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Name some examples of neurotransmitters and where they act in the body.
- Acetylcholine
- Norepinephrine
- GABA
- Seratonin
- Dopamine
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What is TBI?
Blow or Jolt to the head or a penetrating head injury that disrupts the function of the brain.
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Are TBI's confined to a specific set of symptoms?
no, they have a broad spectrum of disabilities and symptoms.
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What tool is used to classify TBI?
glasgow coma scale
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What are the two types of TBI?
- Primary or direct
- Secondary (caused by swelling, hypoxia, etc)
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What is tetrapelgia?
Lesions involving 1 of the cervical segments dysfunction of both arms, both legs, bowel and bladder
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What is parapelgia?
Lesion involving the thoracic lumbar or sacral results in dysfunction of the lower extremities bowel or bladder
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What is meant by complete lesion?
Implies total loss of sensation and voluntary muscle control
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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
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If someone is a quadraplegic what the level of their injury?
C4
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If someone is a paraplegic what the level of their injury?
T6
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If the level of injury is at T1 where is the expected paralysis?
Legs
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Name some examples of primary TBI.
- diffuse axonal injury
- focal lesions of laceration
- contusion
- hemorrhage
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Name some examples of secondary TBI.
- Diffuse or multifocal
- concussion
- infection
- hypoxic brain injury
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Types of focal TBI:
- contusions & hemorrhages
- epidural (extradural) hematoma
- subdural hematoma
- intracerebral hematoma
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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.
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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
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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
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What should the CCP be in a pt with TBI?
no less than 60 mmHg
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What are the primary goals for initial treament of the TBI pt?
- Stabilazation of vitals
- Prevention of further injury
- reduction of increased ICP
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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.)
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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.
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What are the typical signs of Inc ICP?
- Cushings triad
- -HTN
- -decreased RR
- -decreased Hr
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What is a seizure?
single event of abnormal discharge in the brain that results in an abrupt and temporary altered state of cerebral function
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What is epilepsy?
chronic disorder of abnormal, recurrent, excessive and self terminating discharge from neurons
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What is status epilecticus?
continuous seizure lasting at least 5 minutes or 2 or more discrete seizures with incomplete recovery of consciousness
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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
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What are the three types of partial seizures?
- simple: consciousness not impaired
- Complex: consciousness impaired
- Evolving into secondary generalized
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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
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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
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What is the patho of parkinsons disease?
depletion of dopamine via degeneration of basal ganglia cells
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What are the classic characteristics of parkinsonism?
- Tremor
- Rigidity
- Bradykinesia
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What is the patho of ALS?
- Degenerative changes to nerve:
- -UMN: spasticity reduced muscle strengths
- -LMN: flaccidity, paralysis and muscle atrophy
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What functions remain unchanged in ALS?
intellect, sensory, vision, hearing, bowel/bladder
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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
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What deficiency is associated with neural tube defects?
maternal folic acid
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What is the eitiology of spina bifida?
essentially unknown
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What is hydrocephalus?
Damage to flow or absorption of CSF
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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.
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Can hydrocephalus cause coma?
Yes
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Generally what is the cause of congenital hydrocephalus?
noncommunicating CSF from structural lesions
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What is the cause for acquired hydrocephalus?
Subarachnoid hemorrhage, meningitis, head injury and neoplasia.
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What is normal pressure hydrocephalus?
inc pressure causing enlargement of ventricles without raising ICP
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