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Patho Exam #4 > Acute Brain > Flashcards

Acute Brain Flashcards

1
Q

As a result of an increase volume in the cranium.

A

Increased Intracranial Pressure

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2
Q

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

A

cranium

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3
Q

This volume in the cranium is composed of three elements:

A

cerebral tissue, cerebrospinal fluid, and blood

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4
Q

Normal increased intracranial pressure is

A

0-15 mmhg​

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5
Q

_______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 ​
​

A

Monro-Kellie hypothesis

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6
Q

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

A

ICP

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7
Q

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

A

ICP

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8
Q

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

A

ICP; decreases

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9
Q

______ or ______ helps manage ICP

A

MRI and CT

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10
Q

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

A

60

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11
Q

Removing ______ and improving cerebral ______ to manage brain injury

A

lesion; oxygenation

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12
Q

most sensitive indicator of altered brain function

A

change in level of consciousness

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13
Q

State of alertness and attentiveness dependent upon activity in _____ neurons

A

RAS

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14
Q

Standardized tool for assessing LOC in acutely brain-injured persons

A

Glasgow Coma Scale

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15
Q

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

A

motor response

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16
Q

Ranges for glasgow scale

A

Mild >12
Moderate 9-12
Severe <8

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17
Q

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

A

Pupil Reflex

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18
Q

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

A

ICP

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19
Q

Eye movements controlled by ______ nerves

A

CN III, IV, and VI

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20
Q

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

A

Nystagmus

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21
Q

Impaired reflex implies brainstem dysfunction

A

Oculovestibular Reflex

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22
Q

_____entails rotating the patient’s head from side to side

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

A

Doll’s eyes maneuver; Oculovestibular Reflex

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23
Q

_____inject cold water into ear

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

A

Cold Calorics; Oculovestibular Reflex

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24
Q

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

A

corneal reflex

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25
Q

Mean arterial pressure maintained above __ mm Hg

Cerebral perfusion pressure: ___mm Hg

A

70; 60

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26
Q

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

A

hypothermia

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27
Q

leading cause of death and disability in U.S.

A

TBI

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28
Q

What are the 2 types of TBI

A

Primary injury and intracranial hematomas

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29
Q

3 types of primary TBI injury

A

Focal
Polar
Diffuse

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30
Q

3 types of intracranial hematomas

A

Epidural
Subdural
Subarachnoid

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31
Q

TBI type localized to site of impact

A

Focal

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32
Q

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

A

Polar

33
Q

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

A

Diffuse

34
Q

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

A

Concussion

35
Q

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

A

Contusion

36
Q

localized collection of blood within the cranium

A

Intracranial hematoma

37
Q

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 _____

A

TBI

38
Q

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

A

Acutely elevated ICP

39
Q

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

A

Severely high ICP

40
Q

prophylactic antibiotics treatment for ______

A

open head injuries

41
Q

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

A

base skull fractures

42
Q

Cause abnormalities of cerebral perfusion

Transient ischemic attacks (TIA), ischemic stroke, and hemorrhagic stroke

A

CVD/Stroke

43
Q

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

A

stroke

44
Q

Most common form of stroke

A

ischemic

45
Q

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)

A

Stroke

46
Q

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

A

ischemic stroke

47
Q

________strokes associated with atherosclerosis and coagulopathies

A

thrombotic

48
Q

______strokes associated with cardiac dysfunction or dysrhythmias (atrial fibrillation)

A

embolic

49
Q

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

A

ischemic stroke

50
Q

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 _____

A

thrombotic; ischemic stroke

51
Q

If neurologic deficits completely resolve

A

transient ischemic attack (TIA)

52
Q

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

A

transient ischemic attack (TIA)

53
Q

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

A

transient ischemic attack (TIA)

54
Q

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

A

transient ischemic attack (TIA)

55
Q

Hemorrhage within the brain parenchyma

A

Hemorrhagic Stroke

56
Q

Usually occurs secondary to severe, chronic hypertension

Most occur in basal ganglia or thalamus

A

Hemorrhagic Stroke

57
Q

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

A

Hemorrhagic Stroke

58
Q

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

A

stroke

59
Q

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

A

Ischemic stroke

60
Q

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

A

Hemorrhagic stroke

61
Q 
Brain imaging
CT Scan
MRI ( MR DWI-diffusion weighted imaging)
CTA
MRA
Transcranial doppler
diagnose \_\_\_\_\_\_
A

stroke

62
Q

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

A

motor

63
Q

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 ________

A

Motor Deficits

64
Q

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

A

Motor Deficits

65
Q

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

A

sensory

66
Q

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

A

sensory deficits

67
Q

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

A

aphasia

68
Q

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

A

Broca aphasia

69
Q

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

A

Wernicke aphasia

70
Q

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

A

Cognitive deficits

71
Q

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

A

CNS infections

72
Q

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

A

bacterial; viral

73
Q

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

A

Meningitis

74
Q

Most common bacteria are Streptococcus pneumoniae

in ______

A

Meningitis

75
Q

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

A

Meningitis

76
Q

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

A

Meningitis

77
Q

Diagnosis: lumbar puncture

A

Meningitis

78
Q

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

A

Meningitis

79
Q

Prevention: vaccinations for Hib and N. meningitidis

A

Meningitis

Patho Exam #4 (7 decks)

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