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Pathophysiology > Alterations in Neurological Function > Flashcards

Alterations in Neurological Function Flashcards

1
Q

____ ____ is the pressure within the skull

A

Intracranial pressure

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2
Q

Our average ICP is from 0-10, but we may have slight elevation from things like…

A

Sneezing, coughing

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3
Q

An ICP of ___-___ is moderate intracranial hypertension

A

20-40

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4
Q

An ICP of above ____ is severe intracranial hypertension (this happens in 50% of all TBIs)

A

40

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5
Q

____ ___ ____ is the mean arterial blood pressure

A

Cerebral perfusion pressure

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6
Q

Cerebral perfusion pressure is the force needed to overcome the pressure of the _____

A

Skull

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7
Q

Normal cerebral perfusion pressure is ___-___ mmHg

A

70-100

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8
Q

The Monro-Kellie Hypothesis explains ____ of CSF, brain tissue, and blood

A

Compliance

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9
Q

The Monro-Kellie Hypothesis states that an increase in either CSF, brain tissue, or blood would lead to ____ in the other two

A

Compensation (decrease)

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10
Q

We can monitor intracranial pressure using an ____ ____

A

Intraventricular catheter

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11
Q

What are some possible causes of increased intracranial pressure?

A

-Trauma
-Brain tumors
-Spinal tumors
-Spinal trauma
-Stroke
-Severe liver or heart failure
-Anything that increases cerebrospinal fluid production
-Anything that decreases cerebrospinal fluid removal

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12
Q

Manifestations of increased intracranial pressure:

A

-Deterioration in level of consciousness
-Restless and then lethargy
-Posturing (decorticate and then decerebrate)
-Headache
-Vomiting
-Visual abnormalities (diplopia, decreased visual acuity, disconjugate gaze)
-Deterioration of motor function
-Altered blood pressure and pulse (Cushing’s response)
-Pupillary dysfunction
-Gag and cough reflexes
-Distention of retinal veins
-Cranial nerve XI (shoulder shrugs)
-Altered respiration
-Altered temperature
-Loss of brain stem reflexes
-Papilledema (retinal inflammation)

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13
Q

What does Cushing’s Response cause?

A

-Decreased heart rate
-Increased blood pressure
-Decreased respiratory rate
-Widening pulse pressure

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14
Q

Cheyne strokes are periods of rapid breathing that may occur if there is damage at the ___ ___

A

Cerebral hemispheres

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15
Q

Central neurologic hyperventilation might occur if there is damage to the ____

A

Midbrain

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16
Q

Apneustic breathing might occur if there is damage to the ____

A

Pons

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17
Q

Ataxic breathing might occur if there is damage to the _____

A

Medulla

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18
Q

Decerebrate posturing results from severe damage to the top of the ____ ____

A

Brain stem

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19
Q

_____ posturing results from damage to one or both corticospinal tracts

A

Decorticate

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20
Q

Someone might have loss of corneal reflexes if they have damage to cranial nerve ____

A

VI

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21
Q

Someone might have loss of the oculocephalic reflex (dolls eyes) if they have damage to cranial nerve ____

A

VIII

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22
Q

Someone might have loss of the oculovestibular reflex (iced kalorics) if they have damage to cranial nerve ____

A

VIII

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23
Q

The ___ ___ ___ measures best response to pain

A

Glasgow Coma Score

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24
Q

____ herniation is caused by brain shifting above the tentorium

A

Supratentorial

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25
Q

____ herniations result from the brain moving away from the side of injury over the falx; nerves and arteries can get pulled over the midline which leads to ischemia to the frontal lobe and part of the parietal

A

Subfalcine

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26
Q

_____ herniations cause herniation across the tentorium (up or down); this usually occurs when there is a mass pushing the tissue up or down and is most commonly seen with a frontal lobe mass

A

Transterentorial

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27
Q

Symptoms of transtentorial herniations result from high ___ ___

A

Intracranial pressure

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28
Q

____ herniations are caused by lesions in the temporal or parietal lobe and cause someone to have lopsided pressure which pushes the uncus into the brain stem

A

Uncal

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29
Q

When the uncus gets pulled down, there is increased pressure on the brain that leads to ____ ____; you might see a blown pupil on the side of the injury and hemiparesis on the opposite side of the injury

A

Contralateral hemiparesis

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30
Q

_____ herniations push up or downward and are more rare than other types of herniations

A

Infratentorial

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31
Q

If an infratentorial herniation pushes up, it puts pressure on the ____

A

Midbrain

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32
Q

If an infratentorial herniation pushes down, it puts pressure on the ____

A

Medulla

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33
Q

Supratentorial herniation refers to the displacement of the _____ which is above the tentorium

A

Cerebrum

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34
Q

Infratentorial herniation refers to herniation of the ____ which is below the tentorium

A

Cerebellum

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35
Q

The ____ is the first line of defense for the brain

A

Skull

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36
Q

Head injury can cause ____ of the skull

A

Cracking

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37
Q

A ____ skull fracture is less likely to be a depressed fracture and is usually caused by getting hit by a large, flat object

A

Linear

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38
Q

A ____ fracture indicates that the bone has shattered into many pieces (egg shell)

A

Comminuted

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39
Q

A ____ fracture is when the bones gets pushed in a tears some of the brain tissue (can be caused by getting hit by something like a hammer)

A

Depressed

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40
Q

____ skull fractures are fractures of the base of the skull and are very concerning

A

Basal

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41
Q

Basal skull fractures may be an extension of a ___ fracture or an injury on its own

A

Linear

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42
Q

A concern with basal skull fractures is that they can tear the ____ and cause sinus fluid to get into the brain (this can cause high risk for infection)

A

Meninges

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43
Q

What are some signs that the meninges has been torn?

A

-Bitter taste of CSF in the back of the throat
-Might see CSF leaking out of the ear
-Preorbital edema
-Edema of the mastoid muscle

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44
Q

Facial fractures are concerning because if someone needs to be ____, it may cause difficult tube placement

A

Intubated

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45
Q

Brain injuries can result from things like…

A

-Falling
-Gun shots
-Violense
-Trauma
-Sports

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46
Q

____ injuries are broad injuries that effect the whole brain

A

Diffuse

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47
Q

One example of a diffuse injury is a ____

A

Concussion

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48
Q

What are common causes of concussions?

A

-Sports (hockey, football, boxing, soccer, lacrosse)
-Falls
-Car accidents

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49
Q

Symptoms of concussions include…

A

-Momentary loss of reflexes
-Arrest of respiration
-Amnesia before or after the event
-Headache
-Dizziness
-Confusion
-Visual disturbances
-Gait disturbances

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50
Q

Treatment for concussions includes ____ of the brain

A

Rest

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51
Q

___ ___ ___ is an aggregate of symptoms commonly presenting together after head injury

A

Post-concussion syndrome

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52
Q

What are some possible symptoms of post-concussion syndrome?

A

-Headache
-Dizziness
-Insomnia
-Decreased cognitive abilities
-Sleep
-Neuropsychiatric symptoms
-Neuroinflammation

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53
Q

____ ___ injuries result from the head and body suddenly stopping after moving at a high speed (common after car accidents)

A

Diffuse axonal

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54
Q

Diffuse axonal injuries damage ____

A

Axons

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55
Q

Usually, diffuse axonal injuries cause damage to the ____ ____ and cause high rates of mortality

A

Brain stem

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56
Q

With a ____ brain injury, there is not enough blood going to the brain

A

Hypoxic

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57
Q

Hypoxic brain injuries may be caused by…

A

Cardiac or respiratory arrest

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58
Q

Some hypoxic brain injuries may be mild but someone who is out for ~7.5 minutes might be ____ for life/have severe effects

A

Comatose

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59
Q

____ injuries are injuries to a more concentrated location of the brain

A

Focal

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60
Q

_____ ____ are bruises on the brain

A

Cerebral contusions

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61
Q

Cerebral contusions can also cause ____ in the days following the injury

A

Swelling

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62
Q

With cerebral contusions, a high amount of ____ moves into the cells which causes mitochondrial failure and energy failure

A

Calcium

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63
Q

Cerebral contusions cause changes in ___ __ after day 1 of injury

A

Blood flow

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64
Q

At first, there will be an ____ in blood flow to the injured area which leads to not enough blood in healthy tissues nearby

A

Increase

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65
Q

With a _____ injury, the brain and skull get hit hard by something

A

Compression

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66
Q

With a ____ injury, there is negative pressure on the brain tissue

A

Tension

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67
Q

A ____ injury is when axons are torn

A

Shearing

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68
Q

____ and ____ is a common pattern of contusions and is the same concept as the rebound effect that is caused by inertia

A

Coup and countercoup

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69
Q

____ ___ are tears in the brain tissue, usually caused by deep skull fractures or penetrating injuries

A

Cerebral lacerations

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70
Q

____ ____ are caused when a fractured skull tears the vessels between the skull and the dura; this tears the artery

A

Epidural hematomas

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71
Q

The torn artery causes blood to pump into the ___ ___

A

Epidural space

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72
Q

Epidural hematomas cause ____ herniations

A

Uncal

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73
Q

Epidural hematomas are caused by a rupture of arteries in the ___ ___

A

Epidural space

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74
Q

Manifestations of epidural hematomas:

A

-Loss of consciousness
-Coma
-Death (due to herniation)

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75
Q

_____ hematomas are below the dura, so veins instead of arteries will be affected

A

Subdural

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76
Q

___% of head injuries will cause a subdural hematoma

A

15

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77
Q

Subdural hematomas are caused by tearing of the vessels in the ___ ___

A

Subdural space

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78
Q

Subdural hematomas will also eventually lead to ____, but this takes much longer than epidural hematomas and they can be treated if caught early

A

Herniation

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79
Q

A ____ subdural hematoma is usually seen in older people and symptoms might not appear for days to weeks

A

Subacute

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80
Q

With an ____ subdural hematoma, symptoms show up within hours

A

Acute

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81
Q

With a ____ subdural hematoma, the hematoma comes back after treatment; the is commonly seen in elderly or people with alcohol use disorder

A

Chronic

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82
Q

Manifestations of subdural hematomas:

A

-Headache
-High ICP
-Progresses to coma (slowly) if untreated

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83
Q

Intracerebral hematomas are primarily caused by ____

A

Strokes

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84
Q

____ injuries are caused by something moving at a high velocity that moves all the way through the tissue

A

Missile

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85
Q

Missile injuries ____ tissue and cause immediate herniation and death within minutes

A

Displace

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86
Q

Lower velocity missiles will still cause herniation and edema, but will leave someone more time to get ____

A

Treatment

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87
Q

Brain stem injuries are somewhat rare as a primary injury because it is rare for someone to have trauma to the ____

A

Neck

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88
Q

Brain stem injuries are, however, common as a ___ injury

A

Secondary

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89
Q

Brain stem injuries are serious because the brain stem controls things like…

A

Breathing, heart rate

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90
Q

If someone has a brain stem injury, they would start _____ posturing and we would see a lot of autonomic brain stem dysfunction

A

Decerebrate

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91
Q

A ____ injury occurs at the point of impact, while a ____ injury is anything that occurs after that

A

Primary; secondary

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92
Q

Possible etiology of a secondary injury:

A

-Hypoxemia
-Hypotension
-Sustained increased ICP
-Respiratory complications
-Electrolyte imbalance
-Infections

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93
Q

Normally, cerebral blood flow is maintained over a wide range of cerebral perfusion pressures, but a stroke a cause loss of ____

A

Autoregulation

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94
Q

Cerebral edema leads to ____ intracranial pressure

A

High

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95
Q

____ is caused by dilation of the ventricles and a production of cerebrospinal fluid that exceeds reabsoprtion (high ICP)

A

Hydrocephalus

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96
Q

In the ____ form of hydrocephalus, a normal amount of the CSF is being made, but not enough is being reabsorbed; this leads to symptoms of high intracranial pressure

A

Communicating

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97
Q

In the _____ form of hydrocephalus, cerebrospinal fluid can’t freely flow

A

Noncommunicating

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98
Q

Usually, noncommunicating hydrocephalus is ____, but it may also be acquired from tumors or inflammation in or around the tubes that causes things to plug up

A

Congenital

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99
Q

Noncommincating hydrocephalus can also result from ____ ____

A

Hemorrhagic strokes

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100
Q

Symptoms of noncommunicating hydrocephalus develop very ____ because of the fast increase in intracranial pressure

A

Fast

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101
Q

A ____ is defined as an onset of new neurological deficits that fit a known vascular territory (symptoms very by location)

A

Stroke

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102
Q

Strokes are a leading cause of ___ and ___ in the United States

A

Death and disability

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103
Q

Are men or women more likely to have a stroke?

A

Women

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104
Q

What race is at highest risk for strokes?

A

African Americans

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105
Q

Symptoms of stokes are related to alterations in ___ ___

A

Blood flow

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106
Q

An _____ stroke is a “mini-stroke” and a warning sign for a full-blown stroke

A

Ischemic

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107
Q

____ ____ ____ is focal, reversible, and symptoms last for less than 24 hours

A

Transient ischemic attack

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108
Q

The pathology driving a TIA is the same for a full blow stroke, but blood blockage gets _____ before severe symptoms develop

A

Reversed

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109
Q

____% of people with TIA will go on to have a stroke within 3 months if not treated

A

30

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110
Q

_____% of people with TIA will go on to have a stroke within 6 months if not treated

A

60

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111
Q

____% of people with TIA will go on to have a stroke within 1 year if not treated

A

80

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112
Q

With a _____ stroke, the internal lumen is decreased due to atherosclerosis, leading to a thin vessel which allows less blood to get through (suddenly, not enough blood can get through)

A

Thrombotic

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113
Q

Thrombotic strokes are caused by decreased blood flow, usually due to atherosclerotic plaque which can be caused by things like ____ and ____

A

Diabetes and hypertension

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114
Q

Thrombotic strokes usually occur while at ____ when blood pressure drops (the lower blood pressure causes blood to move slower and not perfuse the brain enough (causes hypoxia)

A

Rest

115
Q

____ strokes are still ischemic, but it is caused by something moving through the blood vessel and eventually becomes too big for the vessel and plugs it up

A

Embolic

116
Q

____ ____ increases the risk of embolic stroke

A

Atrial fibrillation

117
Q

Risk factors for embolic stroke:

A

-Atrial fibrilation
-Myocardial infarction
-Atherosclerotic plaque

118
Q

Embolic strokes occur when someone is _____ because high blood pressure causes the clot to move and cause a blockage

A

Active

119
Q

Symptoms of embolic stroke develop ____

A

Quickly

120
Q

A ______ stroke is caused by an intracerebral hemorrhage in the brain tissue

A

Hemorrhagic

121
Q

Half of the people who have a hemorrhagic stroke ____ instantly because intracranial pressure increases so rapidly because of so much blood rushing into the brain

A

Die

122
Q

An _____ hemorrhage is commonly caused by hypertension

A

Intraparanchymal

123
Q

With an _____ hemorrhage, vessels bleed into the ventricle side; so much blood fills up the cranial vault and this commonly leads to instant death

A

Intraventricular

124
Q

Intraventricular hemorrhage can commonly be seen in ____ ____, but can also be caused by trauma

A

Premature babies

125
Q

A ____ hemorrhage is underneath the arachnoid

A

Subarachnoid

126
Q

With a subarachnoid hemorrhage, ruptured vessels in the circle of Willis cause an ____ and rupture into the subarachnoid space

A

Aneurysm

127
Q

Subarachnoid hemorrhages can be caused by ____ vessels that could be caused by trauma and can cause a spike in intracranial pressure

A

Stretched

128
Q

Subarachnoid hemorrhages commonly cause a quick ____

A

Death

129
Q

Blood in the cerebrospinal fluid leads to massive ____ ____ in the brain and the whole body as well as a catecholamine response and cardiac arrhythmias

A

Inflammatory response

130
Q

Manifestations of subarachnoid hemorrhage:

A

-Thunderclap headaches (rupturing blood dumping into the arachnoid space)
-Increase intracranial pressure
-Irritation of blood vessels leading to vasospasm
-May cause mini stroke
-Blurry or double vision
-Light sensitivity
-Severe neck rigidity

131
Q

Signs and symptoms of a stroke in the middle cerebral artery:

A

-Hemiplegia/hemiparesis (face more than arms or legs)
-Aphasia
-Homonymous hemianopsia (loss of one field of vision)

132
Q

Signs and symptoms of a stroke in the anterior cerebral artery:

A

-Paralysis of contralateral foot and leg
-Impaired gait
-Sensory loss

133
Q

Signs and symptoms of a stroke in the posterior cerebral artery:

A

-Homonymous hemianopsia
-Visual deficits

134
Q

General symptoms of a stroke include…

A

-Depression
-Dysfunction of CN III

135
Q

____ ____ are caused by weakness of the muscularis wall of the blood vessels

A

Cerebral aneurysms

136
Q

Cerebral aneurysms are slightly more common in ____ and may also have a familiar component

A

Females

137
Q

___-___% of people who have cerebral aneurysms die at the scene due to high intracranial pressure from rupture

A

10-20

138
Q

If cerebral aneurysms do not ____, they don’t cause any issues but we do not know which ones will

A

Rupture

139
Q

Cerebral aneurysms are usually ____, but may also be caused by atherosclerosis, trauma, infection, or cocaine use

A

Congenital

140
Q

Cerebral aneurysms are more common in ____ circulation than ____ circulation

A

Anterior; posterior

141
Q

What are four classifications of aneurysms?

A

-Berry
-Fusiform
-Saccular
-Disecular

142
Q

Aneurysms occur in places where blood vessels ____

A

Split

143
Q

What are examples of locations of aneurysms?

A

-Internal carotid complex
-Anterior communicating artery
-First bifurcation of MCA
-Bifurcation of the basilar artery

144
Q

Without rupture of an aneurysm, there is no _____

A

Mortality

145
Q

Signs and symptoms of cerebral aneurysms:

A

-Cranial nerve deficits
-Meningeal irritation

146
Q

What are two possible complications of aneurysms?

A

-Aneurysms rebleeding
-Cerebral vasospasm

147
Q

Manifestation of cerebral vasospasm:

A

Gradual deterioration involving tissues perfused by affected vessels

148
Q

____ ____ causes dilated vessels to shunt blood directly from the arterial system into the venous system

A

Arteriovenous Malformation

149
Q

Arteriovenous malformation is a ____ malformation

A

Congenital

150
Q

With arteriovenous malformation, a ___ ____ artery is connected to the veins, so this causes an outpouching of blood swirls and blood to be trapped and stolen from nearby tissues

A

High pressure

151
Q

Arteriovenous malformation can cause the ____ side to become blown out because of such high pressure

A

Venous

152
Q

Arteriovenous malformations are often ____ until they rupture

A

Undiagnosed

153
Q

Sometimes, people may have symptoms from the “____ ____” where there is not enough blood in nearby tissues because the malformation is stealing it

A

Steal effect

154
Q

Manifestation of the steal effect:

A

Headache

155
Q

Most arteriovenous malformations rupture at around ____-___ years old, but they have low mortality since they are smaller than an aneurysm

A

20-30

156
Q

____ is an infection that causes inflammation of the meninges around the brain

A

Meningitis

157
Q

Risk factors for meningitis:

A

-Immune suppression
-Very young and very old people
-Kidney disease
-Cystic fibrosis
-Diabetes

158
Q

The pathogen that causes meningitis common gets into the nervous system through the…

A

-Ears
-Sinuses
-Blood
-Mouth

159
Q

If treated, meningitis has a low ____, but can be deadly without treatment

A

Mortality

160
Q

What are four causes of bacterial/viral meningitis?

A

-Hemophilus influenza
-Neisseria meningitides
-Streptococcus pneumoniae
-E. coli

161
Q

We have a vaccine for ____ ____, so rates of meningitis have come drastically down in the United States

A

Hemophilus influenza

162
Q

____ ___ (meningococcus) is the most common form of meningitis in the United States, but a new vaccine was just developed

A

Neisseria meningitides

163
Q

Streptococcus pneumonia is common in what populations?

A

-Small children
-Adults who had a skull fracture and surgery

164
Q

E. coli can cause meningitis in what populations?

A

-People who are cognitively impaired
-Newborns

165
Q

Signs and symptoms of meningitis:

A

-Fever
-Headache
-Stiff neck
-N/V
-Blurry vision
-Double vision
-Extremity pain
-Abdominal pain
-Reflex abnormality
-Swelling of the optic disc
-Blindness
-Vision field deficit
-Light sensitivity
-Facila paralysis
-Deafness
-Vertigo

166
Q

Meningitis is diagnosed through a ____ ____

A

Lumbar puncture

167
Q

What would the results of the lumbar puncture be if someone had bacterial meningitis?

A

-High protein level
-Low blood glucose

168
Q

What would the results of the lumbar puncture be if someone had viral meningitis?

A

-Slightly increased protein level
-No change in glucose
-High lymphocytes

169
Q

Spinal cord injuries are more common in ____

A

Men

170
Q

What are some common causes of spinal cord injury?

A

-Car accidents
-Violence
-Gun shot

171
Q

Average age of a spinal cord injury is ____

A

40

172
Q

Spine ____ will often heal on their own

A

Fractures

173
Q

_____ spine injuries can lead to difficulty breathing and death

A

Cervical

174
Q

What are some classifications of spinal fractures?

A

-Simple fractures
-Compression (disc is squished in one side)
-Comminuted fracture (eggshell appearance)
-Odontoid fracture
-Thoracic and lumbar fracture
-Subluxation (partial dislocation)
-Dislocations

175
Q

Mechanisms of spinal fracture:

A

-Hyperflexion
-Hyperextension
-Axial compression
-Rotation lateral flexion
-Penetrating

176
Q

Hyperflexion is a wedge fracture of the ____ ____

A

Anterior side

177
Q

Hyperextension is a contusion on the ___ ___

A

Posterior side

178
Q

An axial compression is caused by something like a large beam that falls on the head and causes ___ and ___ damage

A

Brain and neck

179
Q

What are types of injuries to the spinal cord?

A

-Concussion
-Contusions
-Laceration of the cord
-Transection (tearing of the cord)
-Hemorrhage

180
Q

With a _____ spinal cord injury, the point above and below the injury can not communicate at all which causes a lack of motor and sensory impulses below the injury

A

Complete

181
Q

___ ___ ___ is commonly seen with cervical cord injury; it causes damage to the nerve that innervates the arms so people feel like they are in a “barrel” which makes it impossible to move the arms

A

Ventral cord syndrome

182
Q

With ___ ___ ____, symptoms are driven by what is below the injury

A

Anterior cord syndrome

183
Q

If the injury is to the spinothalamic tract, it can cause defects in sensation of…

A

-Pain
-Temperature
-Light touch

184
Q

With an injury to the spinothalamic tract, ____ is lost on the opposite side of injury

A

Pain

185
Q

If there is damage to the corticospinal tract, it impacts ____ function

A

Motor

186
Q

Posterior cord syndrome causes…

A

-Loss of position sense
-Proprioception
-Vibration sense
-Two-point sensation

187
Q

____-____ ____ is caused by a hemi-cord injury, which commonly results from stabbing or missile injury; this causes weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side

A

Brown-Sequard Syndrome

188
Q

What nerves allow us to raise and extend arms?

A

C5-C7

189
Q

What nerves allow us to open and close our hands?

A

C6-C8

190
Q

What nerves allow us to raise our legs?

A

L2-L4

191
Q

What nerves allow us to wiggle our toes?

A

L3-S1

192
Q

What nerves allow us to tighten our anus?

A

S3-S5

193
Q

What nerve innervates the top of our shoulder?

A

C4

194
Q

What nerve innervates the thumb?

A

C6

195
Q

What nerve innervates the middle and ring finger?

A

C7

196
Q

What nerve innervates the little finger?

A

C8

197
Q

What nerve innervates the nipple line?

A

T7

198
Q

What nerve innervates the umbilicus?

A

T10

199
Q

What nerve innervates the big toe?

A

L4

200
Q

What nerve innervates the little toe?

A

S1

201
Q

_____ can be affected by injury to the cervical spine, the thoracic nerves, and the diaphragm

A

Ventilation

202
Q

What nerves innervate the diaphragm?

A

C3-C5

203
Q

____ ____ is a severe drop in blood pressure and heart rate that usually improves 3-5 days after injury

A

Neurogenic shock

204
Q

___ ___ is a severe drop in blood pressure that usually lasts 1-3 weeks but can last up to 3 months

A

Spinal shock

205
Q

Spinal shock causes a loss of ____

A

Reflexes

206
Q

Spinal shock also causes ____ of the muscles because the lower motor neuron is still stimulated; when this develops, spinal shock is ending

A

Spasticity

207
Q

____ ____ causes short-circuiting of autonomic nervous system after a transection of the spinal cord

A

Autonomic dysreflexia

208
Q

Those with spinal cord injuries at ____ or above are at risk for dysreflexia

A

T6

209
Q

Mechanism of autonomic dysreflexia:

A

-Vasodilation above injury
-Vasoconstriction below injury

210
Q

Manifestations of autonomic dysreflexia:

A

-Decreased heart rate
-Bradycardia
-Hypertension
-Nausea
-Blurry vision
-If untreated, may lead to seizures, stroke, or death

211
Q

If a women with autonomic dysreflexia becomes pregnant, she will have to have a _____

A

C-section

212
Q

People with autonomic dysreflexia should have what preventative measures taken?

A

-Bladder and bowel evacuation
-Foot exams

213
Q

People with autonomic dysreflexia have an inability to maintain ____ ____ and frequently experience pain and dysfunctional bowel and bladder

A

Body temperature

214
Q

If a man have autonomic dysreflexia, they can still have an erection, but they can not ____

A

Ejaculate

215
Q

What are some common long-term problems after spinal cord injury?

A

-Postural hypotension (T4-T6 injuries and above)
-Poikilothermia
-Deep vein thrombosis
-Skin integrity
-Pain
-Bowel and bladder dysfunction
-Sexual dysfunction

216
Q

What populations are at higher risk for epilepsy?

A

-People younger than 15
-People older than 65
-Blacks
-More common in females than males

217
Q

_____ epilepsy has no identifiable cause

A

Idiopathic

218
Q

What can cause cerebral epilepsy?

A

-Meningitis increases risk
-Cerebral circulation issues
-Brain cancer

219
Q

What can cause biochemical epilepsy?

A

-Drugs/alcohol (withdrawal, overdose, just the drug itself)
-Electrolyte disorders
-Micronutrient deficiencies

220
Q

A ____ is a repetitive depolarization of action potentials

A

Seizure

221
Q

Symptoms of epilepsy/seizures depend on the ____ of the brain that was involved

A

Area

222
Q

A ____ ____ seizure starts in one place and stays in one place (usually colonic of rhythmic clinging of the face or arm in one area)

A

Simple partial

223
Q

A ____ ____ seizure affects a bigger part of the brain but is only on one hemisphere

A

Complex partial

224
Q

Symptoms of a complex partial seizure?

A

-Colonic activity
-Loss of consciousness
-Stiffness

225
Q

_____ seizures involve both hemispheres

A

Generalized

226
Q

_____ seizures usually occur in kids less than 5; they cause a blank stare and unresponsiveness and then they suddenly lose all muscle tone and drop to floor (last 10 seconds and then they are back to normal)

A

Absence

227
Q

____ ____ seizures are Grand Mal

A

Major motor

228
Q

An _____ may come before a seizure but is considered part of the seizure; it is a change in sensation before the muscle seizure occurs, some people may report changes in smells, taste, skin sensation, emotion, or sounds

A

Aura

229
Q

Major motor seizures last from ___-___ minutes

A

2-5

230
Q

Major motor seizures cause…

A

-Bowel and bladder incontinence
-Loss of consciousness
-Post-ictal phase causes muscle aches, tiredness, confusion, and memory loss

231
Q

Major motor seizures affect both _____

A

Hemispheres

232
Q

Major motor seizures are ___-___

A

Self-limiting

233
Q

___ ____ is a Grand Mal seizure that doesn’t end in 5 minutes

A

Status Epilepticus

234
Q

Status epilepticus has lots of ____ involvement

A

Neuronal

235
Q

Status epilepticus may just be multiple ____ one after the other

A

Seizures

236
Q

Status epilepticus is seen in people who…

A

-Abruptly stop taking anti-epileptics
-Take a drug that interferes with medication

237
Q

Status epilepticus is not ___-___

A

Self-limiting

238
Q

____ disorders are caused by a breakdown of the nervous system or part of the nervous system

A

Degenerative

239
Q

_____ causes decreased cognitive function, memory, rational thinking, and executive function

A

Dementia

240
Q

Possible etiologies of dementia:

A

-Destruction of brain tissue (trauma, tumor)
-Compression (chronic subdural hematoma)
-Inflammation (systemic inflammatory diseases)
-Biochemical imbalances
-Culminate in nerve cell degeneration and brain atrophy

241
Q

____ is the most common type of dementia

A

Alzheimer’s

242
Q

Alzheimer’s is more common in what gender?

A

Women

243
Q

____ may be protective for Alzheimer’s, but once we lose it the protection is lost

A

Estrogen

244
Q

Possible etiologies for Alzheimer’s:

A

-Autoimmune
-Slow virus
-Aluminum exposure
-High blood sugar

245
Q

Alzheimer’s is caused by a problem with the metabolism of ____ that is normally broken down and cleared

A

Amyloid

246
Q

Alzheimer’s causes an accumulation of amyloid plaques that slows the transmission of ____ ____

A

Neuronal impulses

247
Q

As impulses with Alzheimer’s slow, ___ breaks free and microtubules break and cause the formation of neurofibrillary tangles

A

Tau

248
Q

Tangles and plaques cause less impulses to get through and ____ to die off, leading to atrophy of the brain

A

Neurons

249
Q

Early manifestations of Alzheimer’s:

A

-Forgetful
-Confusion
-Stubborn
-Memory loss
-Mood swings
-Loss of cognitive function
-Personality changes

250
Q

Late manifestations of Alzheimer’s:

A

-Pronounced memory loss and cognitive dysfunction
-Aphasia
-Loss of bodily function control
-Indifference to food
-Infections
-Malnutrition
-Loss of muscle control
-Aspiration
-Death usually due to malnutrition or aspiration pneumonia

251
Q

____ ____ ____ causes degeneration of the spine

A

Amyotrophic lateral sclerosis (ALS)

252
Q

Etiology of ALS:

A

-Muscle wasting of the lateral part of the spine
-Degeneration of lateral horns (motor neurons) of the spinal cord

253
Q

Life expectancy after ALS diagnosis is about ___ years

A

5

254
Q

Possible mechanisms of ALS:

A

-About 10% of cases are familial
-Superoxide dismutase 1 is a gene that is related
-Possible relationship to viral infection
-Excess of oxidative stress
-Iron overload
-Too much glutamate
-Protein clumping in the neurons

255
Q

ALS causes loss of ____ ____, but sensation is intact

A

Motor function

256
Q

Manifestations of ALS:

A

-Mentation
-Sensory
-Hyperreflexia
-Bladder control usually spared
-Paralysis (usually more in the upper extremities)
-Dysphagia
-Breathing/airway protection problems
-Respiratory muscle movement

257
Q

___ ___ is caused by a lack of dopamine in the basal ganglia

A

Parkinson’s Disease

258
Q

Most people develop Parkinson’s around age ____

A

60

259
Q

Most cases of Parkinson’s have an ____ cause, but possible viral

A

Unknown

260
Q

What increases the risk of Parkinson’s?

A

-Brain trauma earlier in life
-Certain medication

261
Q

Etiology of Parkinson’s:

A

Loss of dopaminergic neurons in the substantia nigra

262
Q

Pathophysiology of Parkinson’s:

A

Once dopaminergic neurons die, there is no inhibitory impulses to stop excess movement; with Parkinson’s, there is no inhibition of extra impulses

263
Q

What are some motor manifestations of Parkinson’s?

A

-Rhythmic tremor at rest
-Muscle rigidity and tenseness
-Difficult to initiate movement
-Slow movement

264
Q

Secondary manifestations of Parkinson’s:

A

-Facet takes on a mask-like appearance
-Voice becomes monotone and slurred
-Cognitive changes in later stages
-Hallucinations and delusions

265
Q

Autonomic symptoms of Parkinson’s:

A

-Orthostatic hypotension
-Urinary hesitation
-Uncontrolled sweating

266
Q

____ is a disorder of the sense of self, it affects emotions but is different from mood disorders

A

Psychosis

267
Q

Population characteristics for those affected by Schizophrenia:

A

-Older onset in females than males
-Potentially heritable
-If a sibling or parent has it, there is a 50% chance that you will have it too

268
Q

Possible etiologies for Schizophrenia:

A

-Possible mutation that leads to overexpression of C4 (leads to abnormal pruning)
-Viral infection or nutritional deficiency in mother may lead to development in her baby later in life
-Excess dopamine and excess dopamine receptors in the brain

269
Q

Manifestations of Schitzophrenia:

A

-Hallucinations
-Persecutory
-Feeling like someone else is controlling them
-Thoughts and speech are incoherent
-Loss of flow of normal speech
-Loss of emotional expression
-Absence of spontaneous speech

270
Q

Mood disorders affect ____ ____

A

Emotional state

271
Q

What are two mood disorders?

A

-Unipolar (Major Depression)
-Bipolar (Manic Depression Illness)

272
Q

Unipolar causes periods of ____

A

Sadness

273
Q

Bipolar causes periods of sadness broken up by period of ____

A

Mania

274
Q

Unipolar and Bipolar are both much more common in what gender?

A

Female

275
Q

Usually unipolar and bipolar are ____-onset disorders

A

Adult

276
Q

There is a possible ____ predisposition for unipolar and bipolar

A

Genetic

277
Q

Pathogenesis of depression:

A

-Serotonergic receptors: disconnection in the serotonergic neurons (as soon as serotonin is released, it is immediately taken back up)
-Nonadrengeric pathway: sending wakeup signal

278
Q

Manifestations of depression:

A

-Blunted TSH response to TRH
-Elevated cortisol level during day and evening
-Circadian Rhythms
-Sleep alterations – decreased stage 3 and 4 (decreased deep sleep)
-Decreased REM latency
-Early awakening
-Depressed mood
-Loss of interests and pleasure
-Irritability
-Sadness
-Decrease or increase in appetite
-Insomnia
-Fatigue
-Excessive guilt
-Poor concentration
-Seasonal Affective Disorder: specific type of depression that occurs in late fall, early winter when we are not exposed to as much light

279
Q

Average age of onset of bipolar is ___

A

25

280
Q

Manifestations of the manic phase of bipolar:

A

-Sleep disturbances
-Insomnia
-Elevated mood
-Irritability
-Inflated self-esteem
-Decreased need for sleep
-Excessive talking
-Distractibility
-Increased physical activities
-Increased pleasurable activities

281
Q

____ disorders are when someone has anxiety when there is no threat

A

Anxiety

282
Q

With anxiety disorders, the _____ system is activated for no reason (all coming from the amygdala and low levels of GABA)

A

Limbic

283
Q

Manifestations of anxiety disorders are usually driven by high _____

A

Catecholamines

284
Q

Symptoms of anxiety disorders:

A

Increase heart rate
Increased BP
Light headedness
racing heart
difficult breathing
chest discomfort
generalized sweating
general weakness
Trembling
Abdominal stress
chills
hot flashes

Pathophysiology (18 decks)

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