Brain Disorders Flashcards
Distinguish the pathophysiology, causes, and manifestations of brain injury such as ischemia, increased intracranial pressure, cerebral edema, and brain herniation. Discuss the etiology and manifestations of primary and secondary traumatic brain injuries. Describe the pathophysiology and manifestations of ischemic and hemorrhagic strokes. Discuss the causes and manifestations of focal and generalized seizures. Compare and contrast the causes and manifestations of meningitis and encephalitis.
1
Q
What are the 6 degrees of LOC? (from best to worst)
A
full consciousness
confusion
lethargy
obtundation
stupor
coma
2
Q
- a pt who has full consciousness is… (4)
A
awake and alert
orientated x3 -4
comprehends spoken and written words
able to express ideas
3
Q
- a pt who is confused is … (3)
A
disoriented to time, place OR person
memory difficulty
difficulty following commands (reciprocity)
4
Q
what is the most sensitive indicator if pt is affected mentally?
A
LOC (AOx)
5
Q
- a pt who is lethargic is … (4)
A
oriented x3-4
very slow mental processes, motor, and speech
responds to pain appropriately
ask yes or no
be slow and patient, give them options
may need a large stimulus to arouse
6
Q
- a pt who has obtundation … (5)
A
responds verbally with a word
arouasbale with stimulation
responds appropriately to painful stimuli
follows simple commands
appears very drowsy
7
Q
- a pt who has stupor … (4)
A
unresponsive except to vigorous/repeated stim
responds appropriately to painful stimuli
lies quiet w limited spontaneous mvmt
incomprehensible sounds/eye opening
8
Q
with _____ and _______ you need HARSH painful stimuli (pinch, pen on fingernails)
A
stupor
coma
9
Q
- a pt who is in a coma … (3)
A
doesn’t respond appropriately to stimuli
sleeplike state w eyes closed
doesn’t make any verbal sounds
turn off sedative, so response is accurate
10
Q
GCS: eye responses
4
3
2
1
A
- spontantous
- to speech
- to pain
- no response
11
Q
what is the max and min score for GCS
A
3 - 15
12
Q
GCS: motor response
6
5
4
3
2
1
A
- obeys verbal (wiggle ur fingers)
- localizes pain (body moves toward pain)
- flexion - withdrawal
- flexion - abnormal (decerebrate)
- extension - abnormal (decibrate)
- no response
13
Q
GCS: verbal response
5
4
3
2
1
A
- AOx 3 (what year is it? 2025)
- confused conversation (what year is it? 1962)
- speech inappropriate (what year is it? after lunch)
- speech incomprehensible (awagga)
- no response
14
Q
less than 8: _______
less than 5: _______ compromise = _______ ________
A
intubate
severe, organ donor
15
Q
THE BRAIN
____% body weight
gets ____% of CO
gets ____% of O2
A
2
15
20
16
Q
if blood flow to the brain is low or it needs more, blood is __________ away from other organs
A
shunted
17
Q
________ deprivation of O2 with maintained blood flow
A
hypoxia
18
Q
__________: reduced or interrupted blood flow
A
ischemia
19
Q
ISCHEMIC BRAIN INJURY
interferes with ____ and ________ delivery and metabolic ______ removal
can be _______ (1 spot) or ________ (throughout)
may lead to __________ or cell death
A
O2, glucose
waste
focal
global
infarction
20
Q
ISCHEMIC BRAIN INJURY
manifestations (10)
A
generalized depression
listlissness
confusion
restless/combative
drowsy
vision problems
weakness/paralysis
impaired problem solving
seizures
unconsciousness
21
Q
ISCHEMIC BRAIN INJURY
causes (7)
A
stroke
cardiac arrest
respiratory failure
shock
CO poisoning
anemia
high altitude sickness
22
Q
Brain compartments and % (3)
A
blood = 10%
CSF = 10%
brain = 80%
23
Q
INC ICP
brain is enclosed in the _______ = susctiple to _______ in ICP (Nowhere for it to go)
normal range:
A
skull, increase
0 - 15 mmHg
(if brain injury up to 20 is ok d/t swelling)
24
Q
INC ICP
can obstruct ______ blood flow, ______ brain cells, ______ brain tissue and damage brain _________
A
cerebral
destroy
displace
structures
25
ICP can fluctuate a lot, example: (2)
exercising
coughing
26
What causes an increase in the brain compartments?
MONROE KELLIE DOCTRINE
brain (2)
blood (3)
csf (3)
Brain: tumor and edema
Blood: bleeding, vasodilation, obstructed cerebral bflow
CSF: inc production, dec absorption, obstructed circulation
27
what causes a decrease in ICP?
brain: none
blood: vasoconstrict
CSF: inc absorption and dec production
28
INC ICP
what is cushings triad?
htn (wide PP)
bradycardia
irregular breathing (Cheyne-stokes)
LATE SIGN
29
INC ICP
early manifestations
----------------------------------------------------
LOC:
pupil size and rxn to light:
motor:
vital signs
other:
decreased alertness to drowsiness
small and sluggish rxn
hemiparesis (numbness/tingling in one side)
no change
headache, slurred speech
30
INC ICP
late manifestations
-------------------------------------------------------------------------------
LOC:
pupil size and rxn to light:
motor:
vital signs
other:
stupor or coma
large and nonreactive (blown)
hemiplagia (loss of all sensation/function)
CUSH TRIAD: htn (wide PP), bradycardia, abnormal respers (cheyne-stokes: tachy and then apneic)
vomiting, posturing, seizures
31
INC ICP
causes (7)
TBI
stroke
tumor
hydrocephalus (build up of CSF)
meningitis/encephalitis
intracranial hemmorrhage (aneurysm)
severe htn
32
what is CPP?
how do u get it?
what is the range?
cerebral perfusion pressure, pressure needed to overcome to perrfuse adequately
MAP - ICP = CPP
70 - 100 mmHg
33
CEREBRAL EDEMA
occurs with increase in ____ and _____ content = _________ in blood vol
Severity is based on:
what are the 2 types
water, sodium
increase
compensatory mechanisms
vasogenic, cytotoxic
34
CEREBRAL EDEMA
what is vasogenic:
what is cyotoxic
V: fluid escapes into ECF that surround brian cells (swelling)
C: swelling of brain cells themselves
35
CEREBRAL EDEMA = vasgoenic
CAUSE:
WHAT IS IT:
it can cause:
MANIFESTATIONS:
C: tumors, prolnged ischemia, infection, hemorrhage
?: occurs when conditions that impair BBB function and allows transfer of H2O and protein into vascular space
can: displace a cerebral hemisphere and herniation
M: focal neurologic defects, disturbances to consciousness, severe intracranial htn
36
CEREBRAL EDEMA = cytotoxic
CAUSE:
WHAT IS IT:
MANIFESTATIONS:
C: tumor, ischemia, stroke, trauma, lye imbalance
occurs in hypo-osmotic states (H2O intoxication) so water _______ cells and causes swelling
M: stupor and coma (RAPID AND SEVERE)
37
what is a brain hernitation?
displacement of brain tissue under the falx cerebri or through tentorium
seen with an out pocket into brain stem opening
38
what causes a brain herniation?
elevated ICP in 1 brain compartment causes displacement of the cerebral tissue toward an area of lower ICP
39
what is the brain supported by? (3)
skull septa, falx cerebri, tentorium cerebelli
40
what are the manifestations of brain herniation?
leg weakness
altered LOC
decroticate (hands to core)
rostral-caudal deterioration
hemiparesis
ipsilateral pupil dilation
visual field loss
respiratory arrest
41
what is a craniotomy?
take off part of the skull => remove the the problem => put sull back on
minimizes secondary effects
42
what is craniectomy?
skull off => leave off to allow for swelling and prevent herniation
*wear helmet outside of bed
43
What is a primary TBI
the damage caused on impact
focal (local) or diffuse (throughout)
44
What is a secondary TBI?
The damage that is a RESULT of brain swelling, infection, or cerebral hypoxia
diffuse or multifocal
45
What causes TBI (3)
MVA
falls
assaults
46
CSF leaks
common from ____ and ____
____ sign: red inner circle, yellow/clear larger outer circle
DONT _____
at high risk for _______
nose, ear
halo
pack
infection
47
what are the key signs of basilar skull fracture?
raccoon eyes and battle signs
48
ischemic stroke
Causes:
leads to:
manifestations:
C: cerebrovascular obstruction by thrombus or emboli (atherosclerotic)
Transient Ischemic Attack
M: depends of area of infarct
49
hemorrhagic stroke:
Caused by:
Manifestations:
rupture of cerebral blood vessels (old age, htn)
M: LOC, vomiting, focal symptoms depending on brain involvement/location
50
etiology of seizures (2)
alterations in cell membrane permeability or ion distribution across cell membranes
decreased inhibition structural changes that alter the excitability
51
BE FAST meaning
balance
eyes
face
arm speech
time
52
what is meningitis?
etiology?
infection/inflammation of the meninges
viral or bacterial
53
BACTERIAL MENINGITIS
patho:
s/s:
P:
M:
54
VIRAL MENINGITIS
patho: bacteria replicate and lyse in _____ --> release __________ --> release of __________ mediators --> inflammation and ________ exudate results --> meninges ________ and ________ form --> vascular ________, infarction of surrounding tissues, _______ nerve paralysis and ________
s/s: (7)
P: CSF, endotoxins, inflammatory, purulent, thicken, adhesions, congestion, cranial, hydrocephalus
S: fever, chills, headache, STIFF NECK, back/abdextremeity pain, N/V, seizures
55
VIRAL MENINGITIS
P: similar to ________
________ severe and __________ findings in CSF upon dx studies
s/s: (1)
P: bacterial
less
variable
self-limiting (flu/cold-like)
56
ENCEPHALITIS
E: (3)
P: (3 parts)
S/S: (10)
E; virus, bacteria, fungi
P: local necrotizing hemorrhage (generalized) ---> prominent edema --> progressive degeneration of nerve cell bodies
S/S: fever, headache, nuchal rigidity, neurologic disturbances (lethargy, disorientation, seizures, focal paralysis, delirium, coma)
57
PARKINSON DISEASE
E (1)
P (2 parts)
S/S (3)
E: unknown (genes + envrmnt)
P: presence of lewy bodies, alpha synuclein found in lewey bodies = dopamine issues
S/S: unintentional muscle mvmts, twitching, slowness of mvmt and thought
ex) nathan from ER
58
ALZHEIMER'S DISEASE
E (3 parts)
P (2)
S/S (4)
E: unknown (NT disruption + oxidative stress + neuroinflammation)
P: cortical atrophy and loss of neurons
S/S: progressive cognitive changes, depression, agitation, sleep disorders
ex) ellis grey
59
HUNTINGTON'S DISEASE
E (1)
P (3 parts)
S/S (7)
E: genetic mutation
P: progressive degeneration, atrophy and cell death
S/S: dishelved appearance, mood swings, possible aggression, suicidal ideation, chorea, memory deficits, slowing of cognitive function
ex) dangerous hunter
60
What are the 2 subtypes of generalized seizures?
motor
nonmotor
61
What are common causes of seizures?
Brain injury, infections, stroke, genetic factors, metabolic disorders, and drug withdrawal.
62
What are focal seizures?
Seizures that originate in one specific area of the brain. They can be simple (no loss of consciousness) or complex (impaired awareness).
63
What are the two phases of a tonic-clonic seizure?
Tonic phase (stiffening of muscles) followed by clonic phase (jerking movements).
64
What is an absence seizure?
A brief, sudden lapse in consciousness, often seen in children, with staring spells.
65
What are myoclonic seizures?
Brief, shock-like jerks of muscles, often occurring in clusters. no LOC
*usually both sides
66
What happens in an atonic seizure?
Sudden loss of muscle tone, leading to falls or head drops.
*head injury
67
what is a tonic seizure?
sudden muscle stiffening (arms and legs), causes falls in standing
68
What is status epilepticus?
A medical emergency where a seizure lasts more than 5 minutes or multiple seizures occur without recovery in between.
69
what are the 5 types of motor seizures?
tonic-clonic
tonic
clonic
myoclonic
atonic seizure
70
why are status epilepticus seizures dangerous?
Prolonged seizures can cause brain damage, hypoxia, metabolic disturbances, and death
71
What should you do if someone is having a seizure?
Keep them safe, turn them on their side, do not put anything in their mouth, and time the seizure.
72
What is a key feature of focal aware seizures?
Consciousness is not impaired; the person remains aware of their surroundings.
73
What are some possible symptoms of focal aware seizures?
Muscle twitching, sensory disturbances (tingling, flashing lights), déjà vu, or emotional changes like sudden fear or joy.
74
What is a key feature of focal impaired awareness seizures?
Consciousness is altered or impaired, often with confusion or unresponsiveness.
75
What common behaviors occur during a focal impaired awareness seizure?
Automatisms—repetitive, involuntary movements such as lip-smacking, picking at clothes, or chewing motions.
76
What is an epidural hematoma (epidural bleed)?
A type of traumatic brain bleed where blood collects between the dura mater and the skull, usually due to an arterial rupture.
77
What is the most common cause of an epidural bleed?
Head trauma, often from a skull fracture that tears the middle meningeal artery
78
How quickly do symptoms of an epidural bleed develop?
Symptoms develop rapidly, often within minutes to hours due to arterial bleeding.
79
What is the classic progression of symptoms in an epidural hematoma?
LOC --> Lucid interval → followed by a sudden decline in consciousness as the hematoma expands.
80
What are early symptoms of an epidural hematoma?
Headache, dizziness, nausea, vomiting, and confusion.
81
What severe neurological symptoms can occur as an epidural bleed progresses?
Altered consciousness, seizures, weakness on one side (hemiparesis), dilated pupil (blown pupil) on the side of the bleed, and coma.
82
What is a life-threatening complication of an epidural hematoma?
Brain herniation, leading to respiratory arrest and death if untreated.
83
What is a subdural hematoma (subdural bleed)?
A type of brain bleed where blood collects between the dura mater and the arachnoid membrane, usually due to venous rupture
84
What is the most common cause of a subdural hematoma?
Head trauma, especially from shearing forces that tear the bridging veins (e.g., falls, motor vehicle accidents, or shaken baby syndrome).
85
How does a subdural hematoma differ from an epidural hematoma?
Subdural bleeds are venous (slower bleeding) and appear crescent-shaped on CT, whereas epidural bleeds are arterial (faster bleeding) and appear lens-shaped.
86
Q: How does the timing of symptoms differ between acute, subacute, and chronic subdural hematomas?
Acute: Symptoms develop within minutes to hours after severe trauma.
Subacute: Symptoms appear days to weeks after injury.
Chronic: Symptoms develop over weeks to months, often after minor trauma
87
Why can chronic subdural hematomas go unnoticed for a long time?
The slow venous bleeding allows the brain to adapt, leading to gradual symptom onset, especially in the elderly.
88
What are early symptoms of a subdural hematoma?
Headache, drowsiness, confusion, and mild weakness.
89
What are signs of worsening subdural hematoma?
Progressive neurological decline, weakness on one side (hemiparesis), slurred speech, seizures, and altered consciousness.
90
What symptom is more common in chronic subdural hematomas?
Slow cognitive decline that can mimic dementia, along with personality changes and memory issues.
91
What is a severe complication of an untreated subdural hematoma?
Brain herniation, leading to coma and death.
92
What is an intracerebral hemorrhage (ICH)?
A type of brain bleed that occurs within the brain tissue (parenchyma) due to rupture of small blood vessels.
93
What are the most common causes of intracerebral hemorrhage?
Hypertension (most common), trauma, aneurysm rupture, arteriovenous malformations (AVMs), anticoagulant use, and cerebral amyloid angiopathy.
94
How does an intracerebral hemorrhage differ from subdural and epidural bleeds?
ICH: Bleeding occurs inside the brain tissue.
Subdural: Bleeding occurs between dura and arachnoid (venous).
Epidural: Bleeding occurs between dura and skull (arterial
95
How quickly do symptoms of an intracerebral hemorrhage appear?
Symptoms develop suddenly and progress rapidly, often within minutes to hours.
96
Why is an intracerebral hemorrhage a medical emergency?
The bleeding increases intracranial pressure (ICP), leading to brain tissue damage and herniation if untreated.
97
What are common early symptoms of an intracerebral hemorrhage?
Severe headache, nausea, vomiting, and sudden neurological deficits (weakness, speech difficulties, vision changes).
98
What is a severe complication of intracerebral hemorrhage?
Brain herniation, which can cause irregular breathing, dilated pupils, and loss of consciousness.
99
What happens if the olfactory nerve is damaged?
Anosmia (loss of smell), reduced taste sensation, possible CSF leak if damaged by trauma.
100
What are signs of optic nerve damage?
Loss of vision (blindness), blurry vision, loss of pupillary reflex (when shining a light in the affected eye).
101
What happens if the oculomotor nerve is damaged?
Ptosis (drooping eyelid)
dilated pupil (blown pupil)
eye deviation downward & outward (strabismus)
double vision (diplopia).
102
What are signs of trochlear nerve damage?
Difficulty looking down and in, vertical diplopia, head tilting to compensate for misalignment.
103
What happens if the trigeminal nerve is damaged?
Loss of facial sensation, weak jaw movement, jaw deviation toward affected side, and risk of trigeminal neuralgia (severe facial pain)
104
What happens if the abducens nerve is damaged?
Inability to move the eye laterally, double vision (diplopia), and inward eye deviation (esotropia).
105
What happens if the facial nerve is damaged?
Facial paralysis, loss of taste (anterior 2/3 tongue), dry eye/mouth, Bell's palsy (if unilateral).
106
What are signs of vestibulocochlear nerve damage?
Hearing loss, dizziness, vertigo, nystagmus, tinnitus (ringing in ears).
107
What happens if the glossopharyngeal nerve is damaged?
Loss of taste (posterior 1/3 of tongue), difficulty swallowing (dysphagia), absent gag reflex.
108
What happens if the vagus nerve is damaged?
Hoarseness, difficulty swallowing, absent gag reflex, loss of parasympathetic control (heart & digestion issues).
109
What happens if the accessory nerve is damaged?
Weakness turning the head (sternocleidomastoid) and shoulder droop (trapezius muscle).
110
What happens if the hypoglossal nerve is damaged?
Tongue deviation toward the affected side, slurred speech, and difficulty swallowing.
111
What is the most common cause of a basilar skull fracture?
Severe head trauma, often from motor vehicle accidents, falls, or direct blows to the head
112
Why is a basilar skull fracture particularly dangerous?
It occurs at the base of the skull, potentially damaging cranial nerves, blood vessels, and the brainstem, leading to life-threatening complications
113
What are the hallmark signs of a basilar skull fracture?
Battle’s sign – Bruising behind the ears (mastoid ecchymosis).
Raccoon eyes – Bruising around the eyes (periorbital ecchymosis).
CSF leak – Clear fluid from the nose (rhinorrhea) or ears (otorrhea), indicating a dura tear.
Hearing loss, dizziness, or facial nerve palsy if cranial nerves are affected
114
Why is a CSF leak concerning in a basilar skull fracture?
It increases the risk of meningitis, as bacteria can enter through the skull fracture.
