CNRN Flashcards
Lhermitte’s sign
May be present in MS. It’s described a electric shock sensation
Lhermitte’s sign
May be present in MS. It’s described a electric shock sensation
Draining cerebrospinal fluid with lumbar drain trials
Normal
Pressure
Hydrocephalus
Caused by hypercoagulable state
Stroke caused by central venous thrombosis
Which presents with visual changes, h/a and depression ?
Pseudomotor cerebri
Demyelinatimg disorder of the CNS
MS
Measures 2.5 cm in diameter
Giant aneurysm
Measures 2.5 cm in diameter
Giant aneurysm
Out pouching of the vessel wall
Fusiform aneurysm
How many pairs of cervical nerve roots are found in the cervical region?
8
Wet-incontinence
Wacky-dementia
Wobbly-gait disturbance
Normal pressure hydrocephalus
Small cells. Stellate cells with numerous long processes, found
primarily in the gray matter of the brain and spinal
cord
Microglia
Support the neurons functions through secretion of metabolic neurotrophic factor , insulin like growth factor
Oligodendrocytes
Glial cells with extremely long processes that wrap round neuronal axons . A single one can myelinate multiple axons
Oligodendrocytes
Much more common. Occur in gray matter along cells bodies.
Help make up pia matter
Protoplasmatic
Astrocytes
Type of glial cell. Star like bodies numerous processes that extend to multiple structures of the CNS
Astrocytes
Transmit signal via action potential forms within the nervous system to lower neuron , muscles and glands
Motor neurons
Receive signal from the outside world and transmit it to specific areas of the brain
Sensory neurons
Gold standard for determining brain death
Cerebral blood flow
Primitive behavior (sex, rage, fear, biological rhythms)
Emotional control
Filters external stimuli
Lymbic system
Can be fixed by coiling
Sack like
Most common type
Berry aneurysm
Sacular aneurysm
Patient with h/a. Loses consciousness after intubation
Emergency head CT
Patient presents with acute onset of cortical blindness
Occlusion of bil posterior cerebral arteries
Ich of 4
Associated with 97 percent mortality at 30’days following an intracerebral hemorrhage
Patient c/o shock like pain to the L side of the face and seem to be associated with chewing
Trigémino neuralgia
Compression of CN V
Yellow appearance of CSF that occurs several hour after bleeding into the subarachnoid space
Xantheochromia
Yellow appearance of CSF that occurs several hour after bleeding into the subarachnoid space
Xantheochromia
Pt post bleed day 4 develops a right sided pronator drift r arm weakness
Suspect cerebral vasospasm which occur 3-14 days post bleed and up to 21 days from initial bleed
Vision loss on the same side of both eyes
Homonymous hemianopia
Gold standard for signaling cavernous malformation
Gradient echo MRI
Vertigo, nausea, fullness of the ear
Most common symptom of Menieres Disease
Dilantin should be administered iv
No faster than 50 mg/ min
If too fast cardiac arrest. Do not give it ICP
During vasospasm period of hemorrhagic stroke
Nimodipine
60 mg po q 4 hrs for 21 days
Gold standard for dx leptomeningeal tumor
Cerebrospinal analysis
Connective tissue disease that causes weakening of the medial layer within the vasculature
Places the patient at risk for arterial dissection
Ehlers Danlos
Myathenia gravis
associated with thyroid disorder
Chemo medication for glyoblastoma. Crosses the blood/brain barrier
Temodar
Common in carotid dissection which can be caused by
Whiplash, coughing, sneezing, sexual intercourse
CPP adults and pediatric normal values
Cerebral
Perfusion pressure
Adults 60-80
Pediatrics 40-50
Map-ICP
CPP-cerebral perfusion pressure
Normal 60-80
Is associated with hypoxic state and tissue ischemia
Low CPP
What is commonly confused with Dementia?
Normal pressure hydrocephalus
Patient with SAH is at increased risk for what type of hydrocephalus?
Communicating
The skull is a
Fixed box there is no room for additional contents
Monroe-Kellie doctrine
Irregular respirations
Bradycardia
Widening pulse pressure
S/S Cushings syndrome
Hypo ventilation, fever, HTn, Sz, drugs, altitude
Secondary cause of increased ICP
What produces CSF?
Choroid plexus
2-6 months after acute injury. This is sympathetic overload
autonomic dysreflexia
2-6 months after acute injury. This is sympathetic overload
autonomic dysreflexia
Results from compression of the 3rd portion of the deudenum between aorta and superior mesenteric artery leading to upper GI obstruction
S/s nausea and vomiting
Superior messenteric artery syndrome
What spinal injury require continuous mechanical ventilation?
Intermittent?
Cont- C1-C3
Intermittent- C3-C5
Hallmark clinical s/s of neurogenic shock
Hypotension
Bradycardia
Gold standard technique for
Initial immobilization to temporarily stabilize the cervical spine
Garner-Wells tongs
Secondary spinal cord injury
24-2 hours after initial injury
Loss of proprioception occurs in which injury?
Posterior syndrome
Flexión injury causes
Anterior cord syndrome
Hyper extension injury causes
Posterior cord syndrome
Motor and proprioceptive loss on ipsilateral side
Pain and temp loss on contralateral side
Brown sequard syndrome
Weakness of arms greater than legs
Central cord syndrome
Eye opening
Verbal response
Motor response
Components of the GCS
Spontaneous
To voice
To pain
None
Eye opening response
GCS
alert
Confused
Incomprehensible words
Incomprehensible sounds
None
Verbal response GCS
Normal
Location to pain
Withdraw from pain
Decorticate posture
Decerebrate
Motor response GCS
What is the most sensitive indicator of change in neurological status in a baseline intact patient?
LOC
Cause of pin point pupils
Narcotics
Pons issues
Optic control central and peripheral test by having pt read
CN 2
Olfactory smell test
Have patient smell coffee
CN 1
Occulomotor
Pupil response
Test via cardinal fields
CN 3
Trochlear motor
Moves eyes toward tip of nose
Test via cardinal field
CN 4
Trigéminal
Three deviations of the nerve
V1- ophthalmic
V2- maxillary
V3-mandibular
Test- have pt chew
Facial sensation on forehead, maxilla and mandible
CN5
Trigéminal
Three deviations of the nerve
V1- ophthalmic
V2- maxillary
V3-mandibular
Test- have pt chew
Facial sensation on forehead, maxilla and mandible
CN5
Abducents -motor
Innervates lateral rectus- lateral movement of the eyes
Test by having patient moves eyes form ear to ear
CN 6
Motor to facial muscle for expression
Sensory of anterior 2/3 of tongue
Test- have it wrinkle forehead, raise eyebrows, close eyes tight, show teeth
CN7
Vestíbulo cochlear sensory for hearing
Test- running fingers by pts ears
CN 8
Vestíbulo cochlear sensory for hearing
Test- running fingers by pts ears
CN 8
Glossopharingeal both sensory to the posterior 2/3 of the tongue, larynx and pharynx to mediate the gag reflex
Test- have pt say Ahh
CN9
Vagus
Branches from the vagus innervates organs throughout the body
Test-have pt cough
CN 10
Spinal accessory nerve-motor
Motor movement of the ne ck and shoulders
Test- have pt shrug and turn the head
CN 11
Hypoglossal nerve
Movement of tongue
Test- Have pt stick tongue out
Left dysfunction -left deviation
Right dysfunction - right deviation
CN 12
79 y/o with acute onset of homonymous hemianopia. Where is the stroke?
Occipital
Expressive aphasia can be the result of an occlusion on which cerebral
Artery?
MCA
Middle cerebral artery
Supplies anterior cerebral circulation
Expressive and receptive aphasia
MCA
Pt with anterior cerebral artery ischemic stroke
LLE weakness
IV rtPA for eligible patients should be administered within
3 -4.5 hrs
Visual -spatial information /orientation
Sensory interpretation
Voluntary movements
Object manipulation
Key characteristics of the parietal
Lobe
Patient can form words but is incoherent and in appropriate
Can’t follow verbal commands but may follow if demonstrated
Wernickes aphasia
Receptive aphasia due to damage of the temporal
Lobe (primarily left)
Interprets the meaning of spoken / written words
Werneckes aphasia
Receptive aphasia due to damage of the temporal
Lobe (primarily left)
Interprets the meaning of spoken / written words
Werneckes aphasia
Auditory ability
Long term
Memory
Werneckies area
Key characteristics of the temporal lobe
Expressive aphasia
Damage to the broca causes the inability to perform the motor aspect of speech
Types of aphasia
Damage to the broca area
Patient can understand but can’t form words
They follow verbal commands and execute requests
Brocas aphasia
Emotions
Impulse control
Motor function
Broca’s area
Social , sexual behavior
Memory
Frontal lobe
Imbalanced movement
ETOH
Ataxia
Gait movement
Paralysis of one side of the body
Dragging of paralyzed leg
Hemiparetic