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Exam 3 Pathophysiology > Disorders of the Brain > Flashcards

Disorders of the Brain Flashcards

1
Q

What is hydrocephalus

A

Increased ventricular accumulation of CSF in skull; compresses brain tissue and blood vessels; “water on the brain”
• Excess CSF accumulates b/c production >absorption d/t obstruction of flow
• Most have normal production of CSF but a problem with lack of reabsorption
o Ventricular enlargement
o Increased intracranial pressure

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2
Q

What are the different classifications of hydrocephalus

A

o Non-communicating
o Communicating
o Congenital
o Acquired

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3
Q

What are the causes of hydrocephalus?

A 
Causes of hydrocephalus are:
o	MOST COMMON: developmental abnormalities (Synosis at connecting channel between ventricles or thickened arachnoid membrane)
o	Intraventricular hemorrhage
o	Neural tube defect
o	Brain tumor
o	Scar tissue
o	Meningitis (infection of meninges) (this can cause obstructive hydrocephalis during acute infection or lead to fibrosis in the meninges, impairing absorption)
o	Traumatic injury
o	CSF flow obstruction
o	Tumors, infection, scar tissue
o	Impaired CSF absorption
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4
Q

What is another name for “noncommunicating hydrocephalus”?

A

“obstructive hydrocephalus”

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5
Q

What is noncommunicating hydrocephalus (obstructive hydrocephalus)?

A

It occurs when CSF flow through ventricles is blocked

It usually develops from defects (fetal development abnormalities) such as:

  • Neural tube defects
  • Stenosis
  • Chiari malformations
  • Dandy-Walker

Can also develop from lesions, tumor, hemorrhage

The obstruction leads to increased back pressure of fluid in the ventricles of the brain which then gradually dilates or enlarges ventricles and compresses vessels and brain tissue

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6
Q

What are the clinical manifestations of hydrocephalus in OLDER CHILDREN AND ADULTS

A

In adults, the head cannot further enlarge so the classical signs of ICP develop as the volume of CSF expands (think of cushing’s triad):
o Increased blood pressure
o Altered heart rate
o Headache
o Vomiting
o Decreased level of consciousness
o Papilledema - optic disc swelling, usually bilateral and can occur over a period of hours to weeks.
o Decreased memory
o Difficulty coordination, impaired balance
o Urinary incontinence

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7
Q

What are the diagnostic methods to detect hydrocephalus?

A
  • Measure head circumference (esp in neonates)
  • Transillumination: light penetrates to the inside of the skull
  • If there is an excess of CSF, light is scattered to different parts of the skull, producing patterns characteristic to hydrocephalus
  • Imaging studies
  • CT Scan/MRI: can locate obstruction/abnormal flow + determine size of ventricles
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8
Q

What are ways to treat hydroencephalus?

A

Can perform surgery to remove an obstruction or provide a shunt for the CSF from ventricle into peritoneal cavity or other extracranial site such as the R atrium of the heart

• Establish and maintain normal CSF volumes and pressure
o Ventriculoperitoneal shunt
• Shunt: ventricle to peritoneal cavity (in CHILDREN: important to replace shunt as child grows)
-shunts are vulnerable to blockage, infections. Continuous monitoring is required to prevent further brain damage
o Ventriculoatrial shunt
o Endoscopic third ventriculostomy

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9
Q

What is TIA?

A

TIA=Transient Ischemic Attack.

TIAs result from temporary localized reduction of blood flow in the brain. They can (but not always) serve as a warning sign and lead to early diagnosis of a stroke. Recovery is usually within 24 hours.

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10
Q

What are the signs and symptoms of TIA?

A

The S&S are always directly related to the location of the ischemia.
o Patient remains conscious
o Intermittent short episodes of impaired functio
e.g., muscle weakness in arm or leg
o Visual disturbances
o Numbness and paresthesia in face
o Transient aphasia or confusion may develop
o Attacks last a few minutes or longer but rarely >1-2 hours
• Repeated attacks may be a warning sign for obstruction related to atherosclerosis.

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11
Q

What is the treatment for TIA?

A

Treatment needs to be PROMPT!
o Antiplatelet medication, anticoagulants
o Surgical: Carotid Endarterectomy – plaques removed from carotid artery

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12
Q

What are the classifications of stroke?

A

2 Classifications:
o ISCHEMIC – Embolic, Thrombotic (MORE COMMON: 70-80%)
• occlusion of cerebral blood vessel or embolism, or thrombus
o HEMORRHAGIC
• Rupture of cerebral vessels (aneurysm)-typically in PTs with severe HTN
• Intracerebral hemorrhagic
• Effects evident in both hemispheres – its complicated by secondary effects of bleeding (i.e. someone on Coumadin)

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13
Q

What are the MODIFIABLE risk factors of stroke/CVA?

A 
Modifiable risk factors:
o	Hypertension
o	Hyperlipidemia (high cholesterol)
o	Smoking
o	Diabetes
o	Atrial Fibrilation
•	Cause embolisms
o	Carotid Disease
o	Coagulation Disorders
o	Sickle Cell Disease
o	Obesity/Inactivity
o	Heavy Alcohol use
o	Cocaine Use
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14
Q

What are the NON MODIFIABLE risk factors for stroke/CVA?

A 
Nonmodifiable risk factors:
o	Old Age
o	Female Sex – post-menopausal 
o	African American Race d/t increased incidence of HTN, obesity, diabetes
o	Heredity (Genetics)
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15
Q

What is the leading cause of disability and the 3rd cause of death in the US?

A

Cerebrovascular Accident (CVA), aka Stroke

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16
Q

What is an embolic stroke?

A

It is caused by a thrombus or group of thrombi that break off from one area of the body and travel to the cerebral arteries via carotid artery or vertebral basilar system. The usual source of emboli is the heart.

17
Q

What are the possible causes of an embolic stroke?

A

Embolic stroke can occur in patients with:
• Non valvular Afib
• Ischemic heart disease
• Rheumatic heart disease
• Insertion of prosthetic heart valve
• Mural thrombi (wall of ventricle) MI
• Can also occur w/ insertion of a prosthetic heart valve
• Plaque that breaks off from carotid sinus or internal carotid artery

o Embolic strokes usually affect the larger cerebral blood vessels
o The have sudden onset
Other risks include: Atrial fibrillation, recent MI, endocarditis

18
Q

What is a thrombotic stroke?

A

Thrombotic strokes account for more than half of all strokes and are commonly associated with the development of atherosclerosis in either an intracranial or extracranial artery such as the carotid artery

o Atherosclerotic plaque in cerebral circulation leads to obstruction of a cerebral artery
• Rupture of one or more plaques exposes foam cells (clot promoting elements in blood), leading to clot formation (occlusive stroke if the clot is big enough to cut off blood flow)
o Usually occurs gradually ‐ evolves over several days
o Usually affects larger cerebral blood vessels
o Elderly are most at risk group
o Patients often also have atherosclerotic heart disease

19
Q

Tell me about Hemorrhagic strokes.

A

With hemorrhagic Strokes – vessel integrity is interrupted & bleeding occurs into brain issue and/or the space surrounding the brain
o Can cause a rapid increase in ICP, compression of brain structures, leading to potential coma and death
o Occurs suddenly, usually with activity such as:
• Head trauma (e.g. intracerebral hemorrhage or a subarachnoid hemorrhage)
• Rupture of aneurysm
o Often accompanied initially by nausea, vomiting, and headache

20
Q

What are the risk factors of a hemorrhagic stroke?

A

• HTN
• Trauma,
• Vasculitis
• Erosion of blood vessels by tumor
• Arteriovenous malformations: uncommon abnormality that occurs during embryonic development
–>Tangled, spaghetti-like mass of malformed, thin-walled dilated vessels
–>Congenital absence of capillary network forms an abnormal communication between arterial + venous systems
• Coagulation disorders (e.g. Thrombocytopenia )
• Anticoagulant medication (causes prolonged bleeding)

21
Q

How can we treat hemorrhagic strokes?

A
  • Repair hemorrhage by stopping the bleeding
  • To decrease ICP, give Manitol (a diuretic that reduces ICP)
  • If necessary remove piece of skull to alleviate ICP.
22
Q

What are the clinical manifestations of stroke?

A

It depends largely on the location of the (obstruction) infarct + size of artery. The presence of collateral circulation diminishes the size of affected area
Manifestations can include:
o Paralysis or paresis (weakness) - mostly contralateral
o Lack of voluntary movement or sensation contralaterally (opposite side of body)
o Gait disturbances, sensory changes, dysarthria (slurred speech)
o Aphasia: lack of ability to express, understand words
• Affects ability to expresse or understand words
o Cognitive or affective disorders
o Dysphagia
o Altered level of consciousness

23
Q

What could be the effects of damage (from stroke) to the LEFT hemisphere?

A

The L hemisphere is dominant in all people except for 15-20% of population. It is the center for language, math skills, and analytic thinking.

Damage effects can include:
• Aphasia (inability to use or comprehend language)
• Alexia/dyslexia: reading problems
• Agraphia: difficulty writing
• Difficulty with mathematical calculations

24
Q

What could be the effects of damage (from stroke) to the RIGHT hemisphere?

A

The R hemisphere pertains to visual and spatial awareness.

Damage effects can include:
•	Disoriented to time + place
•	Poor impulse control
•	Poor judgment
Person is usually aware of the deficits.
25
Q

What is expressive, or motor aphasia?

A

o Impaired ability to speak or write fluently or appropriately
o Occurs when Broca area in dominant frontal lobe is damaged

26
Q

What is receptive, or sensory aphasia?

A

o Inability to read or understand the spoken word
o Source: inability to process information in the brain
o Result of damage to the Wernicke area in the left temporal lobe
o Usually also affects expression

27
Q

What is global aphasia?

A

o Combination of expressive AND receptive aphasia
o Major brain damage, including Broca area, AND Wernicke area, and many communicating fibers
o Trouble communicating, reading, and writing

28
Q

What is fluent, or non-fluent aphasia?

A

o Fluent aphasia: Pace of speech is relatively normal; includes made-up words; associated with damage to Wernicke area
o Non-fluent aphasia is slow and labored with short phrases; associated with damage to Broca area

29
Q

What are other effects of a CVA (stroke)?

A

o Dysarthria: Words cannot be articulated clearly
o Motor dysfunction can also occur – usually a result from cranial nerve damage or muscle impairment
o Agraphia: Impaired writing ability
o Alexia: Impaired reading ability
o Agnosia: Loss of recognition or association

30
Q

So what should I do if I think someone is having a stroke?

A

TIME IS BRAIN.

  1. Call 911
  2. Transport person to hospital
  3. Time between onset of stroke and treatment is directly related to the severity of the brain damage. Every minute counts!!
31
Q

How to treat an ischemic stroke?

A

o Thrombolytic agents (i.e. TPA) are used for ischemic strokes
• Contraindications: use of oral anticoagulants, history of GI Bleeds, recent MI, surgery in last 14 days, stroke or head injury in last 3 months, BP>200/120
• Clot busters (i.e. TPA, tissue plasminogen activator) is administered via IV. It dissolves the arterial occlusion to re-establish blood flow
o Surgical: remove clots
o Public education important due to the 3-hour time limit on use of TPA.

32
Q

When caring for a 52 yo male w/ hydrocephalus, which of the following signs would be most concerning of a worsening of the condition?

a. decreased respirations
b. increased head circumference
c. increased pulse
d. decreased temp

A

a. decreased respirations

Cushing’s triad: irregular respirations (caused by impaired brain stem function), bradycardia, hypertension (widening pulse pressure)

33
Q

You are caring for a 79 yo pt with Hx of falls, A fib, but no other medical history. He is lying in his bed and starts to have significant left sided hemiparesis and facial drooping. Based on his history + presentation, this patient likely is suffering from what?

A 
Embolic stroke
(caused by moving clot; risks include a fib, recent MI, endocarditis)
34
Q

You are caring for a patient with a new onset of CVA in the ER. The patient presents with loss of memory + receptive aphasia. This is consistent with a CVA of the:

A

Temporal lobe

Temporal lobe: hearing, memory, speech perception

35
Q

Typical signs of a TIA include:

A

Transient muscle weakness in the hand or leg
TIA: result from temporary localized reduction of blood flow in the brain  intermittent short periods of impaired function

36
Q

what type of CVA is an Arterial occlusions caused by thrombi formed in arteries supplying the brain or in the intracranial vessels?

A

Thrombotic stroke

37
Q

what type of CVA is Fragments that break from a thrombus formed outside the brain ?

A

embolic stroke

38
Q

What is another name for an intracranial hemorrhage?

A

hemorrhagic stroke

39
Q

What is the word for loss of comprehension OR production of language?

A

aphasia

Exam 3 Pathophysiology (9 decks)

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