ch16: disorders of the central & peripheral nervous systems and neuromuscular junctions Flashcards
closed (blunt) trauma
injury where skull has not been penetrated, not as serious as open trauma
open (penetrating) trauma:
skull has been penetrate; more serious
coup/contrecoup injury
- hit in head really hard → brain gets injured at site [coup]
- bounce to the back of the skill and have injury there [contrecoup]
focal brain injury
- contusions: vasculature breached = bruising
- isolated to one particular area
diffuse brain injury
DAI - diffuse axonal injury
- neurons themselves damaged (axons torked or separated)
- injury at multiple different areas
what are 3 types of hematomas?
- extradural hematoma
- subdural hematoma
- intracerebral hematoma
what is the most common type of hematoma?
subdural hematoma
what is a hematoma?
damage in circulatory system that causes massive release of blood
extradural (epidural) hematoma
hematoma that occurs outside the meninges and outside of the cerebrum
subdural hematoma
hematoma that forms between meninges and cerebrum (brain)
–> most common
intracerebral hematoma
hematoma that forms underneath the meninges within the cerebrum itself
concussion
bruising of the brain, can be due to multiple foci, coup/contrecoup injury…
mild concussion
individual hasn’t lost consciousness
concussive syndrome
right after a concussion, can experience dizziness, nausea, retro/anterograde amnesia
classic cerebral concussion
what type of trauma is associated with this?
individual has lost consciousness (typically open trauma)
postconcussive syndrome
can see effects of concussion months or years later: gait disorders, personality changes, irritability, difficulty speaking
post traumatic seizures
brain damaged by concussion; neurons ATTEMPT to regenerate but create seizure like episode
what is the last thing you want to do to someone who is having a seizure?
restrain them –> might break their bones
chronic traumatic encephalopathy (CTE)
“dementia pudulisma”
–> what sport is it more common in?
repeated head injury causes tau protein polymerization –> display similar signs and symptoms as alzheimer’s disease
–> common in football players
what are 4 types of primary spinal cord trauma?
- hyperextension injury
- flexion injury
- axial compression injury
- flexion rotation injury
hyperextension injury
injury of spinal cord; blow from the bottom front causes head to go up and back
- can lead to SPINAL CORD COMPRESSION
flexion injury
injury of spinal cord; blow from back causes head to go down
- can lead to WEDGE FRACTURE
axial compression injury
injury of spinal cord; blow from top crushes spine
- can lead to COMPRESSION FRACTURE with or without SPINAL CORD COMPRESSION
flexion rotation injury
injury of spinal cord; excessive rotation of the neck causes DISRUPTION OF INTERVERTEBRAL DISCS
comminuted (burst) fracture
multiple fractures that result in multiple bone fragments
dislocation
moved to a position that is not supposed to be there
spinal shock
what can it temporarily cause
can happen anywhere along the spine and leads to a dysfunction in nerves that join here
–> can temporarily cause paralysis
what are common sites of spinal injury/trauma?
C1-C2, C4-C7, T10-L2
what are some degenerative spine disorders?
- degenerative disc disease
- herniated intervertebral disc
degenerative disc disease (DDD)
- what site is most common
damaged disc causes pain
–> lumbar vertebrae most common site of trauma
what are 3 types of degenerative disc diseases?
- spondylolysis
- spondylolisthesis
- spinal stenosis
spondylolysis
fracture in the lumbar vertebrae, but no protrusion
spondylolisthesis
specific type of dislocation; vertebrae moves forwards toward anterior part of the body
(surgery has to go from the front)
spinal stenosis
narrowing of canal that the spinal cord runs through –> pressure on spine –> SPINAL SHOCK POSSIBLE
herniated intervertebral disc
rubbery discs that lie between vertebrae of spine protrude out –> pressure on spinal cord –> POSSIBLE SPINAL SHOCK
what are 5 types of cerebrovascular disorders (CVA, strokes…)
- transient ischemic attacks (TIAs)
- thrombotic stroke
- embolic stroke
- hypoperfusion
- hemorrhagic stroke (intracranial)
transient ischemic attacks (TIAs)
- what is a sign that person is experiencing this
deprivation of blood to the brain (common in geriatric patients), can be caused by occlusion of blood vessel due to clot
SIGN: patient speaks gibberish and has bursts of dementia
thrombotic stroke
stroke due to blood clots commonly found in CAROTID ARTERIES
- -> progressive stroke (may have TIAs): slower development
- -> completed stroke: rapid onset, more serious, COMPLETE occlusion of blood to the brain
embolic stroke
embolism causes stroke and deprivation of blood to the brain (more rare)
–> lacunar stroke: occurs deeper in brain, due to plaque causing blockage of blood
hypoperfusion
decreased ability of the blood to perfuse the brain tissue
hemorrhagic stroke (intracranial)
cerebral hemorrhage…
breach in circulatory system that supplies the brain, due to RUPTURED ANEURYSM
what are the two types of intracranial aneurysms?
(aneurysm = bulge in blood vessel within the brain)
- saccular aneurysm: one side of vessel bulges
- fusiform aneurysm: circumferential, all sides of vessel bulges
arteriovenous malformation (AVM)
deformation of vessels that can result in aneurysms (genetic or injury)
subarachnoid hemorrhage (SAH)
hemorrhage that happens between arachnoid layer and pia mater
what are some infections/inflammatory disorders of the spinal cord?
- meningitis
- abscesses
- encephalitis
meningitis
(what bacterial causes it)
–> how to assess pt for it?
inflammation of the meninges
caused by: meningococcal meningitis
ASSESS: ask pt to touch chin to chest = if pain = meningitis
ASSESS: spinal tap = if CSF cloudy = meningitis
bacterial meningitis
most common meningitis, caused by meningococcal meningitis
–> can lead to gangrenous conditions
aseptic meningitis
meningitis caused by virus or fungus
abscess
pus filled nodule with a lot of inflammation
brain abscesses (2)
- extradural abscesses: outside dura mater of cerebrum
- intracerebral abscesses: below all meninges and within cerebrum
spinal cord abscesses (2)
- epidural abscesses: outside dura mater of spinal cord
- intramedullary abscesses: within spinal cord/brainstem
encephalitis
inflammation of the brain and spinal cord
- infectious disease and usually VIRAL
- -> spread by mosquitos (west nile virus)
what are three types of tumors of the CNS?
- gliomas (intracerebral tumors)
- extracerebral tumors
- spinal cord tumors
gliomas (3)
- astrocytomas: tumors of the astrocytes (cells that support nerve cells) MOST COMMON
- oligodendroglioma: tumors of the oligodendrocytes (cells protecting nerve cells)
- ependymoma: tumors of CSF (ependymal cells maintain CSF) –> unsteady gait, CSF out of nose
extracerebral tumors (3)
- meningioma: tumors of the cells that make up meninges –> pressure on spinal cord –> POSSIBLE SPINAL SHOCK
- neurofibromas: type of nerve tumor that forms soft bumps on or under skin (affect SCHWANN CELLS that make up myelin sheaths) - usually hereditary
- metastatic carcinoma: piece of tumor breaks off and spreads via lymphatic system –> stops at meninges and grows there
spinal cord tumors (4)
- intramedullary tumors: within spinal cord itself
- extramedullary tumors: just outside spinal cord
- intradural tumors: within dura mater
- extradural tumors: outside dura mater
