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Name some examples of neurotransmitters and where they act in the body.
What is TBI?
Blow or Jolt to the head or a penetrating head injury that disrupts the function of the brain.
Are TBI's confined to a specific set of symptoms?
no, they have a broad spectrum of disabilities and symptoms.
What tool is used to classify TBI?
glasgow coma scale
What are the two types of TBI?
- Primary or direct
- Secondary (caused by swelling, hypoxia, etc)
What is tetrapelgia?
Lesions involving 1 of the cervical segments dysfunction of both arms, both legs, bowel and bladder
What is parapelgia?
Lesion involving the thoracic lumbar or sacral results in dysfunction of the lower extremities bowel or bladder
What is meant by complete lesion?
Implies total loss of sensation and voluntary muscle control
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
If someone is a quadraplegic what the level of their injury?
If someone is a paraplegic what the level of their injury?
If the level of injury is at T1 where is the expected paralysis?
Name some examples of primary TBI.
- diffuse axonal injury
- focal lesions of laceration
Name some examples of secondary TBI.
- Diffuse or multifocal
- hypoxic brain injury
Types of focal TBI:
- contusions & hemorrhages
- epidural (extradural) hematoma
- subdural hematoma
- intracerebral hematoma
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.
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
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
What should the CCP be in a pt with TBI?
no less than 60 mmHg
What are the primary goals for initial treament of the TBI pt?
- Stabilazation of vitals
- Prevention of further injury
- reduction of increased ICP
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.)
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.
What are the typical signs of Inc ICP?
- Cushings triad
- -decreased RR
- -decreased Hr
What is a seizure?
single event of abnormal discharge in the brain that results in an abrupt and temporary altered state of cerebral function
What is epilepsy?
chronic disorder of abnormal, recurrent, excessive and self terminating discharge from neurons
What is status epilecticus?
continuous seizure lasting at least 5 minutes or 2 or more discrete seizures with incomplete recovery of consciousness
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
What are the three types of partial seizures?
- simple: consciousness not impaired
- Complex: consciousness impaired
- Evolving into secondary generalized
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
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
What is the patho of parkinsons disease?
depletion of dopamine via degeneration of basal ganglia cells
What are the classic characteristics of parkinsonism?
What is the patho of ALS?
- Degenerative changes to nerve:
- -UMN: spasticity reduced muscle strengths
- -LMN: flaccidity, paralysis and muscle atrophy
What functions remain unchanged in ALS?
intellect, sensory, vision, hearing, bowel/bladder
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
What deficiency is associated with neural tube defects?
maternal folic acid
What is the eitiology of spina bifida?
What is hydrocephalus?
Damage to flow or absorption of CSF
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.
Can hydrocephalus cause coma?
Generally what is the cause of congenital hydrocephalus?
noncommunicating CSF from structural lesions
What is the cause for acquired hydrocephalus?
Subarachnoid hemorrhage, meningitis, head injury and neoplasia.
What is normal pressure hydrocephalus?
inc pressure causing enlargement of ventricles without raising ICP