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pathophysio > CNS Disorders > Flashcards

CNS Disorders Flashcards

1
Q

A critical factor in determining neuronal cell fate after injury

A

ATP depletion

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2
Q

Ischemia & Hypoxia
-decreased____at the ____level
-results in ___neurologic dysfunction due to ____

A

-O2; cellular level
-immediate; inability to generate ATP

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3
Q

2 mechanisms that can cause brain cell death

A
  1. anaerobic metabolism
  2. deterioration of ion gradient
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4
Q

Cellular energy failure
-how long w/o O2 for irreversible brain damage

A

5-10 min

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5
Q

Excess glutamate (an excitotoxin) stimulates

A

neurons that take up large amounts of injurious calcium ions – calcium overload injury = cytotoxic edema and swelling

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6
Q

Reperfusion Injury and free radicals?
free radicals:

A

when O2 reenters cells; produces reactive O2 products that behave as free radicals: hydroxyl radicals,superoxide,peroxide

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7
Q

Increased intracranial pressure (ICP) normal levels

A

0-15mmHg

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8
Q

primary brain injury

A

a direct result of initial insult

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9
Q

secondary injury

A

progressive damage resulting from body’s physiological response to the initial insult

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10
Q

clinical manifestations of ICP

A

-headache, vomiting, decreased consciousness (drowsiness)
-blurry vision, edema of the optic disk (papilledema)

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11
Q

Herniation

A

result of increased ICP
protrusion of brain tissue through opening of brain – DEADLY

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12
Q

papilledema

A

edema of optic disk

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13
Q

Diagnostic test for brain injury

A

CT or MRI

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14
Q

general treatment for brain injury

A

focus on managing cerebral oxygenation
-surgery, CPP (cerebral perfusion pressure) > 60mmhg for no ischemia

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15
Q

Coma

A

Complete loss of consciousness

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16
Q

indicator of altered brain function

A

Change in level of consciousness

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17
Q

Glasgow coma scale evaluation

A
  1. eye opening
  2. motor response
  3. verbal response
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18
Q

Somnolent

A

excessive drowsiness, only responds to stimuli with incoherent mumbles + disorganized movement

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19
Q

Glasgow Coma Scale: Evaluation component:

A

Mild (>12), moderate (9 to 12), to severe (<8)

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20
Q

Most important eval in Glasgow coma scale

A

motor response

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21
Q

Manifestaions of Brain injury: Pupil reflex
indicates function of the brainstem and cranial nerves _ and _

A

2 and 3

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22
Q

which cranial nerves control eye movements

A

CN 3,4,6

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23
Q

Oculovestibular reflex

A

impaired reflex implies brainstem dysfunction

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24
Q

Doll’s eye movement

A

eyes move in opp direction to head rotation

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25
Q

Cold calorics

A

injection of cold water into ears. Normal response: tonic deviation of both eyes towards water

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26
Q

Leading cause of death and disability in the U.S

A

TBI (traumatic brain injury)

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27
Q

Primary injury

A

initial injury on brain cells

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28
Q

focal injuries (coup)

A

localized site of impact

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29
Q

polar injuries (coup contracoup)

A

accel-decel movement of brain in skull

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30
Q

Mechanisms of TBI

A

Concussion, contusion, intracranial hematoma

31
Q

contusion

A

CT or MRI reveals an area of brain tissue damage (necrosis, laceration, bruising)

32
Q

3 types of intracranial hematomas

A
  1. epidural
  2. subdural
  3. subarachnoid
33
Q

intracranial hematoma

A

localized collection of blood within the cranium

34
Q

location of epidural

A

caldevia bone + dura mater, middle meningeal A

35
Q

location of subdural

A

dura + arachnoid membrane

36
Q

location of subarachnoid

A

arachnoid + pia mater

37
Q

Epidural hematoma

A

-collection of blood between dura and skill
-involves arterial injury –> rapid onset of symptoms

38
Q

Manifestations of epidural hematoma

A

brief disturbed consciousness followed by normal cognition (lucid interval), then rapid decrease in consciousness

39
Q

Treatment for epidural hematoma

A

surgery

40
Q

Acute subdural hematoma symptom onset

A

24 hrs after injury

41
Q

subarachnoid hemorrhage

A

rupture of bridging veins
commonly associated with rupture of cerebral aneurysms or arteriovenous malformations

42
Q

Treatment for subarachnoid hemorrhage

A

-cardiopulmonary stabilization – cerebral oxygenation
-maintain body temp (mild hypothermia, PaCo2, serum glucose, intravascular volume

43
Q

treatment for acutely elevated ICP

A

administer mannitol (osmotic diuretic)
sedation
hypothermia
mild hyperventilation
barbiturate coma

44
Q

treatment for severely high ICP

A

diuretics, hypertonic saline, moderate hyperventilation, and barbiturate coma

45
Q

open head injury treatment

A

prophylactic antibiotics

46
Q

Base skull fracture

A

fracture of temporal, occipital, sphenoid, frontal, ethmoid bone

47
Q

Halo Test

A

CSF can seep out as clear fluid from ears or nose

48
Q

black eyes “raccoon signs”

A

bilateral periorbital hematomas

49
Q

Battle’s signs

A

bruising under ear

50
Q

Cerebrovascular disease and stroke epidemiology

A

Transient ischemic attacks (TIA), ischemic stroke, hemorrhagic stroke

51
Q

most common form of stroke

A

ischemic

52
Q

ischemic stroke

A

sudden occlusion of cerebral artery secondary to thrombus formation or emboli

53
Q

clinical manifestations of ischemic stroke

A

contralateral hemiplegia, hemisensory loss, contralateral visual field blindness

54
Q

treatment for ischemic stroke

A

salvage penumbra, anticoagulants, antiplatelet, endarterectomy, angioplasty TREATMENT MUST BE INSTITUTED WITHIN 3 HRS OF SYMPTOM ONSET

55
Q

Transient ischemic attack
Nuerologic symptoms last _____, but may last ____.
Symptoms may resolve ____ without evidence of ____.

A

only minutes; 24 hrs
completely; neurologic dysfunction

56
Q

Treatment for TIA

A

daily aspirin

57
Q

TIA are important warning signs

A

of thrombotic disease and carry a significant risk for subsequent stroke

58
Q

Hemorrhagic stroke usually occurs secondary to ____

A

severe, chronic hypertension

59
Q

hemorrhagic stroke occurs in

A

basal ganglia or thalamus

60
Q

treatment for hemorrhagic stroke

A

blood pressure management

61
Q

Motor and Sensory Deficits
initially motor deficits occur as ____or ______; recovery of motor function occurs with ____

A

flaccidity; paralysis; onset of spasticity

62
Q

Sensory disturbances occur in same locations as ____ and may involve ____

A

motor paralysis; neglect or visual impairment

63
Q

Aphasia
Brain damage to ____ and can involve ___ language modalities

A

language deficit, dominant cerebral hemisphere; all language modalities

64
Q

Broca Aphasia (Verbal motor, expressive)
Consists of ___ articulation and ___ vocabulary

A

poor; sparse

65
Q

Evidence of cognitive deficits

A

language impairment, impaired spatial relationship skills, short-term memory, poor judgement, concentration, memory, reasoning impairment

66
Q

CNS infection risk factors

A

immunocompromised, debilitation, poor nutrition, radiation, steroid therapy, contact w/ vectors

67
Q

Meningitis – bacterial or viral infection

A

bacterial

68
Q

encephalitis – bacterial or viral

A

usually viral

69
Q

Most common bacteria for meningitis

A

streptococcus pneumonias

70
Q

classic s/s of meningitis

A

headache, fever, stiff neck (meningismus), signs of cerebral dysfunction (confusion, delerium)

71
Q

Encephalitis – inflammation of brain caused by ____

A

west nile virus, western equine encephalitis, herpes simplex

72
Q

S/S of herpes

A

fever, headache, seizure, confusion, stupor, coma

73
Q

Brain abscess – localized collection of ___

A

pus within brain parenchyma

pathophysio (1 decks)

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