Ch 16- Disorders of CNS, PNS, & NMJ Flashcards
Alteration of CNS or PNS: Involve nerve route, nerve plexus, nerves themselves or neuromuscular junction.
Alteration of PNS function
Alteration of CNS or PNS: Involve traumatic injury, vascular disorders, tumour growth, infections and inflammatory response.
Alteration of CNS
At what age range is traumatic brain injury (TBI) the primary cause of death and disability for individuals?
under age of 40 years old
What % of all TBIs sustained by children and youth? Where do they mostly get these TBIs
30%; sports and recreational activities
What type of injury involves alteration in brain function or other evidence of brain disease caused by an external force?
traumatic brain injury (TBI)
What are the two types of TBI?
Primary & Secondary
What is the cause of primary TBI?
direct impact
T or F: Secondary TBI can be focal or diffuse axonal injury (DAI)
FALSE; Primary TBI
What is the difference between focal and DAI?
focal – affecting one area of the brain
DAI – involves more than one area of the brain
What is TBI diagnosis?
Glasgow Coma Scale
What is the cause of secondary TBI?
indirect result of primary injury
Secondary TBI includes ____ response and ____ of cellular and molecular cerebral events
systemic; cascade
How many is the focal and diffuse brain injuries?
focal - 2/3
diffuse - 1/3
T or F: According to GCS, the lower the score, the better.
FALSE; the lower the score the more severe the damage
Give the appropriate score for the accoding to GCS:
Best eye response score:
Eye opening to pain = __
Eye opening to verbal command = __
No eye opening = __
Eyes open spontaneously =__
2,3,1,4
Give the appropriate score according to GCS based on the verbal response:
Inappropriate words = __
No verbal response = __
Incomprehensible sounds =__
Confused =__
Oriented = ___
3,1,2,4,5
Give the appropriate score according to GCS based on the motor response:
obeys commands = __
extention to pain = __
localizing pain =___
no motor response = __
flexion to pain = ___
withdrawal from pain =___
6, 2, 5, 1, 3,4
GCS score of 8 or less is considered a _____ head injury.
severe
GCS score of 13 to 15 is considered a ____ head injury
mild
GCS score of 9 to 12 is considered a _____ head injury.
moderate
What is a primary focal (TBI injury)
can be closed or open injury
T or F: Open injury is more common.
FALSE; close injury
In closed injury, the brain tissue is ______ exposed
not
In open injury, the brain tissue is ______
exposed
What is the difference between closed and open injury?
Closed
- head striking a hard surface, moving object striking head or blast waves.
- dura mater remains intact
Open
- penetrating trauma or skull fracture
- break in dura mater
What are the 5 types of primary focal closed?
- Coup/ countercoup
- Contusion
- Epidural (extradural) hematoma
- Subdural hematoma
- Intracerebral hematoma
What is primary focal open?
compound skull fracture; missile injuries.
What is primary diffuse injury?
diffuse brain injury
What is the primary focal closed brain injury?
specific, observable injuries that occur in a precise location
What % does mild primary focal closed brain injury consists?
80% cases
What severe primary focal closed brain injury consists?
contusions, epidural, subdural and hematomas.
What is the difference between coup and countrecoup?
coup
- injury at site of impact
countrecoup
- injury from brain bound back and hitting opposite site of skill
T or F: Coup is the injury from brain bouncing back and hitting opposite side of skill
FALSE; countrecoup
Contusions aka brain _____
bruising
In contusions, smaller contact area = more ____ the injury
sever
What brain area is the most common injury site for contusions?
frontal lobes
What is the peak time frame for the greatest injury effect of contusions (brain bruising) after the injury occurs
peak 13-16 hours
During contusions, edema forms, which _____ ICP = hemorrhages, edema, infarction, necrosis = tissue becomes ______
increased; pulpy
What type of primary focal closed brain injury is associated with the compression of skill at point of impact produces a contusion?
contusions or brain bruising
What is the diagnosis for contusion?
GCS, CT scan & MRI
What is tx for contusions or brain bruising?
surgical removal of large contusions and areas of hemorrhage may be required
What are the three types of TBI Primary Focal Hematomas?
epidural, subdural, & intracerebral
What is epidural hemotamas (EH)?
bleeding between dura mater and skull
Where is the most common site for epidural hematoma?
temporal fossa
What is the tx for epidural hematomas?
medical emergency
What are some symptoms of EH?
- lose consciousness
- as hematoma grows – severe headache, confusion and seizure
- hemiparesis
- pupil dilation
What is hemiparesis? What
weakness or inability to move one side of body
What does pupil dilation mean for EH?
injury prognosis good if treated before both pupils dilate
Dural refers to _____ _____
dura mater
Which primary focal closed brain injury is associated with bleeding between dura mater and brain?
subdural hematomas
What are the two types of subdural hematomas?
acute and chronic
What is acute subdural?
develop quickly, within hours.
- hematomas grow
- ICP rises
- pressure is applied to bleeding veins
In acute subdural, due to ICP rises, the pressure is applied to bleeding veins which assists in ____-____ ______
short-term limitation
What are the symptoms of acute subdural?
loss of consciousness, pupil dilation, hemianopia, anopia?
What is hemianopia? What type of primary focal closed injury is this associated with?
blindness over half of vision field; acute subdural
What is anopia? What type of primary focal closed injury is this associated with?
aka blindness; acute subdural
What is chronic subdural?
develop over weeks to months
- common in alcohol abuse
- subdural mass bleeding = subdural space fills with blood
- vascular membrane forms around hematoma
What is the tx for chronic subdural?
craniotomy to remove jelly-like blood.
What forms around hematoma in chronic subdural?
vascular membrane
What causes the vascular membrane formation in chronic subdural?
subdural mass bleeding
What are the symptoms of chronic subdural?
headaches and tenderness over hematoma; worsening dementia, paratonia
What does intracerebral hematomas mean?
bleeding within the brain
With what percentage of head injuries are intracerebral hematomas associated with?
2-3% of head injuries
Which lobes are affected by intracerebral hematomas?
frontal and temporal lobes
In intracerebral hematomas, penetrating and shearing forces injure small blood vessels = growing _____/_____
mass/edema
What are the symptoms of intracerebral hematomas?
- sudden rapid decrease in level of consciousness
- pupil dilation
- positive babinski reflex
What do you call to a reflex when big toe bends up and back to top of foot and other toes fan out?
positive babinski reflex
What trauma penetrates dura mater and creates both focal and diffuse injury?
open brain injury
Open brain injury includes ____ skull fractures and _____ injuries (primary focal open)
compound; missiles
What type of primary focal open brain injury is associated with an open path between cranial contents and the environment?
compound skull fracture of CSF
Whenever ____ of the scalp, tympanic membrane, sinuses, eye or mucous membranes occur, a CSF should be considered.
cuts
What are the causes of CSF?
crush & stretch injury
T or F: Stretch injury includes cutting or crushing, whatever missile touches.
FALSE; crush
T or F: Stretch injury is associated with blood vessels and nerve damage, whatever missile touches
FALSE; blood vessels and nerve damage without direct contact
T or F: Crush injury includes cutting or crushing without direct contact.
FALSE; includes cutting and crushing — whatever missile touches
What are the symptoms of CSF?
most open brain injury become uconscious
What type of primary focal open brain injury is caused by substantial blunt, force trauma and involves at least one of the bones that compose the base of the skull?
basilar skull fractures
Due to the spinal fluid leaking for ear or nose with basilar skull fractures, it results with _____ eyes.
blackened
Diffuse brain injury = injury ______ in brain
widespread
What is the diagnosis for primary diffuse injury?
electron micrscope to detect axonal damage
The primary diffuse injury effects from high levles of acceleration and deceleration (_____) or rotational forces. The forces cause ______ of axonal fibers and white matter _____.
whiplash; shearing, tracts.
What are the consequences based on the degree of shearing for primary diffuse injury?
- cognitive consequences
-extensive cognitive impairments
What is a secondary brain injury?
indirect results of primary brain injury which includes both trauma and stroke syndromes.
T or F: Secondary brain injury is the indirect result of primary brain injury that includes only trauma.
FALSE; includes both trauma and stroke syndromes
T or F: In secondary brain injury, both systemic and cerebral process are involved.
TRUE
What is the difference between systemic and cerebral process?
systemic – hypotension, hypoxia
cerebral – inflammation, edema, increased ICP
In secondary brain injury the _____ effects cause disruption to BBB which leads to ____ death.
primary; neuronal
How to manage secondary brain injury?
-prevention of hypoxia
- maintenance of cerebral perfusion pressure
- removal of hematomas
- nutritional management has emerged as critical to care of severe brain injury
What are the three categories of secondary TBI?
mild TBI - mild concussion
moderate TBI – moderate concussion
severe TBI – severe concussion
Which category of secondary TBI is characterized by loss of consciousness for more than 6 hours?
severe concussion
What is the GCS score for severe concussion?
3-8
In severe TBI _____ damage to _____ state to death
permanent; vegetative
What is the tx for severe concussion?
Goal is to maintain cerebral perfusion and promote neural protection
What are the signs of severe concussion?
-increased ICP occurs 4-6 days after injury
- brain imaging abnormal
- changes in pupillary rxn
- cardiac & respiratory systems
- decorticate & decerebrate posture
Which category of secondary TBI is associated with decorticate and decerebrate posturing?
severe concussion
With severe concussion, increased ICP occurs __-___ days after injury.
4-6
Which category of secondary TBI is characterized by immediate but transitory clinical manifestations
mild tbi
T or F: With mild concussion, the loss of consciousness is less than 40 minutes.
FALSE; less than 30 min
What is the GCS for mild concussion?
13-15
What are the symptoms of mild concussion or TBI?
headache, nausea, vomiting
What is the diagnosis for mild TBI?
blood test to determine need for CT scan
What is moderate TBI?
any loss of consciousness last more than 30 min up to 6 hours.
What is the GCS score for moderate concussion?
9-12
What is the result of moderate concussion?
permanent defects in arousal and attention
What are the symptoms of moderate TBI or concussion?
confusion and amnesia lasting more than 24 hours; brain imaging is abnormal
What are the three syndromes that are associated with the complication of TBI?
post-concussion syndrome (1), post traumatic seizures (2) & chronic traumatic encephalopathy (CTE) (3)
What determines the probable complications?
severity & brain location
How long does post-concussion syndrome lasts?
weeks to months after concussion
What are the symptoms requiring further evaluation for post-concussion syndrome?
- drowsiness, confusion, vomiting
- unequal pupils
- CSF drainage from ears or nose
- double vision
T or F: The importance of close observation during the first 24 hours is significant for Post-concussion syndrome.
TRUE
What disorder is associated with post-traumatic seizures?
epilepsy
What % of risk is associated with post-traumatic seizures?
10-20%
T or F: Chronic Traumatic Encephalopathy is highest risk with open brain injuries.
FALSE; Post-Traumatic Seizures
In post-traumatic seizure, there are molecular changes which results in sprouting of new _____ neural activity = increased _____
hyperexcitable; seizures
What is CTE?
progressive dementing disease the develops with repeated brain injury
Which complications of TBI is associated with contact sports esp football, blast injuries with soldiers?
chronic traumatic encephalopathy
In chronic traumatic encephalopathy, _____ neurofibrillary tangles occur in brain
tau
What are the consequence of CTE?
violent behavior, changes in cognitive, motor function, depression and suicide
Who are at risk for spinal cord and vertebral injury?
Male gender (20-39 yrs old); adult (79 yrs old) and older (bec., of falls)
Which spinal cord injury is associated with initial mechanical trauma that results in immediate tissue damage?
primary spinal cord injury
In primary spinal cord injury, injury occurs if an injured spine does not receive adequate _______ following trauma.
immobilization
T or F: For primary spinal cord injury, injury to C1-7 = life threatening.
FALSE; C1-4
What is the reason the causes damage to C1-4 to be life threatening?
loss of CV and respiratory function
In secondary spinal cord injury, death of _______ = myelin _______
oligodendrocytes; degeneration
Secondary spinal cord injury is a _____-causing process (vascular, cellular, biochemical) occuring within minutes and continues for _____
disease; weeks
For secondary spinal cord injury, the hemorrhage appears in _____ matter, result in _____ of entire ____ matter at spinal level. Thus ____ occurs which leads to impaired circulation, resulting in _____. These symptoms occur at _____ cord segments _____ & ____ injury
grey; death; grey; edema; ischemia; two; above; below
In secondary spinal cord injury,____ swelling = increased dysfuntion = ______ to distinguish permanent and temporary damage.
cord; difficult
For vertebral injuries, vertebral ____, dislocation and bone _____ = shearing & ______
fractures; fragment; compression
Hyperextension?
disruption of intervertebral discs
Flexion?
vertebral wedge fracture
Rotation?
shearing force and rupture of ligament support
Vertebrae fracture ____ due to torn supporting _____
easily; ligaments
Vertebra ______ and dislocation occurs.
misalignment
Vertebral injuries occur at most ______ portions of column
moveable
What are the damage that might experience for people with vertebral injuries?
hyperextention, flexion and rotations damage
What are the 2 manifestations for vertebral injuries?
spinal shock & neurogenic shock
T or F: Neurogenic shock develops immediately after injury.
FALSE; spinal shock
How long does spinal shock last?
lasts 7-20 days
Spinal shock returns with reflex _______ of bladder
emptying
Which vertebral injury manifestation is associated with complete loss of function at or below level of injury?
spinal shock
With spinal shock, _______ cannot regulate body heat, thus person assumes temperature of air
hypothalamus
What do you call to a person who assumes temperature of air?
poikilothermic
T or F: Neurogenic shock occurs with injury below T6.
FALSE; above T6
What are the result of neurogenic shock?
hypotension, vasodilation
With neurogenic shoch, the parasympathetic activity is _______.
unopposed
What is the cause of unopposed parasympathetic activity of neurogenic shock?
due to absence of sympathetic activity
What is occurence of migraine in Canada?
25% of women; 8% men & 10% children
Migraine has _____ and ______ components
genetic & environmental
Migraine is classified with ____, ______ aura & ______
aura; without; chronic
What is aura?
begins as spreading neural hyperactivity in occipital brain region
Occipital brain region is the _____ processing regions.
visual
How long does neurological headache lasts for migraine?
4-72 hours
What are the 4 clinical phases of migraine?
premonitory phase (1), migraine aura (2), headache phase (3) & recovery phase (4)
What phase of migraine is associated with symptoms occur hours to days before onset of aura (tired, irritable)
premonitory phase
What is the recovery phase of migraine?
irritability, fatigue
The headache phase of migraine begins on _____ side of head, eventually spreads to entire head
one
____ of persons have aura symptoms that last up to ____ hour(s). What clinical phase of migraine is this?
1/3; one; migraine aura
What is the tx for cluster headache?
O2 inhalation/ sumatriptan (meds)
Cluster headaches pain is related to _______ inflammation. Also sympathetic ______ and parasympathetic _____
neurogenic; underactivity; activation
Who is mostly affected by cluster headaches?
Men ages 2-50 yrs old
T or F: With cluster headaches, it is followed by long periods of remission.
true
Which primary headache syndrome involves trigeminal nerve and the pain for headaches may alternate sides each episodes, sever, throbbing and up to 8 attacks per day?
cluster headaches
Which primary headache syndrome is the most common type of recurring headache?
tention-type headaches (TTT)
What is the age onset for tension-type headaches?
10-20 yrs old
What is the cause of tension-type headaches (TTH)?
hypersensitivity of pain fibers from trigerminal nerve.
What is the tx for tension-type headaches?
mild TTH treated with ice; more severe treated with aspirin
TTH is the gradual onset moves to sensation of ____ ____ around head. It is _____ over a period of days.
tight band; episodic
T or F: Episodic TTH can develop in chronic TTH which represents headaches that can occur from 20 days/month.
FALSE; can occur 15 days/month
What is the main difference between meningitis and encephalits?
meningitis
- infection of meninges and subarachnoid space
encephalitis
- inflammation within the brain
What are the two types of meningitis?
bacterial and viral meningitis
Which type of meningitis is associated with serious infections to which infants and children are susceptible?
bacterial meningitis
What are the most common pathogens for bacterial meningitis?
Streptococcus, S. pneumonia, & E. coli
What are some progressive symptoms of bacterial meningitis?
spinal rigidity, seizures and positive Babinski reflex
With bacterial meningitis, pathogens cross ____ _____ ____ and enter _____-spinal fluid, which then multiple, and release _____. Thus ICP can occur die to blockage of _____ circulation
blood brain barrier; cerebral; toxins; CSF.
What viral meningitis?
be be direct infection or secondary to disease such as measles, mumps or herpes
T or F: Viral meningitis is a virus that can directly invade brain and cause inflammation.
FALSE; viral encephalitis
Post-infection encephalitis may occurs due to an ______ response.
autoimmune
The virus of viral encephalitis can ______ invade brain and cause ______
directly; inflammation
What are the 2 demyelinating disorders?
multiple sclerosis & guillain-barre
Demyelinating disorders is the result of damage to _____ _____ _____ and affect on neural transmission.
myelin nerve sheath
T or F: Multiple sclerosis is a PNS disorder.
FALSE; CNS disorder
T or F: Guillain-Barre is a CNS disorder
FALSE; PNS disorder
What is the age of onset for MS?
20-40 yrs old
T or F: Multiple sclerosis is common in men.
FALSE; more common in women
What are the risk factors associated with multiple sclerosis?
Epstein-Barr virus (EBV), & genetics
T or F: Multiple sclerosis is not common in Canada.
FALSE; Canada has one of the highest rates of MS
MS is a chronic, immune-mediated inflammatory disease with CNS _______, scarring and loss of axons
demyelination
People with multiple sclerosis is characterized with ______ progression in _____ and spinal cord. Then _ & _ cells cross ____ and attack myelin. This activate ______ cells (CNS immune cells). As a result, death of neurons, brain atrophy with primarily ____ tissue atrophy.
diffuse; brain; B; T; blood brain barrier (BBB); microglia; white
In MS, ___ matter degeneration occurs during _____ stages.
gray; later
What are some tx for multiple sclerosis
corticosteroids, immunosuppressants (both increased risk of infection); plasma exchange if pt doesn’t respond to steroids.
T or F: Corticosteroids and immunosuppressants increased risk of infection for pts with multiple sclerosis.
TRUE
What is the diagnosis for multiple sclerosis?
no single test to diagnose MS
What is the initial symptom for multiple sclerosis?
parethesia
What is parethesia?
burning or prickling sensations
T or F: People with MS experience exacerbation stages relapses) followed by remission.
TRUE
People with MS that experience further exacerbations = ______ of disease.
progression
What is the tx for Guillain-Barre Syndrome?
intravenous immunoglobulin used during acute phase
What are the symptoms of Guillain-Barre syndrome?
vary from tingling and weakness to leg paralysis, quadriplegia.
What is the recovery for Guillain-Barre syndrome?
weeks to years; 30% have residual weakness
Guillain-Barre syndrome is the demyelination of _______ nerves. It occurs _____ to respiratory or gastrointestinal ______.
peripheral; secondary; infection
What is the most common NMJ disorder?
myasthenia gravis
Myasthenia Gravis is a chronic _______ disease.
autoimmune
T or F: Thymoma is associated with brain tumour.
False; associated with myasthenia gravis.
What is thymoma?
tumour of thymus
What antibodies block Ach receptors?
IgG autoantibodies
What does ‘oma’ mean?
denotes tumour or cancer
Myasthenia gravis is associated with antibodies against _____ receptors (____) on postsynaptic membrane.
ACh; AChR
When people have myasthenia gravis, the AChR are not recognized as ‘____’. As a result, _______ occurs. This is the formation of T-cell-dependent ______ autoantibodies which block binding site of AChR to ______
self; thymoma; IgG; acetylcholine
What is the diagnosis for myasthenia gravis?
detection of anti-AChR antibodies
What is the tx for myasthenia gravis?
immunosuppressants & thymectomy for people with thymoma
What are some manifestations for myasthenia gravis?
- muscles of head are earliest areas affected –> result of dysphagia (difficulty of swallowing) = risk of respiratory aspiration; diaphragm and chest wall muscles weaken = imapaired respiration
Brain tumours can be primary or _____.
metastatic
______ tumours do not metastisize readily because there is no lymph channles in brain substance.
primary
_______ (secondary) tumours arise in organ system _____ brain and spread to brain
metastatic; outside
What are the symptoms of metastatic tumours?
- seizures, visual disturbances
Metastatic tumours are ____X more common the primary tumours
10
How many people who have cancer have metastatis to brain?
20-40%
With metastatic tumours, the local effects of tumours are compressing which causing decreased cerebral blood flow and increased _____.
ICP
What do you call to the primary intracerebral tumours?
gliomas
What % of the population of adult who have brain tumours?
50-60%
What is the only known risk factor for brain tumours?
ionizing radiation
Primary brain tumours are graded __ to ___
graded I to IV
What are the 4 types of gliomas?
astrocytoma (1), oligodendroglioma (2), meningioma (3) & ependymoma (4)
Which type of gliomas is more common in children?
ependymoma
Ependymoma arises from ependymal cells with 70% of tumours begin in _____ ventricle.
fourth
Where does meningioma begin?
in dura mater
What is the first symptom of meningioma?
seizures
Meningioma is often located on wings of ______ bone
sphenoid
What is the most common glioma? What %?
astrocytoma; 75%
The survival of people with astrocytoma who have a grade __ and ___ have less than ____ years
III; IV; 5
What is the symptom of oligodendroglioma?
seizures
Where does oligodendroglioma found?
primarily in white matter
T or F: Oligodendroglioma is a fast growing type of gliomas.
FALSE; slow growing (Grade II)
What areas does lower back pain affect?
area between lower rib cage and gluteal muscles with pain often radiating into lower legs
Acute LBP is associated with ____ or ____ strain
muscle; ligament
Chronic LBP includes ____ _____ disease, spondylolysis and spondylolisthesis.
degenerative disc
What is the forward slippage of a vertebra?
spondylolisthesis
What is spinal stenosis?
narrowing of spinal canal
What is the result of the narrowing of spinal canal?
pressure on spinal nerves or cord
DDD is a process of _____ aging and _____
normal; genetic
Spondylolysis occurs in ___ __________ of vertebral arch. Its also a degeneration or ____ of PI
pars interarticularis; fracture
What discs is most affected in herniated intervertebral disc?
L4-L5, L-5-S1
What is nucleus pulposus? What disorder of spine is it associated with?
herniation which compresses spinal nerve thus the pain local/radiated. Associated with herniated interverterbal disc
What is the herniation of an intervertebral disk?
displacement of nucleus pulposus beyond intervertebral disc space
