • infection
    • hypoxic brain injury
  15. Types of focal TBI:
    • contusions & hemorrhages
    • epidural (extradural) hematoma
    • subdural hematoma
    • intracerebral hematoma
  16. Differentiate coup and contra coup.
    • coup = damage to the tissue from the point that the force was applied
    • contracoup = damage to tissue on the opposite side from where the force was applied.
  17. What are the three classes of Diffuse axonal injury and what are their characteristics?
    • Mild:coma 6-24 hours, follow commands by 24. Outcome death uncommon, neurological deficits common
    • Moderate:coma>24 hours without prominent brainstem signs Outcome incomplete recovery of those who survive
    • Severe:coma prolonged with brainstem signs (decortication, Decerebration) Outcome: death severe disability
  18. What is the treatment goal for acute ischemic stroke?
    • Restore blood flow ASAP
    • tPA needs to be started within 3 hrs of onset of symptoms
  19. What should the CCP be in a pt with TBI?
    no less than 60 mmHg
  20. What are the primary goals for initial treament of the TBI pt?
    • Stabilazation of vitals
    • Prevention of further injury
    • reduction of increased ICP
  21. In TBI we should not exceed a MAP of _____?
    120 mmHg (according to an article I read. They also stated that this level should only be refereced assuming there is no ICP monitoring in place.)
  22. Differentiate the characteristics between persistent vegitative state, brain death and minimall conscious state.
    • PVS pt retains protective reflexes, sleep wake cycle, spontaneous eye opening.
    • braindeath indicates cessation of brain activity
    • MCS inconsistent evidence of perception and communication, eyes open sometimes.
  23. What are the typical signs of Inc ICP?
    • Cushings triad
    • -HTN
    • -decreased RR
    • -decreased Hr
  24. What is a seizure?
    single event of abnormal discharge in the brain that results in an abrupt and temporary altered state of cerebral function
  25. What is epilepsy?
    chronic disorder of abnormal, recurrent, excessive and self terminating discharge from neurons
  26. What is status epilecticus?
    continuous seizure lasting at least 5 minutes or 2 or more discrete seizures with incomplete recovery of consciousness
  27. What are the classifications of seizures and what location(s) are they associated with?
    • partial: 1 part of the brain
    • generalized: firing in both hemispheres
    • unclassified: not mentioned in the ppt
  28. What are the three types of partial seizures?
    • simple: consciousness not impaired
    • Complex: consciousness impaired
    • Evolving into secondary generalized
  29. What are they 6 types of generalized seizures?
    • Absence: common in children, interrupt consciousness but not postural control
    • Clonic: repetitive rhythmic that are bilateral and symmetric
    • Tonic: stiffening musculature
    • Tonic-clonic: most common
    • Atonic: abrupt loss of postural control
    • Unclassified
  30. Name a few of the proposed pathophysiology pathways thought to cause seizures?
    • Alterations in cell permiability
    • decreased inhibition of cortical or thalamic neuronal activity
    • neurotransmitter imbalances
  31. What is the patho of parkinsons disease?
    depletion of dopamine via degeneration of basal ganglia cells
  32. What are the classic characteristics of parkinsonism?
    • Tremor
    • Rigidity
    • Bradykinesia
  33. What is the patho of ALS?
    • Degenerative changes to nerve:
    • -UMN: spasticity reduced muscle strengths
    • -LMN: flaccidity, paralysis and muscle atrophy
  34. What functions remain unchanged in ALS?
    intellect, sensory, vision, hearing, bowel/bladder
  35. What is the patho of MS?
    • Damage to myelin (vesicular demyelination)
    • Breakdown of myelin sheath
    • Proliferation of myelin producing cells
    • Many of the olgiodendrocytes are destroyed by T cells and macrophages
    • Surviving olgiodendrocytes may PARTIALLY remyelinate
    • Lesions can form
  36. What deficiency is associated with neural tube defects?
    maternal folic acid
  37. What is the eitiology of spina bifida?
    essentially unknown
  38. What is hydrocephalus?
    Damage to flow or absorption of CSF
  39. What does hydrocephalus do the brain?
    Direct pressure causes degeneration of surrounding white matter, resulting in neuro changes such as declining memory and cognitive ability.
  40. Can hydrocephalus cause coma?
  41. Generally what is the cause of congenital hydrocephalus?
    noncommunicating CSF from structural lesions
  42. What is the cause for acquired hydrocephalus?
    Subarachnoid hemorrhage, meningitis, head injury and neoplasia.
  43. What is normal pressure hydrocephalus?
    inc pressure causing enlargement of ventricles without raising ICP