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path final > Cortical Functions > Flashcards

Cortical Functions Flashcards

1
Q

Divisions of nervous system

A

CNS
- Brain
- Spinal cord
PNS
ANS
- Automatic
- Internal organs

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2
Q

Cerebrum

A

Thought, memory, language, planning, emotion
Small lesion-big impact

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3
Q

Brainstem

A

Midbrain, pons, medulla oblongata
- Cranial nerves
- Level of consciousness and alertness
- Respiratory centers
- Heart rate
- “Pacemaker”

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4
Q

Cerebellum

A

Movement
Posture
Position sense

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5
Q

Spinal cord

A

Anterior (ventral) horn: motor
Posterior (dorsal) horn: sensory

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6
Q

Peripheral nerves

A

12 pairs of cranial
31 pairs
- 8C
- 12T
- 5L
- 5S
- 1C
- cauda equina
Terminate in skin, muscle, and viscera

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7
Q

Autonomic nerves

A

Transmit (output) only
- depends on the sympathetic and parasympathetic to bring information in

Descending paths - motor
- sympathetic
- parasympathetic

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8
Q

Protection and support of the nervous system

A

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

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9
Q

Meninges

A

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

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10
Q

Circulation and nourishment of the nerves occurs by

A

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

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11
Q

Nerve function

A

Acetylcholine stimulates muscle cells
Conductivity or speed:
- diameter of nerve
- myelin
- facilitation

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12
Q

CVA

A

Hemorrhagic (aneurysm) - 15%
Ischemic - 85%
- due to thrombosis (atherosclerosis)
* slower onset (often at night)
- lacunar stroke
- embolism: sudden onset

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13
Q

Impact of a stroke

A

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

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14
Q

CVA risk factors

A

Age
Race
Sex
Genetics
Hypertension
Smoking
Obesity
Diet
Activity
Diabetes
Alcohol and drug abuse
Cardiac issues
High cholesterol

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15
Q

Warning signs of stroke

A
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16
Q

Types of CVAs

A

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

17
Q

CVA rehab and recovery

A

3-6 months
- neural plasticity
Lifetime
- adaptations and improvements

18
Q

CVA interventions

A

Surgical
Medication
- antiplatelet drugs (thrombolytic stroke)
* aspirin with TIA
* warfarim (coumadin): causes excessive bleeding if cut
* plavix: causes excessive bleeding if cut

19
Q

Precautions with CVA

A

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

20
Q

Acquired brain injury

A

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

21
Q

Acquired brain injury is also called

A

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

22
Q

Causes of brain injury (TBI or ABI)

A

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

23
Q

Glasgow Coma Scale

A
24
Q

Classification for TBI

A

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)

25
Q

ABI levels of awareness

A

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

26
Q

ABI scales for levels of awareness

A

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

27
Q

Seizures

A

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
28
Q

Hydrocephalus

A

Increased cranial pressure due to cerebrospinal fluid

29
Q

Dysautonomia

A

Failure of the sympathetic and parasympathetic system

30
Q

DVT

A

Deep vein thrombosis
Danger zone = knee

31
Q

Motor impact of brain injury

A

Paralysis, hypo-hyper tone,
Ataxia and/or tremors
Poor motor planning (cognitive and motor)

32
Q

Injuries associated with brain injury

A

Seizure
Hydrocephalus
Dysautonomia
DVT
Motor impact
Heterotrophic ossification
Cognitive, behavioral, and psychological issues

33
Q

Posture associated with cerebral damage

A

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

34
Q

Concussion

A

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

35
Q

Hematoma

A

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

36
Q

Tumors

A

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
Metastasis: grows and spreads
Symptoms can be any symptoms of stroke or ABI
Course of treatment: depends on location and type; brain tumor can only be treated with radiation or surgery

37
Q

Cortical functions

A

Intelligence
- Not grades
- Prefrontal association areas
- Frontal lobotomy: causes loss of ability to learn and freely think
- Can be taught but can’t 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

38
Q

Language

A

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

39
Q

Types of aphasia

A

Fluent aphasia (Wernicke’s) (receptive)
- Can produce language, but understanding is limited
- Incorrect word 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

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