Chapter 16 - Disorders of the CNS, PNS, and NMJ Flashcards
1
Q
Traumatic injury, vascular disorder, tumour growth factors, infections, and inflammatory processes are involves with alterations in _____ function.
A
CNS
2
Q
Nerve route, nerve plexus, nerves themselves, or neuromuscular junction alterations are involved with ____ function.
A
PNS
3
Q
____________ is the primary cause of death and disability in those under 40 in Canada
A
traumatic brain injury (TBI)
4
Q
30% of TBIs in youth are _____ and ______ activity associated.
A
sport and recreational activity
5
Q
What is a traumatic brain injury (TBI)?
A
alteration in brain function or other evidence of a brain disease caused by an EXTERNAL FORCE
6
Q
Primary TBI is caused by _______ impact
A
direct
7
Q
Primary TBI can be ______ or _______
A
focal or diffuse
8
Q
Focal TBI
A
affects only one area of the brain
9
Q
Diffuse Axonal Injury (DAI TBI)
A
involves more than one area of the brain
10
Q
____ of injuries are focal and _____ are diffuse
A
2/3; 1/3
11
Q
Secondary TBIs are caused by an _______ result of primary injury
A
indirect
12
Q
Systemic responses along with cellular and molecular cerebral events are included in _____ TBIs
A
secondary
13
Q
How are TBIs diagnosed?
A
Glasgow Coma Scale (GCS)
14
Q
The lower the GCS score, the __________ the damage
A
more severe
15
Q
Severe head injury GCS = ___ or less
A
8
16
Q
Moderate head injury GCS = ___ to ___
A
9 to 12
17
Q
Mild head injury GCS = ___ to ___
A
13 to 15
18
Q
The Glasgow coma scale ranks levels of _____, verbal, and ______ responses
A
eye, verbal, motor
19
Q
The characteristics no eye opening, verbal response, or motor response are score level __
A
1
20
Q
The characteristics eye opening to pain, incomprehensible sounds, and extension to pain are consistent with score level __
A
2
21
Q
The characteristics eye opening to verbal command, inappropriate words, and flexion to pain are consistent with score level ____
A
3
22
Q
A primary focal TBI can be ______ or _____ injury
A
closed or open
23
Q
Closed Injury
A
head striking a hard surface, moving object strikes head, blast waves
24
Q
Is a closed or open head injury more common?
A
closed
25
With a closed injury, the ____ ____ remains intact and brain tissue _____ exposed
dura mater; is not
26
Open Injury
penetrating trauma or skull fracture
27
With a closed injury there is a _____ in the dura mater and brain tissue is _______
break; exposed
28
What are the 5 primary focal closed injuries?
-coup/countercoup
-contusion
-epidural (extradural) hematoma
-subdural hematoma
-intracerebral hematoma
29
Primary Focal Close injury means...
specific, observable injury in a precise location
30
____% of Primary Focal Closed injuries are mild
80%
31
What are the severe primary focal closed injuries?
contusions, epidural, subdural, and hematomas
32
Coup
injury at the site of impact
33
Countercoup
injury from the brain bounding back and hitting the opposite side of the skull
34
What is a contusion?
brain bruising due to the compression of the skull at point of impact
35
Contusions result from ______ leaking from an injured vessel
blood
36
The smaller the contact area, the more _______ the injury
severe
37
What happens as a result of a contusion?
-edema
-increased ICP
-hemorrhage
-infarction
-necrosis
=pulpy tissue
38
Where is the most common injury site for a contusion?
frontal lobe
39
The greatest effects of a contusion peak ___-____ hours after injury
18-36
40
How are contusions diagnosed?
GCS, CT scan, MRI
41
How is a contusion treated?
if needed - surgical removal of are of contusion/hemorrhage
42
slide 13
43
An epidural hematoma (EH), occurs with bleeding between the ______ and the _____
dura mater and skull
44
Where is the most common site of an epidural hematoma?
temporal fossa
45
With an epidural hematoma the person usually ________________
loses consciousness
46
What symptoms occur as the EH grows?
-severe headache
-confusion
-seizure
47
__________ and ______ _________ are signs of an EH
hemiparesis and pupil dilation
48
Hemiparesis
weakness or inability to move ONE side of the body
49
Injury prognosis is good if treated before...
both pupils dilate
50
An epidural hematoma is a _________ ________
medical emergency
51
Subdural hematoma is bleeding between the ____ _____ and the _____
dura mater and brain
52
An ______ subdural hematoma develops within hours
acute
53
As a subdural hematoma grows, _____ rises applying pressure to the bleeding veins, assisting in short-term limitation
ICP
54
What are the symptoms of an acute subdural hematoma?
-headache
-confusion
-loss of consciousness
-pupil dilation
-hemianopia
-anopia
55
Hemianopia
blindness over half the vision field
56
Anopia
blindness
57
A _______ subdural hematoma develops over weeks to months
chronic
58
Chronic subdural hematomas are common with...
alcohol abuse
59
With chronic subdural hematomas, there is ____ bleeding that fills the subdural space with blood
mass
60
What forms around a chronic subdural hematoma?
vascular membrane
61
What are the symptoms of a chronic subdural hematoma?
-headache
-tenderness over hematoma
-worsening dementia and paratonia
62
Paratonia
rigidity
63
What is the treatment for a chronic subdural hematoma?
craniotomy to remove the jelly-like blood
64
An intercerebral hematoma is bleeding where?
within the brain
65
Intercerebral hematomas make up __-__% of head injuries.
2-3%
66
Where do intercerebral hematomas mainly occur?
frontal and temporal lobes
67
An intercerebral hematoma results from penetrating and shearing forces that injure ______ blood vessels and form a growing mass
small
68
What are the symptoms of an intercerebral hematoma?
-sudden, rapid decrease in consciousness
-pupil dilation
-positive Babinski reflex
69
Babinski Reflex (+)
tool dragged across foot, big toe bends up towards top of foot and other toes fan out
70
Babinski Reflex (-)
tool dragged across foot, toes scrunch together
71
Name a primary focal open injury:
compound skull fracture/missile injuries
72
A compound skull fracture opens a ____ between cranial contents and the __________
path; environment
73
Compound skull fractures should be considered when...
scalp, tympanic membrane, sinus, eye, or mucous membranes are cut
74
Compound skull fractures can be ______ or ______ injuries
crush or stretch
75
Crush Injury
cutting or crushing (whatever the missile touches)
76
Stretch Injury
blood vessels and nerve damage without direct contact
77
What are the symptoms of a compound skull fracture?
loss of consciousness
78
Basilar skull fractures (type of CSF) are usually caused by _____ ______ trauma
blunt force
79
A basilar skull fracture involves at least on of the bones at the _____________
base of the skull
80
What results from a basilar skull fracture?
spinal fluid leaking from ear or nose, blackened eyes
81
Primary diffuse injuries result from...
-high levels of acceleration/deceleration (whiplash)
-rotational forces
82
What results from a DAI (diffuse axonal injury)?
shearing of axonal fibres and white matter tracts
83
The degree of shearing with a DAI determines congitive ________ and ________ of _______ __________
type and extent of cognitive impairment
84
How are primary diffuse injuries diagnosed?
electron microscope to detect axonal damage
85
A secondary injury is an indirect result of a ________ brain injury (incl. trauma and stroke syndromes)
primary
86
_________ and _______ processes are involved with secondary brain injuries
systemic and cerebral
87
Systemic Processes
hypotension, hypoxia, etc.
88
Cerebral Processes
inflammation, edema, increased ICP
89
The primary effects of secondary injuries disrupt the _____ and lead to neuronal death
BBB
90
How are secondary brain injuries managed?
-prevention of hypoxia
-maintaining cerebral perfusion pressure
-removal of hematomas
-nutritional management
91
Mild TBIs are characterized by immediate but _______ clinical manifestations
transitory (short term)
92
With a mild TBI, loss of consciousness occurs in less than ____ mins
30
93
What are the symptoms of a mild TBI?
-headache
-nausea
-vomiting
94
How is a mild TBI diagnosed?
blood test to determine need for CT scan
95
A moderate TBI is characterized by a loss of consciousness more than ___ min but up to __ hours
30; 6
96
Moderate TBIs result in _________ defects in arousal and attention
permanent
97
What are the symptoms of a moderate TBI?
-confusion and amnesia lasting more than 24 hours
-abnormal brain imaging
98
A severe TBI is characterized by a loss of consciousness for more than ___ hours
6
99
A severe TBI leads to permanent damage in a _________ state or death
vegetative
100
What are the signs of a severe TBI?
-pupillary reaction changes
-change to cardiac and respiratory systems
-decorticate and decerebrate posturing
-abnormal brain imaging
-increased ICP 4-6 days post injury
101
Decerebrate Posturing
laying flat, arms straight down, stiff
102
Decorticate Posturing
laying flat, arms tucked in, stiff
103
What are the symptoms of a severe TBI?
-compromised coordinated movements, along with verbal and written communication
104
What is the treatment goal with a severe TBI?
maintain cerebral perfusion and promote neural protection
105
What are the 3 complication post-traumatic syndromes of a TBI?
1. post-concussion syndrome
2. post-traumatic seizures
3. chronic traumatic encephalopathy (CTE)
106
The severity and _______ of the TBI determine probable complications
location
107
Post-concussion syndrome can last ______ to ______ after a concussion
weeks to months
108
With concussions, a ___ hour observation period is important to determine possible damage.
24
109
What are the symptoms requiring further evaluation post-concussion?
-drowsiness
-confusion
-vomiting
-unequal pupils
-CSF drainage from ears or nose
-double vision
110
Post-traumatic seizures occur with ____ to ____ % of TBIs
10-20%
111
Post-traumatic seizures are at highest risk with...
open brain injuries
112
Molecular changes account for the sprouting of new _____________ neural activity that increase seizures in post-traumatic seizure disorder
hyperexcitable
113
What is chronic traumatic encephalopathy (CTE)?
a progressive dementing disease that develops with repeated brain injury (ie. football players, blast injuries)
114
CTE causes ____ neurofibrillary tangles occur in the brain
tau
115
What are the consequences of CTE?
-violent behaviour
-change in cognitive and motor function
-suicide
116
Males age 20-39 and ___ years or older are more at risk for spinal cord and vertebral injuries
79
117
Primary spinal cord injuries result from the initial mechanical trauma and cause ________ tissue damage
immediate
118
Why is adequate immobilization necessary with spinal injuries?
if not, further injury can occur following trauma
119
An injury to the ______ area is life threatening due to...
C1-4; loss of cardiovascular and respiratory function
120
Secondary spinal cord injuries occur due to ____________ processes
disease-causing (vascular, cellular, biochemical)
121
Secondary spinal cord injuries occur within ____ and last for ______
minutes; weeks
122
Secondary spinal cord injuries may lead to edema that impairs circulation and causes _________
ischemia
123
Secondary spinal injury edema occurs where?
2 segments - one above and one below the injury
124
Swelling of the spinal cord increases dysfunction and makes it difficult to...
distinguish permanent and temporary damage
125
Death of oligodendrocytes means....
myelin degeneration
126
Spinal Hyperextension
disruption of intervertebral discs (ie. head sent backwards)
127
Spinal Flexion
vertebral wedge fracture (ie. head sent forwards)
128
Spinal Rotation
shearing force and rupture of ligament support
129
What makes vertebrae fracture easily?
torn supporting ligaments that misalign and dislocate the spinal fragments
130
Where do vertebral injuries occur?
at the most moveable portions of the column
131
Spinal shock develops _______ after the injury
immediately
132
Spinal shock results in loss of function ____ or ____ the injury
at or below
133
With spinal shock, the __________ cannot regulate body heat so the person assumes the temperature of the air
hypothalamus
134
Poikilothermic
inability to regulate core body temp
135
How long does spinal shock last?
7-20 days
136
What signals the end of spinal shock?
reflex emptying of the bladder
137
Neurogenic shock occurs with injuries about the ___ vertebrae
T6
138
Neurogenic shock is characterized by __________ parasympathetic activity due to the absence of sympathetic activity
unopposed
139
Neurogenic shock results in: (2)
-vasodilation
-hypotension
140
What are the 3 categories of primary headache syndrome?
-migraine
-cluster
-tension type
141
What is a migraine?
an episodic, neurological headache lasting 4-72 hours
142
Migraines occur due to ________ and ___________ components
genetic and environmental
143
Migraines can be with or without _____ or chronic
aura
144
In Canada __% of women, ___% of men, ___% of children suffer from migraines
25; 8; 10
145
Aura
spreading neural hyperactivity in the occipital brain region
146
Premonitory Migraine Phase
symptoms occur hours to days before aura (ie. tired, irritable)
147
____ of people have migraine aura symptoms that last up to 1 hour
1/3
148
Headache phase of migraine
begins on one side of the head and spreads to the entire head
149
What two things characterize the migraine recovery phase?
fatigue and irritability
150
Cluster headaches involve the _________ nerve
trigeminal
151
Some people have __ headache attacks per day that alternates sides each episode
8
152
Headache cluster days are often followed by long periods of _________
remission
153
Cluster headaches primarily affect men age 20-___
50
154
Cluster headache pain is related to __________ inflammation
neurogenic
155
Cluster headaches involve under activity of the ____________ NS and activation of the ___________ NS
sympathetic; parasympathetic
156
How are cluster headaches treated?
-oxygen inhalation
-sumatriptan
157
What is the most common type of recurring headache?
tension-type headaches
158
The age of onset for tension-type headaches is ___-___ years.
10-20
159
The sensation of a TTH is _______ onset that moves into a tight band around the head
gradual
160
Episodic TTH can develop into chronic TTH which are headaches that can occur ___ days/month
15
161
What causes TTH?
hypersensitivity of pain fibers from the trigeminal nerve
162
Mild TTH are treated with...
ice
163
Severe TTH are treated with...
aspirin
164
Meningitis is an infection of the meninges and _______ space
subarachnoid
165
Encephalitis is inflammation in the _______
brain
166
Pathogens infect the CNS via direct ______ or _____ infection
neural or glial
167
Pathogens usually secrete ______
toxins
168
Inflammation leads to ______ which interrupts _____ pathways
edema; CSF
169
________ and ______ are most susceptible to bacterial meningitis
infants and children
170
What are the most common pathogens that cause bacterial meningitis?
Streptococcus pneumoniae and E. coli
171
Pathogens cross the ____ and enter CSF where they multiply and release toxins
BBB
172
How does ICP result from bacterial meningitis?
blockage of CSF circulation
173
What are the progressive symptoms of bacterial meningitis?
spinal rigidity, seizures, + Babinki reflex
174
Viral meningitis can be direct or ________ to disease
secondary
175
Which diseases can viral meningitis follow?
measles, mumps, herpes
176
Viral encephalitis is a result of a _______ viral invasion
direct
177
Post-infection encephalitis occurs due to an...
autoimmune response
178
Demyelinating disorders (MS and Guillain-Barre) are a result of damage to the ____ _____
myelin sheath
179
Demyelinating disorders affect neural __________
transmission
180
Multiple Sclerosis (MS) is a ______ disorder
CNS
181
Guillain-Barre is a _____ disorders
PNS
182
MS is _______ mediated
immune
183
What happens with MS?
CNS demyelination, scarring, loss of axons
184
_________ has one of the highest MS rates
Canada
185
MS is more common in _______ and has an onset of age ___ to ____
women; 20-40
186
MS can result from genetics or which virus?
Epstein-Barr virus (EBV - herpes 4)
187
How does MS progress in the CNS?
diffusely
188
Which 2 immune cells cross the BBB and attack myelin with MS?
T and B cells
189
T and B cells crossing the BBB activates which cells?
microglia cells (CNS immune cells)
190
MS results in the death of neurons and _______ tissue atrophy
white
191
With MS, when does gray matter degeneration occur?
later stages
192
What is the initial MS symptom?
paresthesia (burning/prickling sensation)
193
MS involves exacerbation stages (which are?) followed by remission
relapses
194
With MS, the more relapses, the ______ the disease progresses
more
195
Is there a test to diagnose MS?
no
196
How is MS treated (not cured!)
-corticosteroids and immunosuppressants
-plasma exchange (if not steroid response)
197
Corticosteroids and immunosuppressants increase risk for ________
infection
198
Guillain-Barre Syndrome occurs secondary to a __________ or ______ infection
respiratory or GI
199
How long does it take to recover from Guillain-Barre?
weeks to years
200
___% of those who recover from Guillain-Barre have residual weakness
30%
201
What are the symptoms of Guillain-Barre?
-tingling
-weakness
-leg paralysis
-quadriplegia
202
How is Guillain-Barre treated?
-intravenous immunoglobulin during acute phase
203
What is the most common NMJ disorder?
myasthenia gravis
204
Myasthenia gravis is a chronic ___________ disease
autoimmune
205
With myasthenia gravis, antibodies are produced against ____ receptors on the postsynaptic membrane
ACh
206
Thymoma is a tumour of the _______ and associated with which disease?
thymus; myasthenia gravis
207
Ig_ antibodies block ACh receptors
G
208
How does a Thymoma contribute to myasthenia gravis?
the tumour produces T cell dependent IgG autoantibodies that block the binding site of ACh receptors fro ACh
209
Autoantibodies ______ receptor site
destroy
210
Which muscles are affected first with myasthenia gravis?
head muscles
211
Myasthenia gravis leads to _________ and impaired ________ due to weakened diaphragm and chest wall muscles
dysphagia (difficulty swallowing) and impaired respiration
212
_________ is a risk of dysphagia
aspiration
213
How is myasthenia gravis diagnosed?
detection of anti-AChR antibodies
214
How is myasthenia gravis treated?
-immunosuppressants
-thymectomy for thymoma
215
Brain tumours can be _______ or metastatic (secondary)
primary
216
Primary tumours arise from brain ________
substance
217
Why do primary tumours not metastasize readily?
there is no lymph channels in brain substance
218
Where do metastatic brain tumours originate?
in organ systems outside the brain, they spread to the brain
219
How do metastatic brain tumour affect the local brain area?
compress and cause decreased blood flow and increased ICP
220
What are the symptoms of metastatic brain tumours?
-seizures
-visual disturbances
221
Metastatic brain tumours are ____ times more common than primary tumours
10
222
___-___% of people who have cancer have metastasis to the brain
20-40%
223
Primary intracerebral tumours are called _____
gliomas
224
Gliomas make up ___-___% of adult brain tumours
50-60%
225
__________ radiation is the only known risk for gliomas because they detach electrons from atoms as they pass through matter
ionizing
226
How are primary brain tumours graded? Which is the most lethal?
I-IV; IV
227
Gliomas can be astrocytoma, __________, meningioma, or __________
oligodendroglioma; ependymoma
228
What is the most common glioma?
astrocytoma
229
The survival time of a grade III or IV astrocytoma is less than ___ years
5
230
Oligodendrogliomas are _____ growing (grade II) and reside primarily in ______ matter
slow; white
231
What is the first symptoms of an oligodendroglioma?
seizure
232
Where do meningiomas begin?
dura mater
233
_____________ are often localized to the wings of the sphenoid bone
meningiomas
234
Ependymomas are more common in ___________
children
235
Ependymomas arise from _________ cells
ependymal
236
____% of empendymomas begin in the ______ ventricle
70%; fourth
237
Lower back pain affects between the lower rib cage and _______ muscles, and radiates down the _____
gluteal; legs
238
Acute lower back pain is associated with a ________ or ligament strain
muscle
239
Degenerative disc disease (DDD), spondylolysis, and spondylolisthesis are types of ________ lower back pain
chronic
240
Degenerative disc disease (DDD) is genetic or a process of normal _______
aging
241
Spondylolysis occurs in the _____ ________ (space between the superior and inferior articular processes)
pars interarticularis
242
Spondylolysis occurs to to degenration or _______ of the joint
fracture
243
Spondylolisthesis is the _______ slipping of a vertebra
forward
244
Spinal stenosis is the __________ of the spinal cord that puts pressure on the nerves or cord
narrowing
245
Which discs are most susceptible to disc herniations?
L4-L5, L5-S1
246
What is a herniated intervertebral disc?
displacement of the nucleus pulposus beyond the disc space
247
Disc herniations compress spinal nerves and can lead to intense ________ or radiating pain
local
