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Nervous System Flashcards

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1
Q

The Brain

A
  • Communication and control center of the body
  • Receives, processes, and evaluates many kinds of input, decides on the response needed, and acts on that
  • Controlled by:
  • Involuntary activity- Autonomic nervous system
  • Voluntary activity- Somatic nervous system
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2
Q

The Brain is Protected by:

A
  • Skull
  • Meninges
  • Cerebrospinal Fluid (CSF)
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3
Q

Dura Mater

A
  • Outer layer
  • Tough, fibrous, double-layered membrane
  • Forms the dural sinuses which collect venous blood and CSF for return to the general circulation
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4
Q

Arachnoid Mater

A
  • Middle layer
  • Loose, web like covering
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5
Q

Subarachnoid Space

A
  • Contains CSF and cerebral arteries and veins
  • Lies below the arachnoid
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6
Q

Subdural Space

A
  • Potential space
  • Normally empty, can fill with blood after an injury
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7
Q

Pia Mater

A
  • Inner layer
  • Delicate, connective tissue that adheres closely to all convulsions on the surface of the brain
  • Contains many small blood vessels
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8
Q

Cerebrospinal Fluid

A
  • Provides a cushion for the brain and spinal cord
  • Clear, almost colourless liquid
  • Formed in the ventricles in the brain and flows into the subarachnoid space
  • Here it circulates the brain and spinal cord and eventually returns to venous blood
  • To maintain normal pressures (ICP), it is important that equal amounts of CSF are produced and reabsorbed
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9
Q

Blood Brain Barrier

A
  • Protective mechanism provided by relatively impermeable capillaries in the brain
  • Cells are tightly joined together rather than possessing pores
  • This barrier limits the passage of potentially damaging materials into the brain and controls the delicate balance of electrolytes, glucose, and proteins in the brain
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10
Q

Pons

A

Contain afferent (incoming) and efferent (outgoing) fibers

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11
Q

Medulla Oblongata

A

Vital control center that regulate respiratory and cardiovascular function (breathing and heart rate)

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12
Q

RAS (Reticular Activating System)

A

Determines the degree/arousal/awareness of cerebral cortex

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13
Q

Bronca’s Area

A
  • Motor or expressive speech area
  • Controls the output of words, verbal and written
  • Located at the base of left frontal lobe
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14
Q

Wernicke’s Area

A
  • Comprehends language received, both written and spoken
  • Located at posterior temporal lobe
  • Connective fibers to visual and auditory areas
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15
Q

Neurons

A
  • Highly specialized cells that conduct impulses through the CNS and PNS
  • Require glucose and oxygen for metabolism
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16
Q

Neurotransmitters

A
  • Transmit impulses from cell to cell
    Types:
  • Acetylcholine- chief neurotransmitter of PNS
  • Epinepherine/Norepi- chief neurotransmitter of SNS. Causes vasoconstriction and increases HR. Stimulates alpha and beta receptors
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17
Q

ICP

A

Intracranial Pressure
Normally <15 mmHg

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18
Q

CPP

A

Cerebral Perfusion Pressure
Pressure needed to maintain blood flow to the brain
Normally 70-80 mmHg

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19
Q

MAP

A

Mean Arterial Pressure
70-100 mmHg

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20
Q

What happens when ICP=MAP

A

BLOOD FLOW STOPS

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21
Q

CPP= ?

A

MAP-ICP

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22
Q

Neurogenic Shock Symptoms

A
  • Bradycardia
  • Skin warm and dry
  • No significant blood loss
  • Paralysis and loss of spinal reflexes
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23
Q

Central Nervous System

A

Consists of brain and spinal cord
- Cerebrum: memory, emotion, problem solving, reasoning
- Cerebellum: movement, balance, general motor control
- Brainstem: breathing, blood pressure, eating
- Spinal cord: communication between brain and body, controls movement, sensation, and reflexes

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24
Q

Peripheral Nervous System

A

Somatic: controls voluntary movement and sensation in the skin, muscles, and joints. Responsible for relaying information from brain to skeletal muscles
Autonomic: controls automatic functions like heart rate, breathing, and digestion. Responsible for relaying information from brain to internal organs, allowing out body to function without conscious control

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25
Q

Sympathetic Nervous System

A

Part of the autonomic nervous system. Increases activity of the organs when your body activates its “fight-or-flight” response.

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26
Q

Parasympathetic Nervous System

A

Part of the autonomic nervous system. It helps relax your body after fight or flight situations.

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27
Q

Increased ICP

A
  • Shifts CSF to spinal cavity to compensate, decreasing cerebral blood flow
    - Effective until you become hypoxic
  • Hypoxia = arterial vasodilation in brain in attempt to improve blood supply = adds fluid volume
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28
Q

Signs and Symptoms of Increased ICP

A
  • Severe headache
  • Vomiting
  • Papilledema
  • Seizures
  • Cushing’s reflex
    - Decreased pulse
    - Increased systolic BP with widening pulse pressure
    - Irregular respirations
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29
Q

Cerebral Herniation Syndrome

A
  • Brain swelling forces tissue down through the foramen mangnum
  • Obstruction of blood flow
  • Pressure on brain stem
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30
Q

Signs and Symptoms of Cerebral Herniation Syndrome

A
  • Decreased LOC
  • Coma
  • Dilation of pupil on same side
  • Paralysis on opposite side
  • Decerebrate posturing
  • Increased BP
  • Bradycardia
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31
Q

Treatment of Cerebral Herniation Syndrome

A

HYPERVENTILATION 3:1
The only time you hyperventilate a patient
We need to decrease blood flow to the brain, it causes hypoxia and vasoconstriction but we have to preserve what is left

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32
Q

Concussion

A

Mild blow to the head causing sudden excessive movement of the brain

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33
Q

Signs and Symptoms of Concussion

A
  • Period of unconsciousness or confusion
  • Returns to normal
  • Amnesia
  • Headache
  • Dizziness
  • Tinnitus
  • Nausea
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34
Q

Basilar Fractures

A
  • Occur at base of skull
  • Often accompanied by leaking of CSF through the nose and ears
  • Occurs with blunt force trauma
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35
Q

Signs and Symptoms of Basilar Fractures

A

Diagnosed with dark discolouration around eyes and behind ears

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36
Q

Cerebral Contusion

A
  • Bruised brain tissue with ruptured small blood vessels
  • Usually from a blow to the head
  • Brain swelling may be rapid and severe
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37
Q

Signs and Symptoms of Cerebral Contusion

A
  • Prolonged unconsciousness
  • Altered LOC
  • Personality changes
  • Profound confusion
  • Persistent amnesia
  • Abnormal behaviour
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38
Q

Depressed Skull Fractures

A
  • Displacement of a piece of bone below level of the skull
  • Compress brain tissue
  • Blood supply to that area is impaired
  • ICP often high
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39
Q

Diffuse Anoxal Injury

A
  • Severe blunt trauma to the head
  • Stretching, shearing, tearing of nerve fibers, from brain moving back and forth
  • Generalized edema
  • Subarachnoid bleeding with irritation to the surrounding tissues
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40
Q

Signs and Symptoms of Diffuse Anoxal Injury

A
  • Seizure activity
  • Coma
  • Vomiting
  • Herniation syndrome is possible
  • Often results in permanent vegetative state
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41
Q

Anoxic Brain Injury

A
  • Lack of oxygen to the cells
  • Cardiac arrest, airway obstruction, drowning
  • Spasm of cerebral arteries = perfusion is affected to the cortex
  • 4-6 minutes of anoxia = irreversible
  • Restoring BP and oxygen will not restore perfusion
42
Q

Closed Head Injuries

A
  • Skull is not fractured
  • Brain tissue is injured from force
  • Blood vessels may rupture
  • Contrecoup injury- rebound of skull causes the brain to impact the opposite side of the skull
43
Q

Epidural Hematoma

A
  • Bleeding between the dura and skull
  • Usually from a tear in the middle meningeal artery in temporal region
  • Linear fracture = arterial bleed = quick onset and deadly outcome
44
Q

Signs and Symptoms of Epidural Hematoma

A
  • Head trauma
  • Loss of consciousness
  • Lucid interval then signs of ICP within minutes to hours
  • Rapid death
45
Q

Subdural Hematoma

A
  • Between dura and arachnoid
  • Associated with injury to underlying brain tissues
  • Venous bleed = causes blood to accumulate slowly
  • May be acute or sub-acute
    -acute = 24 hours
    - sub-acute = over a week
  • High risk- alcoholics and elderly on blood thinners
  • Tear in the arachnoid can cause a loss of CSF into the subdural space = creates higher ICP
46
Q

Signs and Symptoms of Subdural Hematoma

A
  • Headache
  • Changes in LOC
  • Slurred speech
47
Q

Subarachnoid Hemorrhage

A
  • Between arachnoid and pia
  • Associated with traumatic bleeding from blood vessels at base of brain
    -Aneurysms
  • Initially localized but becomes diffuse secondary to meningeal irritation
48
Q

Signs and Symptoms of Subarachnoid Hemorrhage

A
  • Decreased LOC
  • Pupil changes
  • Posturing
  • Vomiting
  • Seizures
  • Worst headache they ever had
  • Prob has a history of HTN
49
Q

Intracerebral Hemorrhage

A
  • Bleeding in the brain tissue
  • Frontal and temporal lobes are most common
  • Blunt or penetrating trauma
50
Q

Signs and Symptoms of Intracerebral Hemorrhage

A
  • Altered LOC
  • Similar pattern to CVA’s
  • High mortality rates
51
Q

Coma

A
  • Deep state of unconsciousness
  • Patient cannot be aroused by external stimuli
52
Q

Causes of a Coma

A
  • Structural: intracranial bleeding, head trauma, brain tumour
  • Metabolic: anoxia, hypoglycemia, DKA, thiamin deficiency, kidney and liver failure
  • Drugs
  • Cardiovascular system: Hypertensive encephalopathy. Sudden raise in BP with headache, nausea, seizures. Seen in eclampsia. Shock, dysrhythmias, stroke
  • Respiratory system: COPD, toxic inhalation
  • Infection: Meningitis, sepsis
53
Q

Cerebrovascular Accident

A
  • Sudden alterations in LOC, sensation, and/or voluntary movement due to obstruction or rupture of an artery in the brain
  • These effects may be permanent or temporary
  • CVA, TIA, Stroke
54
Q

Stroke and Intracranial Hemorrhage

A

Sudden interruption of blood flow to the brain that results in neurological deficit

55
Q

Modifiable Risk Factors of Strokes

A
  • High BP
  • High cholesterol
  • Cigarette smoking
  • TIA
  • Heart disease
  • Diabetes mellitus
56
Q

Non-modifiable Risk Factors of Strokes

A
  • Age
  • Gender
  • Race
  • Prior stroke
  • Hereditary
  • Hyper coagulopathy
  • High RBC and sickle cell anemia
57
Q

Pathophysiology of CVA’s

A
  • Four major blood vessels
    - Carotid (80% CBF)
    - Vertebral arteries (20%)
  • Interconnected- circle of willis
  • Collateral blood flow
    - Scalp vessels, vessels of the dura and arachnoid
  • Occlusion results in infarct and ischemia
58
Q

Cerebral Blood Flow

A
  • Autoregulation of the cerebral vessels
  • Constrict and dilate to maintain perfusion pressure
  • Perfusion is regulated at the arteriolar level by levels of oxygen and glucose
  • Ischemia and acidosis are vasodilators
  • Sudden cessation of circulation from occlusion or hemorrhage cannot by readily corrected by auto-regulatory mechanisms
  • Resulting ischemia leads to to neuronal dysfunction and death
59
Q

Types of Strokes

A
  • Ischemic Strokes
    - Rarely lethal in the first hour
    - 80-85% of strokes
  • Hemorrhagic strokes
    - Rapidly fatal
    - Less common
60
Q

Ischemic Strokes

A
  • Occlusion of an artery from plaque build up
    - Often in carotids
  • Embolus causing sudden obstructions
    - Thrombi may break off atheroma
    - May be from tumors, air
61
Q

Signs and Symptoms of Ischemic Strokes

A
  • Hemiparesis or hemipalegia (contralateral)
  • Numbness (contralateral) and facial drooping
  • Aphasia
  • Confusion or coma
  • Convulsions
  • Incontinence
  • Diplopia (double vision)
  • Dysarthria (slurred speech)
  • Headache, dizziness
62
Q

Thrombus vs. Embolus

A

Thrombus: blood clot
Embolus: obstruction of blood flow due to a mass of undissolved matter lodging in a vessel

63
Q

Hemorrhagic Stroke

A
  • Hemorrhage in cranial vault
  • Epidural, subdural, subarachnoid
  • Causes: cerebral aneurysms, AV malformations, HTN, stress or exertion, cocaine or other sympathomimetic drugs
64
Q

Signs and Symptoms of Hemorrhagic Stroke

A
  • Sudden onset accompanied by headache
  • Nausea and vomiting
  • Quick deterioration
  • Hemorrhage = ICP = Coma
65
Q

Cerebral Embolus

A
  • Occlusion of an intracranial vessel from a fragment of a foreign substance
  • Causes: atherosclerotic plaque
  • Thrombi: valvular heart disease and A Fib
  • Air embolism after thoracic surgery
  • Fat embolism after long bone injury
  • Gas embolus- diving injury
66
Q

TIA

A

Transient Ischemic Attack
- Focal cerebral dysfunction - temporary reduction in blood flow
- Lasts minutes to hours (rarely more than 1-2 hours)
- Recovery in 24 hours
-Patient returns to normal, no permanent damage
- Indication of problems
- Obstruction related to atherosclerosis
- Can be from spasm of arteries
- Loss of auto-regulation

67
Q

Signs and Symptoms of TIA

A
  • Related to location of ischemia
  • Weakness
  • Paralysis
  • Numbness of face
  • Speech disturbances
  • Result from a vascular disturbance
68
Q

Seizure Disorders

A
  • A temporary alteration in behaviour or consciousness caused by abnormal electrical activity at one or more groups of neurons in the brain
  • Result of alterations in neuronal membrane permeability secondary to structural lesion or metabolic derangement
  • Na and K enhances the ability or neurons to depolarize and emit an electrical charge = seizure
  • Seizures are periods of sustained hyperactivity in the brain
  • The nerve cells leave their normal activities and fire in massive, synchronized bursts
    - Returns to normal in a few minutes
69
Q

Generalized- Petit Mal

A
  • Absence seizures
  • Occur most often in children 4-12
  • Lapse of consciousness
  • No loss of posture
  • No motor activity
  • Maybe some isolated clonic activity
  • Short duration, return to normal
70
Q

Grand Mal: AKA Tonic-Clonic

A
  • May be preceded with an aura
  • Sudden onset with loss of organized muscle tone
71
Q

Tonic Phase

A
  • Extensor muscle tone activity
  • Sometimes flexion
  • Apnea
  • Short duration
  • Tongue biting
  • Bladder incontinence
72
Q

Clonic Phase

A
  • Rigidity -> relaxation
  • Convulsions
  • 1-3 minutes
  • Massive ANS discharge
  • Hyperventilation, salivation, tachycardia
73
Q

Postictal Phase

A
  • Drowsiness or unconsciousness
  • Lasts minutes to hours
  • Followed by confusion and fatigue
  • Transient neurological deficits
74
Q

Status Epilepticus

A
  • Prolonged seizure activity
  • Reoccuring seizures before consciousness is regained
75
Q

Simple Seizures

A
  • Motor or sensory cortex
  • Motor seizures clonic activity to one specific body part
  • Sensory seizures- tingling, numbness, visual, auditory, or taste symptoms
  • Generally, do not lose consciousness
  • May lead to tonic-clonic
76
Q

Jacksonian Seizure

A
  • Seizure activity involving a brief alteration in movement, sensation or nerve function
  • Generally do not lose consciousness
  • Can be head twitching, word repeating, lip smacking, etc..
77
Q

Complex Seizures

A
  • Arise from focal seizures in temporal lobe (psychmotor)
  • Manifest changes in behaviour
  • Preceded by an aura
  • Abnormal repetitive motor behaviour (automatisms)
  • Period of amnesia
  • Brief duration with return to normal
78
Q

Syncope

A
  • Fainting spell
  • Usually positional with light-headedness
  • Sudden onset, short duration
  • Bradycardia with vagal stimulation
  • May have a mini hypoxic seizure (not actually a seizure) because when you pass out you’re not breathing for a while
79
Q

Tension Headaches

A
  • Muscle contractions of face, neck, scalp
  • Feels like tight band around head
  • Result of stress, persistent noise, poor posture, eye strain
  • Usually treated with analgesics
80
Q

Migraines

A
  • Severe incapacitating headaches
  • Preceded by visual or GI disturbances
  • Onset of intense throbbing pain
  • Lasts 2-72 hours
  • Often accompanied by nausea and vomiting
  • Constriction and dilation of blood vessels
81
Q

Sinus Headache

A
  • Pain in forehead, nasal area and eyes
  • Pressure behind the face- from build up of fluid in sinuses
82
Q

Cluster headache

A
  • Occur in bursts, short lasting but repeat for days or months
  • Severe pain around one eye
  • Tearing and nasal congestion
  • Often caused by abnormalities in bodies biological clock (hypothalamus)
  • AKA: histamine headaches
83
Q

Brain Neoplasms- Tumors

A
  • Malignant or benign
  • Effects depend on size, location, rate of growth, hemorrhaging, edema
  • Issues often arise from icreased ICP due to lack of space
84
Q

Signs and Symptoms of Tumors

A
  • Increased ICP signs
  • Headache
  • Vomiting
  • Lethargy and irritability
  • Personality changes
  • Seizures
85
Q

Brain Abscess

A
  • Purulent material (pus) surrounded by a capsule
  • Develops from bacterial infection from nasal cavity, middle ear, mastoid cells
  • Also from surgery or penetrating trauma
  • Infection = fever
  • Expanding mass = nausea, vomiting, seizures, alterations in LOC, headaches
86
Q

Muscular Dystrophy

A
  • Inherited muscle disorder
  • Slow progressive degeneration of muscle fibers
  • Waste muscles is replaced by fat
  • 12 years- few walk, few survive
  • Death usually from pulmonary infections and heart failure
  • No cure
87
Q

Meningitis

A
  • Infection, usually bacterial, of the meninges in the brain
  • Microbes reach the brain via the blood
  • Can result from head trauma or surgery
  • Can be secondary to other infections
88
Q

Signs and Symptoms of Meningitis

A
  • Severe headache
  • Back pain
  • Nuchal rigidity (hyperextended, stiff neck)
  • Vomiting
  • Irritability and lethargy
  • Fever and chills
  • Rash
89
Q

Kernig’s sign

A

Resistance to leg extension when hip is flexed 90 degrees

90
Q

Brudzinski’s sign

A

Passive flexion of neck causes flexion of both legs/thighs

91
Q

Multiple Sclerosis

A
  • Progressive disease of the CNS
  • Patches of myelin in the brain and spinal cord are destroyed
  • This causes issues in nerve conduction and message impulse
  • Autoimmune disease- body destroys foreign material, including myelin
  • Scarring and nerve fibers damage
  • No cure but there is medicine to help
92
Q

Dystonia

A
  • Local or diffuse alterations in muscle tone- from damage to neuron transmission to muscles
  • Painful muscle spasms, unusual positions, strange movement patterns
93
Q

Parkinson’s Disease

A
  • Degeneration or damage to nerve cells in the basal ganglia (voluntary motor movements) of the brain
  • Lack of dopamine- effects the nerve pathways that control muscle contraction
  • Result- tense muscles, tremors, joint rigidity, slow movements
94
Q

Central Pain Syndrome

A
  • Damage or malfunction in the CNS- sensitization of the pain system
  • Can be caused by infection or disease of the trigeminal nerve
  • Car accidents
  • Trauma
  • Stroke
  • Brief and very painful
95
Q

Bell’s Palsy

A
  • Paralysis/weakness of the facial muscles on one side of the face
  • Due to inflammation of the facial nerve
  • Viral often
  • Usually one sided and temporary
  • Eyelid and mouth droop
  • Numbness and pain
  • Taste impaired, sounds louder
96
Q

Peripheral Neuropathy

A
  • Damage or irritation to the axon or myelin sheath
  • Interrupts nerve message impulses from the site to the brain
  • Slows or blocks the nerve impulses
  • Classifications- around the site and distribution damage
  • Damage to sensory nerve fibers
  • Numbness, tingling, cold, pain
  • Starts at hands and feet -> central body
  • Damage to motor nerve fibers: muscle weakness, wasting
  • Damage to ANS: blurred vision, impaired or absent sweating, changes in BP, Gi disorders
97
Q

Amyotrophic Lateral Sclerosis

A
  • ALS- Lou Gehrig’s Disease
  • Nerves that control muscular activity degenerate in brain and spinal cord
  • Weakness in hands and arms
  • Involuntary quivering
  • Progress to all four limbs, respirations, and swallowing
  • Death in 2-4 years- aspiration, pneumonia, starvation
98
Q

Myoclonus

A
  • Rapid and uncontrolled muscle contractions that occur at rest or during movement
  • A symptom, not a disease
  • May be a symptom of brain disorder or seizure disorder
99
Q

Spina Bifida

A
  • Congenital defect
  • Part of the vertebra fails to develop
  • Portion of the spinal cord exposed
  • Most common in lower back
100
Q

Polio

A
  • Variable ranges of severity
  • Unapparent infection
  • Febrile illness without neurological effects
  • Aseptic meningitis
  • Paralytic disease
  • Spread by feces, food transmission, airborne
  • Fever, headache, sore throat, malaise
  • Paralytic- pain, muscle involvement, brain stem -> inability to swallow or breath
101
Q

Medications for Seizures

A
  • Dilantain
  • Valium
  • Ativan
  • Versed

Paramedic Flashcards (5 decks)

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