Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PCE - Neurology > CVAs and Acquired brain injury > Flashcards

CVAs and Acquired brain injury Flashcards

1
Q

CVA S&S:

A

o SUDDEN numbness or weakness of face, arm, or leg (especially on one side of the body)
o confusion, dizziness
o trouble speaking or understanding speech
o trouble seeing out of one or both eyes
o trouble walking
o loss of balance or coordination
o severe headache with no known cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

CVA Risk factors:

A

o non-modifiable: age (doubles after 55 yrs), M>F, family history, PREVIOUS STROKE OR TIA
o modifiable: HTN, cardiac disease, DM, hypercholesterolemia, smoking, high BMI, cocaine/meth use, oral contraceptives (?)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Types of CVA

A

Ischemic (80%)

Hemorrhagic (20%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What causes an ischemic stroke??

A

caused by thrombosis, embolism, lacunar infarct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the response in the brain following an ischemic stroke

A
  • death of tissue where there is no blood (core death)
  • possible preservation of area surrounding core that is supplied by collaterals (ischemic penumbra) * cerebellum and hippocampus neurons ++ sensitive to ischemia
  • release of glutamate, Ca2+, edema, O2 free radicals, degeneration occurs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What causes a Hemorrhagic stroke

A

caused by aneurysm and AV malformation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Where do the majority of hemorrhagic strokes occur?

A

Cerebral cortex & basal ganglia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Do ischemic or hemorrhagic strokes occur more frequently in young people

A

hemorrhagic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Ischemic stroke Rx:

A
  • get to hospital right away, if ischemic they can get tissue plasminogen activator (TPA) which will dissolve the clots and restore blood flow (within 3 hours)* NOT APPROPRIATE FOR HEMORRAGIC STROKE!!
  • Possible surgery to remove clot
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hemorrhagic stroke Rx

A
  • surgery to stop bleed

* better long term prognosis for recovery of function (than ischemic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the ABCD score used for

A

for prediction of progression and risk of recurrence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the acronym for ABCD

A 
A= age 
B = blood pressure 
C = clinical features (hemiplegia, speech problems) 
D = Duration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

4 steps to prevent the recurrence of a stroke

A

o anticoagulation therapy (aspirin)
o lipid lowering agent
o lifestyle change
o exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Is grey or white matter capable of functional reorganization

A

grey

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is a transient ischemic attack?

How long does it take to resolve?

Likely to reoccur?

A

transient blockage of circulation, mild S/S

resolves usually w/in 24 hours

huge recurrence (80% within a year)

can results in lasting damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is a traumatic brain injury

A

Change in brain function due to external force

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are some possible co-occurences to a TBI

A 
Decrease or loss of consciousness
- impaired cognition
- physical function
- emotion or behavior 
(may be temporary or permanent)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the two classifications for TBI

A

a) closed: no skull # or laceration of the brain, meninges not breached, does not require hitting head
b) open: meninges breached, exposed brain or laceration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are 5 mechanisms for TBI

A

o coup (primary mechanical injury)
o contracoup (secondary mechanical injury) including: ischemia, edema
o DAI (diffuse axonal injury): sheering/tearing from rotational forces in areas of density change (grey to white matter)
o contusion
o anoxic injury forces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the primary injury in a TBI

A

direct damage from mechanical forces, focal or diffuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the secondary brain injury in a TBI

A

circulation deficits (blood flow usually 50% less then pre-injury), edema, increased ICP, epilepsy/seizure, glutamate, contusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are 4 types of hematomas?

A

Epidural
Sub-dural
Subarachnoid
Intracranial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Where do epidurals hematomas occur?
90% are associate with what?
Which brain region do they occur in?
Arterial or venous bleed?

A
  • outside the dura, 90% associated with skull fractures
  • most often in temporal or temporoparietal region
  • arterial bleed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Where do sub-dural hematomas occur?

What type of intervention do they often require?

Arterial or venous bleed>

A
  • blood collects between arachnoid mater and dura
  • often requires surgical intervention (burrholes or craniotomy
  • venous bleed
25
Q

Where do subarachnoid hematomas occur?

What is often their outcome?

A
  • bleeding between arachnoid and pia mater of brain

* fatal

26
Q

What is the most common type of hematoma?

A

intracranial

27
Q

Where do intracranial hematomas occur?

A

under pia mater

28
Q

What is normal intracranial pressure? What is a dangerous level?

A

0-20mmHg = normal

> 20mmHg for over 5 minutes

29
Q

How do you monitor intracranial pressure?

A

• extraventricular drain (EVD, most common), subarachnoid or subdural bolt, intraparenchymal monitor, epidural sensor

30
Q

What is an important consideration if using EVD to monitor intracranial pressure

A

have to close stopcock to avoid backflow of large amounts of fluid back into patient
ALWAYS CHECK PHYSICAIN ORDERS!

31
Q

What are signs of a basal skull fracture

A
  • signs are blood or CSF out of nose or ears, raccoon eyes, bruising over mastoid (battle sign)
32
Q

What is a coma?

A
  • altered state of consciousness so that no amount of stimulus or only pain will cause Pt to respond, patient in not aware of self or others, lasts for short length of time and either turns to death or vegetative state
33
Q

What are the effects of a frontal lobe injury

A
  • poor planning and judgment, disinhibition
  • Broca’s aphasia (problem with language production)
  • altered manners, moral, and emotions
34
Q

What are the effects of a parietal lobe injury

A
  • somatosensory function alterations in touch, pressure, temp, and position awareness
  • some language comprehension (Wernicke’s)
  • motor planning issues (apraxia)
35
Q

What are the effects of a temporal lobe injury

A
  • Comprehensive and receptive aphasia (Wernicke’s and Broca’s)
  • memory impairment
  • auditory processing
  • integration and regulation of emotion, motivation, and behaviour
36
Q

What are the effects of an occipital lobe injury

A
  • more damaged in contra-coup injury then coup

- see visual problems and visual field deficits

37
Q

What are the effects of having respiratory issues

A

decrease LOC,
compromised respiratory center
increased oral secretions

38
Q

What is the Rx for respiratory issues related to TBI

A

 manual techniques, suctioning etc. should be used with caution
 suction: pre and post O2 should be 100% , only suction for 10 seconds

39
Q

How do you modify TBI treatment for ICP control

A

maintain neutral head at all times, keep Rx short and combine Rx with other procedures

40
Q

Abnormal posture contributes to…

A

handling and contracture formation

41
Q

What does decerebrate posturing indicate

A

brain stem damage (lesions or compression in midbrain) and lesions in cerebellum

42
Q

What does decerebrate posture look like

A

extension of UE and LE

43
Q

What does decorticate posturing indicate

A

damage to areas including cerebral hemisphere, thalamus, cord, corticospinal tract

44
Q

What does decorticate posturing look like

A

arms flexed

Legs extended

45
Q

How do you prevent contractures post TBI

A

place muscles in lengthened position, 20 minutes to 12 hours/day, use of resting splints; splinting and casting and passive ROM

46
Q

How do you manage confusion/agitation post TBI

A
  • keep instructions short and simple, avoid over stimulation, be aware of mental and physical fatigue
  • protect joints especially if have flaccidity, transfers take more people, have environment prepared
47
Q

What is a concussion?

A
  • complex pathological process affecting the brain, induced by traumatic biomechanical forces
  • mild form of brain injury (most common TBI)
48
Q

Concussion S&S

A

o loss of consciousness may or may not be present
o behavioral change (overly emotional, cannot control them)
o cognitive impairment (problems with thinking and planning ahead)
o sleep disturbance, dizziness, irritability, memory and visual changes

49
Q

Baseline cognitive Ax for concussion

A

SCAT 5

50
Q

What is second impact syndrome

A

o rare/fatal uncontrolled swelling of brain

o minor 2nd blow before initial symptoms are resolved

51
Q

What is post-concussion syndrome?

What does it increase your risk of?

A

o persistent symptoms

o 3+ concussions = 5X greater risk Alzheimer’s, 3x memory deficits

52
Q

Grades of concussion

A
  • grade 1: does not lose consciousness, dazed
  • grade 2: no LOC, period of confusion, does NOT recall event
  • grade 3: loss of consciousness for short time, NO memory of event, requires eval asap, classic concussion
53
Q

5 Outcome measures for TBI

A
  • Glasgow coma scale
  • Rancho levels of cognition
  • Length of LOC
  • Length of post traumatic amnesia
  • Review of diagnostics imaging
54
Q

Glasgow coma scale scoring + when is it use

A

3 categories: eye opening, verbal response, motor response,
total score out of 15

done usually in acute injury

55
Q

Rancho levels of cognition good predictor of what?

High score good or bad

A
  • good predictor of functional outcomes after injury (1-10 scale)
  • want a higher score
56
Q

When do most changes on diagnostic imaging occur

A

in first 6 months

57
Q

What is the time limit for functional improvement follwoing a TBI

A

unlimited!

58
Q

Why are outcome measures not totally predictive of function

A

preinjury health, social support, age, nature of injury (location and extent), patient motivation  ALL PLAY FACTOR

PCE - Neurology (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions