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Pathophysiology Exam 2 > Disorders of Brain Function > Flashcards

Disorders of Brain Function Flashcards

1
Q

What are the General Principles of Brain Disorders?

A

Cerebral hemispheres are most susceptible to injury.

Neurological dysfunction worsens as lower brain areas are more involved.
-Motor function
-Pupils
-Eye movements
-Vital signs
-Respirations

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2
Q

How does the brain function?

A

Level of consciousness (LOC)

Cognition and content

Arousal and wakefulness

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3
Q

What is Level of consciousness (LOC) within the brain?

A

Is there a disorder in a focal (small) or global (widespread) brain area?

Is the individual able to recognize and respond to stimuli?

LOC alterations range from inattention to coma.

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4
Q

What is Cognition and content within the brain?

A

Requires a fully functioning cerebral cortex

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5
Q

What is Arousal and wakefulness within the brain?

A

Requires interaction between cerebral cortex and Reticular activating system

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6
Q

What is Arterial Cerebral Blood Flow?

A

Internal carotid arteries - anterior brain

Vertebral arteries - posterior brain

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7
Q

What is Venous Cerebral Blood Flow?

A

Venous blood from the brain circulates into the internal jugular vein, then the superior vena cava to return to the right side of the heart.

Because veins in the brain do not have valves, flow is related to gravity and pressure in venous sinuses

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8
Q

What is Cerebral Blood Flow?

A

About 750 milliliters/minute of Arterial blood circulates into the brain but more of the brain blood is in the veins.

Local metabolic cellular demands influenced by carbon dioxide, blood ph, and oxygen:

-Increased carbon dioxide - causes vasodilation
-Decreased blood pH (acidosis) - causes increased cerebral blood flow
-Decreased oxygen -causes increased cerebral blood flow

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9
Q

What is Autoregulation?

A

Autoregulation is an organ’s ability to regulate its blood flow despite peripheral blood pressure and is most sophisticated in the brain.

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10
Q

What is Autoregulation in relation to the brain?

A

The brain has the most efficient autoregulation of any organ.

Autoregulation is assumed intact to some degree when MAP 60-140mm Hg.

Autoregulation is associated with the brain’s ability to utilize oxygen normally.

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11
Q

What increases blood flow to the brain?

A

Increased carbon dioxide: hypercarbia

Decreased pH: acidosis

Decreased oxygen: hypoxemia

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12
Q

What is the Monroe-Kellie Hypothesis?

A

To maintain steady intracranial pressure, when there is an increase in one component, there must be a decrease in another component. These components include:

Cerebrospinal fluid

Cerebral blood volume

Intracellular/extracellular fluid volume

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13
Q

What are the key points regarding the Monroe-Kellie Hypothesis?

A

The skull is rigid.

Intracranial space is limited.

Increase in volume of any component without decrease in another component causes increase intracranial pressure.

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14
Q

What can cause increase in volume of any of the intracranial components?

A

Trauma

Stroke

Aneurysm

Hematoma

Lesion - tumor

Infection

Toxins

Hypoxia/anoxia

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15
Q

What is Traumatic Brain Injury (TBI)?

A

TBI is the most severe injury that can occur other than burns!

Primary injury: The initial impact event that leads to damage within the brain

Secondary injury: The central nervous system affects such as brain swelling, infection and hypoxia with systemic alterations that occurred due to primary injury

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16
Q

Secondary Brain Injury:

How long can it take for neurological injuries to evolve?

A

Anywhere between hours to days

17
Q

What is the Central Nervous System Responses in Secondary Injury?

A

Intracranial hematomas

Cerebral ischemia

Cerebral edema

Increased intracranial pressure

Infection

18
Q

What is the Systemic Body Responses in Secondary Injury?

A

Hypermetabolism

Hypercatabolism

Hyperglycemia

Gastroparesis

19
Q

What is a Concussion?

A

Temporary neurological dysfunction

IF Loss Of Consciousness - < 5 minutes OR none

20
Q

What are some signs of a concussion?

A

Possible amnesia

Headache

Nausea/Vomiting

Cognitive alteration

Visual alteration

Chronic pain

21
Q

What is a contusion?

A

Possible laceration of brain tissue/structures

The brain floats in the cerebrospinal fluid that provides some mechanical protection

Bruising of brain tissue

Manifestations can be similar to concussion but with more severe neurological effects such as coma, paralysis, and cerebral swelling.

22
Q

What are the signs of a Basilar Skull Fracture?

A

Raccoon Eyes

Battle’s Sign

Rhinorrhea - nose

Otorrhea - ear

Postnasal drip:
Halo sign on dressing - meningitis risk

23
Q

What are the different types of Intracranial Hemorrhage/Hematomas?

A

Epidural-arterial: Bleeds faster

Subdural - venous: Bleeds slower usually
- Acute
- Subacute/chronic - Elders at high risk

Subarachnoid - venous or arterial

24
Q

What is a Diffuse Axonal Injury (DAI)?

A

Most severe forms of traumatic brain injury

Can include tension, stretching, and shearing nerve fibers due to:

Trauma

Rotational forces

Acceleration-deceleration

*Look for the “H-shape” of the cerebral ventricles

25
Q

How does a Stroke differ from a Brain Attack and Cerebrovascular Accident?

A

Inadequate perfusion to areas of brain

Injury to brain tissue and altered cerebral metabolism occurs due to lack of blood perfusion and/or bleeding within the brain.

Ischemia - leads to changes in central nervous system and systemic metabolism.
- Potentially reversible

Infarction -causes death of brain cells.
- Not reversible

26
Q

What time is greatest for stroke risk?

A

Following a transient ischemic attack (TIA) “Mini Stroke”

Up to 50% have stroke within 3 months

Following a “minor” cerebrovascular accident (CVA)

At what time was the person last KNOWN to be “normal” ?

27
Q

What are some stroke risk factors?

A

Risk increases with age

Male incidence higher than female and at younger age compared to females

Hypertension

Prior stroke

Family history

Smoking

Diabetes mellitus

Cardiac disease

Hypercholesterolemia

Hypercoagulability

28
Q

What are some manifestations of an acute stroke?

A

Focal neurological signs

May rapidly evolve

Loss of function depends upon area of the brain involved

29
Q

What are some manifestations of a TIA?

A

Temporary blood flow distribution in brain

Signs/symptoms resolve quickly

No permanent loss of function

30
Q

What are 2 major types of strokes?

A

Ischemic - clots often originate in areas of artery bifurcation or left side of heart.
-Thrombotic
-Embolic

Hemorrhagic

31
Q

What is an ischemic stroke?

A

Brain tissue that is distal to the blood clot will become ischemic or if not reversed, will become infarcted with altered neurological function.

32
Q

What is a Thrombotic Stroke?

A

Thrombosis is the most common cause of ischemic stroke.

Older age is a common factor

Atherosclerosis and/or peripheral artery disease.

Hypercoagulability

Barin cortex often affected:
- Aphasia
- Visual fields defects
- Temporary blindness in one eye

33
Q

What is an Embolic Stroke?

A

A clot moved through the arterial circulation and lodged in the brain arterial circulation, sites where vessels bifurcate are often involved.

Common sources of embolism include:
- A-fib
- Intra-operative embolus
- Recent myocardial infarction
- Bacterial endocarditis

High fatality

Sudden onset and widespread deficits

34
Q

How can Atrial Fibrillation be a leading risk factor for a stroke and why?

A

A clot can form in the blood and then travel up to the brain, causing a stroke.

35
Q

What’s a Hemorrhagic Stroke?

A

The most frequently fatal type of stroke is due to spontaneous rupture of a blood vessel in the brain.

Common risks are advancing age and hypertension

Onset is often when the person is active

Headache and vomiting related to an increased intracranial pressure.

Rapid progression to coma and fatality

36
Q

What effects does a stroke have of motor and sensory?

A

Motor tracts originate in cortex and cross-over in the medulla in the lower brain (the region of the neck)

Sensory tracts originates in the periphery and cross over in the spinal cord

Ipsilateral means “same side”

Contralateral means “opposite side”

37
Q

What are some common clinical manifestations for a stroke?

A

Numbness, tingling of face, extremity

Eye ptosis: eyelid drooping

Contralateral hemiplegia

Emotional outbursts

Loss of bowel/bladder control

Slurred speech

Aphasia

Blurred/double vision

Pathophysiology Exam 2 (8 decks)

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