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Clinical Conditions > Exam 10: Traumatic CNS Conditions > Flashcards

Exam 10: Traumatic CNS Conditions Flashcards

1
Q

cerebrum

A

main portion of the brain

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2
Q

cortex

A

covers the brain, gray matter (non-myelinated), contains the cell bodies

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3
Q

corpus collosum

A

bridge between left & right hemisphere

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4
Q

lobes

A

frontal, parietal, temporal, occipital

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5
Q

what protects the brain

A

skull, meninges, cerebrospinal fluid, subarachnoid space, ventricles

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6
Q

meninges

A

dura mater: outermost layer, thick and dense
arachnoid: thinner middle layer
pia mater: carries blood vessels to the brain

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7
Q

cerebrospinal fluid

A

acts as a shock absorber, flow continuously through the brain and spinal cord

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8
Q

if pressure builds up…

A

damage to the brain will occur

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9
Q

frontal lobe + prefrontal cortex

A

highest level of cognition
motor on the back end
- personality
- executive functions
- abstract reasoning
- organization
- multi-tasking
- memory
- problem solving
- impulse control
- motor cortex

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10
Q

injury to frontal lobe

A
  • 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
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11
Q

parietal lobe

A

sensory is front end of lobe
- sensation including touch and pressure
- reading skills
- processes vestibular input and manages proprioception
- somatosensory cortex

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12
Q

injury to parietal lobe

A
  • 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
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13
Q

temporal lobe

A
  • 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
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14
Q

expressive aphasia

A

can understand language but cannot speak

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15
Q

where is broca’s area located

A

frontal lobe
- expressive aphasia

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16
Q

where is wernicke’s area located

A

temporal lobe
- receptive aphasia

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17
Q

receptive aphasia

A
  • difficulty comprehending language
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18
Q

broca’s area & wernicke’s area are connected by the…..

A

arcuate fasciculus

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19
Q

cerebellum

A
  • little brain
  • underneath the cerebrum
  • affects balance, posture, motor control, vestibular function, muscle tone
  • deficits: ataxia, tremor, coordination, balance, dizziness, falls, puking
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20
Q

brain stem

A
  • 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
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21
Q

causes of brain injury

A
  • vascular injury
  • metabolic/ tissue injury
  • concussive force injury
  • blunt force trauma
  • invasive trauma
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22
Q

what is: vascular injury

A

anoxia (w/o oxygen), cerebrovascular accident or incident (CVA or CVI), hypoxia, aneurysm, closed head injury with swelling and bleeding in the brain

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23
Q

what is: metabolic/ tissue injury

A

due to infection, high temp, chemical use and abuse, brain tumor, low or high blood sugars

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24
Q

what is: concussive force injury

A

due to car accidents, concussions, falls, IED explosions (veterans), shaken baby syndrome

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25
Q

what is: blunt force trauma

A

assault, falls, hitting head during car accident, helmet collision in sports, things that fall on the head

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26
Q

what is: invasive trauma

A

gunshot wounds, stabbing, foreign objects lodged, open wounds, skull fracture

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27
Q

tract

A
  • 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
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28
Q

tract vulnerabilities

A
  • the longer, the more vulnerable
  • concussion can cause vision problems
  • not shown on MRI or CT scan, further testing must be done
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29
Q

skull fracture

A
  • 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
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30
Q

etiology of brain injury

A

primary damage: acceleration, deceleration and rotation or possible intrusion of a penetrating object
secondary damage: increased intracranial pressure, ischemia, cerebral hypoxia, intracranial hemorrhage

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31
Q

coup-contrecoup injury

A

brain hits one side of skull (coup), bounces off and hits another side of the skull (contrecoup)

32
Q

diffuse axonal injury

A
  • 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
33
Q

epidural bleeds

A

arterial and change quickly due to the higher pressure in the vessels which allows for greater bleeding

34
Q

subdural bleeds

A

are in veins and can be more slow to develop; these can be misleading as the patient can initially seem to be ok

35
Q

3 categories of TBIs

A
  • mild
  • moderate
  • severe
36
Q

mild TBI

A
  • LOC <10 mins
  • GCS: 13-15
  • 80% of TBIs
  • permanent disability in 10%
37
Q

moderate TBI

A
  • hospitalization
  • initial GCS 9-12+
  • 20% moderate to severe
  • permanent disability in 66%
38
Q

severe TBI

A
  • LOC and/or post traumatic amnesia >24 hrs
  • GCS: 1-8
  • permanent disability in 100%
39
Q

ranchos los amigos scale (levels of cognitive functioning scale)

A
  • 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
40
Q

decorticate posture

A
  • extension posturing
  • flexion of UE, extension of LE
  • brain stem intact
41
Q

decerebrate posture

A
  • extensor posture of UE and LE
  • damage to brain stem (more deadly)
42
Q

damage to right parietal lobe

A
  • visuospatial deficits: difficulty finding their way around new or familiar places
43
Q

damage to left parietal lobe

A
  • disrupt a patient’s ability to understand spoken and/or written language
44
Q

cerebral circulatory system (circle of willis)

A

largest:
- anterior cerebral artery
- middle cerebral artery (biggest, where strokes usually occur)
- posterior cerebral artery

45
Q

etiology for CVA/CVI

A
  • 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
46
Q

prognosis of CVA/CVI

A
  • 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
47
Q

transient ischemic attack (TIA)

A
  • 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
48
Q

2 main types of CVA/CVI

A
  • ischemic or thrombotic (clot stops blood supply to an area of the brain)
  • hemorrhagic (blood leaks into brain tissue)
49
Q

ischemic stroke

A
  • 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
50
Q

lacunar stroke

A
  • 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
51
Q

emergency intervention for stroke

A

t-PA therapy for the treatment of acute ischemic stroke (tissue plasma activator)
- blood thinner
- increases risk of brain bleeds

52
Q

hemorrhagic stroke

A
  • 20% of strokes
  • rupture in blood vessel (aneurysm) with bleeding into or around cerebral tissue
53
Q

aneurysm

A
  • bulging of a wall of an artery as a result of weakness in the vessel wall
  • it is prone to rupture at any time
54
Q

2 types of brain hemorrhages

A
  • 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
55
Q

facts about hemorrhagic strokes

A
  • 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)
56
Q

left-brain functions

A
  • analytic thought
  • logic
  • language
  • science and math
57
Q

right-brain functions

A
  • holistic thought
  • intuition
  • creativity
  • art & music
58
Q

(L) CVA

A
  • 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
59
Q

(R) CVA

A
  • 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
60
Q

hemiparesis

A

one-sided weakness

61
Q

hemiplegia

A

one-side paralysis

62
Q

ataxia

A

uncoordinated

63
Q

perseveration

A

repeating a task

64
Q

lability

A

emotional response doesn’t match situation

65
Q

hemianopsia

A

defective vision or blindness in one half of the visual field

66
Q

aphasia

A

difficulty with expressive or receptive language

67
Q

apraxia

A

poor motor planning and/or using object inappropriately

68
Q

unilateral neglect

A

inattention to one side of the body

69
Q

dysphagia

A
  • difficulty swallowing
  • risk for aspiration
  • thickened liquids
  • diet restrictions
70
Q

spasticity vs. flaccidity

A
  • spasticity: bent wrist, closed fist, flexed elbow; excessive/ hypertonic response
    flaccidity: low tone following a stroke; complete hemiplegia; hypotonic
71
Q

prognosis of CVA

A
  • most recovery is 6mo - 1 yr
  • recent research shows much longer improvement (reroute neural pathways - neural plasticity)
  • typically greater for younger client
72
Q

recovery for CVA

A
  • proximal to distal
  • LE before UE
  • sooner movement is seen, better prognosis
73
Q

seizures

A
  • 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
74
Q

spinal cord injury

A

spinal cord levels: based on where spinal roots emerge from
- cervical: 8 levels
- thoracic: 12 levels
- lumbar: 5 levels
- sacral: 5 levels

75
Q

injury classification

A
  • paraplegia vs. quadriplegia
  • complete vs. incomplete
  • severed vs. crushed

Clinical Conditions (16 decks)

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