nervous Flashcards
Define consciousness
The state of awareness of self and the environment, and of being able to orient to new stimuli
Consciousness is divided into what two components?
Arousal (wakefulness) & awareness (content of consciousness)
- What parts of the brain are required for a normal state of arousal (wakefulness)? What must be damaged in order for loss of arousal to occur?
Reticular activating system = diffuse network involving brainstem, medulla & thalamus, and functioning cerebral cortex
Direct injury to the RAS or to both cerebral hemispheres
- What is included in “awareness”?
All cognitive functions (awareness of self and environment, moods, reasoning, judgement)
- List and know general meaning of levels of consciousness
Coma = completely not arousable
Stupor = arousable only to pain
Obtundation = lower level of arousal, sleepy
Delirium = restlessness, hallucinations, delusions
Confusion = disorientation, fuzzy thinking, poor response to current stimuli
- Name and describe the scale used to commonly assess level of consciousness. (You don’t have to memorize meaning of numbers, just identify each category, the response at the top and bottom end of each scale, the fact that it is a total score, and whether a high score is a good or a bad result.)
Glasgow coma scale (15 is normal, 13-14 is associated with mild head injury, 8 – 12 is associated with moderate head injury, < 8 is associated with severe head injury)
Eye opening: 1 = no response, 2 = to pain, 3 = to command, 4 = spontaneously
Best verbal response: 1 = no response, 2 = incomprehensible sounds, 3 = inappropriate words, 4 = confused, 5 = oriented appropriate words, phrases
Best motor response: 1 = no response, 2 = extension (decerebrate), 3 = abnormal flexion (decorticate), 4 = withdraws from pain flexion, 5 = localizes pain, 6 = obeys commands
- Define brain death, and be familiar with how it is determined.
Irreversible loss of brain function; brain cannot maintain internal homeostasis; no recovery possible
Well established underlying pathology, deep unresponsive coma & absence of motor reflexes, absent brainstem reflexes, requires mechanical ventilation “apnea test”, lack of other causes e.g. drugs, shock
- Define: persistent vegetative state, minimally conscious state, locked-in syndrome.
Complete unawareness of self or surrounding environment. Sleep-wake cycles are present, brain stem reflexes are intact, but there is bowel and bladder incontinence
Individuals may follow simple commands, manipulate objects, gesture, have intelligible speech, but are consistent with these actions
Complete paralysis of voluntary muscles with the exception of eye movement. Individual is fully conscious with intact cognitive function, but cannot communicate through speech or body movements
- Describe Cheyne-Stokes breathing and neurogenic hyperventilation, including the possible location of brain damage that would cause these two patterns of breathing.
Higher brain injury can result in Cheyne-stokes breathing: alternating periods of apnea and tachypnea, due to response to levels of carbon dioxide in blood (loss of smoothing out of breathing pattern usually performed by higher brain centres)
Injury to midbrain: > 40 breaths per minute when inspiratory/expiratory centres are continuously stimulated
- What alterations can occur with pupillary response, and what information can this yield?
Upon being exposed to light, pupil response can range from combinations of fixed, dilated, pinpoint, and unequal (pupils responses differ). Can help determine location/extent of brain damage
- What is the normal oculomotor “doll’s eye” response in a comatose patient? What are two abnormal oculomotor responses?
Normal response is movement opposite from head movement. Abnormal is following head movement, or independent movement (assessable only in comatose patients)
- What general types of motor responses may occur with neurological damage? Be familiar with examples.
May be purposeful, absen4t or inappropriate (e.g. associated with decreased consciousness are several reflexes: grasping, sucking, palmomental, snout
Abnormal responses in the upper and lower extremities: decorticate / decerebrate postures
- Describe decorticate and decerebrate postures and location of brain damage they indicate.
Upper extremities are flexed at the elbows and held close to the body and lower extremities that are externally rotated and extended. May occur with severe cerebral hemisphere damage
Increased tone in extensor muscles and trunk muscles, with clenched jaw and extended neck = head in neutral position, all for limbs rigidly extended. Occurs with brain stem lesions
- Define seizure. Be familiar with causes.
A sudden, explosive, disorderly discharge of cerebral neurons, that produces a temporary change in brain function, usually involving motor, sensory, autonomic or psychic clinical manifestations and a temporary altered level of arousal
Cerebral lesions, biochemical disorders, cerebral trauma or epilepsy (these factors can result from many causes, including fever, brain tumors, infections, genetic predispositions)
- Differentiate between a seizure and a convulsion.
Convulsions is jerky, muscle contraction – relaxation cycles whereas seizures are sudden, explosive, disorderly discharge of neurons
- Define agnosia, hemineglect, dysphasia, aphasia (Wernike’s and Broca’s).
Failure to recognize the form/nature of objects; usually only affects one sense. Caused by any damage to a specific part of the brain
Inability to attend to and react to stimuli coming from the contralateral (to site of damage) side of space. Won’t visually track, orient or reach to the neglected side. May not use those limbs, or take care of them
Understanding (receptive) and use (expressive) of symbols (written or verbal) is disturbed or lost. Caused by dysfunction in left cerebral hemisphere (stroke, cancer)
Inability to communicate
(receptive) aphasia: result of damage to the centre of the brain responsible for the comprehension of language. Individual speaks in a “word salad” - uses nonsense words in long, meandering sentences
(Expressive) aphasia: result of damage to the centre of the brain responsible for the production of language. Individual has difficulties “findings” the correct word
- Name 3 general alterations that can occur if the neuromotor function of the nervous system is affected.
Alterations in muscle tone, alterations in movement, alterations in complex motor performance
- What is muscle tone and what does it do? How is it controlled?
Muscle tone is the normal state of muscle tension which allows for controlled movement and maintenance of posture. It is controlled by the stretch reflex (which can be inhibited by the CNS – otherwise any stretch of an antagonist muscle (which allows the agonist muscle to act) would be inhibited and we wouldn’t be able to perform large movements that require a full range of movement).
Alterations in muscle tone can be caused by injury to any section of motor pathway: peripheral nerve, NMJ, spinal cord, brain
- What changes in muscle tone are brought about by injuries to the upper motor neurons vs the lower motor neurons?
An injury in the upper motor neurons generally produces increased tone as the inhibitory effect of the brain on the spinal cord reflexes is removed (rigidity = hypertonia)
An injury in the lower motor neurons produces decreased tone (flaccidity = hypotonia)
- Define hypotonia and hypertonia.
Hypotonia = decreased muscle tone
Hypertonia = too much muscle tone so that arms or legs are stiff and difficult to move
- Define paresis, paralysis and hyperkinesia.
Weakness of muscle due to alteration in how the motor units are activated (muscle strength depends upon order and number of motor units recruited)
Loss of motor neuron function so that a muscle group is unable to overcome gravity (total loss of movement)
Excessive movements (tremors)
- Is the influence of the location of the lesion (whether upper or lower motor neuron) the same for the flaccidity/spastic nature of paresis/paralysis as it is for muscle tone?
Upper motor neuron lesion: produces spastic (stiff/rigid) paresis/paralysis: spinal reflexes remain intact but there is loss of cortical (brain) inhibition. (although the muscle will eventually atrophy due to loss of use, since the muscle reflexes are still intact, the atrophy takes longer)
Lower motor neuron lesion: produces flaccid (limp) paresis/paralysis since muscle excitation is lost (muscle atrophy occurs faster, since spinal reflexes are lost)
- Define the terms hemi-, para- and quadri-, as applied to paresis and paralysis.
Weakness or inability to move on one side of the body, making it hard to perform everyday activities
When you’re partially unable to move your legs (paraparesis) & complete inability to move legs (para-paralysis)
Condition in which you have muscle weakness in all 4 of your limbs