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Neuroscience > Mod 14 Brain Environment and TBI > Flashcards

Mod 14 Brain Environment and TBI Flashcards

1
Q

What are the 3 layers of the brain meninges from superficial to deep?

A

dura mater
arachnoid mater
pia mater

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2
Q

What is the dura mater?

A

thick connective tissue

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3
Q

What are the two layers of the dura mater?

A
  • outer periosteal layer
  • inner meningeal layer
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4
Q

What spaces are associated with the dura mater?

A

epidural and subdural space

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5
Q

What are the dural sinuses?

A

pathway for blood to get back into the venous system from the head cavity

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6
Q

Which surfaces drain into the superior sagittal sinus?

A

upper lateral and medial surfaces

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7
Q

Where do a majority of the cortex venous blood drain into?

A

transverse > sigmoid sinus

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8
Q

What is the pathway for deep structure venous drainage of the brain?

A

cerebral veins > straight sinus > left transverse and sigmoid sinus > internal jugular vein

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9
Q

What are the 3 dura septa?

A
  • falx cerebri
  • tentorium cerebelli
  • falx cerebelli
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10
Q

What does the falx cerebri separate?

A

the two cerebral hemispheres

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11
Q

What does the tentorium cerebelli separate?

A

separates cerebrum from cerebellum

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12
Q

What does the falx cerebelli separate?

A

separates the two hemispheres of the cerebellum

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13
Q

What do the supratentorial compartment and infratentorial compartment refer to?

A

supra = above the tentorium cerebelli

infra = below the tentorium cerebelli

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14
Q

What do the dural septa do?

A

constrain anterior-posterior and medial-lateral brain movement

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15
Q

What is unique considering the blood supply of the arachnoid mater?

A

avascular meninge

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16
Q

What is important to remember about the attachment of the arachnoid to the dura?

A

makes a potential space with the subdural space, does not exist unless blood that isn’t supposed to be there fills the space

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17
Q

What is the subarachnoid space filled with?

A

CSF and arachnoid trabeculae (attachments to Pia mater)

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18
Q

How is the size of the subarachnoid space determined?

A

space size varies on brain location

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19
Q

What are the spaces where the subarachnoid space is bigger in the CNS?

A

cisterns

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20
Q

What is the role of arachnoid villi?

A

granulations that penetrate dural sinuses to get CSF into venous system

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21
Q

What is the pia mater?

A

delicate connective tissue

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22
Q

What are the two layers of the pia mater?

A
  • epipia
  • intima pia
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23
Q

What is the intima pia and what does it do?

A

cerebral vessels on top that help create a perivascular wall for blood vessels to dive into brain and get to designated location

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24
Q

What is meningitis?

A

inflammation of arachnoid and pia due to infection

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25
Q

What are the types of meningitis?

A

bacterial and fungal

west nile is viral but also has severe effect

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26
Q

How does meningitis start or originate?

A
  • travel in blood from other parts of the body (liver/intestines)
  • can originate in the scalp or dural sinus
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27
Q

What is meningoencephalitis?

A

when meningitis infection also impacts the brain

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28
Q

What are the symptoms of meningitis?

A

fever, headache, back pain

edema and pressure can lead to seizures/vomiting

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29
Q

What are the examples of focal neurologic deficits with meningitis and meningoencephalitis that can pin point where insult occurred?

A

cranial nerve palsy: brainstem

motor loss: primary motor cortex

language loss: left lateral hemisphere pressure

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30
Q

What is meningioma?

A

tumor that typically arises from arachnoid villi (granulations)

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31
Q

What is important about malignant (rare) meningioma?

A

they don’t penetrate any neural tissue but can still displace or compress brain tissue causing seizures

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32
Q

What does the CSF do?

A

protects and nourishes the CNS

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33
Q

Where and how is CSF produced?

A

choroid plexus

  • hydrostatic pressure of 15 mL H2O
  • produced at rate independent of intraventricular pressures
34
Q

What is the circulatory pathway of CSF?

A
  1. ventricles
  2. subarachnoid space
  3. arachnoid villi
  4. dural sinuses
  5. venous system
35
Q

How does the pressure system of the CSF work?

A
  • pumped through with assistance of arterial pulse of choroid plexus
  • villi act as one way valve
36
Q

What is the relationship between pressure of the venous system and CSF?

A

venous < CSF = valves open

venous > CSF = valves close to prevent back flow (when lifting or coughing)

37
Q

What is hydrocephalus?

A

increased accumulation of CSF
- causes enlarged skull in kids (skull not yet fused)
- increased intracranial pressure (ICP) in adults

38
Q

What are the etiologies/ causes of hydrocephalus?

A
  • sequelae of spina bifida
  • tumor
  • meningitis
39
Q

How does hydrocephalus impact CSF flow?

A

can cause direct or indirect interruption of CSF flow

40
Q

What is the cascade of compromised absorption of CSF into the venous system?

A

enlarged ventricles > cerebral compression > arterial compromise > adverse neuro symptoms

41
Q

How do shunts affect hydrocephalus?

A

provide alternate route for CSF to escape

pressure sensitive tube that runs from ventricle to various locations

42
Q

What are the 4 different types of shunts for hydrocephalus?

A
  • ventriculoperitoneal shunt
  • ventriculoatrial shunt
  • ventriculoatrial shunt to internal jugular vein
  • shunt to subarachnoid space
43
Q

What is normal pressure hydrocephalus?

A

increase in ventricle dilation without increased intracranial pressure

44
Q

When do we see normal pressure hydrocephalus?

A
  • in elderly
  • following intracranial hemorrhage
  • following infection
45
Q

What are the symptoms of normal pressure hydrocephalus?

A

large ventricular area exerts force on surrounding neural tissue

  • urinary incontinence
  • cognitive impairments
  • gait/balance difficulties
46
Q

What is TBI?

A

injury to the brain as a result of blow to the head
- moving head striking surface (MVA, football)
- moving surface striking head (violence, abuse)

47
Q

What are the results of TBI?

A

skull fracture or closed head injury that can lead to various brain insults

48
Q

What are the two types of skull fracture?

A

depressed: area of skull pushed down into neural tissue

compound: skin is broken, and skull is splintered

49
Q
A
50
Q

Which lobes of the brain are at risk of coup - counter coup impacts?

A

frontal and temporal lobes

51
Q

What is an epidural hematoma?

A

collection of arterial blood in space between dura and cranium

typically associated with more abrupt deterioration of function

52
Q

How do epidural hematomas occur?

A

result of torn meningeal artery that impacts intracranial pressure

53
Q

What is a subdural hematoma?

A

collection of venous blood in space between dura and arachnoid mater

54
Q

How do subdural hematomas occur?

A

result of torn cerebral vein that impacts intracranial pressure

55
Q

How is the development of deterioration with subdural hematomas?

A

slow development of pressure that leads to slow deterioration of function

severity of symptoms vary

56
Q

What is the difference between a subdural and epidural hematoma?

A

sub: vein, slow
epi: artery, fast

57
Q

What is a herniation?

A

shift of the brain that is result of increased fluid in the brain

58
Q

What are the types of herniations?

A
  1. subfalcial: cingulate gyrus pushed under falx cerebri to oppositie hemisphere (altered consciousness
  2. uncal: medial temporal lobe pushed into tentorial notch (CN III and midbrain compression)
  3. cerebellar: cerebellum pushed down into foramen magnum (brainstem and cervical spine)
59
Q

How can intracranial pressure be checked?

A

checked with spinal tap (lumbar cistern) and measured by manometer

60
Q

What can the spinal tap procedure be used for?

A

analysis for:
- subarachnoid/intracerebral hemorrhage
- bacterial meningitis = cloudy CSF (WBCs)

61
Q

What is diffuse axonal injury (DAI)?

A

stretch of nerve fibers as result of rotational forces on the brain

62
Q

What happens during DAI?

A

white matter of cerebrum and brainstem under shear forces causing damage to axons

63
Q

What impairments happen because of DAI?

A

impairment of higher level functioning (decision making, executive function)

64
Q

What is cerebral contusion?

A

swelling and capillary hemorrhage (bruise on cerebrum)

65
Q

What is cerebral laceration?

A

actual tears in neural tissue

66
Q

What is a concussion?

A

mTBI

  • head trauma with symptoms that can last seconds to weeks
67
Q

What are the symptoms of a concussion?

A

headache, dizziness, confusion, visual impairments

68
Q

What can be the potential results of multiple concussions in one’s life?

A
  • prolonged symptoms/increased severity
  • susceptibility to adverse neurometabolic changes
  • susceptibility to ALS or alzheimers
69
Q

What is a coma?

A

profound state of unconsciousness where a person cannot be aroused

70
Q

What is the cause of a coma?

A

compromised brainstem and thalamic reticular activating system

71
Q

What other pathologies often come with a coma?

A

contusion, herniation, hemorrhage

72
Q

What is posturing?

A

body pattern often seen in a coma determined by lesion’s locations in association to the red nucleus

73
Q

What is decorticate posturing?

A
  • lesion above red nucleus
  • loss of UE flexor inhibition
  • one tract unchecked
  • UEs flexed and adducted, LEs extended
74
Q

What is decerebrate posturing?

A
  • lesion below red nucleus
  • loss of extensor inhibition
  • two extensor tracts unchecked
  • extension of all extremities, IR of UEs, plantar flexion of feet
75
Q

What is involved in a TBI examination?

A
  • level of coma (Glasgow scale)
  • loss of consciousness
  • memory impairments
  • cognition/judgement impairments
  • emotional impairments
  • motor/sensory impairments
  • functional mobility independence
76
Q

What are other considerations when it comes to TBI?

A
  • previous level of functioning
  • psychosocial factors (how injury took place and support system)
77
Q

What are the levels of the Glasgow coma score?

A

mild = 13-15

moderate = 9-12

severe < 8

78
Q

What is the Ranchos Los Amigos Scale of Cognitive Function?

A

scale that assesses cognitive functioning in individuals in coma, not a fluid scale but is hierarchical

  • can track individuals progress
79
Q

What is the management and rehab of a coma?

A
  • monitor vitals
  • protect skin
  • monitor ICP
80
Q

What is management and rehab of an acute-outpatient setting?

A
  • interdisciplinary approach
  • motor/sensory/function movements similar to CVA
  • challenge is creating ideal environment for motor learning when individual has multiple impairments

Neuroscience (15 decks)

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