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DPT 520 > CSF and Blood Supply > Flashcards

CSF and Blood Supply Flashcards

1
Q

where is CSF formed?

A

in the ventricles

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2
Q

where does CSF circulate?

A

through the ventricles and subarchnoid space

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3
Q

the CSF is absorbed into ____

A

lymph

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4
Q

what are the roles of CSF?

A

regulates extracellular environment (aiming to optimize neural fxn)

protect the CNS

removes metabolites/waste from the brain (glymphatic system-glia and lymphatic system)

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5
Q

what is CSF made of?

A

water, amino acids, vitamins, proteins, and specific ions

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6
Q

what is the pathway of CSF circulation?

A

lateral ventricle–>3rd ventricle-> 4th ventricle–>subarachnoid space–>venous system

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7
Q

what are common causes of disorders of CSF?

A

obstruction or increased volume

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8
Q

what causes increased volume of CSF?

A

overproduction of CSF or introduction of blood to the CSF

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9
Q

what are communicating CSF disorders?

A

caused by blockage outside of the ventricular system

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10
Q

what are non-communicating CSF disorders?

A

caused by blockage within the ventricular system

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11
Q

where is the most common place to have CSF blockage?

A

in the cerebral aqueduct

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12
Q

what are common disorders of CSF?

A

hydrocephalus

epidural and subdural hematomas

Chairi malformation

Dandy Walker malformation/cyst

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13
Q

what is usually the cause of epidural and subdural hematomas?

A

brain trauma

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14
Q

what are the 2 causes of obstruction of CSF?

A

Chairi malformation

Dandy Walker malformation/cyst

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15
Q

what are the s/s of hydrocephalus in infants?

A

poor feeding, fussy babies, irritable, chronic headache

low activity

disproportionately large head size pressing on the optic nerve=downward gaze of the eyes

enlarged ventricule puts pressure on white matter

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16
Q

what are common causes of hydrocephalus in infants/fetus?

A

failure of the 4th ventricle to open and form, Dandy Walker, Chiari

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17
Q

what are the s/s of hydrocephalus in older children/adults?

A

W triad: Wet (incontinence), Wobbly (gait disturbance), and Wacky (confusion, mild dementia)

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18
Q

are the s/s of hydrocephalus worse or better in adults? why?

A

worse bc the skull can’t expand

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19
Q

what are common causes of hydrocephalus in adults?

A

TBI, intraventricular hemmorrhages, subarachnoid hemorrhages

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20
Q

if hydrocephalus is not resolved quickly in infants, what may result?

A

learning disabilities and cognitive issues

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21
Q

how is hydrocephalus managed?

A

shunt system

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22
Q

what is a VP (ventriculoperitoneal) shunt?

A

a shunt from the ventricle to the peritoneum

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23
Q

what is the most frequently used shunt for hydrocephalus?

A

VP shunt

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24
Q

what is a VA (ventriculoarterial) shunt?

A

shunt from ventrical to arterial system

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25
Q

what is a ventriculopleural shunt?

A

shunt from ventricles to pleural space

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26
Q

what is meningitis?

A

inflammation of the meninges

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27
Q

what are the causes of meningitis?

A

bacteria, fungus, virus, or parasite infection reaching the brain or SC

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28
Q

what are the s/s of meningitis?

A

similar to a cold or flu (fever, headache, vomiting, sleepiness, difficulty walking, irritable)

neck stiffness (nuchal rigidity)

photophobia (sensitivity to light)

confusion/altered mental status, seizure

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29
Q

what areas does the MCA supply?

A

globus pallidus, putamen, most of the lat hemisphere, part of internal capsule and caudate

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30
Q

what areas does the PCA supply?

A

midbrain, occipital lobe, and inferomedial temporal lobe

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31
Q

what areas does the ACA supply?

A

med frontal and parietal lobes

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32
Q

what do the superficial cerebral veins drain?

A

the cortex and adjacent white matter to the sup sagittal sinus, or one of the sinuses around the inferior cerebrum

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33
Q

what do the deep cerebral veins drain?

A

the basal ganglia, diencephalon (thalamus, hypothalamus, epithalamus) and nearby white matter to the straight sinus

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34
Q

where do both the superficial and deep cerebral veins eventually drain to?

A

the dural sinuses and then the internal jugular vein

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35
Q

what is a stroke?

A

loss of blood supply in a specific area that correlates w/a specific loss of fxn

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36
Q

strokes are categorized according to both ___ and ____

A

pattern and cause

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37
Q

what is a TIA?

A

focal ischemia w/clinical symptoms lasting <24 hrs with no s/s after

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38
Q

what is a reversible ischemic neurologic deficit (RIND)?

A

clinical symptoms of stroke last bw a day and 3 wks

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39
Q

t/f: multiple focal lesions in the brain lead to greater loss of fxn in stroke?

A

true

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40
Q

t/f: TIAs are predictive of future strokes

A

true

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41
Q

what is the ABCD2?

A

guidelines for high stroke risk factors following TIA

Age >60
BP (>140 SBP or >90 DBP)
Clinical feature (unilateral weakness or speech disturbance)
Duration >60 min
Diabetes

over 5 points=very high risk for a subsequent stroke following a TIA

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42
Q

what are the 2 types of stroke?

A

ischemic (infarction) and hemorrhagic

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43
Q

is hemorrhagic or ischemic (infarction) stroke more common?

A

ischemic (infarction)

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44
Q

do hemorrhagic or ischemic (infarction) stroke tend to have more devastating s/s?

A

hemorrhagic

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45
Q

what is a brain infarct (ischemic stroke)?

A

an embolus/thrombus lodges in a vessel, obstructing blood flow

46
Q

what artery is usually affected in ischemic stroke?

A

MCA

47
Q

how are ischemic strokes usually diagnosed?

A

CT scan (perfusion)

MRI (avoid radiation)

transcranial and carotid doppler (flow of major brain arteries)

cerebral angiography (injection of dye into vessels for series of radiographs usually b4 surgery)

PET (cerebral metabolism-used a lot post stroke)

48
Q

what is a hemorrhagic stroke?

A

weakness vessel ruptures, bleeding into the surrounding brain (due to aneurysm or trauma)

intracranial hemorrhage

subarachnoid hemorrhage

49
Q

t/f: hemorrhagic stroke have high risk for re-hemorrhage

A

true

50
Q

what are the s/s of hemorrhagic stroke?

A

severe acute onset headache, change in alertness, vomiting

51
Q

what is the medical management for ischemic stroke?

A

IV recombinant tissue plasminogen activator (tPA) within 4 1/2 hours of onset of stroke

endovascular procedure to place a device in the blocked vessel (performed ASAP)

52
Q

what is the gold standard for ischemic stroke medical management?

A

tPA

53
Q

what is the medical management for hemorrhagic stroke?

A

control bleeding and reduce pressure in the brain

BP controlling meds

taken off any anticoagulants

54
Q

what is a common area for stroke?

A

watershed area

55
Q

what is an ACA stroke?

A

stroke affecting the frontal lobe leads to personality changes and cognitive changes (divergent thinking and declarative memory)

contra hemiplegia and hemisensory deficits

loss of fine touch but no other somatosensations

LE>UE

gait apraxia

incontinence

putamen and internal capsule

56
Q

how is gait apraxia in ACA stroke different from PD gait?

A

there is no UE involvement, there is normal arm swing, and there is normal standing posture

57
Q

what is the somatosensory loss associated with ACA stroke?

A

contra loss of fine touch sensation in LE

58
Q

what is the motor loss associated with ACA stroke?

A

hemiplegia (LE>UE)

gait apraxia

59
Q

are there special sensory and autonomic losses with ACA stroke?

A

nope

60
Q

what are the emotional and behavioral changes associated with ACA stroke?

A

flat affect

impulsive

perseveration

confusion

motor inactivity

61
Q

what are the cognitive, language, and memory changes associated with ACA stroke?

A

difficulty w/divergent thinking

62
Q

what is a MCA stroke of the cortical branch?

A

optic radiation lesion causes contralateral homonymous hemianopsia

loss in lateral parts of sensorimotor cortex leads to contra hemiplegia and sensory deficits in UE and face

UE and face>LE

63
Q

if there is a L hemisphere lesion in MCA stroke, what is the impairment?

A

aphasia (inefficient communication)

64
Q

if there is a R hemisphere lesion in MCA stroke, what is the impairment?

A

poor spatial awareness, neglect, poor nonverbal communication

65
Q

what is the somatosensory loss associated with MCA stroke of the cortical branch?

A

hemisensory loss face and UE>LE

66
Q

what is the motor loss associated with MCA stroke of the cortical branch?

A

face and UE>LE

hemiplegia

67
Q

what is the special sensory and autonomic losses associated with MCA stroke in the cortical branch?

A

homonymous hemianopsia

68
Q

what are the emotional and behavioral changes associated with MCA stroke of the cortical branch?

A

if R: easily distracted, poor judgement, impulsiveness

if L: apraxia, compulsiveness, and overly cautious

69
Q

what is a MCA stroke of the deep branch?

A

striate arteries most commonly affected

supply to striatum and internal capsule cut off leads to loss of motor fxns

contra hemiplegia or UE, LE, and face

stereotypic standing posture : flexion synergies of UE, extension synergies of LE

no sensory deficits

70
Q

what are the somatosensory losses associated with MCA stroke of the deep branch?

A

none

71
Q

what are the motor losses associated with MCA stroke of the deep branch?

A

contra hemiplegia of UE, LE, and face

flexion synergies of UE

extension synergies of LE

72
Q

what is a PCA stroke of the midbrain braches?

A

damage to the oculomotor nuclei, nerve, and or descending neurons from cortical eye movement centers

73
Q

what is a PCA stroke of the branches of the visual cortices?

A

calcarine (visual) cortex) affected: cortical blindness of the contra visual field; normal pupillary light reflexes

secondary visual field: visual agnosia (inability to recognize objects by sight despite intact vision)

74
Q

what are the impairments associated with a PCA stroke of the midbrain branches?

A

impaired eye movements, not a lot of contra hemiplegia

75
Q

what is a PCA stroke of the deep branches?

A

supplies the diencephalon and hippocampus

LMN signs

thalamic syndrome (sever p!, contra hemisensory loss, flaccid hemiparesis)

poor declarative memory

76
Q

what is an anterior choroidal artery stroke?

A

affects the posterior internal capsule

control hemiplegia

hemisensory loss

contra homonymous hemianopsia

77
Q

what is the watershed area?

A

site of anastomoses of the distal branches of cerebral arteries

vulnerable to ischemia

often cuases UE paresis and paresthesia

78
Q

what is a stroke affecting the BS/cerebellum?

A

vertebrobasilar artery ischemia

79
Q

what are the most common signs of vertebrobasilar artery ischemia?

A

gait and limb ataxia

limb weakness

oculomotor palsy

oropharyngeal dysfxn

loss of vision

double vision

numbness

dizziness

headache

vomiting

80
Q

why are the vertebral arteries susceptible to shear forces at the AA jt?

A

bc they run through the transverse foramen of the cervical vertebrae

81
Q

what is the CC of vertebral artery disorders?

A

pain usually in the posterior neck/occiput, spreading to the shoulders

82
Q

what are the results of an emboli in the vertebral arteries?

A

dizziness, inability to sit upright, gait impairments, nausea, vomiting, dysarthria, headache

83
Q

what does a complete occlusion of the basilar arteries result in?

A

death (bc of the vital fxns of the BS)

84
Q

what does partial occlusion of the basilar arteries result in?

A

tetraplegia, loss of sensation, coma, CN signs

85
Q

what does severe partial occlusion of the basilar arteries result in?

A

locked-in syndrome

86
Q

what is an arteriovenous malformation (AVM)?

A

developmental abnormality

abnormal connection of arteries to veins

no s/s until rupture

upon rupture: subdural hematoma and/or intracerebral hemorrhage

87
Q

what is an aneurysm?

A

looks like a protruding sac from the blood vessels

88
Q

what is the CC in an aneurysm?

A

“the worst headache I had in my life”

89
Q

what is the most common type of aneurysm?

A

saccular aneurysm

90
Q

where does a saccular aneurysm usually occur?

A

in the circle of Willis

91
Q

t/f: hemorrhage from an aneurysm rupture may be massive, causing sudden death, or a wide variety of s/s

A

true

92
Q

what causes acquired aneurysms?

A

HTN, smoking, substance abuse

93
Q

what is the blood brain barrier?

A

specialized permeable barrier bw the capillary endothelium of the CNS and extracellular space (tight junction bw capillary endothelial cells and pericyte and astrocyte)

prevents pathogens from entering the CNS

prevents certain drugs and protein antibodies from accessing the brain (dopamine)

94
Q

where is the blood brain barrier absent?

A

in areas that directly sample content of the blood/secrete into the blood

parts of the hypothalamus, 3rd ventricle, 4th ventricle

95
Q

is the cerebrum more or less vulnerable to hypoxia? why?

A

more bc of it increased consumption of oxygen

96
Q

in a vegetative state, why is the brain still functioning?

A

bc the BS is still functioning but not the cerebrum

97
Q

t/f: the cerebral arteries can autoregulate local blood low by dilating if BP/O2 is inadequate or constrict if reversed

A

true

98
Q

what is cerebral edema?

A

excessive accumulation of fluid in the brain

99
Q

what are the causes of cerebral edema?

A

trauma/concussion

cardiac arrest

high altitude

100
Q

how does trauma/concusssion cause cerebral edema?

A

fluid leaking from the damaged capillaries

101
Q

what is high altitude cerebral edema (HACE)?

A

fatal altitude sickness

progressive

102
Q

what are the s/s of HACE?

A

headache, weakness, disorientation, memory loss, hallucinations, psychotic behavior, coma, ataxia (less frequent)

103
Q

what elieviates cerebral edema?

A

shunting, meds, moving to lower altitudes

104
Q

what is ICP?

A

pressure within the skull

105
Q

t/f: ICP can produce brain herniation

A

true

106
Q

what are the causes of ICP?

A

cerebral edema, hydrocephalus, tumors, bleeding

107
Q

what are the s/s of ICP?

A

nausea, vomiting, headache, drowsiness, frontal lobe gait ataxia, and visual/eye movement problems

108
Q

what are the causes of brain herniation?

A

TBI

intracranial hemorrhage

tumor

109
Q

what is a cingulate herniation?

A

mass on one hemisphere that displaces the cingulate cortex under the falx cerebri (fold of dura matter)

may compress the ACA (contra motor loss in LE)

may not have s/s

110
Q

what is an uncal herniation?

A

space-occupying lesion in temporal lobe

displaces the uncus medially

compresses the midbrain

dysfxn of the oculomotor nerve and ARAS

DPT 520 (13 decks)

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