CNS Flashcards
What is the function of glial cells?
Provide structural and physiological support, they are more numerous than neurons
What are the five jobs of the glial cells?
- Blood-brain barrier
- Phagocyte capability
- Restore
- Assist with repair
- Secretion of CSF
What is neurogenesis?
Damaged nerve cells attempt to grow back - a slow process that is not as successful in the CNS as other areas
Define the following terms: ascending tract, descending tract, lower motor neurons, upper motor neurons, reflex arc
Ascending tract: carries sensory information to higher levels of the CNS
Descending tract: carries information responsible for muscle movement
Lower motor neurons: final pathway of descending tract influencing skeletal muscles
Upper motor neurons: influences skeletal muscle movement
Reflex Arc: involuntary response to a stimulus
What is the difference between dorsal and ventral nerves?
Dorsal is afferent and sensory (toward the spinal cord) and ventral are efferent and motor (away from the spinal cord)
What types of medications can and cannot pass the blood-brain barrier?
Lipid soluble medications CAN pass the barrier, whereas water soluble cannot
What are the three protective structures of the CNS?
Meninges, skull, and vertebral column
Define a migraine/headache
Unilateral throbbing pain that has a triggering event or factor
Manifestations are associated with neurological and ANS dysfunction
Are headaches/migraines bilateral or unilateral?
Unilateral
Are headache/migraines more common in men or women?
Women
What is the average age window for individuals to undergo headaches/migraines?
35-55
What is the exact cause of migraines and headaches?
It is unknown
What are the six risk factors for chronic migraine?
- Overuse of acute migraine treatment medications
- Ineffective treatment
- Obesity
- Depression
- Low education levels
- Life stressors
What co-morbidities are chronic migraines associated with?
- Epilepsy
- Stroke
- Depression
- Anxiety
- IBS
What are the eight trigger factors for chronic migraines?
Dietary factors, menses, head trauma, physical exertion, fatigue, stress, weather, and medications
What eight food products may exacerbate headaches/migraines?
Chocolate, cheese, oranges, tomatoes, onions, MSG, aspartame, and alcohol (specifically, red wine)
Name the three migraine phases?
Prodrome, headache, and postdrome phase
With each phase, the condition of the patient worsens
Describe the prodrome phase of a headache
First phase - Psychic disturbances, low mood, food cravings, frequent yawning, stiff or painful neck
Describe the headache phase
Second phase - Shelter from noise, light, odors, people and stressors
Describe the postdrome phase
Third phase - Inability to concentrate, fatigue, depressed/euphoric mood, lack of comprehension
Most egregious phase
What does an aura mean for headaches?
Visual field defects, tingling or burning sensations, paresthesia, motor dysfunction, dizziness, confusion, loss of consciousness
* May feel unsteady walking
What diagnostic studies can determine a migraine or headache?
No tests that definitively show the presence of a migraine
What is metoclopramide? What are its contraindications and side effects?
Used as an anti-emetic for migraines
Contraindicated in individuals with seizures or allergies
Side effects - extra pyramidal (dyskinesia and dystonia). With long-term use >12 weeks, tardive dyskinesia can occur
What is tardive dyskinesia? What medication is it associated with?
Involuntary and abnormal movements of the jaw, lips and tongue
Associated to long-term use (>12 weeks) of metoclopramide
What are non-pharmacological therapies for migraines/headaches?
Acupuncture, biofeedback, cognitive therapy, and relaxation therapy
How many mL/min of blood get circulated to the brain?
750-1000 mL/min (20% of CO)
What five things can occur if blood supply to the brain is altered?
- Neurological metabolism can change in 30 seconds (due to inadequate glucose)
- Metabolism stops in 2 mins
- Cellular death in 5 mins
- Cerebral auto regulation
- Collateral circulation may develop
Does stroke increase with age?
Stroke risk increases with age, doubling each decade after 35
What disease’s risk doubles each decade after 35?
Stroke
What are the 11 modifiable risk factors of stroke?
Hypertension, heart disease, diabetes, increased cholesterol and carotid stenosis, smoking, alcohol, obesity, decreased PA, diet, use of illicit drugs, birth control pills
What are the major types of stroke? Briefly define them
Ischemic - inadequate blood flow from the partial or complete occlusion
Hemorrhagic - bleeding into the brain tissue
What is the most common type of stroke?
Ischemic
What are the three types of ischemic stroke? Define each
- TIA - temporary episode of neurological dysfunction
- Thrombotic stroke - blood clot forms, vessel is narrowed and occlusion happens
- Embolic stroke - emboli lodges and occludes
What are the two types of hemorrhagic strokes? Define each
- Intracerebral hemorrhage - rupture of a vessel
- Subarachnoid hemorrhage - aneurysm, bleeding into CSF
What are the motor function clinical manifestations of stroke?
Impairment of mobility, respiratory function, swallowing and speech, gag reflex, and self-care abilities
Define akinesia, hyporeflexia, and hyperreflexia
Akinesia - loss of skilled voluntary movements
Hyporeflexia - depressed reflexes
Hyperreflexia - hyperactive reflexes
Define aphasia and dysphasia
Aphasia - affects comprehension of language, inability to speak, or both
Dysphasia - impaired ability to communicate
Define expressive aphasia and receptive aphasia
Expressive aphasia - Broca’s aphasia, difficulty expressing thoughts through speech or writing, know what they want to say can’t find the words
Receptive aphasia - Wernicke’s aphasia, difficulty understanding spoken or written language, difficult to understand, incorrect words, no hesitation
Define anomic/amnesic aphasia, global aphasia, and dysarthria
Anomic/amnesic aphasia - difficulty finding correct names for specific objects, people, places, or events
Global aphasia - loss of all expressive and receptive function
Dysarthria - disturbance in muscular control of speech
What are the four types of spatial-perceptual alterations that occur from stroke?
- Incorrect perception of self and illness
- erroneous perception of self in space
- agnosia - inability to recognize an object by sight, touch, or hearing
- apraxia - inability to carry our learned sequential movements on command
Define agnosia and apraxia
Agnosia - Inability to recognize an object by sight, touch, or hearing
Apraxia - Inability to carry our learned sequential movements on command
How quickly should an individual presenting with a stroke receive a CT scan?
When any individual presents to the ER with stroke symptoms, they must be getting into the CT within 25 minutes and the CT must be read within 45 minutes of the patient walking in the door
What percentage of clogging does the carotid vessel need to be to NOT hear a bruit?
85%
What are the two goals of ambulatory and home care for stroke recovery?
- Prevent deformity
- Maintain and improve function
What is the duration after a stroke that the major part of neurological recovery occurs?
First three months, and may continue for up to 1 year or longer
How can we improve/accommodating eating in stroke patients?
Use unaffected side, provide cutlery that the patient can use, plate guards, adjust diet to the patient’s ability (i.e., pureed, cut up)
How can we accommodate incontinence in stroke patients?
Toilet to accommodate periods of incontinence - every 2 hours
What type of diet should a post-stroke patient be on?
Low sodium, high fibre, low cholesterol, high protein, and many fruits/vegetables
What 4 things can we implement to aid constipation in stroke patients?
- Fluid intake 2500-3000 mL daily
- Prune juice 120 mL or stewed prunes daily
- Cooked vegetables/fruits 3x daily
- Whole grain cereal/bread 3-5x daily
Define functional incontinence
Individual cannot get to the bathroom fast enough
What six things can be implemented to promote continence?
- assessing for distention
- offer bedpan/urinal/commode/bathroom every 2 hours during waking and every 3-4 hours at night
- focus patient with direct command
- assist with clothing and mobility
- majority of fluid intake from 0700-1900
- encourage usual position
What are short-term interventions for urinary incontinence?
In-dwelling catheter, intermittent catheter, frequent toileting, incontinence briefs
What are post-void residuals?
Scanning the bladder for urine left over after toileting
What sensory-perceptual function changes occur in RCVA?
Difficulty judging position, distance, and rate of movement
Impulsive, impatient, deny problems
How can we help RCVA individuals with sensory-perceptual function?
Break tasks down into simple steps
What sensory-perceptual function changes occur in LCVA?
Slower in organization and performance of tasks, impaired spatial discrimination
Admits to deficits, fearful, anxious response - patients are very fearful
Behaviours are slow and cautious
Which CVA will present with anxiety and fearfulness in completing tasks?
LVCA
How does an LCVA affect present?
Exaggerated mood swings - inappropriate laughter to inappropriate crying
How 4 things can a nurse do to respond to inappropriate emotional responses in stroke patients?
Distract, explain, maintain (be consistent and reinforce), and avoid (avoid certain topics or completely disregard comments)
What 10 broad things are the inter-professional team concerned with in managing in stroke patients?
Medication, surgical therapy, ambulatory/home care, bowel function, bladder function, sensory-perceptual function, affect, coping, sexual function, community reintegration
Define MS
Chronic, progressive, degenerative, autoimmune disorder
Disseminated demyelination of nerve fibres in the brain, spinal cord, and optic nerve
What country has the highest rate of MS?
Canada
Are men or women more affected by MS?
Women
What is the general age of MS and what age is the typical onset of symptoms?
20-50 years of age
Onset of symptoms is usually 30-35 years
What four ethnic groups is MS the least common in?
Hispanics, asians, blacks, and indigenous
What is the cause of MS?
Unknown cause, unlikely due to a single cause
What are the 7 precipitating factors (event or trigger of onset) of MS?
Infection, smoking, physical injury, emotional stress, excessive fatigue, pregnancy, poor state of health
What are the 3 processes that are part of MS?
Chronic inflammation, demyelination, gliosis
What is gliosis? What disease is it related to?
Hypertrophy of glial cells - MS
What is the life expectancy since time of onset for someone with MS
More than 25 years
Is MS symptoms slow and gradual or rapid?
Slow and gradual clinical manifestations - may be initially missed
Vague symptoms for months to years
Do some individuals present with rapid, progressive deterioration of MS?
Yes. Some have severe long-lasting symptoms, others occasional mild symptoms
How effect do MS exacerbations have on individuals?
with each exacerbation, individual will have significant deterioration of CNS function
Is there a definitive diagnostic test for MS?
No
Why would we use an MRI for MS diagnosis?
Multiple MRIs over time to visualize the progression of brain degeneration
What will be present in CSF upon biopsy for MS?
WBCs may be present due to inflammation
What needs to be present in order to diagnose MS?
Evidence of at least two inflammatory demyelinating lesions in two different locations within CNS
All other diagnoses must be ruled out
Damage/attack at different times
How does medication manage MS?
Decreases progression and control symptoms
Why is physiotherapy and speech therapy important for MS management?
Aids with developing and preserving strength
SLP - maintains the structure and function of the mouth to be able to eat and speak
What diet should MS patients be on? What supplement is necessary?
Diets in low-fat, gluten-free, and raw vegetables, supplementation of a megavitamin
Note: No diets have been linked that are perfect/best for MS management
Define conventional, alternative, and complementary therapy
Conventional – heavily tested and scientifically backed
Alternative therapy – not a ton of science backing it, but has shown evidence of aiding specific symptoms
Complementary – a mixture of both therapies
What is Betaseron? What are its contraindications? What are its side-effects?
Interferon beta blocker - helps to reduce the number of flareups and clinical symptoms, decreases inflammation
Harmful to embryo/fetus and may cause miscarriage, allergies
Depression, suicidal thought, liver (abnormal LFTs), fever, chills, SOB, and chest tightness
What medication may cause abnormal LFTs?
Betaseron
Who can Betaseron exclusively be prescribed to?
Only prescribed to patients with DIAGNOSED MS
Who would corticosteroids be prescribed to?
Administered to patient’s where there is a suspicion of MS but no formal diagnosis yet or relapse management
What is the concern with administering corticosteroids to MS patients?
Increased risk of infection, decreased immune response – an even higher risk of infection in MS patients, as they are autoimmune
Define dementia
The collection of symptoms caused by various diseases affecting the brain
What ethnic group is dementia higher in?
Higher among indigenous people, younger age of onset
Does dementia effect men or women more?
Men
Is dementia considered primary or secondary to a treatable condition?
Dementia is secondary to a treatable condition, and is not a normal part of aging
Define Alzheimer’s
A chronic, progressive, degenerative disease with an unknown etiology
What is familial Alzheimer’s? What age does it effect?
Younger than 60 onset, and is known as early onset AD
Where are amyloid plaques typically first noticed in the brain? Which disease are they related to?
Present in the brain in abnormal quantities, first develop in areas used for memory and cognitive function, then areas responsible for language and reasoning
Related to AD/dementia
What are neurofibrillary tangles?
Abnormal collection of twisted protein threads inside nerve cells that alter the responsiveness of the brain in AD patients
What is vascular dementia? What does it result from?
Multi-infarct dementia that results from ischemic, ischemic-hypoxic, or hemorrhagic brain damage caused by cardiovascular disease
It may be single or multiple infarcts
Define dementia w/ Lewy Bodies
Presence of Lewy bodies throughout the cortex, brainstem, and autonomic structures
Could be a single area of the brain or multiple
Define frontotemporal dementia and what changes you will initially see
Degeneration of the frontal lobe, temporal lobe, or both
Notice changes in personality and behaviour initially
How do clinical manifestations between vascular dementia and all other types differ?
Vascular presents as a sudden change due to inhibited oxygen supply, whereas all other types are gradual with progressive deterioration
What are the seven As of dementia? Briefly define each
Amnesia - memory loss
aphasia - language comprehension or expression deficits
agnosia - not familiarizing common objects or people
apraxia - inability to perform motor tasks
altered perception - LOC and orientation
apathy - lack of interest or enthusiasm
anosognosia - unaware of their condition
Why is it pertinent to do routine labs for someone when diagnosing dementia?
Dementia may mimic other conditions, therefore labs are pertinent to ruling out other conditions
What six things does cognitive testing evaluate?
Memory, attention, ability to perform calculations, language, visuospatial skills, and alertness
What are the three assessments often used for dementia/alzheimer’s
o MMSE (Mini-Mental State Examination)
o MoCA (Montreal Cognitive Assessment
o CICA (Canadian Indigenous Cognitive Assessment)
What are the six medical conditions that may increase the risk of dementia?
Type 2 diabetes, stroke & TIA, hyperlipidemia, hypertension, obesity, and chronic inflammatory conditions (arthritis)
Aside from medical conditions, what three additional modifiable risk factors may increase the risk of dementia?
Head injury, history of clinical depression, and inadequate intellectual stimulation
What is donepezil? What condition is it used for? What are the contraindications and side effects?
Cholinesterase inhibitors
Works in the brain to increase levels of acetylcholine by inhibiting acetylcholinesterase; is used with mild to moderate AD
Allergy
Increases ulcer risk, seizures, drowsiness, dizziness, insomnia, muscle cramps, GI bleed, bradycardia, tachycardia, hypotension
Can cause changes in dreams, specifically nightmares
What drug increases the presence of nightmares?
Donepezil
What is clopidogrel? What condition is it used for? Contraindications? Side effects?
Prevents platelet aggregation
Used to reduce thrombotic events
Allergy, thrombocytopenia (low platelet count), active bleeding, leukaemia, traumatic injury, GI ulcer, vitamin K deficiency, recent stroke
Side effects - bleeding
What is Aspirin used for in stroke/thrombosis? Contraindications? Side effects?
Prevents platelet aggregation
Contraindicated in allergy, thrombocytopenia, active bleeding, leukaemia, traumatic injury, GI ulcer, vitamin K deficiency, recent stroke
Side effects - bleeding
