Chapter 22 - CNS Part 2 Flashcards by Rebecca Warnecke

What location of the cerebrum are more susceptible to a brain contusion?

Gyri of the frontal and temporal lobes

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What is the term for when the location of injury occurs at the impact site of a cerebral contusion?

Coup injury

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What is the term for when the location of injury occurs at the opposite side of the site of a cerebral contusion?

Contrecoup injury

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What condition is a tearing of cerebral parenchyma that disrupted vasculature that leads to hemorrhage?

Laceration

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What is the condition of movement of one brain region relative to another region?

Diffuse axonal injury (DAI)

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What kinds of movements can cause diffuse axonal injury?

Angular acceleration or shaking

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What is the most common location for diffuse axonal injury?

Lateral ventricles and brain stem

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What condition is responsible for 50% of post traumatic comas?

Diffuse axonal injury

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What is a reversible alteration of consciousness from head injury in the absence of contusion?

Concussion

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What is disrupted and what is unaffected with concussions?

Disrupted function, unimpaired structure

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What constitutes post-concussion syndrome?

Decreased cognition, loss of consciousness, amnesia, nausea, depression, anxiety, irritability, headache, dizziness, photophobia

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What is usually the recovery time period for a concussion?

7-10 days without treatment (80% recovery rate)

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CT scans are done after concussions to rule out what serious issue?

Hemorrhage

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What present as risks for concussions?

History of concussions, females, football, soccer, equestrian sports, bicycle riding

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Epidural hematoma affect what blood vessels?

Dural arteries

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Subdural hematomas affect what blood vessels?

Veins

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What are the prime demographics for subdural hematomas?

Infants due to thin vessels, geriatrics due to cerebral atrophy

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Which occur more rapidly: epidural or subdural hematomas?

Epidural hematomas

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Which is more common: epidural or subdural hematomas?

Subdural hematomas (epidural hematomas make up 2% of severe head traumas)

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What artery is most likely affected by epidural hematomas?

Middle meningeal artery

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Which is more of a medical emergency: epidural or subdural hematomas?

Epidural

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What is the frequency of a subdural hematoma occurring with head trauma?

5-25%

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What is the most common neural tube defect?

CNS malformation

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What is the frequency of CNS malformation?

1:1,000 live births

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What are risks for CNS malformations?

Folate deficiency or previous child with CNS a malformation (5% recurrence)

What occurs with a neural tube defect?

It fails to close

What is a myelomeningocele?

Extension of CNS through vertebral defect leading to lower extremity motor/sensory defects

What is the most common location of the spine for myomeningoceles?

Lumbosacral region

What is the most common neural tube defect condition?

Asymptomatic spina bifida occult

What is anencephaly?

Absence of brain

What is an encephalocele?

CNS diverticulum through cranium

What condition develops following trauma to the cerebrum that injures and disrupts vessels leading to hemorrhage?

Contusion

Type 1 Arnold-Chiari malformation is associated with what condition?

Syringomyelia

What is syringomyelia (syrinx)?

Cyst within spinal cord

What condition involves the extension of the fourth ventricle?

Hydromyelia

1/3 of those with cerebral palsy have what signs and symptoms?

Decreased cognition or seizures

What is a movement disorder involving non-progressive defects in motor neurons as a result of damage during cerebral development?

Cerebral palsy

What are risk factors for cerebral palsy?

Prematurity, hypoxia, infection

Does cognitive decline occur in all cerebral palsy cases?

No, about 1/3 of them

What is the most common way that infections of the nervous system are spread?

Hematogenously (other ways = direct implant by trauma, local extension, PNS)

What is the serious issue with epidural abscesses?

Can compress the spinal cord (neurosurgical emergency)

What is a subdural empyema?

Infection of skull or sinus in the subdural space

What do epidural abscesses and subdural empyemas have in common?

Both are collections of pus

What is meningitis?

Subarachnoid inflammation of leptomeninges

What makes up the leptomeninges?

Arachnoid and pia mate

What three signs/symptoms are extremely indicative of acute pyogenic (bacterial) meningitis?

Headache, nuchal rigidity, and photophobia

What is seen in the cerebrospinal fluid with acute pyogenic (bacterial) meningitis?

Bacterial culture, increased pressure, increased neutrophils, increased proteins (exudate), decreased glucose

What are the two neurological exams for meningitis? (Not on test, but we will see in future classes)

Kernig sign, Bruszinski sign

What bacteria are likely to cause meningitis in neonates?

E. Coli and group B strep (strep agalactiae)

What type of bacteria is likely to cause meningitis in young children?

Haemophilus influenzae

What bacteria is likely to cause meningitis in adolescents and young adults?

Neisseria meningitidis

What bacteria is likely to cause meningitis among older adults?

Strep. pneumoniae, listeria monocytogenes

Which type of meningitis is self-limiting and which is generally fatal when left untreated?

``` Aseptic = self-limiting Bacterial = fatal if left untreated ```

What kind of necrosis can be produced from a bacterial abscess?

Liquefaction necrosis

Tertiary syphilis or Lyme disease are associated with what kind of meningitis?

Spirochetal (chonric)

What kind of white blood cells are seen with viral encephalitis?

Mononuclear (monocytes, macrophages)

What viruses can spread to the CNS and cause viral encephalitis?

Rabies, polio, rubella virus, West Nile, HSV-1, HSV-2, VZR, CMV, HIV

Fungal infections are most commonly seen among what population?

Immunocompromised

Candida albicans and Aspergillus fumigatus can cause what kind of parenchymal infections?

Fungal

What does poliovirus attack?

Gray matter of the spinal cord/brainstem

Where does the VZV remain dormant in chickenpox?

DRG

What are the signs and symptoms of polio?

Gastritis, motor neuron damage leading to wasting and flaccidity

What is the most common disorder of myelin?

Multiple sclerosis (MS)

What is affected with MS?

White matter (demyelination)

Which disorder of myelin is known to be "relapsing-remitting"?

What is the frequency of MS?

1:1,000

What is the cause of the myelin deterioration in MS?

Autoimmune inflammatory attack from lymphocytes and macrophages resulting in white matter lesions (plaques)

What are some risks for MS?

Family history (15X), young adults, females (2X)

If a monozygotic twin has MS, what is the likelihood that the other will too?

25%

What gene plays a part in family history being a large predictor for development of MS?

HLA-DR2

What is the location for the white plaques associated with MS?

Anywhere in the CNS (cerebrum, near ventricles, optic nerve/chiasm, brainstem, spinal cord, cerebellum

What is the activity of an active plaque in MS?

Ongoing myelin breakdown

What is the activity of inactive plaques in MS?

Little myelin and minimal inflammation with permanent damage

What vision ailment is commonly seen with MS?

Diplopia (unilateral vision impairments leading to double vision)

What are some signs and symptoms of MS?

Cranial nerve dysfunction, ataxia, motor/sensory impairments, bowel/bladder dysfunction, sexual dysfunction, seizures, decreased cognition, depression

What is the treatment for MS?

IV corticosteroids for immunosuppression to reduce relapses

Deficiency in what substance associated with CNS issues like Wernicke-Korsakoff syndrome, confusion, memory, ataxia, chronic alcoholics, chronic gastritis?

Thiamine (B1)

Necrosis and macrophages in the thalamus can be seen with what kind of deficiency?

Thiamine (B1)

What is Beriberi?

Lower extremity paresthesia, paralysis, nystagmus

Beriberi is seen with what deficiency?

Thiamine (B1)

What are the effects of cobalamin (B12) deficiency?

Demyelination, subacute combined degeneration of the spinal cord, ataxia, paraplegia

What are the effects of hypoglycemia?

Mimics global hypoxia (edema)

What is the main source of hypoglycemia in the US?

Type I diabetes (insulin injections)

What part of the brain is susceptible to injury with hypoglycemia?

Hippocampus

What are the effects of hyperglycemia?

Hyperosmolar state, confusion, stupor, coma, glycosuria, decreased water

Hyperglycemia is associated with what medical condition?

Type II diabetes