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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.
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.
- 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.
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)
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)
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.
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.
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.
Frontal, central, pariental, occipital lobes functions?
- frontal: cognitive and personality behavior.
- Pariental: motor and sensorym language.
- occipital: vision.
- Temporal: hearing, memory, speech.
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.
- 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.
Chronic Disorders of neurologic function?
- Brain and cerebellar disorders:
- Seizure disorder/epilesy
- Parkinson's Disease.
- Cerebral Palsy.
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.
- 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.
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).
- 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.
- Dopamine deficiency in the basal ganglia.
- Tremor occurs at rest.
- When dopamine levels fall acetylcholine is not inhibited allowing increased excitation.
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.
- 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.
Spinal cord and peripheral nerve disorders?
- Multiple sclerosis
- Spina Bifida.
- Amyotrophic lateral sclerosis.
- Spinal Cord injury.
- Guillian-Barre Syndrome.
- Bell Palsy.
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.
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.
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.
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.
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,
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.