16. Neuro: Disorders of CNS and PNS

Question 1

Most common locations of vertebral injuries

Answer 1

• cervical (1,2,4-7) - T1-L2

Question 2

bleeding within the brain

Answer 2

intracerebral hematoma

Question 3

spinal injury due to direct contusion of the spinal cord by bone/disk material in the spinal canal (crushed vertebral body); caused by forced applied at top of head

Answer 3

vertical/axial compression

Question 4

spinal injury that includes shearing force to the acceleration force and ruptures support ligaments in addition to producing fractures

Answer 4

rotational injury

Question 5

displacement of the nucleus pulposus or annulus fibrosis beyond the intervertebral disk space -> nucleus pulposus extrudes and compresses nerve roots

Answer 5

herniated intervertebral disk

Question 6

aneurysm that results from diffuse arteriosclerotic changes and are found most commonly in the basilar arteries or terminal portions of the internal carotid arteries

Answer 6

fusiform (giant) aneurysms

Question 7

inflammation of the brain and spinal cord; can be viral, fungal, or bacterial

Answer 7

meningitis

Question 8

mass of dilated vessels between the arterial and venous system without an intervening capillary bed; usually present at birth but symptoms have delayed onset (before 30 y/o)

Answer 8

arteriovenous malformation (AVM)

Question 9

causes of cerebral infarction

Answer 9

• abrupt vascular occlusion (thrombosis/emboli) - gradual vessel occlusion - partial occlusion of stenotic vessels - may also be hemorrhagic in nature

Question 10

spinal injury that causes wedge/compression fracture of vertebral body and compresses spinal cord parenchyma or vascular structures

Answer 10

hyperflexion spinal injury

Question 11

straitening of knee w/ hip and knee flexed produces pain in back and neck regions

Answer 11

Kernig sign

Question 12

How is myasthenia gravis diagnosed and treated?

Answer 12

AChE inhibitors (Tensilon)

Question 13

clinical manifestations meningitis

Answer 13

• headache and AMS - phonophobia - photophobia - neck stiffness - high fever - petechial rash (if meningococcal infection)

Question 14

results when an area of the brain loses its blood supply

Answer 14

cerebral infarction

Question 15

stroke usually caused by occlusion of a single, deep perforating artery that supplies small penetrating subcortical vessels; will have pure motor or sensory deficits

Answer 15

lacunar stroke

Question 16

brain injury at the site of impact

Answer 16

coup injury

Question 17

acquired inflammatory disease causing demyelination of the peripheral nerves w/ relative sparing of axons; acute onset w/ ascending motor paralysis that usually occurs after respiratory or GI infection

Answer 17

Guillain-Barre syndrome

Question 18

most common type of brain aneurysm that is usually due to congenital abnormalities in the arterial wall; occur in large intracranial vessels and will cause subarachnoid hemorrhage if ruptured

Answer 18

saccular (berry) aneurysms

Question 19

bleeding between the dura mater and the skull; artery usually source of bleeding and usually accompanied by a skull fracture

Answer 19

epidural hematoma

Question 20

ballooning and weakening of a blood vessel in the brain

Answer 20

intracranial aneurysm

Question 21

trauma that penetrates the dura mater; involves compound skull fractures

Answer 21

open brain injury

Question 22

symptoms of intracranial tumors

Answer 22

• focal deficits depending on location - cerebral edema - IICP sxs (AMS, headache, vomiting, seizures, unsteady gait, loss of sphincter control)

Question 23

passive flexion of neck produces neck pain and increased rigidity

Answer 23

Brudzinski sign

Question 24

associated w/ systemic hypo perfusion caused by heart failure, pulmonary embolism, or bleeding that causes inadequate blood supply to the brain

Answer 24

hypoperfusion/hemodynamic stroke

Question 25

most common causes of autonomic dysreflexia

Answer 25

distended bladder or rectum; also caused by pain receptors in the skin, penis, and uterus

Question 26

spinal injury that causes dislocation of posterior elements and compression of spinal cord

Answer 26

hyperextension spinal injury

Question 27

Most common area of the head epidural hematomas are seen

Answer 27

temporal fossa

Question 28

a mass of blood is formed as bleeding continues into the brain -\> adjacent brain tissue is displaced and compressed -\> causes ischemia, edema, IICP, and necrosis

Answer 28

hemorrhagic stroke

Question 29

normal activity of the spinal cord ceases at and below the level of injury due to lack of continuous nervous discharges from the brain; transient

Answer 29

spinal shock

Question 30

most common cause of spinal cord trauma

Answer 30

vertebral injuries

Question 31

in autonomic dysreflexia, what parasympathetic response will occur above lesion (4)?

Answer 31

- arterial dilation - flushed skin - headache - sweating

Question 32

causes of spinal shock

Answer 32

presence of hemorrhage or edema at the spinal cord; also due to transection of the cord which would not be transient

Question 33

clinical manifestation of spinal shock

Answer 33

complete loss of reflex function (skeletal, bladder, bowel, sexual function, thermal control, and autonomic control) below level of lesion

Question 34

a process of normal aging as a response to continuous vertical compression of the spine (axial loading)

Answer 34

degenerative disk disease (DDD)

Question 35

occurs when there is obstruction to arterial blood flow to the brain from thrombus formation, an embolus, or hypo perfusion related to decreased blood volume or heart failure

Answer 35

ischemic stroke

Question 36

acute febrile illness, usually of viral origin, with nervous system involvement

Answer 36

encephalitis

Question 37

condition due to a compressed nerve in the spine that can cause pain, numbness, tingling, or weakness along the course of the nerve/dermatome

Answer 37

radiculopathy

Question 38

involves fragments that break from a thrombus formed outside the brain (usually heart, aorta, or common carotid)

Answer 38

embolic stroke

Question 39

Blunt trauma to the head can result in what types of brain injuries that can occur at the same time?

Answer 39

focal brain injury and diffuse axonal injury

Question 40

fracture that opens a communication between cranial contents and the environment -\> increased risk of infection

Answer 40

compound skull fracture

Question 41

where do embolic strokes usually occur?

Answer 41

small brain vessels or bifurcations (narrowing)

Question 42

escape of blood from a defective or injured vessel into the subarachnoid space; often due to ruptured aneurysms

Answer 42

subarachnoid hemorrhage (SAH)

Question 43

syndrome of sudden, massive reflex sympathetic discharge associated w/ spinal cord injury at T6 or above where descending inhibition is blocked

Answer 43

autonomic hyperreflexia (dysreflexia)

Question 44

episode of neurological dysfunction lasting no more than 1 hour and resulting from focal cerebral ischemia

Answer 44

transient ischemic attack (TIA)

Question 45

chronic autoimmune disease where IgG antibodies are produced against ACh receptors -\> block binding of ACh and decrease muscle contraction

Answer 45

myasthenia gravis

Question 46

in autonomic dysreflexia, stimulation of the sympathetic nervous system will cause what (4)?

Answer 46

- vasoconstriction - hypertension - skin pallor - pilomotor spasms (goosebumps)

Question 47

symptoms of myasthenia gravis

Answer 47

- weakness and fatigue - ptosis (drooping of eyelid) - diplopia - difficulty chewing

Question 48

chronic inflammatory disease involving degeneration of CNS myelin, scarring (sclerosis or plaque formation), and loss of axons

Answer 48

multiple sclerosis

Question 49

Most common causes of encephalitis

Answer 49

- bites from mosquitoes, ticks, or flies - HSV1

Question 50

bleeding between the dura mater and the brain; vein usually source of bleeding

Answer 50

subdural hematoma

Question 51

fracture at the base of the skull; pts can leak spinal fluid from their ears/nose and have raccoon eyes

Answer 51

basilar skull fracture

Question 52

4 types of vertebral injuries

Answer 52

- simple fracture - compressed fracture (wedge; vertebral body compressed anteriorly) - comminuted fracture (vertebral body shattered into several fragments) - dislocation

Question 53

fracture of the lamina (usually in the lumbar region; L5) and it causes a separation between adjacent vertebrae

Answer 53

spondylolysis

Question 54

secondary to spondylolysis; anterior displacement (sliding) of the inferior vertebral segment

Answer 54

spondylolisthesis

Question 55

arise from arterial occlusions caused by thrombi formation in arteries supplying the brain or intracranial vessels

Answer 55

thrombotic stroke

Question 56

3 types of back pain and what causes them

Answer 56

- muscular: result of spasm in tissue producing ischemia - joint: usually due to osteoarthritis or disease arthritis - fibroskeletal: usually due to fractures/dislocation of ligamentous structures

Question 57

Explain the cause of autonomic dysreflexia

Answer 57

- sensory receptors below level of cord lesion are stimulated - intact autonomic nervous system reflexively responds -\> increase BP (sympathetics) - baroreceptors in cerebral vessels, carotid sinus, and aorta sense HTN and stimulate parasympathetics - HR decreases but vessels don't dilate because efferent impulses can't pass through cord

Question 58

injury from the brain rebounding and hitting opposite side of skull after impact

Answer 58

contrecoup injury

Question 59

narrowing of the spinal canal that causes pressure on the spinal nerves or cord and can be congenital or acquired (more common); associated w/ trauma and arthritis

Answer 59

spinal stenosis