Nervous System Flashcards
SCALP Anatomy (superficial to inferior): Fn:
S:
C:
A:
L:
P:
Fn: protect & insulate (very vascular)
S: Skin
C: Connective tissue
A: Aponeurotica
L: Loose connective (areolar) tissue
P: Periosteum (pericranium)
Monroe-Kellie doctrine, which states:
Intracranial volume(fixed)=Brain volume(to include any mass or lesion volume) + CSF volume + Blood volume
Any expanding lesion within the cranium results in
a increase in intracranial pressure
Vomiting w/ head injury is a frequent result of:
= Increasing intracranial pressure
CPP)
CPP form/:
If MAP falls below 50 mmHg:
= Cerebral Perfusion Pressure provides cerebral blood flow
= MAP - ICP
= normal ICP reduces CPP to critical levels.
Flow ends/drains:
= Venous drainage occurs initially through bridging veins that drain cerebral surface & “bridge” w/ dural sinuses (large, thin-walled veins) & ultimately drain into internal jugular veins & lastly superior vena cava.
Most head injury PTs who’re in a coma & likely to need endotracheal intubation have a GCS score of:
8 or less
Material that surrounds gray matter in the spinal cord & is made up largely of axons is called:
The covering that protects the entire spinal cord and peripheral nerve roots is called the:
= White matter
- Spinal meninges
Most of the cranial cavity is occupied by the:
Cerebrum
The cauda equina, is located:
Vertebra C-2 is known as:
Vertebra C-1 is known as:
= Below the level of L2
= the Atlas
= the axis
The spinal cord ends in the area of:
By adulthood, sections of spinal column that’ve fused are:
= L1/L2
= Coccyx & Sacrum
Most frequent cause of trauma death:
Most common penetrating head wounds:
= Severe head trauma
= gun shot wounds
Sig/ head injury PT should receive/maintain oxy/ if < than:
If spinal injury is suspected, head & neck should be pos/ed:
Hypos for brief time can worsen outcome of head injuries:
= 96%
= gently moved into a Neutral position
= hypotension & hypoxia
S/S of this type of hemorrhage may take hours, or even days to develop:
Subdural hematoma
lobe that controls Fns as N/V reflex, hunger, thirst, & temp:
Hypothalamus
When brain tissue is pushed through an opening (due to increasing intracranial pressure), it is called:
Herniation
The sensory components of the spinal nerves that innervate specific and discrete surface areas are called:
Dermatomes
Cerebrum) lobes
= occipital, temporal, parietal, frontal
Foreman magnum Fn & relation w/ brain
hole for SC & Brain stem sit right above hole
Meninges) Protective membranes that cover the entire CNS:
Layers of the meninges:
= Protective membranes the cover the entire CNS
= Dura, Arachnoid Mater, & Pia Mater
Both brain & SC bathed in what acting as cushion & vol:
= CSF~150mL; watery, clear fluid that acts as cushion
Mid brain) 1 Hypothalamus:
2 Thalamus:
= “homeostasis” Endocrine Fn, N/V reflex, hunger, thirst, kidney Fn, body temps, emotions
= Establishes & maintains consciousness; pathways for optic & olfactory nerves
Cerebellum Fn:
location:
Brainstem + Cerebellum:
= Coordinates: Fine Motor, Posture, Equilibrium, M. tone, CN8
= Located in the posterior fossa
= Hindbrain (Contains 2 hemispheres)
Reticular Activating System (RAS) built of
Works by:
Drugs that effect RAS:
= network of interconnected neurons in brainstem
= Ascending fibers carry signals to activate cerebral cortex Associated w/ LOC, REM sleep, & filtering background noise
= benzos ketamine etimodomite
CNS blood supply) 1 Brain receives ~ of body’s blood flow/min:
2 Circle of Willis:
3 comprised of:
1= ~15- 20%
2= system “circle of feeders” coming off 4 arteries that provide supplements (blood oxy glucose) to brain
3= Carotid system (anterior) & Vertebrobasilar system (posterior)
Brain perfusion] Cerebral Perfusion Pressure (CPP) form:
MAP’s relation w/ perfusion:
Head injury PTs will have increase BP b/c:
= MAP – ICP (Norm/ ICP between 5-15 mmHg average 10mL)
= MAP needs to stay > ICP to maintain brain perfusion
= increase MAP helps to keep the MAP>ICP. (bodys attempt to compensate)
Blood-Brain Barrier) built so:
Prevents & Protects:
= CNS capillary walls thicker, more complete, not as permeable as elsewhere in body.
= Doesn’t permit interstitial flow of proteins & materials as freely as normal capillaries, Protects w/ need lipid loving to get through, anything that can get through can cause damage
Ears) Pinna:
External auditory canal Glands:
Middle & inner ear:
Semicircular canals:
= Visible outer portion of the ear
= secrete wax (cerumen) for protection
= Structures required for hearing
= balance/ equilibrium
Vertebral Column) 5 sections of spine:
Sections vertebrae:
Atlas & Axis:
w/ sublex PT, never:
= Cervical, Thoracic, Lumbar, Sacral, Coccyx
= C7, T12, L5, S5, Cx 4
= C1 den of axis between C1&2, axis “holds world” your head
= force sublex into neutral position
Spinal Canal) Vertebral Foramen:
Articular facets:
Back, chest, pelvic muscles provide:
kids can hyperflex more vs adults b/c:
= Contains and protects spinal cord
= form joint between vertebra (above & below) Held in place by various lig/s
= supports. (post&anterioer longitudinal ligament) (Intervertebral disc & body of vertebral)
= kids have larger wedges compared to adults
Spinal Cord) length & width:
SC conducts impulses:
Pairs of nerve fibers exiting SC:
Nerve fibers terminate @:
If cauda equina compressed too long:
= Approximately 18 inches long & ½ inch wide
= Conducts impulses to & from PNS & for some reflexes
= 31 pairs of N. fibers out SC
= L1or L2 / Cauda Equina “Horse Tail”
= can loose bladder cord/control, lower extrm sense
SC) Pyramidal Tract:
Posterior Columnus:
Spinothalamic Tract:
= Motor fn. on the same side
= Position & vibration sensation on the same side
= Pain & temp sensation to opposite side
Traumatic Brain Injury (TBI) axon tear:
injury type to:
= Trauma to brain capable of physical, intellectual, emotional, social, & vocational changes.
= direct or indirect injury to the tissue of the cerebrum,
Cerebellum, or brainstem
Coup Injuries:
Contrecoup Injuries:
= Occur directly at the point of impact as the brain moves towards and collides with the interior of the skull
= Occurs at the opposite side of the direct impact * Brain sloshes backward and collides with the interior of the skull
Epidural Hematoma) what & where:
Nearly always the result of:
Commonly hand & hand w/:
= Accumulation of blood between the skull and dura mater
= blow to the head that produces a linear fracture
= hand & hand w/ basilar skull fracture
Epidural Hematoma)
= Hx head trauma, Rapid onset of symptoms, LOC, Lucid interval (min-hours), +ICP w/ N/V/AMS, Lapse in unconsciousness, paralysis on contralateral side of head injury, Dilated, fixed pupil on ipsilateral side., Death
PTs usually have better outcome b/c acute symptoms
H/A, blurry vision, N/V
Venous fast bleed
Subdural Hematoma) what & where:
Occurs after or w/:
Deadly b/c:
Meningies involveved & most common vessel:
= Accumulation of blood beneath dura mater but outside brain = falls or injuries involving strong deceleration forces
= Venous bleed slower S/S onset slower High mortality
= Dura & arachnoid involved} Most common vessel is the superior sagittal sinus
Intracerebral Hemorrhage) located @ & from:
Note w/ symptomology:
S/S:
= w/in brain tissue w/ Penetrating & blunt injuries
= may vary, mimics CVA, Depends on regions & severity
= AMS commonly, Thunderclap H/A, Vomiting, 1 dilated pupil, rapid deterioration
Mild Axonal Injury) S/S of a Mild Concussion:
Dont need what in order to to sustain concussion
– AMS that gradually improves – Combativeness – Amnesia * Retrograde & anterograde – Repetitive questioning
= LOC
Diffuse Axonal Injury) Caused by:
3 Classification categories:
Nerves can repair selfs b/c schwan cells but never back to 100 b/c scar tissues (make new neurons daily)
= direct blow to the head * Severe acceleration/deceleration
= Mild diffuse axonal injury (mild concussion) – Moderate diffuse axonal injury (classic concussion) – Severe diffuse axonal injury (brainstem injury)
Intracranial Perfusion) Brain perfusion may be disrupted by:
Any reduction in cerebral blood flow triggers:
If pressure continues to expand:
Brain’s response to high CO2 & increasing ICP causes:
= increasing ICP, hypotension,
= BP rise (autoregulation) for adequate cerebral perfusion
= ICP becomes so high, ICP can impead on Fn or SC
= hyperventilation and hypertension
Brain Injury) 1 S/S:
2 Treatment of Brain Herniation:
3 Vent/ing Brain Herniation:
4 Do not let PT become:
5 Note with ETCO2 & ICP:
1= AMS, Alterations in personality, Amnesia, Cushing’s triad
2= Maintain ETCO2 between 30-40, Vent/ at upper end of norm/, Admin IV fluids for SBP 90-100,
3= Adults: No more 20 per/min, Children: No more 30per/min Infants: No more 35 per/min
4= hypoxic or hypovolemic
5= Norm ETCO2 35-45 but controlled hypervent/ 30-40
(if overoxygenate can actually decrease amount going to brain)
Moderate Axonal Injury) MOI:
Severity:
= Shearing, stretching, tearing of axons occurs; minute brain tissue bruising.
= “classic concussion”, severity> mild concussion (Maybe basilar fracture) rq moderate amounts of injury)
Indirect Brain Injury) def/:
Cause:
= Diminishing circulation to brain tissue (ICP)
= Increasing ICP exacerbated by hypoxia, hypercarbia, systemic hypotension(must maintain BP & O2)
Severe Axonal Injury) def/:
qualification/ usually needs:
PT outcome:
= Sig/ mechanical disruption of axons in both cerebral hemispheres w/ extension into brainstem
= (rq sig energy) usually full LOC & require quick intervention)
= Many PTs don’t survive or have some permanent neurologic impairment
Brain Herniation) def/:
Initial stages:
Late Stage:
S/S:
Para/Sympathetic Nervous System affect:
= Trauma causes swelling inside skull
= blood & CSF are compressed out.
= Increasing ICP forces brain out foramen magnum (can cause cushings)
= 1 pupil sluggish or dilated, or unequal (anisocoria), Decorticate or Decerebrate posturing, Abnorm/ Resp/s, Severe altered/LOC, Weakness/Paralysis, Projectile vomiting
= Cuts off PSNS response thus + SNS (SNS thoracic lumbar) (PSNS cranial sacral)
Spinal Cord Injuries) Flexion Injury:
Hyperextension Injury:
Compression Injury:
Flexion-Rotation Injury:
Distraction Injury:
Penetration Injury: (stabbing or severing SC)
= head forward
= head back
= crushing vertabrae ex diving/ hitting head
= hanging/internal decap
= spine flexes & extends w/ too much force
= Penetration Injury (stabbing or severing SC)
Spinal Cord Injuries) Concussion(swelling):
Contusion(bruising):
= Temporary & transient disruption of cord function
= Bruising SC, Likely repair itself w/ limited residual deficits
SC Compression:
Damage:
Rx:
IF pt aint breathing:
= 2ndary to displacement of a vertebral body;
= Restricted perfusion, ischemic damage, maybe SC damage
=Try to do appropriate might need to go out of box
= take over ventilations, then try protect
SC Laceration:
Minor lacerations outcome:
Sig/ or severe lacerations outcome:
= Bony frags/sharp objects driven into vertebral foramen or SC stretched to point of tearing
= some recovery expected
= permanent neurologic deficit
SC Hemorrhage:
irritation by:
Note w/ location:
= Disrupting blood flow from Increased pressure from accumulating blood
= blood passing through blood–brain barrier (blood & brain/SC fluid dont mix well)
= Lower SC injury better outcome & Diaphragm C3/4!!!!
SC Transection:
Thoracic spine:
Cervical spine:
Lumbar spine:
= Partially or completely cut in SC w/o Potential to send & receive nerve impulses below injury
= Incontinence & paraplegia
= Partial/complete resp/ paralysis, quadriplegia, incontinence
SC SCIWORA) def/:
Mostly seen in:
Scanning:
= SC Injury w/o Radiographic Abnormality
= Mostly seen in children, but occasionally in elderly.
= X-Ray & CT normal but MRI will show injury
SC Injuries) S/S:
Step offs:
SC injuries w/ PEDIs & Adults:
= EXTRMs Paralysis, Pain w/ & w/o M-nt, SC Tenderness, Impaired breathing, Priapism(~>C3 & higher injury), Posturing, Loss of bowel/bladder control, EXTRM Nerve impairment
= vertebrae moves, moving vertebrae usually mean fracture, PSNS responsible for priapism,
= not common but possible in PEDIs w/ C2 most common & C5-7 for adult
Spinal Cord Syndromes) Anterior Cord Syndrome:
Results from:
S/S:
Commonly seen w/:
= bony frag/s or pressure compressing arteries of anterior SC
= severe extension-flexion injury
= Loss of motor, sensory, light, & temp/ Fn below injury site
= Old & pedis rear end MVC w/ improper head restraint
Central Cord Syndrome) Usually results from:
Considered what type of injury:
S/S:
More commonly seen in patients:
= hyperextension of the cervical spine
= incomplete cord injury
= motor loss/weakness to upper EXTRMs & bladder Fn loss
= >50 years of age &/or w/ arthritis
SC Syndromes) * Brown-Sequard Syndrome: – Caused by a penetrating injury (hemitransection) – Motor & sensory loss to ipsilateral side – Pain and temperature loss to contralateral side
Right side injury: motor & fine sensory to right side, temp & pain to left side & reverse/vice-versa for left side injury
- Brown-Sequard Syndrome: – Caused by a penetrating injury (hemitransection) – Motor & sensory loss to ipsilateral side – Pain and temperature loss to contralateral side
Right side injury: motor & fine sensory to right side, temp & pain to left side & reverse/vice-versa for left side injury
Cauda Equina Syndrome) def:
Usually caused by:
S/S:
= Nerve roots @ lower end of SC are compressed
= herniated disc, tumor or infection
= Loss of bowel & bladder control – Saddle anesthesia
Spinal Shock) def:
S/S:
Duration:
= Temp/ insult to SC affecting body below Lvl of injury
= Area becomes flaccid & loses feeling, Paralysis below injury, bladder/bowel loss, Loss of temp control below injury site
= Most often temporary but can lead to warm shock
Neurogenic Shock) def:
Problems:
Occurs @ causing:
= SC/Brain Injury disrupts ability to control body autonomic Fns = “pipe” problem, Unable to maintain BP, Severe reduction CO
= above T-vertebrae, loss of all SNS innervation, causing widespread BP plummet
CLs) Temporal Lobe) know:
Functions:
= sensory processor
= Hearing & auditory processing, memory storage (hippocampus is located here), language comprehension (Wernicke’s area, typically left hemisphere), emotional responses & smell processing.
Diceph/) Insular Lobe) know by: Critical processor
Fns:
Location:
= Critical processor
= Taste perception, emotional responses & self-awareness, visceral functions (EX: heartbeat, breathing).
= Deep within the lateral sulcus, beneath the frontal & temporal lobes. (hidden beneath temporal & frontal lobes)
Occipital Lobe) know by: all ojos
Functions: Visual processing & interpretation, recognizing shapes, colors, & motion
= all ojos
= Visual processing & interpretation, recognizing shapes, colors, & motion
CLs) Frontal Lobe) know by:
Fn:
= Personality
= Motor control (primary motor cortex), problem-solving, decision-making, & planning (executive functions), personality & emotions, speech production (Broca’s area, typically left hemisphere).
Parietal Lobe) Know:
Function:
= Sensory perception (touch, temperature, pain)
= Sensory perception (touch, temp, pain), spatial orientation & awareness of body position, understanding language (Wernicke’s area, typically left hemisphere).
Choroid plexus) located & Fn:
CSF flow starts at 1:
CSF through surrounding 2:
CSF returned to3:
CSF dumped off 4:
=in brain ventricles gen/s CSF in largest 2-4 ventricles
= lateral ventricles to 3rd & 4th ventricle
= through subarachnoid space surrounding brain & SC
= venous circulation through arachnoid granulations
= dural sinuses of brain & through spinal arachnoid space to arachnoid villi found @ end of SC (spinal cistern)
Gray matter:
White matter:
= (cell bodies) sensory processing
= mostly comprising communication pathways (axons) motor
Nasal cavity) formed by:
def/:
Turbinate’s:
Lower cavity:
soft palate:
= juncture of the ethmoid, nasal, and maxillary bones
= channel running posteriorly w/ bony septum dividing it into L&R-chambers & plates protruding medially from lateral sides
= form support for vascular mucous membranes that warm, humidify, & collect particulate matter from the incoming air.
= bordered by bony hard palate & cartilaginous soft palate posteriorly
= moves upward to close posterior nasal cavity opening during swallowing.
Vertebral arch is formed:
pedicles:
Laminaes:
transverse processes & superior & inferior articular processes project from: (Figure 57-12). The superior and inferior articular processes (otherwise known as facet joints) comprise the joints between one vertebra and the vertebrae immediately above and below it.
= 2 pedicles & laminaes
= protrude posteriorly connecting vertebral body to laminae
= posterior to pedicles & connect midline spinous process to pedicles on either side.
= the junction of the pedicles and the laminae
intervertebral disc) def:
Nucleus pulposus:
Annulus fibrosus:
= separates each vertebrae but C1/2 & fused vertebrae of sacrum & coccyx
= inner sphere, gelatinous and absorbs compressive stress
= outer collar, contain the nucleus pulposus.
The major supporting ligaments are the anterior longitudinal ligament and the posterior longitudinal ligament (Figure 57-13). The anterior longitudinal ligament runs vertically along the anterior surface of the vertebral body from the sacrum to the first cervical vertebra and onto the skull’s occipital bone. This ligament helps to prevent hyperextension of the vertebral column. The posterior longitudinal ligament is narrower and weaker than the anterior longitudinal ligament. It runs vertically along the posterior surfaces of the vertebral bodies in the vertebral canal from the sacrum to the second cervical vertebra. The posterior longitudinal ligament helps to prevent hyperflexion of the vertebral column.
Vertebral ligaments:
ligamentum flavum:
interspinous ligament:
supraspinous ligament:
nuchal ligament:
= Primarily located posteriorly & connect vertebrae together
= strongest supporting ligament of vertebral column, helps maintain curvatures of spine & straighten spine after flexing
= Thin ligament connects spinous processes of 2 adjoining vertebrae together
= runs posteriorly along the spinous processes from the seventh cervical vertebra to the sacrum
= protects & supports the neck. It runs from the seventh cervical vertebra to the skull’s occipital bone
white matter, then form three bundles or columns of myelinated (covered with a protein sheath) nerve fibers on each side of the cord around the gray matter: the anterior white column, the lateral white column, and the posterior white column. This white matter composed of nerve cell pathways called axons contains bundles of axons that transmit signals upward to the brain in what are called ascending tracts and bundles that transmit signals downward through the cord in what are called descending tracts. These tracts are paired with one ascending and one descending on each side. Injury can affect either or both.
white matter, then form three bundles or columns of myelinated (covered with a protein sheath) nerve fibers on each side of the cord around the gray matter: the anterior white column, the lateral white column, and the posterior white column. This white matter composed of nerve cell pathways called axons contains bundles of axons that transmit signals upward to the brain in what are called ascending tracts and bundles that transmit signals downward through the cord in what are called descending tracts. These tracts are paired with one ascending and one descending on each side. Injury can affect either or both.
Spinal Nerve Plexuses) def/:
Locations:
Key myotomes for neurologic evaluation:
Dermatomes
= sensory components of spinal nerves innervate specific & discrete surface areas called dermatomes
= distributed from the occiput of the head to the heel of the foot and buttocks.
= arm extension (C-5), elbow extension (C-7), small finger abduction (T-1), knee extension (L-3), & ankle (plantar) flexion (S-1).
Shortened Nrv. pathway involved in a reflex action is:
Speed of reflex ultimately allows for
= reflex arc
= quick responses, reducing the seriousness of injury. Other reflexes help stabilize the body if it stands in one position for a length of time.
Spinal cord injuries include
concussion, contusion, compression, laceration, hemorrhage, and transection.
CN 1:
= Olfactory → smell “1 nose”
CN 2:
= Optic → vision (sensing light) “2 eyes”
CN 3:
= Oculomotor: pupil m-vt (controls pupils sizes) “3 words cocaine constricts pupils”
CN 4:
= Trochlear: eye motor function (look up & down) “it go up, down, up, down”
CN 5:
= trigeminal “suicide “= chewing muscles (chewing mastication), Sensory→Ophthalmic (forehead), maxillary (cheek)& mandibular (chin) “5 fingers to the face/chew”
CN 6:
= abducens= Lateral Eye m-vt “6 letters (TO SIDE)”
CN 7:
= facial: controls facial expressions, taste @ front 2/3s of tongue, & some F.s of salivary & lacrimal glands “L I C K M A D”
CN 8:
= vestibulocochlear= sense hearing, balance, equilibrium
CN 9:
= glossopharyngeal= controls taste @ back of tongue, helps w/ swallowing by saliva production. “9 lime”
CN 10:
= vagus “wondering” parasympathetic F.s: HR, digestion, & RR & also provides sensory info from throat & voice box.
CN 11:
= Accessory = traps Muscles motor
CN 12:
= Hypoglossal = motor tongue control out “12 & 21 baskin robin flavors”
Cranial nerves carrying parasympathetic nerve fibers?
CN: 3,7,9,10
Ocular Muscles do what & Innervated by 3CNs:
Remember by:
= control eye m-nt by Oculomotor (CN-III), trochlear (CN-IV),& abducens (CN-VI)
= OCULAR MUSCLES is 13 letters = CN 3+4+6
Cranial nerves name mnemonic:
Cranial nerve names:
= “Oh, Oh, Oh, To Touch And Feel A Girl’s Vagina, Such Heaven!
1. Olfactory
2. Optic
3. Oculomotor
4. Trochlear
5. Trigeminal
6. Abducens
7. Facial
8. Vestibulocochlear (or Auditory)
9. Glossopharyngeal
10. Vagus
11. Spinal Accessory
12. Hypoglossal
Cranial nerve types mnemonic:
Nerve types:
= “Some Say Marry Money, But My Bitch Says Big Boobs Matter Most.”
= 1. Olfactory - Sensory
2. Optic - Sensory
3. Oculomotor - Motor
4. Trochlear - Motor
5. Trigeminal - Both
6. Abducens - Motor
7. Facial - Both
8. Vestibulocochlear (or Auditory) - Sensory
9. Glossopharyngeal - Both
10. Vagus - Both
11. Spinal Accessory - Motor
12. Hypoglossal - Motor
Cranial nerve location mnemonic:
Nerve locations:
= “Sexy EMTs Play Erotic Jokes, Exciting Their Erotic Lover’s Asshole Stimulating Them.”
= Sniffer- smells (Olfactory)
= Eyes - Eyesight (Optic)
= Pupils - Pupils & eye movement (Oculomotor)
= Eyes = eyes movement (Trochlear)
= Jaw -mastication (Trigeminal: sense face & motor jaw)
= Eyes - Eye movement (Abducens)
= Taster - Taste & facial expression (Facial)
= Ears - Ears hearing & balance (Vestibulocochlear)
= Licker- tongue taste & swallow (Glossopharyngeal)
= ABDMN- Autonomic control thorax & ABDMN (Vagus)
= Shoulders -shrug & neck m-nt (Spinal Accessory)
= Tongue - Tongue movement (Hypoglossal)
pre-Botzinger complex:
VRG ventral respiratory group:
DRG dorsal respiratory group:
Pontine resp group=
= “Sa node” of the RR
= transmits signals via phrenic nerve & intercostal nerves
= keeps in check w/ VRG “Backhand man”
= smooths out transition of inhalation & exhalation
Hering-Breuer reflex=
prevents over expansion of lungs from inhalation>
During inspiration, lungs become distended, activating stretch receptors.
chemoreceptors=
in the carotid bodies and in the arch of the aorta. These chemoreceptors are stimulated by decreased PaO2, increased PaCO2, and decreased pH
Kiesselbach area(little area)=
where 4 different arteries connect together→ super vascular
Pre-Botzinger complex=
“Sa node” of the RR
VRG ventral respiratory group=
transmits signals via the phrenic nerve & intercostal nerves
DRG dorsal respiratory group=
keeps in check w/ VRG
Pontine respiratory group=
smooths out transition of inhalation & exhalation
Baroreceptors) Fn:
A&P:
= receptors that monitor blood pressure
= Great vessels recept/ Gives feedback to brain > Sympathetic NS Activation, AArch & carotid arteries> feedback to medulla >SNS
Monro-Kellie Doctrine:
in short:
= The pressure-vol/ relationship between ICP, Vol/ of CSF, blood, brain tissue, & CPP
= In the fixed space of the cranial cavity, when one increases, the others must decrease
Cerebrum) 1 Frontal Lobe
2 Broca’s Area
3 Central Sulcus/Fissure
4 Parietal Lobe
5 Postcentral Gyrus
6 Precentral Gyrus
7 Occipital Lobe
8 Temporal Lobe “Hearing & Language”
9 Cerebellum “Balance & Coordination” fine motors
10 Pons
11 Medulla Oblongata
12 Corpus callousum
1= “Personality”
2= Broca’s Area
3= Central Sulcus/Fissure
4= “Sensory” Wernicke’s Area “speech comprehension”
5= Primary sensory cortex
6= Primary motor cortex
7= “Vision”
8= “Hearing & Language”
9= “Balance & Coordination” fine motors
10= Pons
11= Medulla Oblongata
12= Corpus callousum
Body makes how much CSF in 24Hrs
What structure is maker:
~500-600mL
CNS) The Brain: Makes up ~ what% of cranial vault
Cranium’s 3 major structures
= 80%
= Cerebrum, Cerebellum, Brainstem
Drugs that effect RAS:
= hypnotic drugs EX benzos ketamine editomite
CNS blood supply) 1 Brain’s % of body weight & uses for ATP
2 Brains Oxy & glucose consumption:
Brain is supplied by:
1= 2% }Uses lots of blood & oxy, can only use glucose for ATP
2= Consumes 25% of body’s glucose & 20% of oxygen supply
3= Circle of Willis} Carotid system (anterior) & Vertebrobasilar system (posterior)
CN 3,7,9,10
Pupil correlates w/ L. of injury EX right pupil blown is right brain trauma
Trigeminal neuralgia aka:
tic douloureux
Thumbs up test:
Stroke:
= could be used to potentially determine bells palsy vs stroke
= same side face & opposite side motor
Jaw wire shut: cut if absolute need airway access} cut wires going bottom to top
Wire jaw PTs will go back into surgery if wires cut bc mandible if mandible broken, theyll not be able to open mouth
Maxilla fractures require immense force
NEVER LET HEAD INJURY PTs
HYPOXIC & HYPOTENSIVE
Contrecoup) def/:
S/S:
Most common injury:
= brain “sloshes” toward impact & then away from it, again impacting the skull’s interior
= blow to forehead might cause injury to the occipital region (visual center) & produce visual disturbances (“seeing stars”).
= frontal (from impact to occipital) b/c frontal bones have irregular inner surface.
Any expanding lesion within the cranium results in
a increase in intracranial pressure
Flow ends/drains:
= Venous drainage occurs initially through bridging veins that drain cerebral surface & “bridge” w/ dural sinuses (large, thin-walled veins) & ultimately drain into internal jugular veins & lastly superior vena cava.
Most head injury PTs who’re in a coma & likely to need endotracheal intubation have a GCS score of:
8 or less
Most of the cranial cavity is occupied by the:
Cerebrum
The spinal cord ends in the area of:
By adulthood, sections of spinal column that’ve fused are:
= L1/L2
= Coccyx & Sacrum
lobe that controls Fns as N/V reflex, hunger, thirst, & temp:
Hypothalamus
The sensory components of the spinal nerves that innervate specific and discrete surface areas are called:
Dermatomes
Cerebrum) lobes
= occipital, temporal, parietal, frontal
Foreman magnum Fn & relation w/ brain
hole for SC & Brain stem sit right above hole
Meninges) Protective membranes that cover the entire CNS:
Layers of the meninges:
= Protective membranes the cover the entire CNS
= Dura, Arachnoid Mater, & Pia Mater
Mid brain) 1 Hypothalamus:
2 Thalamus:
= “homeostasis” Endocrine Fn, N/V reflex, hunger, thirst, kidney Fn, body temps, emotions
= Establishes & maintains consciousness; pathways for optic & olfactory nerves
Cerebellum Fn:
location:
Brainstem + Cerebellum:
= Coordinates: Fine Motor, Posture, Equilibrium, M. tone, CN8
= Located in the posterior fossa
= Hindbrain (Contains 2 hemispheres)
CNS blood supply) 1 Brain receives ~ of body’s blood flow/min:
2 Circle of Willis:
3 comprised of:
1= ~15- 20%
2= system “circle of feeders” coming off 4 arteries that provide supplements (blood oxy glucose) to brain
3= Carotid system (anterior) & Vertebrobasilar system (posterior)
Blood-Brain Barrier) built so:
Prevents & Protects:
= CNS capillary walls thicker, more complete, not as permeable as elsewhere in body.
= Doesn’t permit interstitial flow of proteins & materials as freely as normal capillaries, Protects w/ need lipid loving to get through, anything that can get through can cause damage
Ears) Pinna:
External auditory canal Glands:
Middle & inner ear:
Semicircular canals:
= Visible outer portion of the ear
= secrete wax (cerumen) for protection
= Structures required for hearing
= balance/ equilibrium
Spinal Canal) Vertebral Foramen:
Articular facets:
Back, chest, pelvic muscles provide:
kids can hyperflex more vs adults b/c:
= Contains and protects spinal cord
= form joint between vertebra (above & below) Held in place by various lig/s
= supports. (post&anterioer longitudinal ligament) (Intervertebral disc & body of vertebral)
= kids have larger wedges compared to adults
Coup Injuries:
Contrecoup Injuries:
= Occur directly at the point of impact as the brain moves towards and collides with the interior of the skull
= Occurs at the opposite side of the direct impact * Brain sloshes backward and collides with the interior of the skull
Epidural Hematoma) what & where:
Nearly always the result of:
Commonly hand & hand w/:
= Accumulation of blood between the skull and dura mater
= blow to the head that produces a linear fracture
= hand & hand w/ basilar skull fracture
Epidural Hematoma)
= Hx head trauma, Rapid onset of symptoms, LOC, Lucid interval (min-hours), +ICP w/ N/V/AMS, Lapse in unconsciousness, paralysis on contralateral side of head injury, Dilated, fixed pupil on ipsilateral side., Death
PTs usually have better outcome b/c acute symptoms
H/A, blurry vision, N/V
Venous fast bleed
Subdural Hematoma) what & where:
Occurs after or w/:
Deadly b/c:
Meningies involveved & most common vessel:
= Accumulation of blood beneath dura mater but outside brain = falls or injuries involving strong deceleration forces
= Venous bleed slower S/S onset slower High mortality
= Dura & arachnoid involved} Most common vessel is the superior sagittal sinus
Diffuse Axonal Injury) Caused by:
3 Classification categories:
Nerves can repair selfs b/c schwan cells but never back to 100 b/c scar tissues (make new neurons daily)
= direct blow to the head * Severe acceleration/deceleration
= Mild diffuse axonal injury (mild concussion) – Moderate diffuse axonal injury (classic concussion) – Severe diffuse axonal injury (brainstem injury)
Spinal Cord Syndromes) Anterior Cord Syndrome:
Results from:
S/S:
Commonly seen w/:
= bony frag/s or pressure compressing arteries of anterior SC
= severe extension-flexion injury
= Loss of motor, sensory, light, & temp/ Fn below injury site
= Old & pedis rear end MVC w/ improper head restraint
Central Cord Syndrome) Usually results from:
Considered what type of injury:
S/S:
More commonly seen in patients:
= hyperextension of the cervical spine
= incomplete cord injury
= motor loss/weakness to upper EXTRMs & bladder Fn loss
= >50 years of age &/or w/ arthritis
Reflex arc:
Acquires impulse speed via:
= sensory ascending Nrv. pathway involved in reflex action
= Short pathway
Pons:
Medulla Oblongata:
= Communication interchange between CNS components
= Respiratory center, cardiac center, vasomotor center.
Cauda Equina Syndrome) def:
Usually caused by:
S/S:
= Nerve roots @ lower end of SC are compressed
= herniated disc, tumor or infection
= Loss of bowel & bladder control – Saddle anesthesia
SC) 1 white matter surround & covered w/
2 White matter forms what bundles/columns:
3 White matter composed of:
4 Ascending SC tracts Fn:
1= surround Gray matter & covered w/ myelinated Nrv-fibers
2= Anterior, Lateral, & Posterior white columns
3= (Axons) Nrv-cell pathways
4= Transmit sense/info signals up to brain
Neurogenic Shock) def:
Problems:
Occurs @ causing:
= SC/Brain Injury disrupts ability to control body autonomic Fns = “pipe” problem, Unable to maintain BP, Severe reduction CO
= above T-vertebrae, loss of all SNS innervation, causing widespread BP plummet
SC) 1 white matter surround & covered w/
2 White matter forms what bundles/columns:
3 White matter composed of:
4 Descending SC tracts:
1= surround Gray matter & covered w/ myelinated Nrv-fibers
2= Anterior, Lateral, & Posterior white columns
3= (Axons) Nrv-cell pathways
4= message/effector to end of tract “Brain to Motor)
CLs) Temporal Lobe) know:
Functions:
= sensory processor
= Hearing & auditory processing, memory storage (hippocampus is located here), language comprehension (Wernicke’s area, typically left hemisphere), emotional responses & smell processing.
Categories of Motor Pathways:
Categories of somatosensory Pathways:
=
= posterior funiculus-medial lemniscal pathway, Anterolateral pathway, Spinocerebellar pathway
Occipital Lobe) know by: all ojos
Functions: Visual processing & interpretation, recognizing shapes, colors, & motion
= all ojos
= Visual processing & interpretation, recognizing shapes, colors, & motion
CLs) Frontal Lobe) know by:
Fn:
= Personality
= Motor control (primary motor cortex), problem-solving, decision-making, & planning (executive functions), personality & emotions, speech production (Broca’s area, typically left hemisphere).
Parietal Lobe) Know:
Function:
= Sensory perception (touch, temperature, pain)
= Sensory perception (touch, temp, pain), spatial orientation & awareness of body position, understanding language (Wernicke’s area, typically left hemisphere).
Choroid plexus) located & Fn:
CSF flow starts at 1:
CSF through surrounding 2:
CSF returned to3:
CSF dumped off 4:
=in brain ventricles gen/s CSF in largest 2-4 ventricles
= lateral ventricles to 3rd & 4th ventricle
= through subarachnoid space surrounding brain & SC
= venous circulation through arachnoid granulations
= dural sinuses of brain & through spinal arachnoid space to arachnoid villi found @ end of SC (spinal cistern)
Gray matter:
White matter:
= (cell bodies) sensory processing
= mostly comprising communication pathways (axons) motor
Vertebral arch is formed:
pedicles:
Laminaes:
transverse processes & superior & inferior articular processes project from: (Figure 57-12). The superior and inferior articular processes (otherwise known as facet joints) comprise the joints between one vertebra and the vertebrae immediately above and below it.
= 2 pedicles & laminaes
= protrude posteriorly connecting vertebral body to laminae
= posterior to pedicles & connect midline spinous process to pedicles on either side.
= the junction of the pedicles and the laminae
intervertebral disc) def:
Nucleus pulposus:
Annulus fibrosus:
= separates each vertebrae but C1/2 & fused vertebrae of sacrum & coccyx
= inner sphere, gelatinous and absorbs compressive stress
= outer collar, contain the nucleus pulposus.
Vertebral ligaments:
ligamentum flavum:
interspinous ligament:
supraspinous ligament:
nuchal ligament:
= Primarily located posteriorly & connect vertebrae together
= strongest supporting ligament of vertebral column, helps maintain curvatures of spine & straighten spine after flexing
= Thin ligament connects spinous processes of 2 adjoining vertebrae together
= runs posteriorly along the spinous processes from the seventh cervical vertebra to the sacrum
= protects & supports the neck. It runs from the seventh cervical vertebra to the skull’s occipital bone
white matter, then form three bundles or columns of myelinated (covered with a protein sheath) nerve fibers on each side of the cord around the gray matter: the anterior white column, the lateral white column, and the posterior white column. This white matter composed of nerve cell pathways called axons contains bundles of axons that transmit signals upward to the brain in what are called ascending tracts and bundles that transmit signals downward through the cord in what are called descending tracts. These tracts are paired with one ascending and one descending on each side. Injury can affect either or both.
white matter, then form three bundles or columns of myelinated (covered with a protein sheath) nerve fibers on each side of the cord around the gray matter: the anterior white column, the lateral white column, and the posterior white column. This white matter composed of nerve cell pathways called axons contains bundles of axons that transmit signals upward to the brain in what are called ascending tracts and bundles that transmit signals downward through the cord in what are called descending tracts. These tracts are paired with one ascending and one descending on each side. Injury can affect either or both.
Spinal Nerve Plexuses) def/:
Locations:
Key myotomes for neurologic evaluation:
Dermatomes
= sensory components of spinal nerves innervate specific & discrete surface areas called dermatomes
= distributed from the occiput of the head to the heel of the foot and buttocks.
= arm extension (C-5), elbow extension (C-7), small finger abduction (T-1), knee extension (L-3), & ankle (plantar) flexion (S-1).
Shortened Nrv. pathway involved in a reflex action is:
Speed of reflex ultimately allows for
= reflex arc
= quick responses, reducing the seriousness of injury. Other reflexes help stabilize the body if it stands in one position for a length of time.
Ocular Muscles do what & Innervated by 3CNs:
Remember by:
= control eye m-nt by Oculomotor (CN-III), trochlear (CN-IV),& abducens (CN-VI)
= OCULAR MUSCLES is 13 letters = CN 3+4+6
DRG dorsal respiratory group=
keeps in check w/ VRG
Cerebrum) 1 Frontal Lobe
2 Broca’s Area
3 Central Sulcus/Fissure
4 Parietal Lobe
5 Postcentral Gyrus
6 Precentral Gyrus
7 Occipital Lobe
8 Temporal Lobe “Hearing & Language”
9 Cerebellum “Balance & Coordination” fine motors
10 Pons
11 Medulla Oblongata
12 Corpus callousum
1= “Personality”
2= Broca’s Area
3= Central Sulcus/Fissure
4= “Sensory” Wernicke’s Area “speech comprehension”
5= Primary sensory cortex
6= Primary motor cortex
7= “Vision”
8= “Hearing & Language”
9= “Balance & Coordination” fine motors
10= Pons
11= Medulla Oblongata
12= Corpus callousum
Body makes how much CSF in 24Hrs
What structure is maker:
~500-600mL
CNS) The Brain: Makes up ~ what% of cranial vault
Cranium’s 3 major structures
= 80%
= Cerebrum, Cerebellum, Brainstem
CN 3,7,9,10
Pupil correlates w/ L. of injury EX right pupil blown is right brain trauma
Contrecoup) def/:
S/S:
Most common injury:
= brain “sloshes” toward impact & then away from it, again impacting the skull’s interior
= blow to forehead might cause injury to the occipital region (visual center) & produce visual disturbances (“seeing stars”).
= frontal (from impact to occipital) b/c frontal bones have irregular inner surface.
Reflex arc:
Acquires impulse speed via:
= sensory ascending Nrv. pathway involved in reflex action
= Short pathway
Pons:
Medulla Oblongata:
= Communication interchange between CNS components
= Respiratory center, cardiac center, vasomotor center.
SC) 1 white matter surround & covered w/
2 White matter forms what bundles/columns:
3 White matter composed of:
4 Ascending SC tracts Fn:
1= surround Gray matter & covered w/ myelinated Nrv-fibers
2= Anterior, Lateral, & Posterior white columns
3= (Axons) Nrv-cell pathways
4= Transmit sense/info signals up to brain
SC) 1 white matter surround & covered w/
2 White matter forms what bundles/columns:
3 White matter composed of:
4 Descending SC tracts:
1= surround Gray matter & covered w/ myelinated Nrv-fibers
2= Anterior, Lateral, & Posterior white columns
3= (Axons) Nrv-cell pathways
4= message/effector to end of tract “Brain to Motor)
Categories of Motor Pathways:
Categories of somatosensory Pathways:
=
= posterior funiculus-medial lemniscal pathway, Anterolateral pathway, Spinocerebellar pathway
