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Pathophysiology > 44 Acute Disorders of Brain Function > Flashcards

44 Acute Disorders of Brain Function Flashcards

1
Q

Mechanisms of Brain Injury

A 
1 Ischemia + Hypoxia
2 Cellular Energy Failure
3 Excitatory Amino Acids
4 Reperfusion Injury
5 Incr Intracranial Pressure [ICP]
6 Brain Compression + Herniation
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2
Q

Ischemia

A
  • decr. blood flow
  • results in immediate neurologic dysfunction
  • —-due to inability of neurons to generate ATP needed for energy-requiring processes
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3
Q

ischemia + hypoxia

A
  • usually occurs together
  • isch is decr bf
  • hypox is decr O2 ay cell lvl
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4
Q

Neuronal Tissue

A
  • highly sensitive to O2 deprivation
  • has great ATP requirement
  • has limited capacity for anaerobic metab during ischemia
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5
Q

Cellular Energy Failure

A

after 5-10min w/o O2: irreversible brain damage

—bc neuronal tissue is dependent on glucose for ATP production + stores v little glycogen

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6
Q

Cellular Energy Failure

2 mechanisms

A

1 anaerobic metabolism

2 deterioration of ion gradient

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7
Q

glutamate is an…

A

excitotoxin aka excitatory amino acid neurotransmitter

—important in learning/memory

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8
Q

Excitatory Amino Acids

brain injury

A

excessive glutamate may be released bc of impaired membrane integrity
-reuptake mechanism fail to remove excess glutamate bc they are energy-dependant process

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9
Q

excess glutamate/excitatory amino acid

effect

A

excess stimulates nearby neurons that then take up large amounts of injurious Ca ions
-causes Ca overload injury

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10
Q

Ca overload injury

A

cytotoxic edema + swelling

–due to excess glutamate

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11
Q

Reperfusion Injury

A

when O2 re-enters cells, can produce reactive O2 products that act as free radicals

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12
Q

free radical examples

A

hydroxyl radicals
superoxide
peroxide

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13
Q

in brain cell injury, ischemia leads to…

A

1 hypoxia>mitochondrial failure>decr ATP>Ca overload>free radical>cell death
2 reperfusion injury>immune cells> cell death
3 glutamate release> open NMDA channels> Ca overload> free rad> cell death

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14
Q

Volume of Cranium

3 components

A

1 brain tissue
2 cerebrospinal fluid [CSF]
3 blood

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15
Q

NORMAL Intracranial Pressure [ICP]

A

0-15 mmHg

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16
Q

Increased ICP can occur w…

A

1 space-occupying lesions
2 vasogenic or cytotoxic edema
3 obstruction of CSF
4 excessive production of CSF

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17
Q

3 types of Increased ICP causes

A

1 INCR brain tissue vol
2 INCR CSF vol
3 INCR blood vol

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18
Q

papilledema

A

edema of optic disk

-may occur due to INCR ICP

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19
Q

Increased ICP

s/s

A
  • headache
  • altered lvl of consciousness/drowsiness
  • vomit
  • blurry vision
  • papilledema
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20
Q

as ICP rises…

A
  • compression of neural tissue + blood vessels
  • DECR lvl of consciousness
  • IMPAIRED pupil responsiveness to light
  • altered resp patterns
  • unresponsive to stimuli
  • unable to move, verbalize, or open eyes
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21
Q

Herniation

A

protrusion of brain tissue thry an opening in the supporting dura of the brain
–deadly

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22
Q

Level of Consciousness [LOC]

A

state of alertness + attentiveness to one’s enviro + situation

-change in LOC is most sensitive indicator of altered brain function

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23
Q

most sensitive indicator of altered brain function

A

LOC

-may fluctuate so important to monitor + treat changes

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24
Q

Coma

A

complete loss of consciousness

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25
Q

Glasgow Coma Scale

A

standardized tool for assessing LOC in acutely brain-injured persons
-numeric scores given to arousal-directed responses of eye opening, verbal utterance, + motor rxn

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26
Q

Glasgow Coma Scale

mild, moderate, severe

A

mild: >12
mod: 9-12
sevr: <8

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27
Q

Glasgow Coma Scale

motor responses

A 
-most powerful predictor of patient outcome
based on:
-decorticate posturing
-abnormal flexor
-decerebrate posturing
-abnormal extension
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28
Q

Pupil Reflex

A

indicates function of brainstem + CN II + III

-change in size, shape, + reactivity of pupil is early indicator of ICP + possible brain herniation

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29
Q

Oculovestibular Reflex

A
  • doll’s eyes maneuver entails rotating the patients head fr side to side
  • —NORMALLY eyes turn in the opposite direction of head rotation
  • impaired reflex implies brainstem dysfunction
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30
Q

leading cause of death + disability in U.S.

A

traumatic brain injury [TBI]

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31
Q

how are most head injuries incurred?

A
  • transportation-related accidents
  • falls
  • fire
  • arms
  • sports accidents
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32
Q

Types of Traumatic Brain Injuries [TBI]

A

1 PRIMARY INJURY
—focal, polar, diffuse
2 INTRACRANIAL HEMATOMAS
—epidural, subdural, subarachnoid

33
Q

Primary Injury

A

type of TBI fr initial truma/injury on brain cells

3 types: focal, polar, diffuse

34
Q

Focal Primary Injury

A

coup: localized to sire of impact

35
Q

Polar Primary Injury

A

coup contracoup

  • due to acceleration-deceleration mvmt of brain w/in skull
  • –results in double injury (usually opposite focal injury)
36
Q

Diffuse Primary Injury

A

due to mvmt of brain w/in skull

-widespread axonal injury

37
Q

Primary Injury

mechanisms

A

-CONCUSSION
-CONTUSION
INTRACRANIAL HEMATOMA

38
Q

Concussion

A
  • mild traumatic brain injury
  • alteration/loss of LOC (<30min)
  • —-but no evidence of brain damage on CT
39
Q

Concussion

s/s

A
  • headache
  • n/v
  • dizziness
  • fatigue
  • blurred vision
  • cognitiv + emo disturbances
40
Q

most common military/athlete injury?

A

concussion

41
Q

Contusion

A

CT or MRI reveals area of brain tissue damage

–necrosis, laceration, bruising

42
Q

Intracranial Hematoma

A

localized collection of blood w/in cranium
-disruption of vasculature can result in intracranial hemorrhage
3 types: epidural, subdural, or subarachnoid

43
Q

Epidural Intracranial Hematoma

A

collection of blood bw DURA + SKULL

  • typically involved ARTERIAL INJURY
  • –thus RAPID ONSET OF SYMPTOMS
44
Q

Subdural Hematoma

A

collection of blood bw DURA + OUTER LAYER OF ARACHNOID MEMBRANE

  • typically involves BRIDGING VEINS
  • -slower onset of symptoms

-may be acute or subacute

45
Q

Subdural Hematoma

acute vs subacute

A

ACUTE: symptoms w/in 24hrs of injury

SUBACUTE: incr ICP (headache, vomit, blurred vision)
—-2-10 days later

46
Q

Subarachnoid Hematoma

A

collection of blood bw ARACHNOID MEMBRANE + PIA MATER
-due to rupture of bridging veins that pass the arachnoid space

  • more commonly assoc w rupture of cerebral aneurysms or arteriovenous malformations
  • –arterial origin
47
Q

Traumatic Brain Injury [TBI]

treatments

A

1 CardioPulmonary Stabilization

2 maintnc of norm body temp/mild hypothermia, norm PaCO2, norm serum glucose lvl, + norm intravasc vol

48
Q

TBI - base skull fracture

A

halo test: CSF can seep out as clear fluid fr ears/nose
racoon sign: bilateral perioorbital hematomas: black eyes

battle’s sign: bruising under ear

49
Q

treatment for open head injury

A

prophylatctic antibiotics

50
Q

stroke

A

sudden onset of neurologic dysfunction due to cardiovascular disease that results in an area of brain infarction

-3rd leading cause of death

51
Q

most common form of stroke

A

ischemic stroke

52
Q

cerebrovascular disease + stroke cause…

A

abnormalities of cerebral perfusion

- transient ischemic attacks (TIA), ischemic stroke, + hemorrhagic stroke

53
Q

Ischemic Stroke

A

results fr sudden occlusion of cerebral artery secondary to thrombus formation or emboli

54
Q

Thrombotic Strokes

A

type of ischemic stroke

*assoc w atherosclerosis + coagulopathies

55
Q

Embolic Strokes

A

type of ischemic stroke

*assoc w cardiac dysfunction or dysrhythmias (atrial fibrillation)

56
Q

Ischemic Stroke

s/s

A
  • **ALL CONTRALATERAL
  • hemiplegia
  • hemisensory loss
  • visual field blindness
57
Q

in an ischemic stroke, is a neurologic deficits completely resolve…

A

a Transient Ischemic Attack [TIA] occurs

58
Q

Transient Ischemic Attack [TIA]

A

occurs when a neurologic deficit completely resolves in an ischemic stroke

59
Q

Transient Ischemic Attack [TIA]

s/s

A
  • neurologic symptoms typically last only minutes but they may last as long as 24 hours
  • symptoms resolve completely w/o evidence of neurologic dysfunction
60
Q

Ischemic Stroke

treatment

A 
aimed at minimizing infarct size + preserving neurologic function
1 thrombolytics
2 anticoagulant
3 antiplatelet
4 endarterectomy
5 angioplasty
6 stents
61
Q

Motor Deficits

A

initially motor deficits occur as flaccidity or paralysis

-recovery of motor function occurs w onset of spasticity

62
Q

Sensory Deficits

A

sensory disturbances occur in same locations as motor paralysis + may involve neglect or visual impairment

  • loss of visual field on paralyzed side also contributes to neglect
  • homonymous hemianopsia
  • assess fall risk
63
Q

homonymous hemianopsia

A

contralateral field blindness

  • same side of retina in each eye is blinded
  • occurs in sensory deficits
64
Q

Language Deficits

A

aphasia occurs w brain damage to the dominant cerebral hemisphere + can involve all language modalities

65
Q

2 types of Aphasia/Language Deficit

A

1 Broca Aphasia

2 Wernicke Aphasia

66
Q

Broca Aphasia

A

verbal motor/expressive

-poor articulation + sparse vocab

67
Q

Wernicke Aphasia

A

sensory, acoustic, + receptive

-impaired auditory comprehension + speech

68
Q

Types of Stroke Sequelae

A
  • cognitive deficit
  • language deficit
  • motor deficit
  • sensory deficit/diisturbances
69
Q

most common causes of SubArachnoid Hemorrhage

A

Cerebral Aneurysm + Arteriovenous Malformation [AVMs]

70
Q

Cerebral Aneurysm

A

lesion of an artery that results in dilation + ballooning of a segment of the vessel
-60% will either die or suffer permanent disability

-high blood pressure, acute alcohol intoxication, + recreational use (esp cocaine) implicated

71
Q

Central Nervous System Infection

A

organisms may gain access to the CNS via 1 1 bloodstream
2 direct extension fr primary site
3 peripheral + cranial nerves
4 maternal-fetal exchange

72
Q

…commonly assoc w bacterial infections

A

meningitis, cerebral abscess

73
Q

…commonly assoc w viral infections

A

encephalitis

74
Q

Meningitis

A
  • streptococcus pneumoniae

- bacteria invade leptomeninges; accum of inflammatory exudate can result in obstructive hydrocephalus

75
Q

Meningitis

s/s

A
  • headache
  • fever
  • meningismus
  • cerebral dysfunction
  • —-confusion, delirium
76
Q

meningismus

A

stiff neck fr meningitis

77
Q

Meningitis

diagnosis

A

lumbar puncture

78
Q

Meningitis

prevention

A

vaccination for Hib + N. meningitidis

Pathophysiology (32 decks)

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