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Patho 2 > CNS- 23 > Flashcards

CNS- 23 Flashcards

1
Q

CNS consists of

A

brain and spinal cord

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2
Q

brain consists of:

A

cerebrum
cerebellum
brain stem (midbrain, pons, medulla)

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3
Q

cerebrum consists of:

A

outer layer of gray matter (cortex)
deep gray matter
white matter

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4
Q

cortex

A

replete with neurons that are employed for intellectual (cognitive) functions as well as for sensory and motor functions above the vegetative level

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5
Q

deep gray matter

A

consists of groups of neurons such as the thalamus and basal ganglia that perform functions similar to the cortex, albeit at a much more primitive level

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6
Q

white matter

A

composed primarily of the axons and their myelin sheaths.

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7
Q

brain axons

A

long processes of neurons that connect with neurons in other prts of the brain and spinal cord.

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8
Q

axons of spinal cord neurons

A

innervate skeletal muscles

*voluntary thought generated from neurons of the cerebral cortex can control skeletal muscle movement

some axons convey sensory impulses in the opposite direction- from the spinal cord to carious parts of the brain

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9
Q

cerebellum

A

situated in the posterior inferior aspect of the skull

responsible for coordination of motor functions

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10
Q

brainstem

A

a relay between brain and spinal cord and is also a control center for heart rate, respiration rate, sleep and wakefulness, integration of eye movements and other functions

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11
Q

meninges

A

cover the brain
include an outer, tough membrane called the DURA (next to the skull), and an inner lace-like membrane= PIA-ARACHNOID (lies directly over the cortex

form a continuous covering over the spinal cord too

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12
Q

cerebrospinal fluid

A

utilized for metabolic exchange, as an excretory vehicle and as a means to absorb pressure changes in the CNS

formed in the ventricles of the brain by secretion from the CHOROID PLEXUS and by filtration through the ependyma.
-flows from 3 ventricles in the anterior part of the brain, through a narrow aqueduct, to the medulla (area of brain stem). then passes out of the ventricular system and percolates between the layers of the pia-arachnoid membrane, bathing the brain and spinal cord before being absorbed back into veins.

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13
Q

most blood flows to the brain through:

A

the 2 internal carotid arteries anteriorly and the paired vertebral arteries posteriorly

carotid to bulk of cerebrum
vertebral to brain stem, cerebellum and post cerebrum (supply control centers for respiration and consciousness)

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14
Q

circle of willis

A

vessels all interconnect at the base of the brain

*so occlusion at one major artery to the brain may no necessarily result in deprivation of blood

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15
Q

blood-brain barrier

A

selective exclusion of substances- brain capillaries are constructed to function in such a manner as to prevent passage of many substances into the brain that can easily reach tissues in other organs.

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16
Q

important cellular constituents of the brain stem and spinal cord:

A

neurons
astrocytes
oligodendroglia

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17
Q

neurons

A

large cells found in gray matter that conduct nervous impulses

  • efferent processes (axons) may extend for long distances in gray and white matter
  • short afferent processes (dendrites) connect to other neurons through synapses
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18
Q

astrocytes

A

spider lie processes provide structural support to the CNS

regulate blood-brain barrier and tissue electrolytes

when brain is injured, astrocytes proliferate to form a glial scar composed of glial processes but lack collagen

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19
Q

oligodendroglia

A

manufacture and maintain the myelin sheath that surrounds and protects axons and dendrites

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20
Q

major brain diseases

A 
CVAs/strokes- 3rd cause of death
traumatic injuries
infections (meningitis, encephalitis, abscess)
alzheimer disease
neoplasms
multiple sclerosis
parkinson's
senile dementia
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21
Q

most common presenting symptoms

A 
headache
diminution or loss of motor function
sensory loss
seizures
disturbances in intelectual or memory capabilities
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22
Q

neurologic exam

A

exam of motor and sensory systems
testing cognitive function
special tests for ability to perform coordinated movements

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23
Q

motor system exam

A 
gait
posture
symmetry of muscle mass
muscle strength
coordination
quality of reflexes
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24
Q

decreased reflux indicates:

A

lesion in peripheral nerve with resultant inability to either transmit the sensoryy impulse back to the spinal cord or to transmit the motor impulse out to the muscle

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25
Q

hyperactive reflex

A

represents an intact nerve but without the modifying control normally mediated by the CNS

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26
Q

focal vs general

A

focal= referable to a specific area of nervous system involvement

general=involving integrated functions of the whole brain

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27
Q

hemiparesis

A

weakness of one side of the body

focal

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28
Q

focal examples

A

hemiparesis
localized areas of sensory deprivation
abnormalities of 1 or 2 cranial nerves
localized headaches

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29
Q

general examples

A

intellectual impairment
generalized headaches
stupor
loss of consciousness (coma)

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30
Q

major cause of generalized s&s

A

increased intracranial pressure

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31
Q

foramen magnum

A

only major opening in the skull- for spinal cord

substance of the brain tends to be pushed toward this foramen as a consequence of any increased intracranial pressure

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32
Q

treatment of increased intracranial pressure

A

removal of any space occupying lesion

steroid drugs and osmotic agents may help relieve brain edema by drawing fluid back to vascular system

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33
Q

most important lab exam for CNS

A

analysis of cerebrospinal fluid usually by a needle into lumbar parachnoid space in sitting

pressure is measured as fluid is being drawn.

34
Q

electroencephalogram (EEG)

A

evaluates electrical activity simultaneously in various areas of the brain

35
Q

developmental abnormalities of the CNS divided into:

A

1: malformations
2: destructive brain lesions

36
Q

malformations

A

result of deleterious forces acting upon the embryonic or fetal brain~1/2 gestation

down syndrome
spina bifida
meningomyelocele
anencephaly
hydrocephalus
37
Q

spina bifida

A

post arches and spines of some vertebrae are absent

if severe a meningomyelocele results

38
Q

meningomyelocele

A

defect in the spinal column through which spinal cord and meninges protrude into the skin of the back.

may result in severe paralysis of the legs

39
Q

anencephaly

A

severe malformation- entire forebrain is missing

infants are stillborn or die soon after birth

40
Q

destructive brain lesions

A

occur in last 1/2 of gestation or during firth 2 years of life.
most occur at time of labor - result of anoxia from prolonged/difficult labor or respiratory distress

also common from infections. especially meningitis
vary greatly in severity

most pts have motor problems , 1/3 mentally retarded

cerebral palsy
maternal diet
drugs
radiation 
toxins
41
Q

cerebral palsy

A

non-progressive condition manifested by motor retardation and sometimes mental.

42
Q

inflammatory diseases

A

meningitis
encephalitis
rabies
myelitis

43
Q

meningitis

A

=inflammation of the pia-arachnoid
most often caused by bacteria
usually abrupt onset
bacteria gains access to brain and spinal cord via blood.

escherichia coli and group B streptococci cause majority of newborn cases
haemophilus influenzae for small children

44
Q

s&s of meningitis

A

fever, headache, neck rigidity, pain caused by muscle spasm from nerve irritation

45
Q

neisseria meningitis

A

can occur in epidemics

46
Q

encephalitis

A

=diffuse inflammation of the brain
usually caused by viral infections (mosquito borne) occur in epidemics
*west nile, st louis, equine, venezuelan

47
Q

s&s of encephalitis

A

irritability
drowsiness
headache

no tx. pts die, fully recover or recover with neurologic deficit

48
Q

rabies

A

the virus travels up the peripheral nerve to the brain and once infected death is practically inevitable.

49
Q

s&s of rabies

A 
pain at bite site
fever
malaise
vomiting
progressing to delirium
painful laryngeal spasm when attempting to drink (hydrophobia)
50
Q

myelitis

A

infection of the spinal cord

51
Q

poliomyelitis

A

specific infection of the gray matter of the spinal cord

killing anterior horn motor neurons with resultant paralysis

52
Q

vascular disease and trauma

A

CVA (1/3 die, 1/3 serious neuro deficits)

trauma

53
Q

cerebrovascular accident (stroke)

A

=sudden neurologic deficit caused by either vascular occlusion from thrombosis or embolism, from hemorrhage to the brain, or from ruptured saccular aneurysm

  • majority from emboli
  • *common atherosclerotic vascular disease
54
Q

artery most occluded by emboli

A

middle cerebral artery: largest and a direct continuation of the carotid artery
supplies the part of the cortex controlling motor function

55
Q

aphasia

A

impaired language function

56
Q

brain hemorrhage

A

rupture of vessels and bleeding into the brain

57
Q

saccular (berry) aneurysms

A

occur mostly in the circle of willis where vessels branch. deficiencies in the blood vessel walls result in outpouching.

58
Q

trauma

A 
concussion
contusion
epidural hematoma
subdural hematoma
penetrating injuries
59
Q

why should a pt be watched closely after trauma?

A

late deterioration- subdural or epidural bleed developed immediately following injury but did not affect the pt until a critical amount of blood accumulated

60
Q

concussion

A

momentary loss of consciousness and loss of reflexes following head trauma
amnesia for the traumatic event and complete recovery
no structural damage in the brain

61
Q

contusion

A

bruises of the surface of the brain from time of impact

“coup lesions”-contusion of same side
“contrecoup lesions”- opposite side

result in hemorrhages from small blood vessels in the brain can cause further vessel occlusion and edema- vulnerable for intracranial pressure

62
Q

epidural hematoma

A

epidural hemorrhage occurs between dura and skull
associated with severe trauma- skull usually fractured.

bc artery is ruptured (middle meningeal) the blood accumulates rapidly and pt will die w/in hours unless hematoma is removed.

63
Q

subdural hematoma

A

=collection of blood beneath the dura
rupture of veins on the dorsum of the brain
bc bleeding is venous- does not accumulate as rapidly as epidural so not as life threatening but bleed still needs to be removed surgically to prevent compression of brain

64
Q

penetrating injuries

A

bullets
fractured bone splinters
herniation- spinal cord
*infection to wound

65
Q

degenerative diseases

A 
multiple sclerosis
creutzfeldt-jakob disease
senile dementia
parkinsons
hydrocephalus
epilepsy
66
Q

multiple sclerosis

A

women>men
=focal loss of myelin sheath (demyelination)- appears to render axons incapable of properly transmitting a nervous impulse.

can occur anywhere in the brain and spinal cord so varies with pt

visual impairment

unknown cause

5-25 lifespan. remission and relapse

pt becomes debilitated from muscle weakness

dx: increased immunoglobin G (IgG) protein in cerebrospinal fluid
MRI-may see lesion

67
Q

creutzfeldt-jakob disease (CJD)

A

human prototype of a group of diseases in animals and humans that result in brain degeneration. rare
“slow virus” diseases
“mad cow”

pt becomes rapidly demented and usually die 4-6 months after dx w/ severe brain degeneration

68
Q

cause of CJD

A

appears to be the result of transformation of a normal brain protein into an abnormal configuration allowing it to replicate.

protein PRION builds up in the brain- associated with gray matter degeneration

69
Q

senile dementia

A

=decrease in cognitive function, memory loss
-pick at their clothes, get lose easily, often irritable

degree depends on loss of substance in the frontal lobes, the region of that brain associated with higher cognitive function

70
Q

alzheimer’s disease

A

dementia accompanied by certain microscopic brain changes

disease of age
large number of plaques, tangles and amyloid are found in hippocampal formation in the temporal lobe- explaining loss of recent memory

71
Q

parkinson’s disease

A

-caused by degeneration of certain portions of the extrapyramidal (involuntary) motor system, especially the substantia nigra nucleus in the midbrain

classic inclusion= LEWY BODY

tremors at rest, masklike facial expression, shuffling gait, rigidity of skeletal muscles

72
Q

hydrocephalus

A

=”water brain”
ventricles enlarge bc of block in the flow of cerebrospinal fluid at some level.

stenosis of aqueduct btwn 4and 5th ventricles- head may enlarge
if pressure is not released brain may herniate toward foramen magnum

73
Q

epilepsy

A

=recurrent seizures

seizures=focal or generalized disturbances of neuronal electrical activity, may manifest abnormal movements or sensations and loss of reflexes, memory or consciousness

74
Q

seizures may be caused by

A

electrolyte imbalance, high fever, uremia

75
Q

generalized brain neoplasms symptoms

A

headaches
vomiting
blurred vision
seizures

from intracranial pressure

76
Q

astrocytomas

A

slower growing brain tumors from astrocytes

77
Q

glioblastoma

A

fast growing malignant brain tumor
most common in adults
result in death w/in 1-2 years

78
Q

meningioma

A

2nd most common brain tumor

benign neoplasm that arises from dura and slow growing

79
Q

adenomas

A

pituitary tumors
difficult to remove
some secrete growth hormone and result in gigantism or acromegaly

80
Q

medulloblastoma

A

arises in cerebellum in children from primitive cells that are neuronal precursors
malignant but do respond well to radiation

Patho 2 (10 decks)

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