Chapter 16. Disorders of Brain Function Flashcards
Describe the water shed region?
-1st area of damage when blood flow to the brain drops suddenly
What are common pathways of Brain damage?
-Effects of ischemia ( reduced blood supply to the brain)
-Excitatory amino acid injury(excessive release chemicals)
-Cerebral edema( excess fluid)
-Injury due to increased intracranial; pressure
What are conditions that cause injury to the brain?
-Trauma
-tumors
-stroke
-metabolic derangements like dka
-Degenerative disorders
**Classifications of skull fractures
What is simple/linear frcature?
-Break in the continuity of bone
-straight edged, linear,
**Classifications of skull fractures
What is a comminuted fracture?
A splintered or multiple fracture line
**Classifications of skull fractures
What is depressed fracture ?
-Bone fragments are embedded into brain tissue, the fracture is said to be depressed
**Classifications of skull fractures
What is a basilar fracture?
A fracture of the bones that form in the base of the skull
**Levels of consciousness
1.What is full consciousness?
Awake, alert, and ready to party
**Levels of consciousness
2.What is confusion?
Progressively disorientation, forgets stuff, difficulty following commands
-restless/agitated
**Levels of consciousness
3.What is lethargy?
-Alert and oriented x3(person, place and time)
-But is sluggish
-Sleeps frequently but awakens to voice or gentle shaking
**Levels of consciousness
4.What is obtundation?
-Extreme drowsiness, minimally responsive, barely follows commands, -Requires vigorous stimulation to awaken
-stays awake for a few minutes
-pinch someone to wake them up
**Levels of consciousness
5. What is stupor?
-Minimal movement
-Repsonds in groans and moans
-Awakens briefly only with repeated stimulation
-Like being passed out drunk
**Levels of consciousness
6. What is coma ?
Does not respond to verbal stimuli, does not speak,
-Decorticate/decerebrate posturing
-no response to pain
**Levels of consciousness
7. What is delirium ?
- State of altered level of consciousness that is an emergency
-The person is experiencing psychosis.
What is the criteria for diagnosis of vegetative/brain death state?
-NO longer aware
No longer able to act
-No voluntary behavior response
-Do not understand language
-Incontinence with bowel/ bladder
-Erratic cranial nerve responses
Has to continued for a month
What is hypoxia to the brain?
-Decreased oxygen with blood flow maintained to supply the brain.
-somewhere else in the body can be stopping o2 from being distributed onto the brain
What is ischemia to brain ?
-Reduced or interrupted blood flow
-Focal cerebral ischemia -Stroke
-Global cerebral ischemia- MI
Describe intracranial pressure
pressure within skull increases
Used to describe pressure within the skull because of the structure of brain and surround tissues
-Should be at 0-15 mmHg of mercury
Because brain is housed by skull that does not move if anything damages the brain then pressure will increase which can cause brain injury.
created by csf,blood
Brain injury can occur by:
-Obstructs cerebral blood flow
-Destroy brain cells
-Displaces brain tissue
-Damages delicate brain structure
What is brain herniation
The brain could be irritated, in a state of torchon,rubbing, or abrasion of brain
something inside brain produces pressured that moves brain tissue
What is hydrocephalus
-An abnormal increase in CSF volume in any part or all of the ventricular system
-Enlargement of the CSF compartment occurs
-Pressure build up do to extra CSF in the ventricles
What are types of hydrocephalus?
-Communicating
Decreased absorption of CSF
-Non communicating
Overproduction of CSF
What is cerebral edema? *
-Occurs on outside of brain usually from disruption in blood-brain barrier
-not in central part where the ventricles are but on the outside of the brain
What is primary/direct injuries?
-Damage caused by impact, something is hitting the brain
-Include diffuse axonal injury and the focal lesions of laceration, contusion, and hemorrhage
What secondary injuries?
-Damage results from subsequent brain swelling, infections, and cerebral hypoxia
What is direct impact brain injury?
-Would be like bumping head
-Head is hit in a localized way
-Could be when someone gets a bump, blow, jolt to head that disrupts normal brain function
-could be motor vehicle crashes, falls, and assault
What is acceleration -deceleration injury?
-Causes cortext to impact forcefully to the anterior and middle fossa. Brain moving back and fourth
-This could be cause by a accident where you are forced to stop and your brain goes back
WHat is shock wave?
Brain is actually shaking
Like explosion/ratting of the brain
**Types of hematomas*
What is epidural hematoma?
-Cause by head injury when skull is directly hit
-Developers between inner table of the bones of the skull and duramater
-Likely due to arterial bleed
-bleed localized
Sure! An epidural hematoma is like a collection of blood outside the brain but underneath the skull. It can happen when there’s a head injury, and the blood builds up, putting pressure on the brain
**Types of hematomas
What is subdural hematoma ?
-a tear in venous system on surface of the cortext or dural sinuses
-developes in the subdural space
**Types of hematomas
What is traumatic intracerebral hematomas?
-Single or multiple, in brain lobe due to ruptured blood vessel
-can occur to any lob of the brain but mostly in the frontal or temporal lobes
What are symptoms of concussion?
-Hazzy- foggy or groggy head feeling
-Headache or pressure in brain
-Dizziness or balance issues
-Feeling confused or trouble remembering things
-Nausea and vomiting
What is concussion?
concussion refers to “ immediate transient loss of consciousness followed by amnesia after blow to head
-recovery usually takes place in 24 hours
Mild symptoms may continue for months
-headache
-irritability
-insomnia
poor concentration and memory
**Common types of strokes
What is an ischemia stroke?
-Most common
-Interruption of 02 usually because of thrombus or embolus
-Sometimes due to blood disorder
Two types would be thrombus(stationary) and embolus (migrating)
-Dyscarisis is disruption to way blood is clotting
**Common types of strokes
What is hemmorrhage?
-Less common
-Rupture of blood vessel where blood escapes to directly contact brain tissue
-Cause by hypertension, aneurysms, arteriovenous malformations ,head injury, or blood
What is Transcient ischemic attack(TIA)
-Short stroke
-symptoms resolves within 24 hours
-Vague symptomes
What is cerebrovascular accident ?
Completed stroke with infraction
What are risk factors of stroke
-Increasing age
-Hypertension
-dyslipidema
_diabiates mellitus
_atria fibrillation
-Smoking/alcohol
-sickle cell disease
-Stenosis
Describe ischemia strokes
Thrombus (blood clot stays in place)
-stationary blood clot
-Build up of atherosclerotic plaque(high cholesterol)
Moore common in area where a blood vessel has a split
-Bifurcation is where blood vessels split
what is diffuse injury
damage to brain injury like concussion
What will someone have when they experience a stroke?
-Motor deficits
-Trouble with speech, movement and thinking
What infarction?
When ischemia results in necrosis or death of brain tissue due to lack of oxygen
Describe hemorrhagic strokes
-less common and more serious
if a blood vessel has burst theres’ not really anything you can do, because blood as left the vessel and bleeding is what’s causing damage
what is the course of hemorrhage?
-Can start minutes to hours after the brain bleeds occur
-One of dangers of increased intracranial pressure
-Increased ICP increased risk for hemorrhagic stroke
risk factors
-Hypertension
-Aneurysm
-Arteriovenous malformation
-Trauma
What are the signs of a stroke?
-Numbness and weakness in face, arm, leg, especially on one side
-Confusion, trouble speaking, trouble understanding speech
-Trouble seeing in one or both eyes
-Difficulty in walking, dizziness, trouble of balance
-Sever headache with no known cause
What is cerebral aneurysm?
Out put pouching in vessel
What happens if aneurysm ruptures?
stroke
Cerebral aneurysms signs and symptoms?
-Small aneurysms are asymptomatic
-Large aneurysms
chronic headaches
neurologic deficits
What is aneurysmal subarachnoid hemorrhage
-Aneurysms bleeding in subarachnoid hemorrhage
Risk factors?
-Congenital defect (gentics)
-Acute increase or intracranial pressure
-Smoking cigarette
-Hypertension
-excessive alcohol intake
What is arteriovenous malformation?
Congestion and clustering of arteries and veins that are torchous and tangled together and blood is communicating when it should no
-Abnormal connections between veins and arteries
What different types of infections in the CNS
-Meninges: meningtis
-Brain parenchyma: encephalitis
Which can be cause by bacterial viral, etcc
What is meningitis?
HALL MARK sign is the neck being stiff(nuccalreginity)
-Flu like symptoms, fever, chills, headache, chills .n/v
Inflammation in the mininges
Inflammation of pia matter, arachnoid, subarachnoid space
What is encephalitis?
Inflammation or infection of parenchyma
with localized hemorrhaging
Cause by injection, misquito , rapid animal bite
also cause by fungis, bacteria, virus
Symptoms
-flu like
-seizures
-altered mental status
-weakness
-visual disturbance
-aphasia
-cerebellar findings
-behavior change
what is epilepsy?
umbrella term to describe a seizure disorder
How does epilespy happen?
-Ions moving across neuronal cell membranes causing decreased inhibition of neuronal activity or changes in the structure that alter excitability of neurons
-Imbalances of neurotransmitter like actelycholine or gaba
-Genetic mutation on ion channel
(do not have to pay attention to detail)
What is a seizure
-abnormal behavior cause by electrical discharge
discrete event with signs and symptoms that vary depending where that neuronal discharge occurs
Sensory, motor, and physicic
What is convulsion?
motor Seizure that involves entire body
What are partial seizures?
specific or less signs and symptoms
What are unclassified seizures
don’t know why they are happening
**Generalized seizure
what is absence seizure
Brief, sudden lapses of consciousness
**Generalized seizure
what is atonic seizure?
Sudden limpness in muscles
sudden loss of muscle tone involving head, trunk, jaw ,and limbs
**Generalized seizure
What is Myoclonc seizures?
brief jerking, muscle movements
sudden low amplitude contractions of muscles
**Generalized seizure
What is tonic seizures?
Sudden tension, or stiffness may afflict arm,legs, or body
muscle contractions (seconds to minutes) assosciated with body movement and sweating
**Generalized seizure
What is tonic clonic/grand mal seizures?
loss of consciousness and violent muscle contractions
high amplitude semi rhythmic muscle movements associated with sweating
What is status epilepticus?
Continual seizures that do not stop
if they do not stop can lead to respiratory failure