MID 2: NEURO

Question 1

Cranium

Answer 1

protects brain and associated structures

Question 2

Meninges

Answer 2

3 protective membranes – the dura mater, the arachnoid, and the pia matter - subdural space lies between the dura and arachnoid – subarachnoid space lies between the arachnoid and pia layers – this contains the cerebrospinal fluid

Question 3

Cerebrospinal fluid

Answer 3

intracranial and spinal structures float in the CSF – protected from injury – 125 – 150 ml CSF is circulating in the subarachnoid space and ventricles – 600 mls produced daily – CSF is formed in the ventricles circulated through the ventricles and then reabsorbed into the venous system through the arachnoid villi

Question 4

Pupillary changes

Answer 4

indicate brainstem dysfunction – brainstem control of arousal is adjacent to areas that control pupils – However, you need to consider that some medications will also affect the pupils

Question 5

Oculomotor responses

Answer 5

Abnormal eye movements, including nystagmus indicate alterations in brainstem function.
eyes should move together – dysconjugate movement - or no eye movement is indication of brain injury

Question 6

Motor responses

Answer 6

can be classified as purposeful, inappropriate, or not present – patients are asked to “squeeze my fingers” to determine their motor response – inappropriate responses include decerebrate and decorticate posturing

decorticate – flexion –( bringing into the core )– is associated with hemispheric damage above midbrain

decerebrate – extending away – is associated with severe damage involving the midbrain and upper pons

Question 7

Patterns of breathing

Answer 7

normally our forebrain produces a rhythmic pattern of breathing – if the LOC decreases the brain relies on CO2 levels to regulate respiration – CO2 climbs so respiration is increased – increased respiration decreases CO2 levels so respiration rate decreases – Cheyne stokes pattern

Question 8

Glasgow Coma Scale (GCS)

Answer 8

• eye-opening response
• verbal response
• motor response

Question 9

Selective attention

Answer 9

• ability to focus – we can choose what we are going to pay attention to
• selective attention deficits can be caused by seizures, contusions, subdural hematomas, stroke neoplasms, Alzheimer’s disease, dementia
• Temporary, permanent, or progressive

Question 10

Amnesia

Answer 10

mild or severe loss of memory

Question 11

Retrograde amnesia

Answer 11

difficulty with past personal history or facts

Question 12

Anterograde amnesia

Answer 12

inability to form new memories

Question 13

Agnosia

Answer 13

defects of recognition and may be tactile, visual, or auditory. They are caused by dysfunction in the primary sensory area or the interpretive areas of the cerebral cortex. Usually only one sense is affected.

Question 14

Dysphasia (aphasia)

Answer 14

an impairment of comprehension or production of language

Question 15

Broca’s area

Answer 15

cannot create speech

Question 16

Wernicke’s area

Answer 16

cannot comprehend speech

Question 17

Intracranial hypertension 4 stages

Answer 17

In stage 1 the brain is trying to compensate - mainly through vasoconstriction - in this stage the patient may be asymptomatic

In stage 2 the intracranial pressure is increasing beyond the ability of the brain to compensate - cellular hypoxia worsens - the body attempts to compensate through systemic vasoconstriction - the patient will start to show signs of increased ICP - confusion and restlessness, decreased level of consciousness

In stage 3 the intracranial pressure is approaching arterial pressure - cellular hypoxia worsens, patient becomes hypercapnic. The patient will decompensate quickly at this point, intervention is required quickly. Patient will show decreased level of consciousness, widening pulse pressure, decreased heart rate, pupils will be small and sluggish

In stage 4 the brain is herniating. ICP equals arterial pressure which prevents cerebral perfusion, hypoxia leads to cellular death which will further increase ICP - patient is past the point of recovery. pupils will be unequal and will eventually be fully dilated “blown pupils” BP, HR, will decreased, Cheyne-stoke breathing

Question 18

Cushing’s triad

Answer 18

• increased BP, decreased pulse rate, irregular breathing rate
• occurs in late stages of acute head injury
• indicates that brain stem herniation is imminent

Question 19

Hypotonia

Answer 19

decreased muscle tone – passive movement of a muscle has little resistance if any

Question 20

Hypertonia

Answer 20

increased muscle tone – passive muscle movement with resistance to stretch

Question 21

Hyperkinesia

Answer 21

excessive purposeless movements - could be tremors, or abnormal involuntary movements

Question 22

Dyskinesia

Answer 22

abnormal movements that occur as spasms – tardive dyskinesia is movements of the face – Tourette’s syndrome – unwanted tics

Question 23

Hypokinesia

Answer 23

loss of voluntary movement – decrease or slowness of voluntary movements – delay in time that it takes to start to perform a movement

Question 24

Spinal shock

Answer 24

• is the temporary loss of all spinal cord function below the level of the lesion – consequence of spinal cord injury – initial reaction is
• Complete paralysis, absence of reflexes, motor, sensory, autonomic function, including disturbances in bowel and bladder function – can last hours to weeks
• over time spinal shock will resolve – damage to spinal cord remains – so initially they may have loss of all function, but as their reflexes return we get a clearer picture of what damage has been done
• Return of spinal reflexes marks the end of spinal shock

Question 25

Paresis

Answer 25

condition of muscle weakness caused by nerve damage or disease – partial paralysis – can be confined to one area – limb or lower body or can be general or progressive as we may see in dementia

Question 26

Paralysis

Answer 26

loss of muscle function in part of your body

Question 27

Hemiparesis/hemiplegia

Answer 27

• one-sided muscle weakness
• upper and lower on one side
• stroke

Question 28

Diplegia

Answer 28

paralysis of corresponding parts of both sides of the body – cerebral hemisphere injuries of specific part of the brain

Question 29

Paraplegia

Answer 29

weakness or paralysis of lower extremities due to spinal cord injury

Question 30

Quadriplegia

Answer 30

weakness or paralysis of all four extremities due to spinal cord injury – looking at this in our spinal cord trauma

Question 31

Brain death

Answer 31

• brain is damaged beyond the point of recovery– brainstem functions have stopped – etiology is not reversible
• absence of motor responses, no spontaneous respirations, no brain functions – doll’s eyes(comatose patient’s brainstem is not intact)., corneal reflex, ice in ears

Question 32

Cerebral death

Answer 32

or irreversible coma, represents permanent brain damage, with an ability to maintain cardiac, respiratory, and other vital functions - person does not speak, open their eyes or have purposeful movements

Question 33

Vegetative state

Answer 33

Arousal returns in vegetative states, but awareness is absent.– does not speak or understand speech, cannot follow commands, but sleep-wake cycles present, has spontaneous eye opening– vegetative states that last longer than 12 months are considered permanent