Acute Brain

Question 1

As a result of an increase volume in the cranium.

Answer 1

Increased Intracranial Pressure

Question 2

The_____ in an adult is a closed fixed space that can’t tolerate anything more than transient increase in the pressure.​
​

Answer 2

cranium

Question 3

This volume in the cranium is composed of three elements:

Answer 3

cerebral tissue, cerebrospinal fluid, and blood

Question 4

Normal increased intracranial pressure is

Answer 4

0-15 mmhg​

Question 5

_______there are compensatory responses to the change in the volume in any of the components of volume in the cranium. So therefore if there’s an increase in csf, there will be a common reduction in blood flow. Brain tissue not so much, it’s very hard to decrease brain tissue. If there’s an increase of pressure in the brain tissue, csf and blood flow will compensatorily will be reduced ​
​

Answer 5

Monro-Kellie hypothesis

Question 6

Increased _____can occur with space-occupying lesions, vasogenic or cytotoxic edema, or with obstruction or excessive production of CSF​

Answer 6

ICP

Question 7

Headache, vomiting, and altered level of consciousness (drowsiness)
Blurry vision, and edema of the optic disk (papilledema)
symptoms of

Answer 7

ICP

Question 8

As ____ rises to higher levels, level of consciousness ____, pupil responsiveness to light becomes impaired; altered respiratory patterns and unresponsive to stimulation; unable to move, verbalize, or open the eyes

Answer 8

ICP; decreases

Question 9

______ or ______ helps manage ICP

Answer 9

MRI and CT

Question 10

CPP greater than _____mm Hg to ensure adequate blood flow and prevent ischemia

Answer 10

60

Question 11

Removing ______ and improving cerebral ______ to manage brain injury

Answer 11

lesion; oxygenation

Question 12

most sensitive indicator of altered brain function

Answer 12

change in level of consciousness

Question 13

State of alertness and attentiveness dependent upon activity in _____ neurons

Answer 13

RAS

Question 14

Standardized tool for assessing LOC in acutely brain-injured persons

Answer 14

Glasgow Coma Scale

Question 15

Whats the most powerful predictor of patient outcome for Glasgow come scale?

Answer 15

motor response

Question 16

Ranges for glasgow scale

Answer 16

Mild >12
Moderate 9-12
Severe <8

Question 17

Indicates the function of the brainstem and cranial nerves (CN) II and III

Answer 17

Pupil Reflex

Question 18

Changes in size, shape, and reactivity of the pupil early indicator of _____ and possible brain herniation

Answer 18

ICP

Question 19

Eye movements controlled by ______ nerves

Answer 19

CN III, IV, and VI

Question 20

________, dysconjugate movement, and ocular palsies may be present in brain injury

Answer 20

Nystagmus

Question 21

Impaired reflex implies brainstem dysfunction

Answer 21

Oculovestibular Reflex

Question 22

_____entails rotating the patient’s head from side to side

Normally eyes turn in opposite direction of the head rotation in ____

Answer 22

Doll’s eyes maneuver; Oculovestibular Reflex

Question 23

_____inject cold water into ear

Normal response: tonic deviation of both eyes toward the side that is irrigated in______

Answer 23

Cold Calorics; Oculovestibular Reflex

Question 24

Wisp of cotton touches cornea of the eye to elicit a blink response
Absence of blink response: indictor of severely impaired brain function

Answer 24

corneal reflex

Question 25

Mean arterial pressure maintained above __ mm Hg | Cerebral perfusion pressure: ___mm Hg

Answer 25

70; 60

Question 26

_____ may be used to reduce brain metabolism. Increased brain metabolism should be avoided

Answer 26

hypothermia

Question 27

leading cause of death and disability in U.S.

Answer 27

TBI

Question 28

What are the 2 types of TBI

Answer 28

Primary injury and intracranial hematomas

Question 29

3 types of primary TBI injury

Answer 29

Focal Polar Diffuse

Question 30

3 types of intracranial hematomas

Answer 30

Epidural Subdural Subarachnoid

Question 31

TBI type localized to site of impact

Answer 31

Focal

Question 32

TBI type due to acceleration-deceleration movement of the brain within the skull, resulting in double injury (usually opposite focal injury)

Answer 32

Polar

Question 33

TBI type due to movement of the brain within the skull, resulting in widespread axonal injury

Answer 33

Diffuse

Question 34

Mild traumatic brain injury; most common injury encountered by military personnel and athletes Alteration or loss of consciousness (< 30 minutes) but no evidence of brain damage on CT Headache, nausea, vomiting, dizziness, fatigue, blurred vision, cognitive and emotional disturbances

Answer 34

Concussion

Question 35

CT or MRI reveals an area of brain tissue damage (necrosis, laceration, bruising)

Answer 35

Contusion

Question 36

localized collection of blood within the cranium

Answer 36

Intracranial hematoma

Question 37

Cardiopulmonary stabilization Radiologic screening to evaluate need for emergent surgical management Maintenance of normal body temperature or mild hypothermia, normal PaCO2, normal serum glucose level, and normal intravascular volume recommended Treatment for _____

Answer 37

TBI

Question 38

administration of mannitol (osmotic diuretic), sedation, hypothermia, and mild hyperventilation Treatment for

Answer 38

Acutely elevated ICP

Question 39

more aggressive measures; diuretics, hypertonic saline, moderate hyperventilation, and barbiturate coma Treatment for

Answer 39

Severely high ICP

Question 40

prophylactic antibiotics treatment for ______

Answer 40

open head injuries

Question 41

CSF can seep out as clear fluid from the ears or nose (halo test); bilateral periorbital hematomas (black eyes, “raccoon sign”) and bruising under the ear (Battle’s sign) signs of

Answer 41

base skull fractures

Question 42

Cause abnormalities of cerebral perfusion | Transient ischemic attacks (TIA), ischemic stroke, and hemorrhagic stroke

Answer 42

CVD/Stroke

Question 43

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

Answer 43

stroke

Question 44

Most common form of stroke

Answer 44

ischemic

Question 45

Females affected more often than males Risk factors are similar to those for other atherosclerotic vascular diseases (hypertension, DM, hyperlipidemia, smoking, advancing age, family history)

Answer 45

Stroke

Question 46

Results from sudden occlusion of cerebral artery secondary to thrombus formation or emboli

Answer 46

ischemic stroke

Question 47

________strokes associated with atherosclerosis and coagulopathies

Answer 47

thrombotic

Question 48

______strokes associated with cardiac dysfunction or dysrhythmias (atrial fibrillation)

Answer 48

embolic

Question 49

Clinical manifestations: contralateral hemiplegia, hemisensory loss, and contralateral visual field blindness

Answer 49

ischemic stroke

Question 50

Treatment: salvaging the penumbra is the aim of early ______therapy; however, treatment must be instituted within 3 hours of symptom onset to be maximally effective in _____

Answer 50

thrombotic; ischemic stroke

Question 51

If neurologic deficits completely resolve

Answer 51

transient ischemic attack (TIA)

Question 52

Neurologic symptoms typically last only minutes, but they may last as long as 24 hours Symptoms resolve completely without evidence of neurologic dysfunction

Answer 52

transient ischemic attack (TIA)

Question 53

important warning signs of thrombotic disease and carry a significant risk for subsequent stroke

Answer 53

transient ischemic attack (TIA)

Question 54

Treatment: daily aspirin; carotid endarterectomy or angioplasty if 70% occluded

Answer 54

transient ischemic attack (TIA)

Question 55

Hemorrhage within the brain parenchyma

Answer 55

Hemorrhagic Stroke

Question 56

Usually occurs secondary to severe, chronic hypertension | Most occur in basal ganglia or thalamus

Answer 56

Hemorrhagic Stroke

Question 57

Degree of secondary injury and associated morbidity and mortality is much higher in _________ than ischemic stroke

Answer 57

Hemorrhagic Stroke

Question 58

Cardiovascular stabilization Brain CT determines type and location ICP monitoring and management Treatment for ______

Answer 58

stroke

Question 59

treatment aimed at minimizing infarct size and preserving neurologic function Thrombolytics, anticoagulant, antiplatelet, endarterectomy, angioplasty, stents

Answer 59

Ischemic stroke

Question 60

treatment aimed at blood pressure management (keep mildly hypertensive at first)

Answer 60

Hemorrhagic stroke

Question 61

``` Brain imaging CT Scan MRI ( MR DWI-diffusion weighted imaging) CTA MRA Transcranial doppler diagnose ______ ```

Answer 61

stroke

Question 62

Initially____ deficits occur as flaccidity or paralysis; recovery of function occurs with onset of spasticity

Answer 62

motor

Question 63

Contralateral to the side of the brain where the stroke occurred Active/passive range of motion exercises should be started in acute phase of recovery for ________

Answer 63

Motor Deficits

Question 64

Elevate edematous limbs, use elastic stockings, and maintain body alignment Aggressive rehabilitation commonly required for ________

Answer 64

Motor Deficits

Question 65

______ disturbances occur in same locations as motor paralysis and may involve neglect or visual impairment

Answer 65

sensory

Question 66

Loss of visual field on the paralyzed side also contributes to neglect Contralateral field blindness: homonymous hemianopsia, the same side of the retina in each eye is blinded Assess fall risk

Answer 66

sensory deficits

Question 67

occurs with brain damage to the dominant cerebral hemisphere and can involve all language modalities

Answer 67

aphasia

Question 68

(verbal motor/expressive) consists of poor articulation and sparse vocabulary

Answer 68

Broca aphasia

Question 69

(sensory, acoustic, receptive) characterized by impaired auditory comprehension and speech that is fluent but does not make sense

Answer 69

Wernicke aphasia

Question 70

Evidenced as language impairment, impaired spatial relationship skills and short-term memory, and poor judgment Concentration, memory, and reasoning may be impaired May require rehabilitative services

Answer 70

Cognitive deficits

Question 71

Organisms may gain access to the CNS through the bloodstream, direct extension from a primary site or along peripheral and cranial nerves, or through maternal-fetal exchange Risk factors: immunocompromise, debilitation, poor nutrition, radiation, steroid therapy, contact with vectors

Answer 71

CNS infections

Question 72

Meningitis and cerebral abscess commonly associated with _____ infections; encephalitis usually ____

Answer 72

bacterial; viral

Question 73

Bacteria usually reach the CNS via the bloodstream or extension from cranial structures like sinuses or ears in

Answer 73

Meningitis

Question 74

Most common bacteria are Streptococcus pneumoniae | in ______

Answer 74

Meningitis

Question 75

Bacteria invade leptomeninges; accumulation of inflammatory exudate can result in obstructive hydrocephalus

Answer 75

Meningitis

Question 76

Classic presentations: headache, fever, stiff neck (meningismus), and signs of cerebral dysfunction (confusion, delirium)

Answer 76

Meningitis

Question 77

Diagnosis: lumbar puncture

Answer 77

Meningitis

Question 78

Treatment: intravenous antibiotic therapy and supportive measures; corticosteroids (controversial)

Answer 78

Meningitis

Question 79

Prevention: vaccinations for Hib and N. meningitidis

Answer 79

Meningitis