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