Exam 10: Traumatic CNS Conditions Flashcards
cerebrum
main portion of the brain
cortex
covers the brain, gray matter (non-myelinated), contains the cell bodies
corpus collosum
bridge between left & right hemisphere
lobes
frontal, parietal, temporal, occipital
what protects the brain
skull, meninges, cerebrospinal fluid, subarachnoid space, ventricles
meninges
dura mater: outermost layer, thick and dense
arachnoid: thinner middle layer
pia mater: carries blood vessels to the brain
cerebrospinal fluid
acts as a shock absorber, flow continuously through the brain and spinal cord
if pressure builds up…
damage to the brain will occur
frontal lobe + prefrontal cortex
highest level of cognition
motor on the back end
- personality
- executive functions
- abstract reasoning
- organization
- multi-tasking
- memory
- problem solving
- impulse control
- motor cortex
injury to frontal lobe
- recent memory, inattentiveness, inability to concentrate, behavior disorders, difficulty learning new information
- lack of inhibition
- emotional lability
- “flat” affect
- contralateral plegia, paresis due to damage in motor cortex
- expressive/ motor aphasia
parietal lobe
sensory is front end of lobe
- sensation including touch and pressure
- reading skills
- processes vestibular input and manages proprioception
- somatosensory cortex
injury to parietal lobe
- inability to discriminate between sensory stimuli
- inability to locate and recognize parts of the body (neglect)
- severe injury: inability to recognize self
- disorientation of environment space
- inability to write
temporal lobe
- processes sensory information
- hearing
- speech
- also involved in memory
- impacts behavior along with frontal lobe
- WERNICKE’S area for speech: people can speek but their words make no sense (aphasia)
- located in left temporal lobe
expressive aphasia
can understand language but cannot speak
where is broca’s area located
frontal lobe
- expressive aphasia
where is wernicke’s area located
temporal lobe
- receptive aphasia
receptive aphasia
- difficulty comprehending language
broca’s area & wernicke’s area are connected by the…..
arcuate fasciculus
cerebellum
- little brain
- underneath the cerebrum
- affects balance, posture, motor control, vestibular function, muscle tone
- deficits: ataxia, tremor, coordination, balance, dizziness, falls, puking
brain stem
- controls the basic functions that sustain life
- the “old” brain or “reptilian” brain
- midbrain, pons, medulla oblongata
deficits: deadly, coma, inability to regulate energy and alertness
causes of brain injury
- vascular injury
- metabolic/ tissue injury
- concussive force injury
- blunt force trauma
- invasive trauma
what is: vascular injury
anoxia (w/o oxygen), cerebrovascular accident or incident (CVA or CVI), hypoxia, aneurysm, closed head injury with swelling and bleeding in the brain
what is: metabolic/ tissue injury
due to infection, high temp, chemical use and abuse, brain tumor, low or high blood sugars
what is: concussive force injury
due to car accidents, concussions, falls, IED explosions (veterans), shaken baby syndrome
what is: blunt force trauma
assault, falls, hitting head during car accident, helmet collision in sports, things that fall on the head
what is: invasive trauma
gunshot wounds, stabbing, foreign objects lodged, open wounds, skull fracture
tract
- group of myelinated nerve fibers within the CNS that carry specific information
- different tracts go within/ between the hemispheres (across corpus callosum)
- made up of projection fibers
- tracts will extend to brain stem and spinal cord
- vulnerable to jarring/shaking injuries
tract vulnerabilities
- the longer, the more vulnerable
- concussion can cause vision problems
- not shown on MRI or CT scan, further testing must be done
skull fracture
- break in one or more of the bones in the skull (head injury)
-presence may indicate that there is a TBI - broken fragments can lacerate or bruise the brain and cause damage to the blood vessels
etiology of brain injury
primary damage: acceleration, deceleration and rotation or possible intrusion of a penetrating object
secondary damage: increased intracranial pressure, ischemia, cerebral hypoxia, intracranial hemorrhage
coup-contrecoup injury
brain hits one side of skull (coup), bounces off and hits another side of the skull (contrecoup)
diffuse axonal injury
- damage to the axons (pathways) that connect different areas of the brain
- occurs when there is twisting and turning of the brain tissue
- brain messages are slowed or lost
epidural bleeds
arterial and change quickly due to the higher pressure in the vessels which allows for greater bleeding
subdural bleeds
are in veins and can be more slow to develop; these can be misleading as the patient can initially seem to be ok
3 categories of TBIs
- mild
- moderate
- severe
mild TBI
- LOC <10 mins
- GCS: 13-15
- 80% of TBIs
- permanent disability in 10%
moderate TBI
- hospitalization
- initial GCS 9-12+
- 20% moderate to severe
- permanent disability in 66%
severe TBI
- LOC and/or post traumatic amnesia >24 hrs
- GCS: 1-8
- permanent disability in 100%
ranchos los amigos scale (levels of cognitive functioning scale)
- those who recover from coma will progress through 10 stages overtime
- levels 9-10 no longer seen in therapy, but may have residual effects
- level I or II: sensory stimulation, PROM
decorticate posture
- extension posturing
- flexion of UE, extension of LE
- brain stem intact
decerebrate posture
- extensor posture of UE and LE
- damage to brain stem (more deadly)
damage to right parietal lobe
- visuospatial deficits: difficulty finding their way around new or familiar places
damage to left parietal lobe
- disrupt a patient’s ability to understand spoken and/or written language
cerebral circulatory system (circle of willis)
largest:
- anterior cerebral artery
- middle cerebral artery (biggest, where strokes usually occur)
- posterior cerebral artery
etiology for CVA/CVI
- interruption in blood flow to the brain
- can be due to blood vessel blockage or rupture
- death to brain tissue due to inadequate supply of oxygen and nutrients
prognosis of CVA/CVI
- 50-70% of people who have a stroke will regain functional independence
- 15-30% will have some permanent disability
- stroke is the leading cause of long-term disability in the U.S.
- depression impacts about 1/3 of stroke survivors
transient ischemic attack (TIA)
- temporary stroke-like symptoms that last less than 48 hrs. and resolve completely
- increases risk of additional stroke
- there is temporary ischemia, but not tissue death because circulation is restored before tissue death
2 main types of CVA/CVI
- ischemic or thrombotic (clot stops blood supply to an area of the brain)
- hemorrhagic (blood leaks into brain tissue)
ischemic stroke
- most common (88%)
- blockage
- circulation to the brain is obstructed, causing ischemia
- pt will most likely not have pain
- damaged areas have: tissues that have died as a result of blood supply loss
- peripheral area in which there may not be temporary dysfunction as a result of edema
lacunar stroke
- small ischemic infarcts in the deep lying brain tissue
- 25% of ischemic strokes
- minimal neurologic symptoms
- purely motor, or purely sensory or both
- typically no aphasia, cognitive, or personality changes
- biggest risk factor is HTN
emergency intervention for stroke
t-PA therapy for the treatment of acute ischemic stroke (tissue plasma activator)
- blood thinner
- increases risk of brain bleeds
hemorrhagic stroke
- 20% of strokes
- rupture in blood vessel (aneurysm) with bleeding into or around cerebral tissue
aneurysm
- bulging of a wall of an artery as a result of weakness in the vessel wall
- it is prone to rupture at any time
2 types of brain hemorrhages
- intracerebral hemorrhage: bleeding directly into the brain
- symptoms develop suddenly, often during activity
- headache, vomiting, convulsions, decreased level of alertness
- subarachnoid hemorrhage: bleeding within the brains surrounding membranes and CSF
facts about hemorrhagic strokes
- fatality rates for hemorrhagic strokes are higher than for ischemic
- clients often make a better recovery from hemorrhagic strokes
- hemorrhagic strokes are more common in young people than ischemic stroke (congenital)
left-brain functions
- analytic thought
- logic
- language
- science and math
right-brain functions
- holistic thought
- intuition
- creativity
- art & music
(L) CVA
- hemi (paresis/plegia) on right side of body
- loss of voluntary movement, sensation and coordination on the right side of face, trunk, and extremities
- aphasia
- right-sided visual field deficits
- slow & cautious personality
- memory deficits are recent and past
(R) CVA
- hemi (paresis/plegia) on left side of body
- impaired sensation on left side
- spatial and perceptual deficits
- unilateral neglect
- dressing apraxia
- left hemianopsia
- impulsive & errors in judgment
hemiparesis
one-sided weakness
hemiplegia
one-side paralysis
ataxia
uncoordinated
perseveration
repeating a task
lability
emotional response doesn’t match situation
hemianopsia
defective vision or blindness in one half of the visual field
aphasia
difficulty with expressive or receptive language
apraxia
poor motor planning and/or using object inappropriately
unilateral neglect
inattention to one side of the body
dysphagia
- difficulty swallowing
- risk for aspiration
- thickened liquids
- diet restrictions
spasticity vs. flaccidity
- spasticity: bent wrist, closed fist, flexed elbow; excessive/ hypertonic response
flaccidity: low tone following a stroke; complete hemiplegia; hypotonic
prognosis of CVA
- most recovery is 6mo - 1 yr
- recent research shows much longer improvement (reroute neural pathways - neural plasticity)
- typically greater for younger client
recovery for CVA
- proximal to distal
- LE before UE
- sooner movement is seen, better prognosis
seizures
- epilepsy: electrical issue with the brain
- can occur after brain injury of any type, including CVA
- generalized vs. partial seizures
- can occur in different lobes of the brain and have different symptoms
spinal cord injury
spinal cord levels: based on where spinal roots emerge from
- cervical: 8 levels
- thoracic: 12 levels
- lumbar: 5 levels
- sacral: 5 levels
injury classification
- paraplegia vs. quadriplegia
- complete vs. incomplete
- severed vs. crushed
