Altered Neurological Fx

Question 1

Name the three contents of cranial vault

Answer 1

brain tissue, blood and CSF

Question 2

Intracranial Pressure (ICP) 
Definition and values

Answer 2

Tension within the cranial fault.
Normal: 5–15 mmHg for a supine adult
Abnormal: >20 mmHg

Question 3

Name the pressure–volume relationship in the head

and its components

Answer 3

Monro-Kellie hypothesis
ICP - CSF, blood, and brain tissue Vol - cerebral perfusion pressure (CPP)
Volume compensation: total intracranial
volume does not change

Question 4

What does the brain do when ICP increases?

Answer 4

• Less blood to head
• CSF into the spinal canal
• increasing absorption / decreasing production of CSF

Question 5

Define Cerebral auto regulation

and equation for cerebral perfusion pressure

Answer 5

Blood flow regulation to compensate for changes in perfusion pressure
CPP = MAP - ICP

Question 6

Result of CPP < 50 mmHg and CPP < 30 mmHg

Answer 6

• Cerebral ischaemia and neuronal death

- Life incompatibility

Question 7

How do you calculate Cerebral Perfusion Pressure?

Answer 7

CPP = MAP – ICP

Question 8

Name the two major consequences of increased ICP

Answer 8

• brain shifts

- brain ischaemia

Question 9

What causes raised ICP?

Answer 9

• Trauma
• Cerebral oedema
• Space occupying lesion, ie tumour
• Metabolic, for eg, diabetic ketoacidosis

Question 10

Name the 4 types of Cerebral Oedema

Answer 10

• Vasogenic
• Cytotoxic
• Ischaemic
• Autogestion

Question 11

Clinical manifestations of raised ICP

Answer 11

Increasing T and BP

Decreasing Pulse and RR

Question 12

Late clinical manifestations of raised ICP

Answer 12

High consciousness deterioration
Increased Pulse P
Irregular shallow, slow breathing
Slow pulse
High T

Question 13

Describe Decorticate Posturing

Answer 13

Arms flexed / bent inward on chest, hands clenched into fists, legs extended and feet turned inward

Question 14

Describe Decerebrate Posturing

Answer 14

Head arched back, arms

extended by the sides, and legs extended

Question 15

Define Brain Death

Answer 15

Complete and irreversible loss of brain function

including involuntary activity necessary to sustain life

Question 16

Define Subarachnoid Haemorrhage (SAH)

Answer 16

Blood accumulating between dura and arachnoid mater of the meninges around the brain

Question 17

Define Meningitis

Name the 3 meninges

Answer 17

Inflammation of the brain and spinal cord membranes due to infection by virus, bacteria, or fungus, protozoa
Meninges: dura mater, arachnoid mater, and pia mater
Becomes septic quickly

Question 18

Define Seizure Disorders

Answer 18

Brief episode of abnormal excessive neuronal discharge that causes:
- altered brain function
with alteration of consciousness
- altered behaviour
- disturbances of motor, sensory and ANS fx

Question 19

Define Epilepsy

Answer 19

Recurrent seizures without an underlying treatable cause

Question 20

Define Encephalitis

Answer 20

Cerebral acute inflammation from:

• viral infection
• autoimmune system attack

Question 21

Define Delirium

Answer 21

Confusional state when a disorder disrupts widespread neuronal networks resulting in altered perception, increased SNS activity with altered behaviour
- Hallucinations and violence present

Question 22

Define Dementia

What does it affect?

Answer 22

Progressive degeneration of neuronal networks in memory, cognition and intellectual function.
Effects:
- behavioural changes
- loss of ability to function normally
- full-time care dependence

Question 23

Define Alzheimer’s disease

Answer 23

Decreased brain size, loss of neurons and synapses w neurofibrillary tangles and plaque formation - No acetylcholine produced

Question 24

Define Parkinson’s disease

Answer 24

Degenerative disorder of the basal nuclei, loss of neurons in the substantia nigra leading to depletion of dopamine

Question 25

Define Huntington’s disease

Answer 25

Rare, autosomal dominant disorder resulting from severe degeneration of inhibitory neurons of basal nuclei

Question 26

Define Multiple sclerosis (MS)

and types

Answer 26

Progressive, inflammatory, autoimmune, demyelinating disorder of the CNS.
Types: cerebellar, spinal or mixed

Question 27

Define Cushing Triad

Answer 27

Change in vital signs due to increased ICP

Increased BP, decrease Pulse, Altered respiratory pattern

Question 28

Sites of Brain Herniation (3)

Answer 28

Lateral mass
Central
Cerebellar

Question 29

Difference between increased ICP and shock

Answer 29

ICP = In BP, Dec P, Dec RR (Cushing's triad)
Shock = Dec BP, In P, In RR

Question 30

Caused of Brain Death

Answer 30

• Traumatic brain injury
  • intracranial haemorrhage
  • hypoxic encephalopathy

Question 31

Define Intracranial aneurysm

Answer 31

Weakness in the wall of a cerebral artery or vein causes a

localised dilation or ballooning of the blood vessel

Question 32

Define Arteriovenous Malformations

Answer 32

Tangled mass of arterial and venous blood vessels that shunt blood directly from the arterial system in to the venous system bypassing capillaries

Question 33

Types of Contusions due to Brain Trauma

Answer 33

• extradural (epidural) haemorrhages or haematomas
• subdural haematomas
• intracerebral haematomas

Question 34

Define Diffuse axonal injury (DAI)

Answer 34

A brain injury in which damage in the form of extensive lesions in white matter tracts occurs over a widespread area.

Question 35

Define Concussion

Answer 35

Temporary axonal disturbance causing attention and

memory deficits but no loss of consciousness

Question 36

Define Lou Gehrig disease

Answer 36

Also known Amyotrophic Lateral Sclerosis is a motor neuron disease
-upper and lower motor neurons of the brain stem and spinal cord affected

Question 37

Guillain-Barré syndrome

and Treatment

Answer 37

Acquired autoimmune disease causing demyelination of the peripheral nerves
- motor paralysis
Treatment: Plasmapheresis

Question 38

Define Myasthenia Gravis

Answer 38

A chronic autoimmune disease
• An IgG antibody is produced against acetylcholine
receptors causing weakness and fatigue of muscles of the eyes and the throat