Braaaaains Flashcards
highest functions: memory, reasoning, sensation, voluntary mvmt
cerebral cortex
-automatic movements - swinging arms while you walk
basal ganglia
sensory impulses, relays to cerebral cortex
thalamus
- maintains homeostasis (temp, heart rate, BP), endocrine, emotions (anger, sex drive)
- hormones secreted here act directly on pituitary gland
hypothalamus
nerve fibers & tracts connecting brain & spinal cord
One part acts on BP & respiratory
midbrain, pons, medulla
- coordination of voluntary movements
- tests: rapid hand movement, coordination
Cerebellum
highway for ascending/descending tracts between brain & spinal nerves; mediates reflexes
Spinal cord
personality, behavior, emotion, intellectual functions
Frontal lobe
sensation from skin & tongue
parietal
vision reception
occipital
hearing, taste, smell
temporal
motor, speech
broca’s
speech & comprehension
wernicke’s
from sensory receptors TO CNS
afferent
from CNS to msks, organs, glands
efferent
skeletal msks (voluntary)
somatic
smooth msks (involuntary) → homeostasis, heart, glands
autonomic
sympathetic
fight or flight → heart rate slows then increases, BP & pupil size DILATES
parasympathetic
rest & digest → gastric secretions, slows heart rate, CONSTRICTS pupils
autonomic nervous system reacts to event, causing bradycardia (slow down) AND allows vasodilation in the lower extremity vessels & causes blood to flow down resulting in fainting
vasovagal
- expressive
- understands what you’re saying
- words are slow and laborious but meaningful
- person is frustrated
- posterior inferior frontal lobe
broca’s
- receptive
- no comprehension
- words are fluent but nonsensical
- no idea that what they’re saying is nonsense
- posterior superior temporal lobe
wernicke’s
+ romberg = indicates
loss of balance. → MS or drunk
+ pronator drift
arm drifts downward, either palm pronates, or arms unable to find original point: somatic cerebral disease
Ptn w/ flaccid msk tone may have what disease processes?
polio
guillian-barre
Ptn w/ spastic msk tone may have what?
cerebral palsy
spinal cord injury
Ptn with rigid msk tone may have…?
tetanus
Ptn w/ cogwheel rigidity may have…?
parkinson’s disease
What is the first sensation lost w/ peripheral neropathies?
Large toe joint metatarsal
With stereognosis or graphesthesia, what should you suspect if they cannot ID either?
sensory cortex lesion
What are the different reflexes that you test?
○DTRs
○Superficial (cornea, abdominal)
○Visceral (pupil)
○Pathologic (babinski)
What are the components needed to have reflexes?
■Intact sensory nerve (afferent)
■A functional synapse in the cord
■An intact motor nerve fiber (efferent)
■The neuromuscular joint
■A competent muscle
How do you chart reflexes? What is NORMAL?
■4+: very brisk, clonus present (hyper)
■3+: brisker than average
■2+: normal
■1+: somewhat diminished
■0: no response
What reflexes are normal in INFANTS but are NOT in adults?
■babinski
●fanning is NOT normal
●curling inward is normal
■grasp
■sucking
What is the order in which LOC deteriorates? (below is out of order)
Responses to pain become purposeless (ptn laughs)
Loss of corneal and gag reflex
Loss of ability to obey simple commands (open eyes, say yes, stick out tongue)
Absence of response to pain (sternal rub)
A&O alters
- A&O alters - last to lose is self
- Loss of ability to obey simple commands (open eyes, say yes, stick out tongue)
- Responses to pain become purposeless (ptn laughs)
- Absence of response to pain (sternal rub)
- Loss of corneal and gag reflex
What is in an acute care neuro assessment?
- LOC
a. alert
b. lethargic (drowsy, but opens eyes, looks @ you, responds to questions, falls asleep)
c. obtunded (opens eyes, looks @ you but responds slowly & is confused)
d. stupor (only arises after painful stimuli, lapses into unresponsiveness if stimulus ceases)
e. coma (unarousable) - Motor fnc
- Pupils
a.if in a coma, light reaction means metabolic coma.
4.VS
What are the 3 components of the glasglow coma scale?
●eye opening (none to spontaneously)
●verbal response (none to oriented)
●motor response (none to obeys commands)
CNS Injury: Decorticate - where is the damage?
damage to corticospinal tract
CNS Injury: Decerebrate - where is the damage?
damage to upper brain stem
What are the general Sx of meningitis?
What are the 2 tests you can do to test for meningitis?
●headache, photophobia (want darkness), fever, abnormal neck mobility (Supple, touches chin to chest without resistance)
●Brudzinski’s Sign:
○+ if hips and knees flex as you flex pt’s neck
○Normally, would be relaxed and motionless
●Kernig’s Sign
○Flex pt’s leg at hip and knee, then try to straighten
○(neck and back pain & resistance occurs)
+ Kernig’s bilat suggests meningeal irritation
Tetraplegia vs paraplegia vs hemiplegia
Tetraplegic: same as quadriplegic
Paraplegic: paralysis of just the legs
Hemiplegia: unilateral brain damage involving corticospinal tract causing 1-sided paralysis. Initially flaccid, becomes spastic.
What is a focal neurologic deficit lasting <1hr without underlying structural defects with the highest risk of stroke within next 30 days?
TIA
What ethnicities are at highest risk for stroke?
african-american & mexican-american
What are the warning signs of stroke?
●Sudden numbness or weakness of the face, arm, or leg
●Sudden confusion or trouble speaking or understanding
●Sudden trouble walking, dizziness, or loss of balance or coordination
●Sudden trouble with vision in one or both eyes
●Sudden severe headache
What is included in primary prevention of stroke?
- control HTN
- quit smoking
- exercise
- lose weight
- control cholesterol and diabetes
- stop drinking heavily
- manage a-fib & asymptomatic carotid artery disease.
What is included in secondary prevention of stroke?
- address secondary risk factors → atherosclerotic large vessel disease, cardiac emboli secondary to afib or cardiac defect.
- Use prevention (aspirin, coumadin)
Resting (static) tremors
tremors @ rest - parkinsonianism
Postural (action) tremors
tremors when actively maintaining a posture - hyperthyroidism, anxiety & fatigue, benign essential tremor
Intention tremors
absent at rest, appear w/ activity, gets worse as target is near - MS
Oral-facial dyskinesias
rhythmic, repetitive, bizarre movements that chiefly involve the face, mouth, jaw, and tongue: grimacing, pursing of the lips, protrusions of the tongue, opening and closing of the mouth, and deviations of the jaw. - occurs in people on psychotropic drugs, long-standing psychoses, elderly individuals, those w/o teeth.
Tics
brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals - tourette’s syndromes, phenothiazines and amphetamines
Dystonia
tony has no tone - twisting & writing of larger portions of the body (trunk, neck) - phenothiazines, spasmodic torticollis
Athetosis
slow & twisty and writhing - usually face & distal extremities. - cerebral palsy
Chorea
brief, rapid, jerky, irregular, unpredictable movements - sydenham chorea (rheumatic fever) and huntington disease
decreased CO b/c **rhythms are too fast or too slow **
arrhythmias
vascular resistance falls w/ exercise, but CO cannot rise. Occurs with or after exercise
aortic stenosis & hypertrophic cardiomyopathy
sudden arrhythmia or decreased CO. Occurs w/ coronary artery disease
MI
sudden hypoxia or decreased CO. Generally occurs if you have DVT
massive pulmonary embolism
constriction of cerebral blood vessels secondary to hypocapnia (reduced CO2 in blood) caused by hyperventilation
- manifestations: dyspnea, palpitations, chest discomfort, numbness, tingling of hands & mouth
hypocapnia due to hyperventilation
insufficient glucose to maintain cerebral metabolism. secretion of epinephrine contributes to Sx
- manifestations: sweating, tremor, palpitations, hunger, headache, confusion, abnormal behavior, coma
hypoglycemia
a temporary loss of consciousness or a fainting spell caused by emotional agitation.
hysterical fainting from conversion rxn
simple partial seizure
person is conscious while having seizure, no amnesia.
- can have motor (tonic or clonic)
- sensory (smells/tastes things that aren’t there, hears things that aren’t there, numbness feeling)
- autonomic (feelings in chest or head, changes in heart rate or breathing, sweating)
- psychiatric symptoms (memory issues, language issues, sudden fear, depression, happiness, deja vu).
consciousness impaired, person appears confused. Will have amnesia. Automatisms: chewing, lipsmacking, walking around, unbuttoning clothes
complex partial
Generalized
begin with bilateral body movements, impairment of consciousness, or both. They suggest a widespread, bilateral cortical disturbance that may be either hereditary or acquired.
- tonic-clonic convulsion (grand mal)
- absence (sudden brief loss of consciousness - blinking, staring, movements of lips and hands)
- atonic seizure - sudden loss of consciousness w/ falling but no movements
- myoclonus - sudden, BRIEF, rapid jerks (tossin’ cheerios)
pseudoseizures
not a real seizure - not neuro related, generally behavioral or psychological
