Neuro Functioning

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Neuro Functioning
2014-12-01 00:49:13

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  1. What are the acute disorders of the brain?
    • Mechanisms of brain injury: ischemic, increased intracranial pressure, reperfusion injury, auro regulation.
    • Traumatic Brain injury: intracranial hematomas.
    • Cerebrovascular disease and stroke.
    • Cerebral aneurysm and arteriovenous malformation.
    • Central nervous system infections: Meningitis, encephalitis, and brain abscess.
  2. 1) ischemia? 2) reperfusion injury?
    • 1: it results in immediate neurological dysfunction due to the inability of the neurons to generate ATP (usually manifestations occur 3 to 5 mins). -- it results in mitochondrial failure, ATP depletion, n accumulation of intracellular calcium ion.
    • 2: inflammatory cells increase edema of the area where the ischemia happened. when O2 reenters the cell, the exchange of e can cause factors that act as free-radicals.
    • ischemia --> cell hypoxia --> mitochondrial failure --> decease ATP and sequestration od Ca2+ --> calcium overload --> free radicals --> cell death.
  3. autoregulation?
    • regulate the flow and maintain perfusion. But hypoxia and high CO2 cause dilation of the cerebral vessels.
    • Solution: hyperventilate the pt to lower CO2 (induced coma) so that there is more space for the swelling to occur.
  4. increased intracranial pressure chts? causes? CM? what is decorticate? and decerebrate?
    • The normal volume of the cranium is: brain tissue, cerebrospinal fluid (CSF) and blood. IICP can occur from space-occupying lesions (hemorrhage, tumor, etc)
    • causes: increased brain tissue volume (brain tumor, bleeds, and concotions) -- increased cerebrospinal fluid (hydrocephalus) -- increased blood volume (stroke).
    • IICP results in compression of vessels and brain tissue leading to ischemia and brain damage.
    • CM: pupils respond differently. headache, projectile vomiting (w/o nausea), widening pulse pressure, and bradycardia.
    • As IICP LOC decreases, pupils response decreases, etc.
    • Decorticate: flexor posturing indicating corticospinal lesion. (hands on chest)
    • Decerebrate: posturing indicating brain stem injury. (hands on the side)

  5. brain compression and hernia? glasgow coma scale?
    • transtentorial herniation: tissue swelling presses down on the tentorial, which in turn, presses down on the brain stem. Type of hernia that kills ppl instantly.
    • coma scale: standardized tool for assessing LOC in acutely brain-injured persons. (mild: 13-15, moderate 9-12, severe <8)
  6. trauma brain injury (TBI) chts? types? concussion vs contusion?  intracranial hematomas MOI? types?
    • severity is classified w the Glasglow coma scale.
    • types: primary injury and intracranial hematomas.
    • primary injury: focal (at the site of the impact), polar (front to back, right to left- accelerated and decelerated), and diffuse (injury in most parts of the brain- shaking baby syndrome)
    • intracranial hematomas: epidural, subdural, subarachnoid.
    • concussion: alteration or loss of consciousness (<30 mins) but no evidence on brain damage on CT scans.
    • Contusion: CT or MRI reveals an area of brain tissue damage.
    • MOI: blunt (closed, non-penetrating, doesn't compromise the dura), penetrating (open, compromises the dura), compression.
    • Epidural: b/t the skull and the dura, usually arterial bleeding-rapid bleeding.-- CM: brief period of disturbed consciousness, then normal cognition, then deteriorates.
    • Subdural: above the archnoid and below the dura. Venous bleeding.-- CM:  no CM for a couple of days, 
    • Subarachnoid: under the arachnoid, cerebral spinal fluid and veins.-- associated w aneurysms or arteriovenous malformation (arteries connected to veins directrly)-- CM: caused bu meningeal irritation, hydrocephalus, etc.
  7. Cerebrovascular disease and stroke chts? types?
    • it causes abnormality of cerebral perfussion.
    • types: transient ischemic attacks (TIA), ischemic stroke, and hemorrhagic stroke.
    • TIA: ppl w chronic HTN, and elderly. Usually they are fine within 24 hrs.-- causes: atrial fib, valve disease, etc.
    • Ischemic stroke: if anoxia lasts for more than 10 mins causes irreversable damages. thrombolitic (plactola, atherosclerosis, assess carotids >50 age) ppl w high cholesterol, paque, etc.-- embolitic(atrial fib, valvular disease, hypercoagulable state).
    • Hemorragic stroke: significant IICP. causes B primary and secondary. ppl w HTN and structural abnormalities.
  8. Stoke sequelae in motor and sensory? language? cognitive?
    • Motor: flaccidity or paralysis; contralateral to the side of the brain where the stroke occurred.
    • Sensory: disturbances occur in same locations as motor paralysis and may involve neglect or visual impairment.
    • language: aphasia (loss of ability to understand or express) occurs. 
    • Broca aphasia (expressive): pt understands but they can't reply.
    • Wernicke aphasia (receptive): pt doesn't understand what u r saying.
    • Cognitive: depends on where the stroke happened. language impairment, impaired spatial relationship skills, and short-term memory, an poor judgment.
  9. Frontal, central, pariental, occipital lobes functions?
    • frontal: cognitive and personality behavior. 
    • Pariental: motor and sensorym language.
    • occipital: vision.
    • Temporal: hearing, memory, speech.
  10. cerebral aneurysm vs arteriovenous malformatio
    • cerebral aneurysm: the most severe headache they have ever had. -- berry aneurysm (aneurysm in the circle of willis)
    • AVM: pts are present w seizures and neurological dysfunction.-- they have not developed normal arterial, capillary, venous, goes from artery to venous.
  11. CNS infections?
    • Meningitis: viral and bacterial -- CM: fever, vomiting, positive kernig's sign and Brudzinski sign, etc.
    • Viral: usually self-limiting w complete recovery (usually caused by herpes) Most ppl don't even know they have had it.
    • Bacterial: leaves residual effects (neisseria meningitis, streptococcus, haemophilus)
    • Encephalitis: inflammation of the brain commonly caused by West nile virus, western encephalitis, and herpes simplex. -- transfer usually from mosquito to animal to humans. -- CM: cerebral edema, headache, fever, confusion, convulsions. -- Manatol is the DOC.
    • Brain absecess: presents as space-occupying lesion w changes in LOC due to pus forming bacteria. -- associated w sinusitis and mastoiditis (in children)-- organisms: strep, staph, and anaerobes.
  12. Chronic Disorders of neurologic function?
    • Brain and cerebellar disorders:
    • Seizure disorder/epilesy
    • Dementia
    • Parkinson's Disease.
    • Cerebral Palsy.
    • Hydrocephalus.
  13. Seizures disorders/epilepsy chts? etiologies? Classification?
    • it it the alteration in electrical charges in the brain due to different reasons, hypoglacimia, cerbral injury, lesions, etc.
    • Occurs in a nonsynchronized manner.
    • Etiologies: genetic, acquired from pathological conditions, head injury, infections, drugs, etc. 
    • Classification:
    • generalized seizures: involve the entire brain from the onset of the seizure.
    • Partial: restricted to one part of the brain.
    • Status epilepticus: continuining series of seizures w/o a period of recovery. It is life-threating bc of hypoxia.
  14. Dementia chts? types? define them.
    • it is an acquired decline in intellectual function, impairment of memory. its is associated w many pathologic processes. Dx should be done by first ruling out manageable causes of demetia (like hyperthyroidism).
    • Types:
    • Alzheimer Disease Dementia: degeneration of neurons in temporal and frontal lobe, brain atrophy, amyloid plaques, and neurofibrillary tangles. -- Brain acetylcholine deficient -- it is not a part of normal aging.-- Dx by exclusion. 
    • Vascular dementia: results from single cerebrovascular insults. -- RF: stroke, HTN, and diabetes.-- CM: memory loss, specially short-term memory, thinking ability declines, anxiety, agitation.
    • Other dementia: associated w other pathologies.
  15. Parkinson's disease?
    • Dopamine deficiency in the basal ganglia.
    • Tremor occurs at rest.
    • When dopamine levels fall acetylcholine is not inhibited allowing increased excitation.
  16. Cerebral Palsy? Hydrocephalus?
    • Common disorder of childhood. Nonprogressive damage to motor control centers of the brain. 
    • Types: spasticity (hypertonia), dyskinesia (difficulty in purposeful movements and fine motor coordination) ataxic (gait disturbances) and mixed.
    • etiology: prenatal infection, birth trauma, exposure to poison, reduced O2 supply to the brain.
    • Hydrocephalus: Characterized by abnormal accumulation of CSF in the cerebral ventricular system.
    • Types:
    • Normal-pressure: due to an increase in volume of CSF w/o change in pressure.
    • Obstructive: Due to an obstruction to the flow of CSF (usually a tumor outside that is compressing the ventricules).
    • Communicative: abnormal absorption of fluid.
  17. Spinal cord and peripheral nerve disorders?
    • Multiple sclerosis
    • Spina Bifida.
    • Amyotrophic lateral sclerosis.
    • Spinal Cord injury.
    • Guillian-Barre Syndrome.
    • Bell Palsy.
  18. Multiple sclerosis chts? patho? CM? tx?
    • it is a demyelinating disease, autoimmune disorder, inflammation and scarring (sclerosis) that destroys the myelin and interrupts the conduction of nerve impulses, slowly progressive.-- higher risk above the 37th parallel. -- cause in unkown. --- marked by exacerbations and remission. 
    • CM: double/blurred vision, weakness, poor coordination, memory impairment is common.
    • Dx: MRI.
    • Tx: no cure, short term steroid therapy, and immune-modifying drugs.
  19. Spina Bifida? types? CM? dx? tx?
    • Defective closure of the bony encasement of the spinal cord (neural tube).
    • TYpes: spinal bifida oculata (not visible) and spina bifida cytica (external protusion).
    • etiologies: environmental factors (lack of folate) and genetics.
    • CM: saclike syst w CSF, spinal cord, and meninges.
    • Dx: prenatally (ultrasound and alpha-fetoprotein testing)
    • Tx: surgery, c-section, folic acid before and during pregnancy.
  20. Amyotophic lateral sclerosis (lou gehrig's Disease) chts? etiologies?
    • Degeneration disease of upper and lower motor neurons of the cerebral cortex.
    • Demyelination occurs.
    • More common in men (40 to 60)
    • fatal in 3 to 5 yrs.
    • Etiologies: idiopathic, viral infection, metabolic disorders, and antoimmune.
    • Congetivelly intact until the end, but paralyzed all the way. can only responde through blinking of the eyes.
  21. spinal chord injuries? what are the shocks that happen afterwards?
    • problem of the young -- usually bc of trauma. -- could be compressed, transected, or contused. -- MOIL: hyperflexion (rupture of the posterior ligament, care accident), hyperextension (ruptures the anterior ligament, falling n hitting the table), Compression (crush the vertebrae and force the bony fragments, diving into a shallow pool)
    • Spinal shock: temporary loss of reflexes below the level of injury -- associated w hypotention and bradycardia.
    • Neurogenic shock: due to peripheral vasodilatation -- hypotension and circularory collapse can occur -- affects respiratory muscles, leading to ventilatory failure.
    • Autonomic Dysreflexia: acute reflexive response to sympathetic activation below the level of injury. -- HTN.
  22. Guillian-Barre Syndrome? Bell's palsy?
    • GBS: demyelinating disease of the peripheral nervous system. unlike MS which is central. -- muscle weakness that begins in the lower extremities and moves upwards. -- Ideopathic, maybe autoimmune.
    • BP: paralysis of the muscles on one side of the face.-- etiology: viruses, self-limiting. -- CM: develops rapidly 24-48 hrs, unilateral facial weakness,
  23. Headaches? types? define them
    • it is the pain in the head from any causes.
    • types: Migraine, tension, cluster, Sinus.
    • Migraine: vasoconstriction follow by vasodilatation is the cause -- have triggers -- pain and nausea unilateral, photophobia, may last up to 72 hrs. 
    • Tension: the most common -- usually bilateral and nos associated w nausea or photophobia. -- associated w psychosocial stressors.
    • CLuster: seasonal -- the pain is very severe around the eyes that ppl go to the ER.