Neuro Flashcards
awareness of oneself & environment
consciousness
awakeness
responsiveness to stimuli
arousal
encompasses all cognitive functions
awareness
loss of awareness & mental capabilities
vegetative state
brain can no longer maintain internal homeostasis
brain death
irreversible coma - death of cerebral hemispheres, excluding brain stem & cerebellum
cerebral death
individual aware & thinking, unable to move or communicate
locked in syndrome
inability to interpret sensations & recognize things
agnosia
deficiency in generation of speech and/or comprehension
dysphasia
loss of ability to understand or produce speech
aphasia
abrupt change in brain causing confusion
delirium
sensation perceived by pt preceding condition affecting brain (ex seizure, migraine)
aura
low muscle tone - decreased DTR
hypotonia
high muscle tone - overly active DTR
hypertonia
certain muscles continually contracted
spasticity
inability to relax muscles during muscle tone assessment
paratonia
(oppositional paratonia) - subject involuntarily resists passive movement
Gegenhalten
muscles contract uncontrollably
dystonia
increased muscle tone, stiffness or inflexibility of muscle
rigidity
excessive muscle movement
hyperkinesia
low muscle movement
hypokinesia
muscle weakness caused by nerve damage
paresis
loss of ability to move all or part of body
paralysis
used to assess LOC
Glasgow coma scale
3 parts of the Glasgow coma scale
highest and lowest scores
what score is comatose?
eye opening; verbal response; motor response
3-15
8 or less is comatose
“passing out”
loss of consciousness
overactivity of or problems with pain-sensitive structures in head
primary headache
h/a that is a sx of a problem
secondary headache
“headband” h/a
tension
h/a behind an eye - one drooping eye - runny nose - occur over 7-10 days
cluster h/a
unilateral h/a with aura, photophobia, phonophobia, n/v
migraine
h/a red flags
first h/a in life after 50yo
waking up with h/a
“worst h/a of my life”
thunderclap h/a
sudden uncontrolled electrical disturbance in brain
seizure
having one seizure _____ the threshold for having another
(except in the case of ______ seizures)
lowers
febrile
seizure affecting both sides of brain
generalized
seizure where person stops moving altogether
petit mal
seizures with LOC, bilateral jerking, rigidity and shaking
tonic clonic (grand mal)
_____ is rigidity
_____ is shaking
tonic
clonic
seizure localized in one brain are
focal
2 types of focal seizures
simple partial - one location in brain
complex partial - an area of the brain
one finger or hand shaking indicates a ________ seizure
focal
continuous seizure
status epilepticus
life threatening seizure
status epilepticus
3 potential causes of seizures
bleeding
tumor
epilepsy
Complications - learning difficulty (esp in children); aspiration; biting tongue or mouth; injury from fall; brain damage
seizures
elevated pressure around brain
elevated ICP
potential causes of high ICP
bleeding
swelling
tumor
idiopathic
can cause papilledema - borders around optic nerve are no longer clear
high ICP
irreversible, fatal complication of high ICP
herniation of brain into spinal cavity
edema in brain
cerebral edema
involuntary flexion/extension of arms and legs
indicates severe brain injury
posturing
involuntary flexion of arms into chest, clenched fists, extended legs
decorticate posturing
involuntary extension of upper extremities in response to external stimuli - head arched back, arms extended by sides, legs extended
decerebrate posturing
which type of posturing is “better”?
decorticate
partial or total memory loss
amnesia
loss of memory of things that happened in the past
retrograde amnesia
inability to form new memories
anterograde amnesia
group of symptoms affecting memory, thinking, social abilities
dementia
early signs of dementia
losing recent memories
unable to draw a clock face (MMSE)
interventions for (some) pts with dementia
frequently orient them to surroundings
abnormal deposits of alpha-synuclein in brain
slow dementia
hallucinations
pts may be called “combative”, “violent”
Lewy Body dementia
uncommon dementia affecting frontal & temporal lobes
radical personality changes
frontotemporal dementia
dementia secondary to CVA
sudden “steps down” in function after each event
vascular dementia
Involves amyloid plaques & neurofibrillary tangles - shrinking of the brain
Alzheimer’s
chromosomal anomaly increasing risk for early onset Alzheimer’s
trisomy 21
closed head TBI
no skull fracture
open head TBI
skull fracture
penetration of brain
TBI with displacement of a piece of skull below skull level
depressed skull fracture
area of brain damaged is contralateral to an injury
contrecoup TBI
why does high ICP cause vomiting?
pressure on neurons in medulla
dangerous complication of concussion
second impact syndrome
can cause chronic traumatic encephalopathy
tx concussion
sitting, resting, low light, doing nothing
collection of blood w/i skull
intercranial hematoma
types of intercranial hematoma (based on location)
epidural
subdural
subarachnoid
intercerebral
which types of spinal cord injury are reversible, and which are irreversible?
reversible - bruising
irreversible - ischemia & necrosis
what not to do for a pt with a halo
do not grab the halo
do not raise head of bed without sitting pt up first
temporary loss or depression of spinal cord reflexes below level of a lesion
spinal shock
paraplegia; quadriplegia; flaccid muscle tone; all sensation below transection lost
spinal shock
- Acute elevation in BP with brady/tachycardia
- Massive sympathetic response that cannot be controlled from brain - dual action from both SNS and PSNS
autonomic dysreflexia
Etiology - full bladder or rectum; infection; genital stimulation; other painful stimuli
autonomic dysreflexia
skin differences above & below lesion; blurred vision; h/a; intracranial or subarachnoid hemorrhage; retinal detachment; death
autonomic dysreflexia
Protrusion of nucleus pulposus of intervertebral disc
herniated disc
usual location of herniated discs
lumbosacral
is a herniated or bulging disc more severe?
herniated
herniated disc sx are usually (unilateral/bilateral)
unilateral
inflammation of meninges
meningitis
which pathogens are more/less virulent in meningitis?
virus - less
bacteria - more
r/f - younger population; immunocompromise; crowding (prison, etc); IV drug use; splenectomy; DM; infection; ventroperitoneal shunt (drains CSF into abdomen); alcoholism
meningitis
fever; nucal rigidity (stiff neck); photophobia; n/v; petechiae; confusion
meningitis
how to test for meningitis
lumbar puncture
brain inflammation
encephalitis
usually direct result of necrotic liquefactive pus
brain abscess
unencapsulated brain abscess/inflammation
cerebritis
brain abscess has a __% fatality rate
32
“mini stroke”
transient ischemic attack
stroke that resolves on its own/without intervention
TIA
warning sign of thrombotic CVA
TIA
sudden death of some brain cells due to lack of O2 when bloodflow to brain is impaired by blockage or rupture
cerebral vascular accident
3 types of CVA
thrombotic
embolotic
hemorrhagic
CVA with gradual onset; occurs at rest; minimal ICP elevation; localized
thrombotic
cause of thrombotic CVA
atherosclerosis in cerebral arteries
cause of embolotic CVA
Clot - Systemic source or atherosclerosis in carotid artery
atrial fibrillation increases risk for _____ stroke
embolotic
CVA with sudden onset; minimal ICP elevation; localized
embolotic
CVA with sudden onset; often with activity; elevated ICP; widespread & severe; can be fatal
hemorrhagic
cause of hemorrhagic stroke
bleeding in brain
localized dilation of cerebral vessel
intracranial aneurysm
2 demyelinating disorders
Guillan barre
multiple sclerosis
demyelination in PNS
guillian barre
demyelination in CNS
MS
ascending paralysis; prickling; paresthesia; weakness; unsteady gait
guillian barre
s/s - variable, may change unexpectedly - numbness; tremor; visual impairment; speech problems; fatigue; dizziness; alteration in bladder or bowel function
MS
Autoimmune - Type II hypersensitivity- postsynaptic muscle membrane is distorted and simplified
myasthenia gravis
what is going on with ACh in myasthenia gravis?
ACh released normally, but receptors on end-plate membrane are reduced - antibodies attach to membrane causing decreased effects of ACh
muscle weakness; eye drooping; diplopia (double vision); dysphagia; severe fatigue
myasthenia gravis
test for myasthenia gravis
Tensil test - injection of high levels of ACh - pt will suddenly be able to move normally again
genetic progressive atrophy of brain
Huntington’s
effects of Huntington’s on the CNS
caudate nucleus atrophies
degeneration of inhibitory medium spinal neurons
decreased neurotransmitters (GABA, substance P)
onset after 40yo; movement changes (chorea); tremor; personality or behavior changes (usually aggression & anger)
Huntington’s disease
tx for Huntington’s
none
it leads to death
Neurodegenerative disorder affecting mainly dopamine-producing neurons in substantia nigra of brain
degeneration of basal ganglion
Parkinson’s
neurotransmitter lost in Parkinson’s
dopamine
tell tale early sign of Parkinson’s
resting tremor that abates with intentional movement
dementia that can arise from Parkinson’s
Lewy body
tx for Parkinson’s
dopamine increasing meds
Lou Gehrig’s disease
amyotrophic lateral sclerosis
degeneration of these parts of brain in ALS
corticospinal tracts, anterior horn cells, bulbar motor nuclei, or combo
cramps; weakness; muscle atrophy of hands or feet; weakness progresses to forearms, shoulders, lower limbs; spasticity; hyperactive DTRs; extension plantar reflexes; clumisness; stiffness; wt loss; fatigue; difficulty controlling facial expression & tongue movement
ALS
tx ALS
supportive
there is no cure
excess CSF in skull
hydrocephalus
2 types of hydrocephalus
- Noncommunicating/obstructive - flow of CSF in ventricular system is blocked
- Communicating - impaired absorption of CSF
type of hydrocephalus in babies
noncommunicating/obstructive
vomiting; poor feeding; elevated ICP; seizure; poor response to touch
hydrocephalus
tx for hydrocephalus
ventroperitoneal shunt
open neural tube birth defect
spina bifida
open neural tube birth defect
spina bifida
open neural tube birth defect
spina bifida
pregnant mothers prevent spina bifida by eating…
which contains…
green leafy
folic acid
spinous processes do not fuse - no herniation of spinal cord or meninges
spina bifida occulta
herniation of meninges
meningocele
herniation of spinal cord, meninges, CSF, nerves
myelomeningocele
warning signs for spina bifida (if it isn’t visible)
caudal dimple
tuft of hair on lower spine
Nonprogressive disorders of movement & posture caused by interruption of O2 to fetus
cerebral palsy
etiology of cerebral palsy
interrupted O2 to fetus causing brain asphyxia DURING fetal period, NOT during birth
abnormal reflexes; floppiness; rigidity of limbs & trunk; involuntary movements; unsteady walking
cerebral palsy
both benign and malignant brain tumors can be life threatening unless…
they are accessible for removal
largest % of primary malignant brain tumors
gliomas
Breakdown in relation between thought, emotion, and behavior
schizophrenia
enlarged cerebral ventricles, thinning of cortex, decreased size of hippocampus
increased dopamine, decreased GABA
schizophrenia
- enlarged cerebral ventricles, thinning of cortex, decreased size of hippocampus
- increased dopamine, decreased GABA
- Decreased blood flow to frontal lobes
schizophrenia
psychosis
loss of contact with reality
sx schizophrenia
- Psychosis
- Hallucinations
- Delusions
- Disorganized speech & behavior
- Flattened affect
- Cognitive deficits
- Occupational & social dysfunction
2 types of sx of schizophrenia
positive - delusions, bizarre behavior
negative - flat emotions, decreased speech
delusions; hallucinations; cognitive function & affect remain relatively well preserved
paranoid schizophrenia
disorganized behavior & speech
disorganized schizophrenia
at least 2 of…
- Immobility
- Excessive purposeless motor activity
- Extreme negativism
- Peculiarities of voluntary movement
catatonic schizophrenia
does not have characteristics of paranoid, disorganized, or catatonic
undifferentiated schizophrenia
continued presence of negative schizophrenia symptoms
residual schizophrenia
definition of anxiety disorder
anxiety lasting >6 months & interfering with daily life
fear; sleeping problems; palpitations; dyspnea; dry mouth
anxiety
broad anxiety over months
generalied anxiety disorder
intrusive thoughts or fears
obsessions
need to carry out certain rituals
compulsion
Frequent episodes of intense anxiety that feels like it cannot be controlled
panic disorder
Intense fear of criticism, embarrassment or humiliation
social phobia
3 neurotransmitters imbalanced in depression
norepinephrine
serotonin
dopamine
nearsightedness
myopia
farsightedness
hyperopia
farsightedness r/t aging
presbyopia
irregular lens/cornea curvature
astigmatism
lazy eye, cross eye
strabismus
double vision
diplopia
involuntary eye movement
nystagmus
hearing loss r/t aging
presbycupis
hearing better in noisy surroundings
paracusis
bacteria from skin get into glands of eye
stye
large & small styes
large - chalazion
small - hordeolum
indication that conjuntivitis is bacterial
purulent discharge
damage to optic nerve worsening over time
glaucoma
pain; halos around light; peripheral vision loss; reddened eyes; n/v; blurred vision
glaucoma
clouding of lens
cataract
deterioration of macula
macular degeneration
loss of central vision
eventual blindness
macular degeneration
loss of peripheral vision
glaucoma
subretinal fluid accumulates between neurosensory retina and retinal pigment epithelium
detached retina
floaters; flashes of light; blurry vision; shadow over visual field
detached retina
bone problem/obstruction deafness
conductive
deafness caused by problem with nerve
sensorineural
infection of middle ear
otitis media
overgrowth of ear bones
otosclerosis
hearing loss c low frequencies; balance issues; tinnitus
otosclerosis
idiopathic disorder of inner ear affecting balance
meniere syndrome
infectious disease that can increase risk for meniere’s
syphilis
test for meniere’s
dix-hallpike maneuver
a catatonic schizophrenic must have at least 2 of these 4 traits
- Immobility
- Excessive purposeless motor activity
- Extreme negativism
- Peculiarities of voluntary movement
