3) Neuro Flashcards
National Head Injury Foundation defines (TBI) as:
“a traumatic insult to the brain capable of producing physical, intellectual, emotional, social, and vocational changes.” It is classified as a direct or indirect injury to the tissue of the cerebrum, cerebellum, or brainstem.
Shortened Nrv. pathway involved in a reflex action is:
Speed of reflex ultimately allows for
= reflex arc
= quick responses, reducing the seriousness of injury. Other reflexes help stabilize the body if it stands in one position for a length of time.
Reflex arc:
Acquires impulse speed via:
= sensory ascending Nrv. pathway involved in reflex action
= Short pathway
ipsilateral:
Contralateral:
= same side
= opposite side
Baroreceptors) Fn:
A&P:
= receptors that monitor blood pressure
= Great vessels recept/ Gives feedback to brain > Sympathetic NS Activation, AArch & carotid arteries> feedback to medulla >SNS
Be able to explain the hypercarbic and hypoxic drives and how do they differ
carbic=too much CO2 so initiates from high PACO2 Oxic= not enough oxy so initiates from low PAO2
Blood-Brain Barrier) built so:
Prevents & Protects:
= CNS capillary walls thicker, more complete, not as permeable as elsewhere in body.
= Doesn’t permit interstitial flow of proteins & materials as freely as normal capillaries, Protects w/ need lipid loving to get through, anything that can get through can cause damage
Brain perfusion] Cerebral Perfusion Pressure (CPP) form:
MAP’s relation w/ perfusion:
Head injury PTs will have increase BP b/c:
= MAP – ICP (Norm/ ICP between 5-15 mmHg average 10mL)
= MAP needs to stay > ICP to maintain brain perfusion
= increase MAP helps to keep the MAP>ICP. (bodys attempt to compensate)
Brain Herniation) def/:
Initial stages:
Late Stage:
S/S:
Para/Sympathetic Nervous System affect:
= Trauma causes swelling inside skull
= blood & CSF are compressed out.
= Increasing ICP forces brain out foramen magnum (can cause cushings)
= 1 pupil sluggish or dilated, or unequal (anisocoria), Decorticate or Decerebrate posturing, Abnorm/ Resp/s, Severe altered/LOC, Weakness/Paralysis, Projectile vomiting
= Cuts off PSNS response thus + SNS (SNS thoracic lumbar) (PSNS cranial sacral)
Brain Injury) 1 S/S:
2 Treatment of Brain Herniation:
3 Vent/ing Brain Herniation:
4 Do not let PT become:
5 Note with ETCO2 & ICP:
1= AMS, Alterations in personality, Amnesia, Cushing’s triad
2= Maintain ETCO2 between 30-40, Vent/ at upper end of norm/, Admin IV fluids for SBP 90-100,
3= Adults: No more 20 per/min, Children: No more 30per/min Infants: No more 35 per/min
4= hypoxic or hypovolemic
5= Norm ETCO2 35-45 but controlled hypervent/ 30-40
(if overoxygenate can actually decrease amount going to brain)
Mid brain) 1 Hypothalamus:
2 Thalamus:
= “homeostasis” Endocrine Fn, N/V reflex, hunger, thirst, kidney Fn, body temps, emotions
= Establishes & maintains consciousness; pathways for optic & olfactory nerves
Pons:
Medulla Oblongata:
= Communication interchange between CNS components
= Respiratory center, cardiac center, vasomotor center.
Cauda Equina Syndrome) def:
Usually caused by:
S/S:
= Nerve roots @ lower end of SC are compressed
= herniated disc, tumor or infection
= Loss of bowel & bladder control – Saddle anesthesia
Central Cord Syndrome) Usually results from:
Considered what type of injury:
S/S:
More commonly seen in patients:
= hyperextension of the cervical spine
= incomplete cord injury
= motor loss/weakness to upper EXTRMs & bladder Fn loss
= >50 years of age &/or w/ arthritis
Cerebellum Fn:
location:
Brainstem + Cerebellum:
= Coordinates: Fine Motor, Posture, Equilibrium, M. tone, CN8
= Located in the posterior fossa
= Hindbrain (Contains 2 hemispheres)
Both brain & SC bathed in what acting as cushion & vol:
= CSF~150mL; watery, clear fluid that acts as cushion
Cerebrum) 1 Frontal Lobe
2 Broca’s Area
3 Central Sulcus/Fissure
4 Parietal Lobe
5 Postcentral Gyrus
6 Precentral Gyrus
7 Occipital Lobe
8 Temporal Lobe “Hearing & Language”
9 Cerebellum “Balance & Coordination” fine motors
10 Pons
11 Medulla Oblongata
12 Corpus callousum
1= “Personality”
2= Broca’s Area
3= Central Sulcus/Fissure
4= “Sensory” Wernicke’s Area “speech comprehension”
5= Primary sensory cortex
6= Primary motor cortex
7= “Vision”
8= “Hearing & Language”
9= “Balance & Coordination” fine motors
10= Pons
11= Medulla Oblongata
12= Corpus callousum
Cerebrum) lobes
= occipital, temporal, parietal, frontal
chemoreceptors=
in the carotid bodies and in the arch of the aorta. These chemoreceptors are stimulated by decreased PaO2, increased PaCO2, and decreased pH
Choroid plexus) located & Fn:
CSF flow starts at 1:
CSF through surrounding 2:
CSF returned to3:
CSF dumped off 4:
=in brain ventricles gen/s CSF in largest 2-4 ventricles
= lateral ventricles to 3rd & 4th ventricle
= through subarachnoid space surrounding brain & SC
= venous circulation through arachnoid granulations
= dural sinuses of brain & through spinal arachnoid space to arachnoid villi found @ end of SC (spinal cistern)
CN 10:
= vagus “wondering” parasympathetic F.s: HR, digestion, & RR & also provides sensory info from throat & voice box.
CN 11:
= Accessory = traps Muscles motor
CN 12:
= Hypoglossal = motor tongue control out “12 & 21 baskin robin flavors”
CN 1:
= Olfactory → smell “1 nose”
CN 2:
= Optic → vision (sensing light) “2 eyes”
CN 3,7,9,10
Pupil correlates w/ L. of injury EX right pupil blown is right brain trauma
CN 3:
= Oculomotor: pupil m-vt (controls pupils sizes) “3 words cocaine constricts pupils”
CN 4:
= Trochlear: eye motor function (look up & down) “it go up, down, up, down”
CN 5:
= trigeminal “suicide “= chewing muscles (chewing mastication), Sensory→Ophthalmic (forehead), maxillary (cheek)& mandibular (chin) “5 fingers to the face/chew”
CN 9:
= glossopharyngeal= controls taste @ back of tongue, helps w/ swallowing by saliva production. “9 lime”
Cranial nerve location mnemonic:
Nerve locations:
= “Sexy EMTs Play Erotic Jokes, Exciting Their Erotic Lover’s Asshole Stimulating Them.”
= Sniffer- smells (Olfactory)
= Eyes - Eyesight (Optic)
= Pupils - Pupils & eye movement (Oculomotor)
= Eyes = eyes movement (Trochlear)
= Jaw -mastication (Trigeminal: sense face & motor jaw)
= Eyes - Eye movement (Abducens)
= Taster - Taste & facial expression (Facial)
= Ears - Ears hearing & balance (Vestibulocochlear)
= Licker- tongue taste & swallow (Glossopharyngeal)
= ABDMN- Autonomic control thorax & ABDMN (Vagus)
= Shoulders -shrug & neck m-nt (Spinal Accessory)
= Tongue - Tongue movement (Hypoglossal)
Cranial nerves carrying parasympathetic nerve fibers?
CN: 3,7,9,10
Cranial nerves name mnemonic:
Cranial nerve names:
= “Oh, Oh, Oh, To Touch And Feel A Girl’s Vagina, Such Heaven!
1. Olfactory
2. Optic
3. Oculomotor
4. Trochlear
5. Trigeminal
6. Abducens
7. Facial
8. Vestibulocochlear (or Auditory)
9. Glossopharyngeal
10. Vagus
11. Spinal Accessory
12. Hypoglossal
decorded position=
flexing forearms outwards
decortit position=
flexing forearms inwards
Diffuse Axonal Injury) Caused by:
3 Classification categories:
Nerves can repair selfs b/c schwan cells but never back to 100 b/c scar tissues (make new neurons daily)
= direct blow to the head * Severe acceleration/deceleration
= Mild diffuse axonal injury (mild concussion) – Moderate diffuse axonal injury (classic concussion) – Severe diffuse axonal injury (brainstem injury)
DRG dorsal respiratory group
Keeps VRG in check
DRG dorsal respiratory group=
keeps in check w/ VRG
Electrical stimulus from the brain is delivered to the diaphragm via the:
=Phrenic nerve
Epidural Hematoma) what & where:
Nearly always the result of:
Commonly hand & hand w/:
= Accumulation of blood between the skull and dura mater
= blow to the head that produces a linear fracture
= hand & hand w/ basilar skull fracture
Foreman magnum Fn & relation w/ brain
hole for SC & Brain stem sit right above hole
CLs) Temporal Lobe) know:
Functions:
= sensory processor
= Hearing & auditory processing, memory storage (hippocampus is located here), language comprehension (Wernicke’s area, typically left hemisphere), emotional responses & smell processing.
CLs) Frontal Lobe) know by:
Fn:
= Personality
= Motor control (primary motor cortex), problem-solving, decision-making, & planning (executive functions), personality & emotions, speech production (Broca’s area, typically left hemisphere).
Gray matter:
White matter:
= (cell bodies) sensory processing
= mostly comprising communication pathways (axons) motor
Hering-Breuer reflex=
prevents over expansion of lungs from inhalation>
During inspiration, lungs become distended, activating stretch receptors.
Epidural Hematoma)
= Hx head trauma, Rapid onset of symptoms, LOC, Lucid interval (min-hours), +ICP w/ N/V/AMS, Lapse in unconsciousness, paralysis on contralateral side of head injury, Dilated, fixed pupil on ipsilateral side., Death
PTs usually have better outcome b/c acute symptoms
H/A, blurry vision, N/V
Venous fast bleed
SC) 1 white matter surround & covered w/
2 White matter forms what bundles/columns:
3 White matter composed of:
4 Descending SC tracts:
1= surround Gray matter & covered w/ myelinated Nrv-fibers
2= Anterior, Lateral, & Posterior white columns
3= (Axons) Nrv-cell pathways
4= message/effector to end of tract “Brain to Motor)
SC) 1 white matter surround & covered w/
2 White matter forms what bundles/columns:
3 White matter composed of:
4 Ascending SC tracts Fn:
1= surround Gray matter & covered w/ myelinated Nrv-fibers
2= Anterior, Lateral, & Posterior white columns
3= (Axons) Nrv-cell pathways
4= Transmit sense/info signals up to brain
Categories of Motor Pathways:
Categories of somatosensory Pathways:
= descending
= posterior funiculus-medial lemniscal pathway, Anterolateral pathway, Spinocerebellar pathway
How does CO2 get transported throughout our body?
Mostly bicarbonate 70%, then hemoglobin 23% , then dissolved in blood <7%
Increase in arterial CO2 = what drive
hypercarbic drive
Diceph/) Insular Lobe) know by: Critical processor
Fns:
Location:
= Critical processor
= Taste perception, emotional responses & self-awareness, visceral functions (EX: heartbeat, breathing).
= Deep within the lateral sulcus, beneath the frontal & temporal lobes. (hidden beneath temporal & frontal lobes)
Internal respiration:
External respiration:
=exchange of gases (O2 and CO2) at the cellular level
=exchange of gases (CO2 and O2) in the pulmonary capillaries
Intracerebral Hemorrhage) located @ & from:
Note w/ symptomology:
S/S:
= w/in brain tissue w/ Penetrating & blunt injuries
= may vary, mimics CVA, Depends on regions & severity
= AMS commonly, Thunderclap H/A, Vomiting, 1 dilated pupil, rapid deterioration
Meninges) Protective membranes that cover the entire CNS:
Layers of the meninges:
= Protective membranes the cover the entire CNS
= Dura, Arachnoid Mater, & Pia Mater
Monro-Kellie Doctrine:
in short:
= The pressure-vol/ relationship between ICP, Vol/ of CSF, blood, brain tissue, & CPP
= In the fixed space of the cranial cavity, when one increases, the others must decrease
Most head injury PTs who’re in a coma & likely to need endotracheal intubation have a GCS score of:
8 or less
Most of the cranial cavity is occupied by the:
Cerebrum
Neurogenic Shock) def:
Problems:
Occurs @ causing:
= SC/Brain Injury disrupts ability to control body autonomic Fns = “pipe” problem, Unable to maintain BP, Severe reduction CO
= above T-vertebrae, loss of all SNS innervation, causing widespread BP plummet
NEVER LET HEAD INJURY PTs
HYPOXIC & HYPOTENSIVE
Occipital Lobe) know by: all ojos
Functions: Visual processing & interpretation, recognizing shapes, colors, & motion
= all ojos
= Visual processing & interpretation, recognizing shapes, colors, & motion
Ocular Muscles do what & Innervated by 3CNs:
Remember by:
= control eye m-nt by Oculomotor (CN-III), trochlear (CN-IV),& abducens (CN-VI)
= OCULAR MUSCLES is 13 letters = CN 3+4+6
Ocular Muscles do what & Innervated by 3CNs:
Remember by:
= control eye m-nt by Oculomotor (CN-III), trochlear (CN-IV),& abducens (CN-VI)
= OCULAR MUSCLES is 13 letters = CN 3+4+6
Parietal Lobe) Know:
Function:
= Sensory perception (touch, temperature, pain)
= Sensory perception (touch, temp, pain), spatial orientation & awareness of body position, understanding language (Wernicke’s area, typically left hemisphere).
Pontine respiratory
Smooths out transition of inhalation & exhalation
CPP)
CPP form/:
If MAP falls below 50 mmHg:
= Cerebral Perfusion Pressure provides cerebral blood flow
= MAP - ICP
= normal ICP reduces CPP to critical levels.
Drugs that effect RAS:
= hypnotic drugs EX benzos ketamine editomite
Reticular Activating System (RAS) built of
Works by:
Drugs that effect RAS:
= network of interconnected neurons in brainstem
= Ascending fibers carry signals to activate cerebral cortex Associated w/ LOC, REM sleep, & filtering background noise
= benzos ketamine etimodomite
S/S of this type of hemorrhage may take hours, or even days to develop:
Subdural hematoma
Cranial nerve types mnemonic:
Nerve types:
= “Some Say Marry Money, But My Bitch Says Big Boobs Matter Most.”
= 1. Olfactory - Sensory
2. Optic - Sensory
3. Oculomotor - Motor
4. Trochlear - Motor
5. Trigeminal - Both
6. Abducens - Motor
7. Facial - Both
8. Vestibulocochlear (or Auditory) - Sensory
9. Glossopharyngeal - Both
10. Vagus - Both
11. Spinal Accessory - Motor
12. Hypoglossal - Motor
Spinal Canal) Vertebral Foramen:
Articular facets:
Back, chest, pelvic muscles provide:
kids can hyperflex more vs adults b/c:
= Contains and protects spinal cord
= form joint between vertebra (above & below) Held in place by various lig/s
= supports. (post&anterioer longitudinal ligament) (Intervertebral disc & body of vertebral)
= kids have larger wedges compared to adults
Spinal Cord) length & width:
SC conducts impulses:
Pairs of nerve fibers exiting SC:
Nerve fibers terminate @:
If cauda equina compressed too long:
= Approximately 18 inches long & ½ inch wide
= Conducts impulses to & from PNS & for some reflexes
= 31 pairs of N. fibers out SC
= L1or L2 / Cauda Equina “Horse Tail”
= can loose bladder cord/control, lower extrm sense
SC) Pyramidal Tract:
Posterior Columnus:
Spinothalamic Tract:
= Motor fn. on the same side
= Position & vibration sensation on the same side
= Pain & temp sensation to opposite side
Spinal Cord Syndromes) Anterior Cord Syndrome:
Results from:
S/S:
Commonly seen w/:
= bony frag/s or pressure compressing arteries of anterior SC
= severe extension-flexion injury
= Loss of motor, sensory, light, & temp/ Fn below injury site
= Old & pedis rear end MVC w/ improper head restraint
Spinal Nerve Plexuses) def/:
Locations:
Key myotomes for neurologic evaluation:
Dermatomes
= sensory components of spinal nerves innervate specific & discrete surface areas called dermatomes
= distributed from the occiput of the head to the heel of the foot and buttocks.
= arm extension (C-5), elbow extension (C-7), small finger abduction (T-1), knee extension (L-3), & ankle (plantar) flexion (S-1).
Spinal Shock) def:
S/S:
Duration:
= Temp/ insult to SC affecting body below Lvl of injury
= Area becomes flaccid & loses feeling, Paralysis below injury, bladder/bowel loss, Loss of temp control below injury site
= Most often temporary but can lead to warm shock
Subdural Hematoma) what & where:
Occurs after or w/:
Deadly b/c:
Meningies involveved & most common vessel:
= Accumulation of blood beneath dura mater but outside brain = falls or injuries involving strong deceleration forces
= Venous bleed slower S/S onset slower High mortality
= Dura & arachnoid involved} Most common vessel is the superior sagittal sinus
The cauda equina, is located:
Vertebra C-2 is known as:
Vertebra C-1 is known as:
= Below the level of L2
= the Atlas
= the axis
The cranium’s several bones fused together at called
pseudojoints called sutures.
The main respiratory center lies in the
Medulla Oblengata
Most common sites for axial loading injuries are between
between T-12 & L2 (for lifting & heel-first injuries) & the cervical region (for head impacts)
The sensory components of the spinal nerves that innervate specific and discrete surface areas are called:
Dermatomes
The spinal cord ends in the area of:
By adulthood, sections of spinal column that’ve fused are:
= L1/L2
= Coccyx & Sacrum
lobe that controls Fns as N/V reflex, hunger, thirst, & temp:
Hypothalamus
Thumbs up test:
Stroke:
= could be used to potentially determine bells palsy vs stroke
= same side face & opposite side motor
Trigeminal neuralgia aka:
tic douloureux
CNS blood supply) 1 Brain receives ~ of body’s blood flow/min:
2 Circle of Willis:
3 comprised of:
1= ~15- 20%
2= system “circle of feeders” coming off 4 arteries that provide supplements (blood oxy glucose) to brain
3= Carotid system (anterior) & Vertebrobasilar system (posterior)
what is hypoxic drive
Anaerobic katabolism aka not enough oxy in blood
What reflex stops us from over ventilating ourselves?
o What receptors are involved?
Hering-Breuer
Stretch receptors
NS Neurotransmitters) Acetylcholine (ACh):
Dopamine:
Serotonin:
= Excitatory in skeletal muscles; inhibitory in cardiac muscle.
= Modulates motor control, mood, & reward pathways.
= Regulates mood, sleep, & gut motility.
Nervous system) Afferent neurons
Efferent neurons
Interneurons
= sensory transmit stimuli from body to CNS.
= Motor Transmit signals from CNS to muscles & glands.
= Facilitate communication between sensory & motor neurons in the CNS
NS Neurotransmitters) Glutamate:
GABA:
= Main excitatory neurotransmitter in CNS.
= Primary inhibitory neurotransmitter in CNS.
Nervous System) Glial cells
Astrocytes, Oligodendrocytes, Microglia, Schwann Cells:
NS Glial cells) Astrocytes:
Microglia:
Oligodendrocytes:
Schwann Cells:
= Regulate blood-brain barrier & nutrient supply
= Immune defense in CNS.
= Myelinate CNS axons.
= Myelinate PNS axons.
Any expanding lesion within the cranium results in
a increase in intracranial pressure
Vomiting w/ head injury is a frequent result of:
= Increasing intracranial pressure
Ears) Pinna:
External auditory canal Glands:
Middle & inner ear:
Semicircular canals:
= Visible outer portion of the ear
= secrete wax (cerumen) for protection
= Structures required for hearing
= balance/ equilibrium
Spinal Canal) Vertebral Foramen:
Articular facets:
Back, chest, pelvic muscles provide:
kids can hyperflex more vs adults b/c:
= Contains and protects spinal cord
= form joint between vertebra (above & below) Held in place by various lig/s
= supports. (post&anterioer longitudinal ligament) (Intervertebral disc & body of vertebral)
= kids have larger wedges compared to adults
Brain Herniation) def/:
Initial stages:
Late Stage:
S/S:
Para/Sympathetic Nervous System affect:
= Trauma causes swelling inside skull
= blood & CSF are compressed out.
= Increasing ICP forces brain out foramen magnum (can cause cushings)
= 1 pupil sluggish or dilated, or unequal (anisocoria), Decorticate or Decerebrate posturing, Abnorm/ Resp/s, Severe altered/LOC, Weakness/Paralysis, Projectile vomiting
= Cuts off PSNS response thus + SNS (SNS thoracic lumbar) (PSNS cranial sacral)
SC Transection:
Thoracic spine:
Cervical spine:
Lumbar spine:
= Partially or completely cut in SC w/o Potential to send & receive nerve impulses below injury
= Incontinence & paraplegia
= Partial/complete resp/ paralysis, quadriplegia, incontinence
Neurogenic Shock) def:
Problems:
Occurs @ causing:
= SC/Brain Injury disrupts ability to control body autonomic Fns = “pipe” problem, Unable to maintain BP, Severe reduction CO
= above T-vertebrae, loss of all SNS innervation, causing widespread BP plummet
Sig/ head injury PT should receive/maintain oxy/ if < than:
If spinal injury is suspected, head & neck should be pos/ed:
Hypos for brief time can worsen outcome of head injuries:
= 96%
= gently moved into a Neutral position
= hypotension & hypoxia
When brain tissue is pushed through an opening (due to increasing intracranial pressure), it is called:
Herniation
Cerebrum) lobes
= occipital, temporal, parietal, frontal
Cerebellum Fn:
location:
Brainstem + Cerebellum:
= Coordinates: Fine Motor, Posture, Equilibrium, M. tone, CN8
= Located in the posterior fossa
= Hindbrain (Contains 2 hemispheres)
What does DURA denote?
DURA refers to hard.
Example: dura mater (outermost layer of the meninges).
Anisocoria:
heterochromia:
=unequal pupils greater than 1mm
=dif/ pupil colors
Pupils: Direct response:
Indirect response:
Accommodation:
Ocular motor movement:
= same pupil in light responds
= pupil opposite of light responds
= eyes cross when finger to nose
= eye movement in “H”
Dysarthria:
Dysphonia:
Aphasia:
= defective speech caused by motor deficits
= voice changes caused by vocal cord problems
= defective language caused by neurologic damage to the brain
Expressive aphasia:
Receptive aphasia:
= words will be garbled &/or expressed
= words will be clear but unrelated to your questions
(PT w/ receptive aphasia can have such difficulty talking that you could mistakenly suspect a psych disorder)
Exhalation process:
Inhalation process:
= Passive use→ of respiratory muscles’ elastic recoil.
= Active use requiring ATP→ of respiratory muscles (diaphragm & intercostals) to increase the chest’s inner diameter.
Eupnea:
Hyperpnea:
Cheyene-Stokes:
= Normal breathing
= Deep breathing
= Gradual increases & decreases in respirations w/ periods of apnea; caused by increasing ICP & brainstem injury
Ocular Muscles:
Innervated by 3 cranial nerves:
= control eye movement
= Oculomotor (CN-III), trochlear (CN-IV),& abducens (CN-VI)
sclera:
Cornea:
Retina:
= white of the eye; Dense avascular structure gives eye shape
= Separates anterior chamber fluid from external environment & permits light to enter the lens & reach the retina.
= Sensory network of eye transforms light rays into electrical impulses that the optic nerve transmits to the brain.
Lens & Function:
Iris:
Iris function
= Cellular structure behind iris; Convex & transparent allows images to focus onto the retina
=Circular contractile muscle; Its pigment produces color of eye
=Controls amount of light reaching the retina by controlling pupil size & initiated by Optic N. CN-II (senses light), & Oculomotor N. CNIII (controls size of pupil)
Bitemporal hemianopsia:
Left/Right Homonymous Hemianopsia:
Homonymous Quadrantic Defect:
= loss of vision in the outside half of each eye
= loss of vision in the right half of both eyes or left half of both eyes
= loss of vision in the same quadrant of both eyes EX LQ & LQ loss
Main Components of a Neuron
Cell body (soma) w/ nucleus, Dendrites transmit impulses to soma, Axons transmit impulses away from soma
Percentage of Blood Flow & Glucose Used by Brain
Brain receives 20% of total blood flow & uses 25% of glucose despite being only 2% of body weight
Major Blood Supply to Brain
= Carotid system (anterior) & Vertebrobasilar system (posterior) → both join at Circle of Willis
Reticular Activating System (RAS) Function
= Maintains wakefulness & consciousness, regulates sleep-wake cycles
Definition of Unconsciousness / Coma
= PT cannot be aroused even by strong external stimuli
Two Main Causes of Altered Mental Status (AMS)
Structural Lesions & Toxic-Metabolic States
Causes of Structural Lesions (AMS)
Brain tumors, degenerative diseases, intracranial hemorrhage, parasites, trauma
Chronic Alcoholism Effect on Brain
Interferes w/ thiamine absorption & use, leading to Wernicke’s Syndrome or Korsakoff’s Psychosis
Causes of Toxic-Metabolic States (AMS)
= Anoxia, DKA, hepatic failure, hypercapnia, hypoglycemia, renal failure, thiamine deficiency, toxins (cyanide, organophosphates)
Wernicke’s Syndrome vs. Korsakoff’s Psychosis
Wernicke’s Syndrome (Reversible): Ataxia, confusion, eye muscle weakness
Korsakoff’s Psychosis (Irreversible): Severe memory impairment
Brown-Séquard Syndrome Effect
Medial spinal cord dissection, causing ipsilateral motor loss & contralateral pain/temp loss
Most Common Type of Neuron:
Main Excitatory Neurotransmitter in CNS:
Main Inhibitory Neurotransmitter in CNS:
= Multipolar
= Glutamate
= GABA
Posterior Column Function
Proprioception & fine touch
CSF & Blood Volume in Brain
Arterial Blood: 30 mL
Venous Blood: 120 mL
CSF: 150 mL
Brain Tissue: 1400 mL
Hyperkalemia affect of Neuronal Function
K+ retention disrupts normal efflux, affecting neuron excitability
Neurotransmitter of Sympathetic Nervous System:
Neurotransmitter of Parasympathetic Nervous System
= Norepinephrine / Noradrenal
= Acetylcholine
Function of Choroid Plexus:
3 Major Components of Intracranial Volume
Causes of Hydrocephalus:
2 Types of Shunts for Hydrocephalus:
= Produces CSF
= 80% brain tissue, 10% blood, 10% CSF
= CSF blockage, leading to increased pressure
= VP shunt (drains to abdomen), VA shunt (drains to right atrium)
Spinothalamic Tract Function & Location:
= Pain & temperature, sits ventrally (ipsilateral function)
Pyramidal Tract Function & Location:
= Motor control, sits dorsally, sends signals ventrally
Spinothalamic Tract Function & Location:
Pyramidal Tract Function & Location:
Posterior Column Function:
= Pain & temperature, sits ventrally (ipsilateral function)
= Motor control, sits dorsally, sends signals ventrally
= Proprioception & fine touch
Examples of toxic-metabolic causes?
Anoxia (lack of oxygen)
DKA (diabetic ketoacidosis)
Hepatic failure (elevated ammonia)
Hypercapnia (↑ CO₂)
Hypoglycemia
Renal failure
Thiamine deficiency
Toxic exposure (cyanide, organophosphates)
Fundamental unit of the nervous system?
Nerve cell (neuron), composed of a cell body (soma), dendrites (transmit impulses to soma), & axons (transmit impulses away from soma).
How much blood flow does the brain receive per minute?
2 main arterial systems supplying the brain?
= 20% of total blood flow despite being only 2% of body weight; consumes ~25% of body’s glucose
= Carotid (anterior) & vertebrobasilar (posterior), both joining at the Circle of Willis before perfusing the brain.
What is the role of the reticular activating system (RAS)?
A: = Maintains consciousness & wakefulness; damage can cause coma.
Lobes of the brain & their functions
Frontal lobe:
Parietal lobe:
Temporal lobe:
Occipital lobe:
Cerebellum:
F] Motor Fn, decision-making, speech (Broca’s area)
P] Sensory perception, proprioception.
T] Hearing, memory, language comprehension (Wernicke’s area)
O] Vision processing.
C] Coordination, balance.
What are the two main causes of AMS?
= Structural lesions & toxic-metabolic states.
How do structural lesions cause AMS?
How do toxic-metabolic states cause AMS?
= Physical damage (tumors, trauma, hemorrhage) encroaches on brain tissue, impairing function
= Lack of O2, glucose, thiamine, or presence of toxins/metabolites thus diffuse cerebral depres/
Examples of structural lesions?
= Brain tumors, degenerative disease, intracranial hemorrhage, parasites, trauma.
How does chronic alcoholism cause AMS?
Treatment for Wernicke-Korsakoff Syndrome?
= Thiamine (B1) deficiency disrupts glucose metabolism, leading to Wernicke’s & Korsakoff’s syndromes
= Admin 100 mg thiamine IV, IM, or PO before glucose in suspected hypoglycemic alcoholic PTs.
What is Wernicke’s syndrome?
= Acute, reversible encephalopathy w/ ataxia, nystagmus, confusion, unsteady gait.
What is Korsakoff’s psychosis?
= Chronic, irreversible memory disorder caused by severe thiamine deficiency.
Primary neurotransmitter of sympathetic nervous system?
Primary neurotransmitter of the parasympathetic nervous system?
= Norepinephrine (NE).
= Acetylcholine (ACh).
Main excitatory neurotransmitter in the CNS?
Main inhibitory neurotransmitter in the CNS?
= Glutamate
= GABA (gamma-aminobutyric acid).
: What structure produces the majority of CSF?
Choroid plexus
Fn of cAMP in cardiac physiology?
= Downregulates, decreasing chronotropy (HR) & inotropy (contractility).
What happens when CSF drainage is blocked?
= (↑ ICP) can cause Hydrocephalus
2 CSF shunts & where do they drain?
VP (Ventriculoperitoneal) shunt → Drains into the abdomen.
VA (Ventriculoatrial) shunt → Drains into the right atrium.
What is Brown-Séquard syndrome
Spinal cord hemisection causing ipsilateral motor loss & contralateral pain/temp loss.
What type of information is transmitted by the dorsal roots of the spinal cord
= Sensory input.
What type of information is transmitted by the ventral roots of the spinal cord?
Motor output.
What is the spinothalamic tract responsible for?
= Pain & temperature sensation; located on the ventral side, meaning damage causes contralateral deficits.
What are the two types of ischemic stroke?
= Embolic & thrombotic.
Q: What is the most common cause of stroke?
= Atherosclerotic plaque rupture & hemostasis leading to thrombotic stroke.
Where do embolic strokes typically originate from?
= Carotid arteries, heart (A-fib), or large neck vessels.
2 main types of seizures?
Generalized seizures & partial (focal) seizures.
Speech Located @
Vision Located @
Personality Located @
Balance & coordination Located @
= most commonly L-temporal lobe of cerebrum
=in the occipital cortex of the cerebrum
= in the frontal lobes of the cerebrum
= in the cerebellum.
Sensory Located @
Motor Located @
=in the parietal lobes of the cerebrum
= in the frontal lobes of the cerebrum.
Each nerve root has a corresponding area of the skin, called
a dermatome, to which it supplies sensation
The 4 categories of peripheral nerves are:
= Somatic sensory & Motor, Visceral (autonomic) sensory & Motor
Toxic-metabolic states involve either:
the presence of circulating toxins or metabolites or the lack of metabolic substrates (oxygen, glucose, or thiamine).
lack of metabolic substrates (oxygen, glucose, or thiamine can produce
diffuse depression of both sides (hemispheres) of the cerebrum, with or without depression within the brainstem.
Alzheimer’s disease is perhaps the
Results from:
PT S/S:
S/S progressions:
The patient will develop a
= most common cause of dementia in the elderly
= death & disappearance of nerve cells in cerebral cortex thus marked atrophy of brain.
= problems w/ short-term memory
= Short-term memory loss, shuffling gait & will have stiffness of the body muscles, aphasia (inability to speak) & psychiatric disturbances} final stages; PT nearly decorticate, losing all ability to think, speak, & move.
Pick’s disease:
S/S:
= permanent form of dementia; tends to affect only certain areas of brain & have abnormal substances (called Pick bodies & cells) inside nerve cells in the damaged areas of brain. These Pick bodies contain an abnormal form of a protein called tau. The exact cause of the disease is unknown
= tend to behave the wrong way in different social settings. The changes in behavior continue to get worse and are often one of the most disturbing symptoms of the disease. Some patients will have more prominent difficulty with decision making, complex tasks, or language (trouble finding or understanding words or writing). There is no specific treatment for Pick’s disease.
Huntington’s chorea/ Huntington’s disease) Cause:
2 Forms & most common:
Adult onset:
Early onset:
S/S:
= genetic defect in chromosome #4.
= (Adult & Early onset) Adult onset is most common = develop symptoms in their mid-30s & 40s
= begins in childhood or adolescence.
= can resembleParkinson’s disease w/ rigidity, slow/unusual Mnt, tremor, behavioral changes (e.g., antisocial behaviors, irritability, and hallucinations), , & dementia (e.g., loss of memory and judgment). There is no treatment
Creutzfeldt-Jakob disease (CJD).
It is believed to result from:
a new variant CJD (nvCJD):
S/S:
= form of brain damage leads to rapid decrease in mental Fn & Mnt
= a protein called Prion; causes normal proteins to fold abnormally
= infectious formrelated to mad cow disease
= dementia, ataxia, hallucinations, jerking, & general decline. CJD is rarely confused with other types of dementia (such as Alzheimer’s disease) because in CJD, symptoms progress much more rapidly. There is no treatment.
Muscular dystrophy (MD) refers to a
Most common form of MD:
= group of genetic diseases characterized by progressive M. weakness & degeneration of skeletal or voluntary M-fibers.
= Duchenne; heart & other involuntary M.s affected in some types of MD
Multiple sclerosis (MS):
S/S:
= unpredictable CNS disease; autoimmune attack against myelin inflammation of certain nerve cells followed by demyelination, or destruction of the myelin sheath, thus inability properly conduct impulses
= include weakness of one or more limbs, sensory loss, paresthesias, and changes in vision. Symptoms can wax and wane over years, and range from mild to severe. Severe cases can be debilitating, rendering patients unable to care for themselves.
Guillain-Barré syndrome (GBS):
Characterized by :
Severe stages:
Prognosis:
= PNS disorder in which inflammation causes loss of myelin that surrounds neurons.
= M-weakness begins @ distal limbs but rapidly advances to involve proximal muscles as well (ascending paralysis)
= Mechanical ventilation is often required (use of steroids provides lil/no improvement)
= majority recover almost all neurologic Fn on own w/ little medical intervention
Dystonia:
Early symptoms of dystonia include:
= group of disorders characterized by M. contractions that cause twisting & repetitive m-nts, abnormal postures, or freezing in middle of action. Such movements are involuntary and sometimes painful. They can affect a single muscle, a group of muscles, or the entire body
=deterioration in handwriting, foot cramps, or a tendency of one foot to drag after walking or running. These initial symptoms can be mild and can be noticeable only after prolonged exertion, stress, or fatigue. In many cases, they become more noticeable and widespread over time. In other individuals, there is little or no progression
Parkinson’s:
4 main characteristics:
= chronic & progressive disorder.
= 1. “Pill Rolling” Tremor, 2. Rigidity, 3. Bradykinesia (Norm/, spontaneous, & autonomic mnt slowed/lost) 4. Postural instability (Impaired balance & coordination)
Central pain syndrome:
Characterized by:
Occurs in PTs who have had:
= condition from damage/injury to brain, brainstem, or SC dev/ Wks, Mns, or Yrs after injury to CNS
= intense, steady pain described as burning, aching, tingling, or a “pins and needles” sensation
= strokes, multiple sclerosis, limb amputations, or SC injuries.
(Pain meds generally provide no relief so they rely on sedation & other methods to keep CNS free from stress)
Amyotrophic lateral sclerosis (ALS) aka
Characterized by:
= Lou Gehrig’s disease, progressive degeneration of specific nerve cells that control voluntary mnt.
= weakness, loss of motor control, dysphasia,& cramping, & eventually weakens the diaphragm
Myoclonus:
can be symptom w/ NS disorders such as:
Pathologic myoclonus:
= temporary, involuntary twitching or spasm of muscle or group of muscles (EX: hiccups)
= multiple sclerosis, Parkinson’s, or Alzheimer’s
= can distort normal movement and limit a person’s ability to eat, walk, and talk
Spina bifida (SB)
Long-term effects:
The three most common types of SB:
= neural defect from failure of 1 or > of the fetal vertebrae to close properly during pregnancy thus a portion of SC unprotected.
>opening can usually be repaired shortly after birth, but the nerve damage is permanent.
= physical & mobility impairments, & most some form of learning disability.
= 1. Myelomeningocele (most severe full exposure)
2. Meningocele (meninges protrude through spinal opening) 3. Occulta (mildest form 1/> vertebrae malformed & covered by a layer of skin)
Poliomyelitis (polio)
It is characterized by:
= infectious, inflammatory viral disease of CNS that can result in permanent paralysis.
= fatigue, H/A, fever, vomiting, stiffness of the neck, & pain to the hands & feet
Peripheral Nervous System (PNS) Parts:
Autonomic Nervous System, Somatic Nervous System, Sympathetic Nervous System
CN with their correct name) CN 4
CN 10
CN 6
CN 9
CN 8
CN 12
CN 11
CN 3
CN 5
CN 7
CN 2
CN 1
Trochlear 4
Vagus 10
Abducens 6
Glossopharyngeal 9
Acoustic (Vestibulocochlear) 8
Hypoglossal 12
Spinal Accessory 11
Oculomotor 3
Trigeminal 5
Facial 7
Optic 2
Olfactory 1
RAS:
Associated with:
Drugs that affect RAS
= Reticular Activating System} Hub from info transmission from dissociation made of network of interconnected neurons in brainstem
= wakefulness, consciousness, REM sleep.
Hypnotic drugs target the RAS to induce sleep
Brain vascular supply) Astrocytes:
Myoglobin:
Brain receives of body’s total blood:
Wight & BGL Consumption:
Vascular supply system :
= open door for glucose
= supports & stores oxygen “muscle O2 storage”
= Brain receives ~20% body’s total blood flow/min
= 2% body weight & Consumes 25% body’s glucose
(Neurons need continuous supply of O2 & gL)
= Circle of Willis: beltway feeder
Carotid system (anterior) paired
Vertebrobasilar system (posterior) paired
Spinal cords:
= ~18in long & ½ inch wide Conducts impulses to & from PNS & for some reflexes.
31 pairs of nerve fibers exit the spinal cord as it descends and enters PNS.
Cranial nerves are PNS (branch off of CNS)
Eyes cranial nerves:
Lost Eye motor control CN:
= 2, 3, 4, 6
= 4 & 6
2 general mechanisms for AMS:
Structural Lesions & Toxic-metabolic states
Other general causes of AMS: Drugs, Cardiovascular problems, Respiratory problems, Infections
Eye’s Vitals) Direct response:
Indirect response (consensual response)
Accommodation:
Extraocular movement:
H test:
Nystagmus:
=pupils correct size & do they respond to you?
= L-pupil respond when light on R-eye (vice versa)
= cross eye
= Do both eyes look in the same direction?
= “Pupil check” is actually for checking iris “colored part” fn
= lacking complete fn, depressensent,
SSRI usually dont but TCAs can
AEIOU-TIPS) A:
E:
I:
O:
U-:
T:
I:
P:
S:
=Alcohol
= Epilepsy
= Infection
= Opiates (most common OD) / Overdose
= Uremia (converts amonia so < toxic)
=Trauma
= Insulin (~ occurs more than Infection)
= Poisoning:
= Psychosis
= Stroke:
Wernicke’s Syndrome (Reversible):
Korsakoff’s Syndrome (Irreversible):
= Acute weakness, ataxia, confusion, unsteady gait, nystagmus.
= Chronic phase w/ severe memory impairment
> Give Thiamine before admin/ of Dextrose for hypoglycemia!
5th leading cause of death each year
= STROKE }Cerebral vascular attack / brain attack) Ischemic 87% & Hemorrhagic 13%
2 sub types of ischemic(Embolic or Thrombotic)
Injury from plaque rupture & hemostasis most common reason for stroke
Thrombotic is moving clot & most common
>Risk Factors: Smoking, HTN, Diabetes, A-Fib, Hyperlipidemia. (smoking & HTN biggest causes
Cincinnati Prehospital Stroke Scale (CPSS)
= 1 + 77% ac & All 3 93-97% accurate (FAST)
= Face Arm Speech Time (LKN)
Facial Droop: – Have the patient smile or show their teeth
Arm Drift: Have the patient extend their arms straight out, with palms up, and hold them there for 10 seconds.
Speech: PT say “you can’t teach an old dog new tricks” (1 sentence, easily relay 6-7 words)
Tonic Clonic / Grand mal Seizures:
May be caused by:
Phases:
Concerns:
= (most common) Temp/ alt/ in cerebral activity changes electrical activity in the cerebral cortex.
= hypoxia, hypoglycemia, fever, tumors, stress, trauma, idiopathic.
= Aura, Tonic, Clonic, Hypertonic, Postical
= airway is clear} Intercostal-M.s & diaphragm temporarily paralyzed w/ copious amounts of secretions
Absence Seizure (Petit Mal Seizure):
Seizure characteristics:
Generalized, nonconvulsive seizure, w/ brief LOC (blank stare), motionless, unresponsive (can become grand mal & rarely has aura)
= “Brain pauses then resumes”, 10-30secs duration, Commonly 3-5 secs only, PT able to resume normal activity immediately after seizure (Glutamate kicks in & shuts down)
If arrive & active seizing
HOW BENZOs rework:
= protect w/ pillows don’t put anything in mouth
= Flows in making RMP more - (70 to 300) making it harder/longer to depolarize
Tension Headaches:
= frontal lobe} Caused by M. contractions in head & neck – Attributed to stress
-Pain is usually described as squeezing, dull, or as an ache.
Different Types:
Tension headaches (most common & from stress)
Migraines
Sinus headaches
Brain Abscess:
= A collection of pus & inflammation localized in the brain.
Analgesics:
Anesthesia:
Endorphins:
= are meds that relieve the sensation of pain
= absence of all sensations
= hormones bind to opioid receptors aka natural painkillers
o.d. (oculus dexter)
o.s. (oculus sinister)
o.u. (oculus uterque)
= Right eye “Dexter is my right hand man”
= Left Eye
= Both eyes “U for Unison”)
Down-regulation:
Excitability from recepetors:
= Med,hormone,ect to a target cell receptor causes # of available receptors to decrease
= of the receptors results in a decreased responsiveness of the target cell to the medication or hormone as the number of available active receptors decreases.
Gamma-aminobutyric acid (GABA) =
= chief inhibitory neurotransmitter in CNS binds
w/ receptors so channel “opens” & Cl influxs prolonging depolarization b/c it makes the inside of the cell more negative than the outside.
Alpha 1 agonist neurotransmitter:
Alpha 2:
Parasympathetic uses:
Muscarinic (5) receptors found:
= NORepi / Noradrenal
= inhibits the release of NORepi
= acetylcholine post & pre ganglion
= M1: CNS, GI, salv glands
M2: SA & AV nodes
M3: Smooth Muscles
Benzodiazepines:
= hyperpolarize the membrane of CNS neurons, thus decreases response to stimuli. & increase GABA receptor–Cl ion channel affinity
Low Back Pain) Sciatica:
From:
Causes:
= Severe pain that radiates along sciatic nerve
= Compression or trauma to the sciatic nerve
= Lumbar herniated disc, Degenerative disc
disease, Spondylolisthesis, Spinal stenosis
Back Pain & Nontraumatic Spinal Disorders
Low back pain
Disk injury
Cauda Equine Syndrome
Poliomyelitis:
Poliovirus Transmitted via:
S/S:
= Infectious disease invades CNS causing permanent paralysis – Destroys neurons in CNS
= fecal -oral route
= Most people infected don’t have S/S
(24-100) will have flulike S/S) & 1-100 will have
weakness & paralysis
Spina Bifida:
Different Types)
1. Myelomeningocele:
2. Meningocele:
3. Occulta:
= Neural tube defect from the incomplete closing of vertebrae & membranes around SC
1) Spinal cord & meninges protrude
2) Only the meninges protrude
3) 1 or more vertebrae are malformed
Amyotrophic Lateral Sclerosis (ALS)
“Lou Gehrig’s Disease” Devastating progressive
neurologic disorder selectively affects motor Fn
Central Pain Syndrome:
Cause by:
S/S:
= Neurological condition that results from damage or dysfunction to the brain, brainstem, & SC
= stroke, MS, tumors, trauma, Parkinson’s
= Burning, Tingling, Loss of sensation
(Not fatal, but causes disabling chronic pain)
Amyotrophic:
Lateral Sclerosis:
= shrinkage of musculature
= loss of nerve fibers in lateral columns of WM of SC
(No cure & poor prognosis – Death w/in 2-5Yrs)
Low Back Pain) Degenerative Disc Disease:
= Natural breakdown of the intervertebral disc
Gamma-aminobutyric acid (GABA):
GABA receptors:
= Chief inhibitory neurotransmitter in the CNS.
= across CNS on Cl-channels in cell membrane.
1) When GABA combines w/ Cl-receptors:
2) Cl (anion-) makes inside of the cell:
3 effect on the membrane:
1) channel “opens” & Cl diffuses through
2) more neg/ than outside & hyperpolarizes
3) membrane making it more difficult to depolarize & Depolarization therefore requires larger stimulus to cause cell to fire
Up-regulation:
More receptors causes:
= Med/hormone causes formation of more receptors than normal
= increases target tissue’s sensitivity to the particular medication or hormone.
Alzheimer’s Disease:
Brain differences:
Effects of brain & S/S:
= Subtle onset of memory loss followed slowly progressive dementia over several years
= diffuse atrophy of cerebral cortex & enlarged ventricles
=Presence of abnormal deposits of proteins
Amyloid plaques & tau tangles |Memory loss, Shuffling gait, Muscle stiffness, Aphasia
Two Main Types of Ischemic Stroke:
Most Common Cause of Stroke:
Common Sources of Emboli in Embolic Stroke
= Embolic & Thrombotic
= Thrombotic stroke (clot formation due to atherosclerosis or plaque rupture)
= Carotid stenosis, AFib, air embolism
Muscular Dystrophy:
Dynamics:
PSUEDOHYPERTROPHY:
Signs & Symptoms:
= Progressive degeneration & necrosis of skeletal M. fibers
= Replacement of M. w/ fat & connective tissue
= increased size from connective-T. infiltration
= Muscle weakness, Contractures, Chronic resp/ infections, weak cough, Cardiomyopathy
Migraine Headaches:
Thought to be caused by changes in blood vessel size in the base of the brain
Pain is usually described as pounding, throbbing, and pulsating.
Often associated with nausea and vomiting and may be preceded by visual changes
Most commonly from vascular size change
Sinus Headaches:
Caused by pressure that is the result of fluid accumulation in the sinus cavities (PTs may have cold-like S/S of nasal congestion, cough, fever)
Prehospital emergency care is not required
Usually bacterial infection & rq antibiotic
Seizures Types:
Generalized Seizures:
Categories:
= Generalized Seizures & Partial Seizures
= electrical discharge in small area of brain but spreads to involve entire cerebral cortex, causing widespread malfunction. Associated w/ unconsciousness
= Grand Mal Seizures (most common(TonicClonic Seizure), Petit Mal Seizures (Absence Seizure), Pseudo Seizures (Hysterical Seizure), Mimic generalized seizures
- Tonic Phase:
- Hypertonic Phase:
- Clonic Phase:
- Postictal:
- Aura:
1= “Tensed” contraction of muscles
2= Muscular rigidity w/ hyperextension of back
3= “Crazy” Rhythmic jerking motion of EXTRMS, SC-muscles & diaphragm temporarily paralyzed, can cause skeletal injuries, Severe acidosis from excessive ATP waste (Co2, H2o, temp)
4= State of confusion & fatigue after clonic phase; Brain restarting & exhausted from activity
5= sensation that sometimes precedes a seizure: Smell, taste, sound, Commonly metallic taste, can be any sense
Stroke Management:
} Stroke Alert
}Establish & Maintain a patent airway (Advanced airway may be required)
}Supplemental O2 (if signs of hypoxia are present)
}BGL (treat hypoglycemia w/ IV dextrose)
}IV (large gauge preferred) & 15 Lead ECG
}Protect paralyzed or Motor deficit PTs from hurting themselves (DONT HAVE PT SIT ON DEFICIT)
}LSD & tPA (Fibrinolytic) @ hospital
Stroke window for tPA
Fibrinolytic checklist
= 3Hr tPA– 0.8 mg/kg (max dose 90 mg)
Majority Hemorrhagic stroke pts have:
> Thunderclap H/A sudden full cranial vault full force “worst H/A of life”
TIA
S/S:
= “Mini Stroke” Blood flow blocked for short time ~ small thromboembolism & body lysation or vasoconstriction
= Lasts few mins to several Hrs usually (can last 24Hrs) Resolves completely within 24 hours
No evidence of neurological deficits
Precurrsor Over 50% has stroke later
Can be single on combination of S/S: visual, phonation, slurring
Definition of Seizures:
Common Causes of Seizures:
2 Main Types of Seizures:
= Temporary alteration in cerebral activity from massive neuronal depolarization
= Hypoxia, hypoglycemia, fever, tumors, stress, trauma, idiopathic
= Generalized Seizures & Partial Seizures
Spinal Cord Dorsal vs. Ventral Roots
Dorsal = Sensory
Ventral = Motor
Peripheral Nerves) Somatic Sensory:
Somatic Motor:
= Afferent nerves transmit sensations: touch, pressure, pain, temp, & position proprioception
= Efferent fibers carry impulses to the skeletal (voluntary) muscles
Peripheral Nerves)Visceral “autonomic” Sensory:
Visceral “autonomic” Motor:
= Afferent tracts transmit sensations from visceral organs EX: Sensations such as a full bladder or the need to defecate
= Efferent fibers exit CNS & branch to supply nerves to the involuntary cardiac muscle & smooth muscle of the viscera (organs) & to the glands.
What happens to neuronal RMP when benzodiazepines are administered?
What effect do benzodiazepines have on seizure activity?
= Neurons become hyperpolarized, reducing excitability
= Stops excessive neuronal firing by enhancing GABAergic inhibition.
What ion is responsible for benzodiazepine-induced neuronal inhibition?
= Chloride (Cl-) influx via GABA-A receptors.
Why does hyperkalemia predispose to seizures?
K+ retention reduces repolarization, keeping neurons partially depolarized & closer to firing threshold.
Benzodiazepine Effect on Seizures) Increased GABA activity:
Reduced Glutamate Activity:
Ion Channel Modulation:
= ↑ Cl- influx → Hyperpolarization Prevents APs from firing
= ↓ Na+ influx → Less Depolarization Decreases excitability
= ↓ Ca2+/Na+ currents Prevents neuronal overfiring
A patient is unable to move their eyes downward and medially. What cranial nerve is dysfunctional?
Cranial Nerve IV
Which cranial nerve is responsible for shrugging shoulders?
Cranial Nerve XI
What cranial nerve allows a patient to move their eyes laterally?
Cranial Nerve VI
What cranial nerve is responsible for sensation to the face and motor innervation of mastication muscles?
Cranial Nerve V
What cranial nerve allows a patient to make facial expressions and close their eyelids?
Cranial Nerve VII
What is the proper care for a Type I diabetic patient with altered mental status and malfunctioning glucometer?
Place the patient on oxygen via a NRB at 12-15 lpm, start an IV and administer 25 grams of IV dextrose for the treatment of suspected hypoglycemia.
What cranial nerve is affected if a patient’s tongue deviates to one side?
Cranial Nerve XII
What cranial nerve is responsible for hearing and balance?
Cranial Nerve VIII
Which cranial nerve transmits visual information from the retina to the brain?
Cranial Nerve II
What cranial nerve might be dysfunctional if a patient has difficulty swallowing?
Cranial Nerve IX
What dysfunction might a patient experience after a viral infection if they lost their sense of smell?
Olfactory CN 1
What is the function of CN I (Olfactory)?
Sensory | Smell | Neither sympathetic nor parasympathetic.
What is the function of CN II (Optic)?
Sensory | Vision | Neither sympathetic nor parasympathetic.
What is the function of CN III (Oculomotor)?
Motor | Eye movement, pupil constriction | Parasympathetic.
What is the function of CN IV (Trochlear)?
Motor | Eye movement (superior oblique) | Neither sympathetic nor parasympathetic.
What is the function of CN V (Trigeminal)?
Both | Facial sensation, mastication | Neither sympathetic nor parasympathetic.
What is the function of CN VI (Abducens)?
Motor | Eye movement (lateral rectus) | Neither sympathetic nor parasympathetic.
What is the function of CN VII (Facial)?
Both | Facial expression, taste (anterior 2/3), lacrimation | Parasympathetic.
What is the function of CN VIII (Vestibulocochlear)?
Sensory | Hearing & balance | Neither sympathetic nor parasympathetic.
What is the function of CN IX (Glossopharyngeal)?
Both | Taste (posterior 1/3), swallowing | Parasympathetic.
What is the function of CN X (Vagus)?
Both | Parasympathetic control of heart, lungs, digestion | Parasympathetic.
What is the function of CN XI (Accessory)?
Motor | Shoulder shrug (trapezius, sternocleidomastoid) | Neither sympathetic nor parasympathetic.
CN 1:
= Olfactory → smell “1 nose”
CN 2:
= Optic → vision (sensing light) “2 eyes”
CN 3:
= Oculomotor: pupil m-vt (controls pupils sizes) “3 words cocaine constricts pupils”
CN 4:
= Trochlear: eye motor function (look up & down) “it go up, down, up, down”
CN 5:
= trigeminal “suicide “= chewing muscles (chewing mastication), Sensory→Ophthalmic (forehead), maxillary (cheek)& mandibular (chin) “5 fingers to the face/chew”
CN 9:
= glossopharyngeal= controls taste @ back of tongue, helps w/ swallowing by saliva production. “9 lime”
CN 11:
= Accessory = traps Muscles motor
CN 12:
= Hypoglossal = motor tongue control out “12 & 21 baskin robin flavors”
A patient is unable to move their eyes downward and medially. What cranial nerve is dysfunctional?
Cranial Nerve IV
Which cranial nerve is responsible for shrugging shoulders?
Cranial Nerve XI
What cranial nerve allows a patient to move their eyes laterally?
Cranial Nerve VI
What cranial nerve is responsible for sensation to the face and motor innervation of mastication muscles?
Cranial Nerve V
What cranial nerve allows a patient to make facial expressions and close their eyelids?
Cranial Nerve VII
What is the proper care for a Type I diabetic patient with altered mental status and malfunctioning glucometer?
Place the patient on oxygen via a NRB at 12-15 lpm, start an IV and administer 25 grams of IV dextrose for the treatment of suspected hypoglycemia.
What cranial nerve is affected if a patient’s tongue deviates to one side?
Cranial Nerve XII
What cranial nerve is responsible for hearing and balance?
Cranial Nerve VIII
Which cranial nerve transmits visual information from the retina to the brain?
Cranial Nerve II
What cranial nerve might be dysfunctional if a patient has difficulty swallowing?
Cranial Nerve IX
What dysfunction might a patient experience after a viral infection if they lost their sense of smell?
Olfactory CN 1
What is the function of CN I (Olfactory)?
Sensory | Smell | Neither sympathetic nor parasympathetic.
What is the function of CN II (Optic)?
Sensory | Vision | Neither sympathetic nor parasympathetic.
What is the function of CN III (Oculomotor)?
Motor | Eye movement, pupil constriction | Parasympathetic.
What is the function of CN IV (Trochlear)?
Motor | Eye movement (superior oblique) | Neither sympathetic nor parasympathetic.
What is the function of CN V (Trigeminal)?
Both | Facial sensation, mastication | Neither sympathetic nor parasympathetic.
What is the function of CN VI (Abducens)?
Motor | Eye movement (lateral rectus) | Neither sympathetic nor parasympathetic.
What is the function of CN VII (Facial)?
Both | Facial expression, taste (anterior 2/3), lacrimation | Parasympathetic.
What is the function of CN VIII (Vestibulocochlear)?
Sensory | Hearing & balance | Neither sympathetic nor parasympathetic.
What is the function of CN IX (Glossopharyngeal)?
Both | Taste (posterior 1/3), swallowing | Parasympathetic.
What is the function of CN X (Vagus)?
Both | Parasympathetic control of heart, lungs, digestion | Parasympathetic.
What is the function of CN XI (Accessory)?
Motor | Shoulder shrug (trapezius, sternocleidomastoid) | Neither sympathetic nor parasympathetic.
CN 1:
= Olfactory → smell “1 nose”
CN 2:
= Optic → vision (sensing light) “2 eyes”
CN 3:
= Oculomotor: pupil m-vt (controls pupils sizes) “3 words cocaine constricts pupils”
CN 4:
= Trochlear: eye motor function (look up & down) “it go up, down, up, down”
CN 5:
= trigeminal “suicide “= chewing muscles (chewing mastication), Sensory→Ophthalmic (forehead), maxillary (cheek)& mandibular (chin) “5 fingers to the face/chew”
CN 9:
= glossopharyngeal= controls taste @ back of tongue, helps w/ swallowing by saliva production. “9 lime”
CN 11:
= Accessory = traps Muscles motor
CN 12:
= Hypoglossal = motor tongue control out “12 & 21 baskin robin flavors”
