NEURO Flashcards
The spinal cord conducts signals to and from the brain and controls ______
The spinal cord conducts signals to and from the brain and controls REFLEXES
CNS: _______ and _________
PNS: _______ and the _______; _______ controls organs and glands and is divided into _____ and _____; the _____ controls sensory organs and voluntary muscles and is divided into ________ and _______
CNS: SPINAL CORD and BRAIN
PNS: ANS and the SNS; ANS controls organs and glands and is divided into SYMPATHETIC and PARASYMPATHETIC; the SNS controls sensory organs and voluntary muscles and is divided into MOTOR (EFFERENT) and SENSORY (AFFERENT)
Two types of cell that make up the nervous system: neurons and ________ cells
Two types of cell that make up the nervous system: neurons and NEUROGLIA cells
Meninges: The three layers of tissue that cover the brain
Dura, arachnoid, and pia matter
Lesions of the cerebellum cause which type of response?
Spastic muscle activity
Changes in level of consciousness
Changes in behaviour
Disturbances of equilibrium
Disturbances of equilibrium
Which type of head injury typically produces rapid clinical deterioration?
Subdural hematoma
Depressed skull fracture without displacement
Epidural hematoma
Subarachnoid hematoma
Epidural hematoma
What are some measures that can be performed to reduce ICP?
Position patient onto their left side in Trendelenburg position
Administer hypotonic saline solution
Administer Mannitol IV solution
Remove the cervical collar to improve blood flow to the brain
Administer Mannitol IV solution
Which statement is true regarding a patient who experiences an epidural hematoma:
- Most often it is a venous bleed
- Cannot be diagnosed on CT scan for 24 hours
- Patient will typically have a brief or no loss of consciousness followed by a lucid period then a rapid decline in consciousness
- Bleed is contained within the dura and the arachnoid membrane
- Patient will typically have a brief or no loss of consciousness followed by a lucid period then a rapid decline in consciousness
Which statement regarding the Circle of Willis is FALSE?
- Most common area for cerebral aneurysms to form
- Primarily supplied by the internal carotid arteries and the basilar artery
- Located in the epidural space
- Allows some preservation of blood flow if one of the arteries becomes blocked
- Located in the epidural space
ICP can be increased by anything that:
Increases intracranial volume
Results in high compliance
Results in low elastanace
Decreases carbon dioxide levels
Increases intracranial volume
Epidural Space:
Between _____ and dura
Where middle meningeal _____ located
Damage to this area can lead to epidural bleed
Subdural Space:
Located between dura and subarachnoid matter
Contains ++small _____
During TBI – can lead to subdural hematoma
Subarachnoid Space:
Between pia matter and arachnoid
Major cerebral ______ located here
Epidural Space:
Between bone and dura
Where middle meningeal artery located
Damage to this area can lead to epidural bleed
Subdural Space:
Located between dura and subarachnoid matter
Contains ++small veins
During TBI – can lead to subdural hematoma
Subarachnoid Space:
Between pia matter and arachnoid
Major cerebral arteries located here
CSF: _____ and ______ fluid that fills the ventricles and subarachnoid space. Acts as shock absorber, provides nutrients and removes wastes. Secreted by the ______ _______ of the ventricles
Produced constantly at ___ ml/hr. Circulating volume is _____ - _____mL.
CSF: CLEAR and COLOURLESS fluid that fills the ventricles and subarachnoid space. Acts as shock absorber, provides nutrients, and removes wastes. Secreted by the CHOROID PLEXUSES of the ventricles
Produced constantly at 20ml/hr. Circulating volume is 135-150mL.
Frontal Lobe: high-level cognitive function, ________ language (______ area) and ________ motor function
Frontal Lobe: high-level cognitive function, EXPRESSIVE language (BROCA area) and VOLUNTARY motor function
Parietal lobe: ________ functions and _______ area (receptive language)
Parietal lobe: SENSORY functions and WERNICKE’S area (receptive language)
Temporal lobe: _______
Temporal lobe: hearing
Occipital lobe: _______
vision
Corpus Callosum: Facilitate communication between brain __________
Hemispheres
Cerebellum: Located at the _______ of the brain. Responsible for _____ motor movements, ________ and balance
Cerebellum: Located at the BOTTOM of the brain. Responsible for FINE motor movements, COORDINATION and balance
All information from your body’s senses (except smell) must be processed through your ______ before being sent to your brain’s cerebral cortex for interpretation. Your thalamus also plays a role in sleep, wakefulness, consciousness, learning and memory
Thalamus
Maintains homeostasis by regulating ANS responses + endocrine function
Hypothalamus
Brainstem comprised of 3 divisions: ______, ______ and ______ ________. It is responsible for many vital functions of life, such as breathing, consciousness, blood pressure, heart rate, and sleep
Midbrain, pons, medulla oblongata
The brain has no reserves for ______ or _______
The brain has no reserves for OXYGEN or GLUCOSE
The Circle of Willis acts as a protective mechanism to preserve cerebral blood flow if one of the arteries becomes blocked.
It is a common area for ________ to develop.
Located at the _______ of the skull.
The Circle of Willis acts as a protective mechanism to preserve cerebral blood flow if one of the arteries becomes blocked.
It is a common area for ANEURYSMS to develop.
Located at the BASE of the skull.
Anterior Cerebral Artery: Supplies the ________ lobe which is responsible for _____, personality, and ________ _____
Middle Cerebral Artery: Supplies a portion of the _____ lobe, the lateral ______ lobe, and the _______ lobe. It is the most commonly occluded in stroke
Posterior Cerebral Artery: Supplies the ______ and ______ lobes.
Anterior Cerebral Artery: Supplies the FRONTAL lobe which is responsible for COGNITION, personality, and MOTOR FUNCTION
Middle Cerebral Artery: Supplies a portion of the FRONTAL lobe, the lateral PARIETAL lobe, and the TEMPORAL lobe. It is the most commonly occluded in stroke
Posterior Cerebral Artery: Supplies the TEMPORAL and OCCIPITAL lobes.
Blood drains from cerebral ____ to venous ____ to the _____ veins to the SVC
Blood drains from cerebral VEINS to venous SINUSES to the JUGULAR veins to the SVC
Are spinal nerves part of the CNS or the PNS?
PNS
Do cranial nerves cross over?
No
_______: the ability to respond to verbal/noxious stimuli
__________: orientation to PPT
AROUSAL: the ability to respond to verbal/noxious stimuli
AWARENESS: orientation to PPT
GCS: Has ____ components:
1) Best ____ Opening Response
2) Best ____ Response
3) Best ____ Response
GCS: Has 3 components:
1) Best Eye Opening Response
2) Best Verbal Response
3) Best Motor Response
The ocular motor nerve (CN 3) is often impaired in patients with severe increased ICP. High ICP = no response
Narcotics can make pupils _______
Atropine can _____ pupils
Epi can also ______ pupils
The ocular motor nerve (CN 3) is often impaired in patients with severe increased ICP. High ICP = no response
Narcotics can make pupils constrict
Atropine can dilate pupils
Epi can also dilate pupils
__________ _______: patient closes their eyes and ask them to lift both arms up with palms up. Assess if one arm drifts down = upper motor neuron deficit
Babinski sign: ______ of toes with stimulation of bottom of foot. Normal = toes ____
Spinal cord testing: cranial nerve testing
Pronator drift: patient closes their eyes and ask them to lift both arms up with palms up. Assess if one arm drifts down = upper motor neuron deficit
Babinski sign: fanning of toes with stimulation of bottom of foot. Normal = toes curl
Spinal cord testing: cranial nerve testing
Normal ICP:
0-10mmHg, but 15mmHg is considered upper limit of normal
What does ICP measure?
Brain, blood, and CSF within the skull
Once _______ and ____ cannot compensate any longer, ICP elevates as mass compresses arterial volume and brain
*Autoregulation fails if SBP < __ or > ___ mmHg + injured brain cells lose ability to autoregulate
Once venous blood and CSF cannot compensate any longer, ICP elevates as mass compresses arterial volume and brain
*fails if SBP < 50 or > 150 mmHg + injured brain cells lose ability to autoregulate
CPP is the ________ gradient across the brain. Normal CPP is ____. Ischemia is not seen until the CPP falls below ____. In patients with ICP, CPP must be closely regulated within _____-_____
Increased ICP = _______ CPP = _____ perfusion to brain cells
CPP calculation:
CPP is the PRESSURE gradient across the brain. Normal CPP is 50-100mmHg. Ischemia is not seen until the CPP falls below 40mmHg. In patients with ICP, CPP must be closely regulated within 70-120mmHg
Increased ICP = DECREASED CPP = DECREASED perfusion to brain cells
CPP calculation: MAP - ICP
Causes of Increased ICP:
Increased ______ volume
Increased _______ volume
Increased _____ volume
Causes of Increased ICP:
Increased BRAIN volume (hematoma, tumour, abscesses)
Increased BLOOD volume (hypercapnia, vasodilation)
Increased CSF volume (increased production or decreased absorption)
Signs of increased ICP:
- _______ LOC
- changes in ______ status
- pupillary abnormalities
- headache, N/V
- changes in VS (______ triad)
Signs of increased ICP:
- DECREASED LOC
- changes in MENTAL status
- pupillary abnormalities
- headache, N/V
- changes in VS (CUSHING’S triad)
Cushing’s Triad:
BP: ______ with _______ pulse pressure
HR: ________
RR: _______
BP: HTN with WIDENED pulse pressure
HR: BRADY
RR: ABNORMAL
___________ hydrocephalus: CSF can still flow between the ventricles, which remain open. Caused by overproduction of CSF
______________ hydrocephalus: Obstructive hydrocephalus. Flow of CSF is blocked between the ventricles
Communication hydrocephalus: CSF can still flow between the ventricles, which remain open. Caused by overproduction of CSF
Non-Communication hydrocephalus: Obstructive hydrocephalus. Flow of CSF is blocked between the ventricles
Primary Brain Injury: during the _________ impact and is ________
The goal is to prevent _______ injury which begins ____ to days after the primary event
Primary Brain Injury: during the INITIAL impact and is PERMANENT
The goal is to prevent SECONDARY injury which begins HOURS to days after the primary event
Secondary injury is anything that causes loss of cerebral autoregulation, impaired perfusion, and ischemia in the brain
How to decrease Secondary Injury:
Early intubation
Rapid transport to trauma centre
Early CT scan
Monitor BG and Na+
What is a focal deficit?
Deficit on one side of the body
How to tell if it is CSF?
Halo around it and test for glucose
When would you see periorbital ecchymosis, auricular ecchymosis (Battle’s sign), and focal deficits?
Basal skull fracture
What is a diffuse axonal injury?
Concussion
Most standard imaging modalities cannot diagnose _____
DAI
Epidural hematoma: most _____, but most ______
Between the _____ and dura.
Fracture of skull in the ______/_______ lobe area, causing a tear in the _______ meningeal ________
Brief of no loss of consciousness followed by lucid period, then rapid decline in consciousness
Epidural hematoma: most RARE, but most SERIOUS
Between the BONE and dura.
Fracture of skull in the TEMPORAL/PARIETAL lobe area, causing a tear in the MIDDLE meningeal ARTERY
Brief of no loss of consciousness followed by lucid period, then rapid decline in consciousness
Subdural Hematoma: Between the _____ and _____ space. _______ bleeding in the _______ lobes
Usually caused by ____-______ injuries
Subdural Hematoma: Between the DURA and ARACHNOID space. VENOUS bleeding in the TEMPORAL lobes
Usually caused by COUP-CONTRECOUP injuries
SAH: Can be _____ or ______.
tSAH is near the _____ of the brain.
aSAH is always near the __________
Often ________ hydrocephalus
Increased risk of ______ –> ________ stroke
SAH: Can be TRAUMATIC or ANEURYSMAL.
tSAH is near the FRONT of the brain.
aSAH is always near the CIRCLE OF WILLIS
Often COMMUNICATING hydrocephalus
Increased risk of VASOSPASM –> ISCHEMIC stroke
Intracerebral Hemorrhage: Brain itself can start to bleed
May develop hours to days after initial injury
Care of patient with TBI
Meticulous neuro VS + VS
Treat increased ICP
Sedation
Stagger nursing activities
Good neck alignment
Pre-oxygenate before suctioning
Allow for rest
- ICP must be treated when it exceeds ___ mmHg or more
- All treatment directed at ______ the volume of one or more of blood, brain, or CSF
(1) Determine cause of elevated pressure and remove the cause
(2) Ensure:
o Check ICP waveform to ensure it is accurate
o HOB > ____ degrees
o Neck _____ – no venous obstruction
o Sedation appropriately adjusted
(3) If the above do not work and ICP still elevated
o Administer _______ or 3% saline (hyperosmolar) - Creates osmolar gradient which promotes the removal of CSF from cranial space = decreased ICP
o Further increasing or adjusting sedation
o Adding a neuromuscular blockade
o Inducing _______ to decrease metabolic demands
o Trialing bolus anesthetic
o Consult with neurosurgery
- ICP must be treated when it exceeds ___ mmHg or more
- All treatment directed at reducing the volume of one or more of blood, brain, or CSF
(1) Determine cause of elevated pressure and remove the cause
(2) Ensure:
o Check ICP waveform to ensure it is accurate
o HOB > 30 degrees
o Neck midline – no venous obstruction
o Sedation appropriately adjusted
(3) If the above do not work and ICP still elevated
o Administer Mannitol or 3% saline (hyperosmolar) - Creates osmolar gradient which promotes removal of CSF from cranial space = decreased ICP
o Further increasing or adjusting sedation
o Adding a neuromuscular blockade
o Inducing hypothermia to decrease metabolic demands
o Trialing bolus anesthetic
o Consult with neurosurgery
Which cells do brain tumours arise from?
Glial cells
S/S of Brain Tumours:
- ________ deficits based on the lobe involved
- signs of increased ______
- seizures
S/S of Brain Tumours:
- FOCAL deficits based on the lobe involved
- signs of increased ICP
- seizures
Meningitis: When the fluid that surrounds the meninges becomes infected
Most common cause: ________
Other causes: lupus, intrathecal medication administration
Top 3 S/S:
- ________ rigidity
- ______ sign (lay supine and bend knee at 90 degrees - pt unable to extend leg)
- ________ sign (lay supine and flex head forward - hips and knees also flex forward)
Isolation precaution: __________
Meningitis: When the fluid that surrounds the meninges becomes infected
Most common cause: bacterial/viral infx
Other causes: lupus, intrathecal medication administration
Top 3 S/S:
- NUCHAL rigidity
- KERNIG sign (lay supine and bend knee at 90 degrees - pt unable to extend leg)
- BRUDZINSKI sign (lay supine and flex head forward - hips and knees also flex forward)
Isolation precaution: DROPLET
What is recommended to have done before a lumbar puncture is performed?
CT Scan
When diagnosing a brain abscess which test is contraindicated due to the risk of cerebral herniation?
Lumbar Puncture - contraindicated in any patient with space-occupying lesion or suspected increased ICP as it could further increase ICP and result in brain herniation
What is encephalitis?
Inflammation of the brain tissue most often caused by a virus
What is a characteristic of a CNS infection?
Focal neurological findings
Headache
Seizures
Progressive, ascending, __________ peripheral nerve dysfunction which leads to paralysis
Often caused by infection or vaccine
Results in damaged _______ ________
Progressive, ascending, SYMMETRICAL peripheral nerve dysfunction which leads to paralysis
Often caused by infection or vaccine
Results in damaged MYELIN SHEATH
GUILLAIN BARRE
Autoimmune disorder that affects
_________ skeletal muscles: transmission of nerve impulses are _______
Unknown cause, but the ______ plays a role in the development
Common sign: drooping ________, weakness to _____ and _______ muscles
Experience _______ muscle weakness throughout the day
Myasthenic Crisis: muscles used to control ______ are affected and weakened
Autoimmune disorder that affects
VOLUNTARY skeletal muscles: transmission of nerve impulses are BLOCKED
Unknown cause, but the THALAMUS plays a role in the development (tumour)
Common sign: drooping EYELIDS, weakness to FACIAL and SWALLOWING muscles
Experience PROGRESSIVE muscle weakness throughout the day
Myasthenic Crisis: muscles used to control BREATHING are affected and weakened
Amyotrophic Lateral Sclerosis:
_______ neuron disease that results in dysfunction of _______ and _______ motor neurons leading to paralysis
It is degenerative and progressive, with no cure (neurons _____)
_______ weakness and muscle function loss with full ________ input
Focal and ______ onset
Difficulty chewing, swallowing and speaking
Progresses to _______ failure
Amyotrophic Lateral Sclerosis:
MOTOR neuron disease that results in dysfunction of UPPER and LOWER motor neurons leading to paralysis
It is degenerative and progressive, with no cure (neurons DIE)
PAINLESS weakness and muscle function loss with full SENSORY input
Focal and ASYMMETRICAL onset
Difficulty chewing, swallowing and speaking
Progresses to RESPIRATORY failure
Sometimes referred to as quadriplegia, is a term used to describe the inability to voluntarily move the upper and lower parts of the body
Tetraplegia
Paralysis that affects your legs, but not your arms
Paraplegia
Medical condition that is considered an incomplete spinal cord injury, in which three limbs are paralyzed
Triplegia
Spinal fractures are labelled as either stable or unstable:
Stable - ______ concern for neurological injury
- Treated with bracing and rest
Unstable - _______ for neurological injury
- Treated with surgery to realign the bones to prevent spinal cord or nerve damage
Spinal fractures are labelled as either stable or unstable:
Stable - NO concern for neurological injury
- Treated with bracing and rest
Unstable - CONCERN for neurological injury
- Treated with surgery to realign the bones to prevent spinal cord or nerve damage
Full Spine Precautions:
- _____ rest only
- ____ bed surface
- Hard ______ collar at all times
- ____-roll with manual cervical stabilization
- no air mattress
- ______ boards must be used for patient transfer
Full Spine Precautions:
- BED rest only
- FLAT bed surface
- Hard CERVICAL collar at all times
- LOG-roll with manual cervical stabilization
- no air mattress
- SPINE boards must be used for patient transfer
How many people does a log roll require?
4
Neurogenic Shock:
- Occurs in SCI at or above ____
- ____tension, ____ skin, ______cardia
- Fluid resuscitation not sufficient to increase ___ and may cause ____ or ARDS
- ______ or pressors may be needed
- Occurs in SCI at or above T6
- HYPOtension, WARM skin, BRADYcardia
- Fluid resuscitation not sufficient to increase MAP and may cause CHF or ARDS
- INOTROPES or pressors may be needed
Autonomic dysreflexia:
- Can occur in patients with SCI at or above ____ after spinal shock
- massive ______ reflex response to a stimulus _____ the level of injury
- common stimuli include a full bladder, distended bowels, skin irritation, tight clothing, or splints
- ____tension, ______cardia, and _____thermia
Autonomic dysreflexia:
- Can occur in patients with SCI at or above T6 after spinal shock
- massive SYMPATHETIC reflex response to a stimulus BELOW the level of injury
- common stimuli include a full bladder, distended bowels, skin irritation, tight clothing, or splints
- HYPERtension, BRADYcardia, and HYPERthermia
TIA - important to assess for presence of ______ activity to determine if _____ or actually a stroke
TIA - important to assess for presence of SEIZURE activity to determine if POST-ICTAL or actually a stroke
When are you able to see brain infarct on a CT?
After 24hrs
STROKE: Prep for CT/MRI of brain within ___ minutes of pt arriving to ED
Determine if hemorragic vs ischemic
Fibrinolytic criteria: no hemorrhage + within ____hrs of symptom onset and start within ___ mins of arriving to hospital
Check glucose, ECG, and BW + 24hr continuous cardiac monitoring to detect _____ as a cause of embolic stroke
STROKE: Prep for CT/MRI of brain within 15 minutes of pt arriving to ED
Determine if hemorragic vs ischemic
Fibrinolytic criteria: no hemorrhage + within 4.5hrs of symptom onset and start within 60 mins of arriving to hospital
Check glucose, ECG, and BW + 24hr continuous cardiac monitoring to detect A-FIB as a cause of embolic stroke
In patients with hemorrhagic stroke, they may experience seizures. Should antiepileptics be given prophylactically?
No - only if seizures occur
What is a huge issue with RS stroke?
Safety - poor judgement in abilities
LS Stroke main deficit is _______
LS Stroke main deficit is APHASIA
Common complications with aSAH:
- __bleeding (watch _____)
- vaso_______ (can cause _____ stroke - occurs __ to ___ days post hemorrhage)
Common complications with aSAH:
- REbleeding (watch HTN)
- vasoSPASM (can cause ISCHEMIC stroke - occurs 2 to 5 days post hemorrhage)
