Cortical Functions Flashcards
Divisions of nervous system
CNS
- Brain
- Spinal cord
PNS
ANS
- Automatic
- Internal organs
Cerebrum
Thought, memory, language, planning, emotion
Small lesion-big impact
Brainstem
Midbrain, pons, medulla oblongata
- Cranial nerves
- Level of consciousness and alertness
- Respiratory centers
- Heart rate
- “Pacemaker”
Cerebellum
Movement
Posture
Position sense
Spinal cord
Anterior (ventral) horn: motor
Posterior (dorsal) horn: sensory
Peripheral nerves
12 pairs of cranial
31 pairs
- 8C
- 12T
- 5L
- 5S
- 1C
- cauda equina
Terminate in skin, muscle, and viscera
Autonomic nerves
Transmit (output) only
- depends on the sympathetic and parasympathetic to bring information in
Descending paths - motor
- sympathetic
- parasympathetic
Protection and support of the nervous system
Cranium
- Cranial vault
- Skull
- Foramen magnum
* Role with fever
* Benefits of fever
- Fontanel: where the parietal and frontal bones come together; soft spot in babies)
Vertebral column
- 33 stacked bones
- 7C
- 12T
- 5L fused
- 4C sacral
* “Broken back”
- Bone
- Nerve
* Intervertebral discs
- Rupture
- Herniation
- Radiculopathy
Meninges
Dura mater
- epidural space
- subdural space
Arachnoid and pia mater
- subarachnoid space
* CSF
> between ventricles and central canal and through the subarachnoid space
> normally clear
> normally produced and reabsorbed
~ too much: IICP - increase of intercranial pressure
~ too little
Meningitis
- bacterial
- aseptic
Circulation and nourishment of the nerves occurs by
CSF provides nutrients to veins and nerves that supply CNS
Vascular system
- Basalar artery
* posterior and lower brain
- Carotid artery
* anterior and medial brain
- Circle of Willis
* back up system
- Jugular vein
* “drain the brain”
- Blood brain barrier
* created by the meninges
Nerve function
Acetylcholine stimulates muscle cells
Conductivity or speed:
- diameter of nerve
- myelin
- facilitation
CVA
Hemorrhagic (aneurysm) - 15%
Ischemic - 85%
- due to thrombosis (atherosclerosis)
* slower onset (often at night)
- lacunar stroke
- embolism: sudden onset
Impact of a stroke
Asymmetrical tone
Sensory and motor
Cognitive
Hemiparesis
- subluxation
Hemiplegia
TIA
Visual field
- Homonymous hemianopsia
* ½ of both eyes
* Left or right
Neglect
Aphasia: inability to speak
Apraxia: inability to move
CVA risk factors
Age
Race
Sex
Genetics
Hypertension
Smoking
Obesity
Diet
Activity
Diabetes
Alcohol and drug abuse
Cardiac issues
High cholesterol
Warning signs of stroke
Types of CVAs
Left and right side - middle cerebral artery
Right side brain damage:
- paralyzed left side: hemiplegia
- left-sided neglect
- spacial-perceptual deficits
Left side brain damage:
- paralyzed right side
- impaired speech-language
- impaired comprehension
Anterior cerebral artery
- less common
- weakness and sensory loss contralateral lef
- apathy
- impulsivity
Vertebrobasilar/Posterior stroke
- balance issue
- clumsy
- impaired sensation
- facial paralysis
Brainstem stroke/ lateral medullary syndrome/ wallenberg syndrome
- impact to cranial nerves
- often results in coma or death
- anything can be affected
CVA rehab and recovery
3-6 months
- neural plasticity
Lifetime
- adaptations and improvements
CVA interventions
Surgical
Medication
- antiplatelet drugs (thrombolytic stroke)
* aspirin with TIA
* warfarim (coumadin): causes excessive bleeding if cut
* plavix: causes excessive bleeding if cut
Precautions with CVA
Don’t trust them - they may not be capable of telling the truth due to CNS damage; short term memory loss
Cardiac and respiratory precautions
Guard against falls
Avoid dislocation
Precautions for sensory loss
Feeding
Family
Acquired brain injury
Nondegenerative
Noncongenital
Non disease caused
External Force
Trauma that causes one of the following:
- Loss of consciousness
- Posttraumatic amnesia
- Disorientation
- Confusion
- Neurological signs
* MRI, paralysis, seizure
Acquired brain injury is also called
Traumatic Brain Injury (TBI)
Open or Closed Head Injury (CHI)
- Penetrating Brain Injury
Blast injury
Acceleration-Deceleration
– Coup CountreCoup
- damage to one part of the brain and resulting damage to the other side
- shaken baby syndrome
- microtearing throughout the brain, making it harder to intervene with because you don’t know what is truly affected
Concussion- Postconcussion Syndrome
Causes of brain injury (TBI or ABI)
1.4 million a year
5.4 billion living with it
MVA
- Most severe
- Most common in adolescents and adults
Falls
- Most common especially in elderly and under 5
Sports
Violence
More in Males
- Influence of Alcohol and Drugs
Classification for TBI
Level of disability
1. Mild - 10% for life
2. Moderate - 66%
3. Severe 100%
Often hard to gauge - effect on executive function, personality, ect. (walking wounded - look and act normally, but are impulsive; can have significant affect on personality)
ABI levels of awareness
Describing awareness:
- Consciousness
* Wakefulness
* Awareness
- Coma
* Not awake or aware
- Vegetative state
* Awake but not aware
- Sleep
* Insomnia - inability to sleep
* Hypersomnia - sleep too much
* Parasomnia - walk or talk in sleep
ABI scales for levels of awareness
Ranchos Los Amigos
- level of responsiveness
- more of a functional scale
- Level VIII: walking wounded; impulsive; dangerous
* generalized: not intention; recognition of stimulus, but nor appropriate response
* localized: specific to stimulus
Glasgow Coma Scale
- level of awareness
Seizures
Sudden uncontrolled electrical disturbance in the brain resulting in convulsions
1. Time it
2. Protect head
3. Make sure they’re in a safe place
4. Roll on side (recovery position) AFTER seizure is over
5. Assess vitals
- don’t restrain them
- don’t put anything in their mouth
Hydrocephalus
Increased cranial pressure due to cerebrospinal fluid
Dysautonomia
Failure of the sympathetic and parasympathetic system
DVT
Deep vein thrombosis
Danger zone = knee
Motor impact of brain injury
Paralysis, hypo-hyper tone,
Ataxia and/or tremors
Poor motor planning (cognitive and motor)
Injuries associated with brain injury
Seizure
Hydrocephalus
Dysautonomia
DVT
Motor impact
Heterotrophic ossification
Cognitive, behavioral, and psychological issues
Posture associated with cerebral damage
Decorticate
- Flexor
- Bilateral flexion of elbow and wrist
- Deep with brainstem intact
Decerebrate
- Extensor posture
- Extension of elbow and feet (plantarflexion)
- May have flexion at wrist
- Deep and brainstem is affected
Opisthotonos (Severe Decerebrate)
- Most severe
- Extension of head and pretty much everything else
- Clenching of teeth
- Arching of back
Concussion
Brain collides with skull which can cause bruising, torn tissues, and swelling
Second impact syndrome: suffering a second concussion before the first one is healed
Symptoms
- headache
- dizziness
- confusion
- nausea
- difficulty hearing and seeing
- lack of concentration
- feeling slowed down
- blurry vision
- feeling tired
- light sensitivity
- irritability
- sadness
- sleeping more or less than usual
Hematoma
Extradural
- usually associated with skull fracture
- young patients (20-40)
- between dura and skull
Subdural
- usually associated with TBI
- between dura and brain
Intracerebral
- usually associated with TBI, especially penetrating and shearing injury
- inside brain tissue
- usually causes permanent damage
- shaken baby syndrome
Tumors
Cases have increased in past decades
Primary: started and stays in the brain
Secondary: started somewhere else, then traveled to the brain)
Malignant/Benign: can grow, but won’t spread
Metastasize: grows and spreads
Symptoms can be any symptoms of strike or ABI
Course of treatment: depends on location and type; brain tumor can only be treated with radiation or surgery
Cortical functions
Intelligence
- Not grades
- Prefrontal association areas
- Frontal lobotomy: causes loss of ability to learn and freely think
- Can be taught but not learn
Memory
- Amnesia
- Types
* Immediate: following seizure or concussion
* Short term: minutes or days
* Long term: lesser past
- Explicit or declarative memory: story you can tell
- Implicit memory: unconscious, habit
* can’t recognize their child, but give them a brush and they bring it to their head
Language
Language is mostly on left side of brain.
Agnosia: failure to recognize patterns; can be tactile, visual, or auditory
* may recognize a bell when it rings, but not when he sees it
Aphasia: impairment in listening, speaking, reading, writing, arithmetic, or using appropriate gestures
Types of aphasia
Fluent aphasia (Wernicke’s) (receptive)
- Can produce language, but understanding is limited
- Incorrect work or sounds
- Inability to name objects, repeat phrases and follow commands
- Reading and writing impairments are common
Non-Fluent aphasia (Broca’s) (expressive)
- Slow, awkward speech, limited vocabulary
- Auditory comprehension intact, can follow directions but can’t name objects or repeat phrases
- Can often sing or curse or repeat a particular phrase
- Agraphia: may be unable to express self in writing
Dysarthria: speech disorder characterized by slurred speech, poor articulation, drooling, decreased facial expressions
- Motor
Oral apraxia: communication problem in which the patient has trouble initiating and sequencing the movements to produce speech
- Stutter
- Speech impediments
Global aphasia: combination of wernicke’s and broca’s
