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Path midterm 2 > chapter 14 > Flashcards

chapter 14 Flashcards

1
Q

is the brain encased in bone and has little room to swell or move?

A

yea, correct

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2
Q

what is grey matter?

A

numerous cell bodies, relatively few myelinated axons

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3
Q

what is white matter?

A

few cell bodies and chiefly made up of long-range myelinated axon tracts

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4
Q

is every function of the body controlled by a specific site in the brain?

A

yes. this is when even microscopically benign brain tumors can cause death if in a central location
- every anatomic part of the brain fulfills a different function from every other part

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5
Q

how many lymphatic channels does the brain have?

A

-very few, reabsorption of edema is difficult

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6
Q

why does the brain need constant glucose supply?

A

because neurons are exquisitely sensitive to glucose deprivation. Cant store glucose- so the brain needs a constant glucose supply= affects the level of consciousness

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7
Q

can large molecules diffuse easily into the brain from the blood?

A

no. they cannot diffuse easily

antibodies cant easily diffuse into brain because of BBB

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8
Q

what are cerebral blood vessels frequently affected by?

A

atherosclerosis

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9
Q

what is the circle of willis

A

The circle of Willis (also called Willis’ circle, loop of Willis, cerebral arterial circle, and Willis polygon) is a circulatory anastomosis that supplies blood to the brain and surrounding structures.
-there are relatively few interconnections elsewhere in the brain

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10
Q

what are neurons exquisitely sensitive to?

A

O2 and glucose deprivation

-brain lacks fuel stores so needs a continuous supply of glucose

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11
Q

why cant bloodborne substances cross capillaries?

A

cells in the capillary walls are essentially cemented together, compared to capillaries in the body

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12
Q

what does the pia mater do?

A

helps keep some molecules from diffusing into the brain from CSF

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13
Q

What can cross the BBB?

A

Small molecules (either fat or water soluble) such as caffeine, nicotine, glucose, amino acids.

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14
Q

what does the BBB block?

A

the BBB blocks proteins such as antigens, antibodies, drugs (antibiotics), and bacteria

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15
Q

where in the brain is there a lack of interconnections?

A

there is a lack of interconnections elsewhere in the cranium besides the circle of willis, this make the brain tissue at the far end of supply especially vulnerable to decreased blood flow because there is no alternative supply.
-this helps explain how pathological alterations to the nervous system can result in major changes in physiogically and psychologically, and how/why conditions like ischemia, cerebral edema, and increased ICP which occur secondarly to a primary disease can be even more devestating than the primary disease itself

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16
Q

what is intracranial pressure dependent on the relationship between?

A

dependent on the relationship between brain tissue, cerebrospinal fluid, and blood

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17
Q

what is the central nervous system surrounded with?

A

its surrounded with CSF, and amount produced must equal the amount drained

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18
Q

how can the brain compensate (short term) with increased pressure?

A
  • displacing CSF to the subarachnoid space
  • blood volume can be shifted
  • brain tissue can be compressed
19
Q

what is the most easily displaceable fluid in the brain?

A

CSF, from ventricles and subarachnoid space to spinal subarachoid space
it can be absorded or produce less

20
Q

what is the Manroe-Kellie hypothesis?

A

volume inside the cranium is a fixed volume

  • blood, CSF, and brain tissue creare a state of equallibrium…
  • any increase in volume of one of either blood, CSF, or brain tissue must be compensated by a decrease in volume of one of the other components
  • AN INCREASE VOLUME OF ONE COMPONENT MUST BE OFFSET BY A DECREASE IN THE OTHERS
21
Q

how does increased intracranial pressure develop? Onset?

A

-increases gradually and may take hours or days

22
Q

for volume equilibrium in the brain, and to avoid ICP, what must occur?

A

aterial blood entering the brain requires a continous outflow on venous blood to make room. if something does not exit the cranial compartment to make room, the ICP increases,

23
Q

what are the volumes of the components of the skull in percentage?

A

brain tissue and extracellular fluid: 85%
blood: 10%
CSF: 5%

24
Q

what is the normal intracranial pressure inside the skull?

A

5-15 mmHg

25
Q

are compensatory mechanism effective in dealing with serious and sustained increased ICP and maintaining coronary perfusion pressure?

A

no. they are not effective and cannot maintain CPP

26
Q

true or false:

with an increase in intracranial pressure, a decreasing in cerebral perfusion results

A

true!

27
Q

what occurs once the brain can no longer compensate for increased intracranial pressure?

A

further injury to the brain occurs:

  • tissue edema
  • -decreased CPP
  • compression of arteries
  • death of brain cells
  • Co2 accumulates
  • vasodilation
28
Q

what can lead to ICP?

A

trauma, stroke, bleeding, embolus, fracture, abscess, excess CSF, brain injury, subarachnoid hemorrhage

29
Q

when the ICP is greater than cerebral perfusion pressure, what happens?

A
  • decreased blood flow
  • ischemia
  • hypoxia
  • neural cell death
  • decompensation
30
Q

once ICP becomes greater than the mean arterial pressure, what happens?

A

cerebral blood flow stops all together

person will die

31
Q

what can happen if intracranial pressure is too high?

A

it can lead to deadly brain herniation, in which parts of the brain are squeezed past strucuture in the skull
or into and around the spinal cord
patient will die

32
Q

what are some manifestations of ICP?

A
  • Altered level of conciousness (LOC) -confusion, restlessness
  • pupillary alternations (pupil sixe, shape, responce to light)
  • Changes in vital signs
  • Water imbalance (ADH) - from pressure on pituitary
  • seizures
  • headaches (more pressure= head hurts)
  • vomiting (vomiting center in the brain may be triggered, tends to be without warning, projectile) with no nausea
  • impaired brain stem and cranial nerve function
  • visual disturbances
33
Q

what is an indicator of secondary injury?

A

ICP

34
Q

what is the most critial index of nervous system function?

A

level of conciousness

-this is assessed by used the glasgow coma scale

35
Q

what are the terms for describing alterned LOC?

A
  • confusion (impaired judgement, decison making, loss of ability to think rapidly and clearly
  • disorientation (to time, place, self)
  • lethargy (limited spontanious movement, easy arousal with speech or touch)
  • obtundation (mild-moderate decrease in awakeness with limited respones to enviroment. falls asleep unless stimulated. answered with minimal response)
  • stupor (deep sleep, may be aroused only by vigorous and repeated stimulation. response is usually withdrawl or localizing
    coma: no verbal response. cannot stimulate movement
36
Q

what does coniousness involve?

A

involves arousal (state of awakeness) and content of though (awareness)

37
Q

true are false:

are pupil changes on the same side of the skull as the injury?

A

yes. it injury and pupil abnormalites are ipsilateral

but as pressure builds, it will eventually affect the other pupil

38
Q

besides LOC, what other clinical manifestations can help determine the extent of brain dysfunction?

A

includes patterns of breathing, size and reactivilty of pupils, eye position, and reflexes

39
Q

what pupil abnormalities can occur?

A

-alterations in size includes pinpoint, larger, dilated
-altered in response: sluggish or fixed
-spontaneous eye opening, pupils equal in size and responsivness to light
When eyes are fixed and dilated= overwhelming injury with damage to brain stem (very poor prognosis

40
Q

what will vital signs show with ICP?

A

temperature: (pressure on hypothalamus)
respirations (medullar and pons)
heart rate (medulla)
blood pressure (medulla)
-changes in vital signs can indicate deterioration in neurological status
-watch for bradycardia, hypotension, inability to maintain body temp (possible brain stem damage)

41
Q

disruption of temp-regulating system in hypothalamus can manifest itself as what?

A

hypothermia or pyrexia (raised body temperature; fever)

42
Q

what is common with alterned LOC?

A

hypoventilation (not enough gas exchange)- can lead to respiratory acidosis

43
Q

what is cushings triad?

A

-indicative of impending herniation:
- bradycardia
-irregular respirations
-widening pulse pressure
(these are late findings)

44
Q

true or false

Clinical manifestations of neurological dysfunction are diverse depending on location and extent of neural tissue damage

A

true

Path midterm 2 (13 decks)

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