Neuro Flashcards
1
Q
Acetylcholine
A
Part of autonomic nervous system; usually excitatory; may be inhibitory (heart vagal nerve)
2
Q
Serotonin
A
Inhibitory; controls mood sleep, inhibits pain
3
Q
Dopamine
A
Inhibitory; affects behavior (attention, emotion) fine movement
4
Q
Norepinephrine
A
Excitatory; affects mood and overall activity
5
Q
Gamma-aminobutyric acid
A
Inhibitory
6
Q
Enkephalin / Endorphin
A
Excitatory; Pleasurable sensation; inhibits pain transmission
7
Q
Corpus Callosum
A
connects the two hemispheres of the brain
8
Q
Thalamus
A
Thalamus relay station for senses except smell. (memory, sensation, and pain impulses)
9
Q
Hypothalamus
A
Important in the endocrine system
Works with the pituitary
Temperature regulation
Hunger center / appetite control
Sleep–wake cycle, blood pressure, aggressive and sexual behavior, and emotional responses (i.e., blushing, rage, depression, panic, and fear
Controls / regulates ANS
10
Q
Basal ganglia
A
responsible for control of fine motor movements, including those of the hands and lower extremities
11
Q
Frontal
A
is the largest lobe, front of the brain. Function: concentration, abstract thought, information storage / memory, and motor function. Broca’s speech area (Speech affected but comprehension preserved). Responsible for person’s affect, judgment, personality, and inhibitions
12
Q
Parietal
A
analyzes sensory information and relays the interpreted information to the cortex. Essential to person’s awareness of body position in space, size, shape, and right-left orientation.
13
Q
Temporal
A
contains the auditory receptive areas, plays role in memory of sound and understanding of language and music
14
Q
Occipital
A
responsible for visual interpretation and memory.
15
Q
Brain Stem
A
midbrain, pons and medulla
Center for auditory and visual reflexes.
Reflex centers for respiration, blood pressure, heart rate, coughing, vomiting, swallowing, and sneezing are also located in the medulla.
16
Q
Cerebellum
A
located behind the brain stem and under the cerebrum
Smooth coordinated movement.
Controls fine movement, balance, andposition (postural) senseor proprioception (awareness of position of extremities without looking at them)
17
Q
Meninges
A
Three layers – anchor the spinal cord
Dura mater
Arachnoid
Pia mater
18
Q
CSF
A
CSF is important in immune and metabolic functions in the brain.
The fourth ventricle drains CSF into the subarachnoid space on the surface of the brain and spinal cord
19
Q
Cerebral Circulation
A
arteries and veins
Provides nutrients and O2 to brain tissue
About 15-20% of Cardiac Output
20
Q
Blood-brain barrier
A
protective function formed by endothelial cells of the brain’s capillaries
21
Q
On Old Olympus Towering Tops A Fin and German Viewed Some Hops
A
Olfactory
Optic
Oculomotor
Trochlear
Trigeminal
Abducens
Facial
Auditory
Glossopharyngeal
Vagus
Accessory
Hypoglosseal
22
Q
Positron Emission Tomography (PET)
A
Computer-based nuclear imaging. PET permits the measurement of blood flow, tissue composition, and brain metabolism and thus indirectly evaluates brain function.
23
Q
Single Photon Emission Computed Tomography (SPECT)
A
SPECT is a three-dimensional imaging technique. SPECT is useful in detecting the extent and location of abnormally perfused areas of the brain, thus allowing detection, localization, and sizing of stroke
24
Q
Myelography
A
X-ray of subarachnoid space through a lumbar puncture
25
Transcranial Doppler
Records blood flow velocities of intracranial vessels
26
Myelography
Uses contrast to evaluate the spinal cord, nerve roots, and spinal linings.
27
Electroencephalogram (EEG)
records of the electrical activity of the brain
Omit coffee tea, cola, chocolate
MAY have meal
Sleep deprivation, Withhold anticonvulsants, tranquilizers, stimulants, and depressants 24-48 hours before
28
Electromyography (EMG)
Evaluates muscle and nerves (motor neurons) that control them. Measures changes in the electrical potential of the muscles
29
Lumbar puncture
Assesses cerebral spinal fluid for viruses, bacteria, CSF pressure, administration of medications
Complications: Post-lumbar puncture headache, herniation of the brain, abscess, hematoma, meningitis, difficulty voiding, elevated temperature, backache / spasms, & stiff neck
30
Babinski’s Reflex
Indicative of upper motor neuron lesion
Abnormal is dorsiflexion of the toes (fanning)
31
CT
with or without contrast (if they have mental status changes, we are going to do without contrast first to see if it is hemorrhagic. Contrast spilling out into brain is bad)
32
MRI
See if they have any metal in their bodies, ask them if they are preggers, which kind of work they do. Any metal will get sucked right out
33
Akinetic Mutism
no response to the surroundings
34
Brain dead
no level of activity (keep alive for organ donation)
35
Coma
clinical state of unarousable of unresponsiveness
36
Decerebration
this is a type of posturing. They stretch out away from the body upon touch
37
Decortication
the patient will automatically pull their arms to their chest upon touch
38
Locked in syndrome
aware of what is going one but cannot move or talk
39
Persistent vegetative State
unresponsive, but they still do the sleep wake cycle. No mental or cognitive function
40
Status Epilepticus
form of epilepsy where the seizure lasts more than normal, and it was one seizure after another without recovery period and does not respond to normal treatments
41
Weight of brain
1400 g
42
Blood
75mL
43
CSF
75mL
44
ICP measured in lateral ventricles. Normal value
0-10, 15 is the highest
45
Monro-Kellie hypothesis
Sum of volumes of brain, CSF, and intracranial blood is constant
Limited space for expansion within the skull
An increase in any one of the components causes a change in the volume of the others
46
Primary Cause of Increased ICP
Head Trauma
47
Secondary causes of increased ICP
Brain tumors
Subarachnoid hemorrhage
Toxic or viral encephalopathies
48
Effects of ICP
↓ Cerebral perfusion
Stimulates edema
Causes herniation
49
Cerebral edema
an abnormal accumulation of water or fluid in the intracellular space, extracellular space or both d/t an increase in the volume of brain tissue
50
Autoregulation
Brain’s ability to change the diameter of its blood vessels to maintain constant cerebral blood flow during alterations in SBP.
51
Cushings Triad r/t Increased Intracranial Pressure
as increase in systolic BP, widening of the pulse pressure and slowing of heart rate late sign requiring immediate intervention
52
Clinical Manifestations of Increased Intracranial pressure
Changes in LOC
Abnormal respiratory and vasomotor responses
Restlessness
Confusion
Increased drowsiness
53
Increased Intracranial Pressure Goal
Decreasing cerebral edema
Lowering volume CSF
Decreasing cerebral blood volume
54
Increased Intracranial Pressure treatment
Osmotic diuretics
Restricting fluids
Draining CSF
Controlling fever
Maintaining BP and oxygenation
Reducing cellular metabolic demands
55
Seizures
Episodes of abnormal motor, sensory, autonomic or psychic activity
56
Burr Holes
hole through the skull to release fluid
57
Craniotomy
opening the skull
58
Craniectomy
removing the skull
59
Cranioplasty
Replacing the skull
60
Generalized SZ`
Both Sides of the brain
61
Focal SZ
originates within one side of the brain and typically doesn’t spread
62
Unknown SZ
don’t fit in either category
63
Underlying cause of SZ
is an electrical disturbance (dysrhythmia) in the nerve cells in one section of the brain
64
Symptoms of SZ
Loss of consciousness
Excessive movement
Loss of muscle tone or movement
Disturbance of behavior, mood, sensation, and perception
65
Causes of SZ
Cerebrovascular disease
Febrile (childhood)
Hypoxemia
Head injury
HTN
CNS infections
Metabolic and toxic conditions
Brain tumor
Drug and ETOH withdrawal
Allergies
66
Generalized SZ Symptoms
BIL hemispheres involved
Intense rigidity of entire body
Alternating muscle relaxation and contraction
Tonic-Clonic contractions
Tongue often chewed
Incontinent of urine and feces
After 1-2 minutes:
Movement subsides
Relaxes and lies in deep coma breathing noisily
Postictal State
67
Focal SZ Symptoms
which affect initially only one hemisphere of the brain - You might be aware of what is going on around you in a focal seizure, or you might not. Different areas of the brain (lobes) are responsible for controlling all of our movements
68
Diagnostics for SZ
Electroencephalography (Motor tool)
CT/MRI: R/O lesions
PET / Single-photon emission computed tomography (SPECT)--Measures cerebral blood flow
Complete seizure profile and history: Includes baseline neurologic exam, Description of seizure activity
Lab studies
69
Interventions during a Seizure
Maintain airway
Use jaw-thrust
**DO NOT attempt to open the airway with your fingers
Keep suction available
Prevent injury
Observe seizure activity
Document seizure activity
Administer appropriate anticonvulsant
Privacy
Loosen clothing
70
Epilepsy
A group of syndromes characterized by unprovoked, recurring seizures
71
Epilepsy classified by specific patterns
Age of onset
Family history
Seizure type
72
Electro-clinical syndrome
is a term used to identify a group of clinical entities showing a cluster of electro-clinical characteristics, with signs and symptoms that together define a distinctive, recognizable, clinical disorder.
73
Risk Factors for Epilepsy
Genetic
Birth trauma
Asphyxia neonatorum
Head injuries
Hormonal
Infections
Toxicities
Fever
Circulatory problems
Metabolic disorders
Drug/Alcohol intoxication
74
Antiepileptic drugs
Phenytoin
Carbamazepine
Valproic acid
Lamotrigine
Ethosuximide
Levetiracetam
75
Phenytoin
Dilantin
Given as a loading dose (1000mg) then a maintenance (125 mg 4x a day) IV
High risk for hyperphagia gingivitis (gums overgrow overtop of their teeth)
Bleeding gums
Do not mix well with contraceptives
IV or oral
Toxic to the veins (change IV daily)
76
Levetiracetam
Given after brain surgery to prevent seizures
Keeps the neurons calm
Makes them mean and irritable
77
Ethosuximide
this is for absent seizures
78
Benzodiazepines
first line to get seizures under control, then loading, then maintenance
79
Agnosia
loss of normal responses with household objects
80
Expressive Aphasia
I cannot get my words to you. left frontal lobe
81
Receptive Aphasia
I cannot understand what you are saying to me
82
Global Aphasia
have both expressive and receptive
83
Apraxia
inability to complete motor acts on a voluntary basis. Not able to recognize exactly what is there
84
Ataxia
uncoordinated movement
85
Hemianopsia
loss of vision somewhere in the vision field
86
Hemiparesis
weakness on one side
87
Hemiplegia
paralysis on one side
88
Hemorrhagic
Rapid
Occurs over minutes to hours
13%
89
Ischemic Strokes
87%. Caused by clot or embolism. Occurs over minutes to hours to days
90
LACUNAR
these are strokes in tiny blood vessels caused by DM
91
How long do we have to treat with thrombolytic Therapy
3.5-4h
92
5 Types of Ischemic Strokes
Atherosclerotic plaques
Lacunar
Cardiogenic embolic strokes
Cryptogenic strokes
Other
93
Atherosclerotic plaques
Large artery thrombotic strokes
94
Lacunar
Small penetrating artery thrombotic strokes
95
Cardiogenic embolic strokes
related to arrhythmias (Afib); embolic RT valvular disease leads to Left MIDDLE cerebral ARTERY
96
Cryptogenic strokes
No known cause
97
Others
coagulopathies, cocaine use, migraines/vasospasms, spontaneous dissection
98
Thrombosis
Atherosclerosis
Bifurcation of common carotid
Most common in diabetics
Lacunar infarct from small vessels d/t hypertension & diabetes
Sickle cell disease
99
Embolism
Travels from outside of brain occludes cerebral artery
Plaque
Clot from atrial fibrillation
Mechanical valves
100
Left Hemispheric Stroke
Affects the right side of the body
Very slow and methodical in their movement
Receptive or global aphasia (left frontal lobe is for speech)
Altered intellectual ability
Slow, cautious behavior
101
Right Hemispheric Stroke
Paralysis weakness on the left side of the body
Left visual field deficit
Spatial/perceptual deficits
Increased distractibility
Poor judgment and poor concentration
Impulsive
102
Generalized findings for a Stroke
Hypertension
Headache
Vomiting
Seizures
Change in mental status
Fever
Changes on ECG
103
Diagnostic tests for a Stroke
CT without contrast
MRI: changes not apparent until 8 hours after
New diffusion-weighted imaging (DWI)
Perfusion imaging (PI)
104
Stroke Prevention
Healthy diet - DASH
Engaging in physical activity
Maintain ideal body weight
Maintain safe cholesterol levels
Smoking cessation
Low-dose estrogen birth control
Reduce heavy alcohol intake
Eliminate illicit drug use
105
Races with the most strokes
African Americans
American Indians
Alaskan Natives
106
Leading Cause of Strokes
Hypertension
107
Medical Management of Strokes
Warfarin (INR 2-3)
Other anticoagulants
Platelet inhibitors
Statins
Antihypertensives
Thrombolytic therapy
-Recombinant t-PA
Endovascular therapy
Surgical Prevention
108
NIHSS
Score <5/42 is indicative of minor stroke
109
Hemorrhagic Stroke
Rupture of arteriosclerotic and hypertensive vessels
Often secondary to hypertension and after age 50
Ruptured aneurysms (2 to 6 mm in diameter)
Produces spasms of cerebral vessels and cerebral ischemia
Extensive residual functional loss
Slow recovery
25-60% mortality
110
Autonomic Dysreflexia
If they cannot pee, they can go into autonomic dysreflexia and have really high blood pressure (I+O). They will need bladder scans
111
Paraplegia
waist down paralysis
112
Tetraplegia
arms and legs paralysis that causes bowel and bladder dysfunction
113
Traumatic Brain Injuries (TBI)
Insult to brain that may produce physical, intellectual, emotional, social, and vocational changes
114
Epidural hematoma
Between the dura and the skull, not in the brain itself, bleeding from arteries
115
Subdural Hematoma
Between the Dura and arachnoid, bleeding from veins
116
Concussion Symptoms
Retrograde amnesia, Coup contra coup, and Diffuse axonal injury
117
Retrograde amnesia
Cannot remember what came before
118
Coupe contra Coupe
brain slams against one side of the brain then the other
119
Diffuse axonal injury
Rapid brain shift and sheers the axons
120
Complications of Spinal Cord Injuries
Pneumonia
Pulmonary embolism
Sepsis
121
SCI Pathophys
Paralysis is below the level of the injury
Most frequent site of injury C5-C7, T12, & L1
Two categories
Primary – Initial trauma
Secondary – edema or hemorrhage
122
Respiratory dysfunction RT level of injury
Diaphragm (C4), Intercostals (T1-T6); abdominal muscles (T6-T12)Injury to cervical cord produces tetraplegia
123
Ataxia
uncoordinated movements
124
Diplopia
double vision
125
Dysphagia
swallowing problems
126
Dysphonia
nasal tone to the voice (MS+(MG)
127
Neuropathy
numbness tingling burning sensation in the extremities
128
Ptosis
drooping eyelid: MG
129
Spasticity
comes from damage to the central nervous system. MS
130
Meningitis:
inflammation of the meninges:
o Headache, stiff neck, rigidity, photophobia (eyes sensitive to light)
o Send out CSF to assess it
Originates through blood or invasive procedures
131
Brain Abscesses
Happens to immunocompromised patients
o Severe headache
o Mental Status Changes
o We need to drain the abscess
132
Encephalitis
inflammation of the brain tissue r/t viruses, arthropod, vectors
o Increased Intracranial pressure
o Clinical Manifestations: headache, fever, confusion, seizures
133
Creutzfeldt—Jakob disease
eating meat by the spinal cord of an old cow
o Mad Cow disease
o Infection in blood and brain
o Psychiatric Syndrome: ataxia and memory loss
o To diagnose, we need a brain biopsy and a lumbar puncture
134
Multiple Sclerosis
Progressive demyelinating disease of the CNS
Impaired transmission of nerve impulses in spine and brain
135
MS Population
Peak age 25-35 years
Women twice as likely than men
Caucasians
Prevalent in colder climates
136
Relapsing Remitting MS
Most common
Manifestations remit with little or no progression
137
Secondary Progressive MS
Gradual neurologic deterioration
138
Primary progressive MS
Gradual continuous deterioration
139
Progressive relapsing MS
Gradual deterioration with occasional superimposed relapses
140
Symptoms of MS
Fatigue
Depression
Weakness
Paresthesia
Ataxia
Loss of balance
Spasticity
Pain
Visual disturbances
Blurred vision
Diplopia
Loss of peripheral vision
Scotoma (Patchy blindness)
Total blindness
Sexual dysfunction
Dysarthria
Dysphagia
141
MS Treatment
Interferon Beta 1a (SQ) / 1b (IM)
Corticosteroids
Glatiramer - Used specifically for remitting-relapsing MS
Works by stopping the body from damaging its own nerve cells
Fingolimod (PO)
Methylprednisolone IV (3-5 days for exacerbations)
Mitoxantrone (IIV q3 Months) – Cardiac toxic - Maximum lifetime dose
142
MS treatment of Symptoms
Baclofen (spasticity)
Benzodiazepines – diazepam (anxiety)
143
Myasthenia-Gravis
Autoimmune disease affecting the myoneural junction characterized by varying degrees of weakness of voluntary muscles
Antibodies directed at acetylcholine receptor sites impair transmission of impulses across the myoneural junction (80%)
Resulting in less stimulation → Voluntary muscle weakness
May have thymic hyperplasia or thymic tumor
144
MG Onset
May appear at any age
2 Peaks of onset
20-30 years - Women
After age 50 – Men
145
Hallmark of MG
Hallmark: Increased weakness with sustained muscle contraction + Ptosis
Improves after periods of rest
146
Edrophonium Test
Edrophonium is given IV. 30 seconds after, the patient’s eyes will go up, then it will droop again
147
Blood Tests for MG
check for acetylcholine receptor antibodies
148
MG + EMG
looks to see if the muscle is working or responding
149
MRI + MG
to assess for enlarged thymus gland
150
Pharmacological Therapy for MG
Pyridostigmine: this is the drug that we give 4x a day
Corticosteroids: immunosuppressive drugs
Cytotoxic drugs: inhibit the T-cells from growing
Surgical removal of thymus gland
151
Myasthenia Crisis
they don’t have enough medication in them
Triggers: respiratory crisis, changed meds, surgery, pregnancy
Symptoms: extreme muscle weakness, fatigue, trouble swallowing, facial muscles have no movement or expression, they can go into severe respiratory distress, cannot cough or swallow, increased secretions=choking
Treatment: increase their meds and may need a mechanical ventilator
152
Cholinergic Crisis
:OVERmedicated
Treatment: decrease the dose
Antidote: atropine
Might need a ventilator for a moment
Severe cramping and muscle weakness and paralysis
153
Guillain-Barre
Acute inflammatory demyelinating polyneuropathy affecting the peripheral nervous system
154
Causes of GB
Autoimmune response from a viral infection
Various potential viruses
155
Types of GB
Ascending –Most common**
Purely motor
Descending
Miller Fisher Syndrome - Rare
Acute Pan-autonomic Neuropathy
156
Phases of GB
Initial/acute (1-3 weeks after viral infection)
Plateau (2-4 weeks)
Recovery occurs in a descending pattern
157
Viruses that can cause GB
Campylobacter jejuni
Cytomegalovirus
Epstein-Barr
Other viruses
**Association with vaccines
158
Characteristics of GB
Pain
Paresthesia
Pain
Hyporeflexive
159
Nursing Management of GB
Vital signs
Respiratory assessments
Assess and manage swallowing
Intake and Output (SIADH)
Mobility
Pain
Preventing complications
160
Medical Treatment
Plasma Exchange
161
Nerves Affected in Trigiminal Neuralgia
Cranial Nerve 5
Causes facial contraction
o Use anticonvulsants to relieve the pain (calms the nerves down)
o They might get gabapentin
162
Bells Palsy
Cranial Nerve 7
o Inflammation of the cranial nerve and instead of causing contraction of the face it causes paralysis of the facial muscle. Drooping eye, drooping face.
o Decrease inflammation by giving steroids (watch for sugar)
163
Bradykinesia
slow body muscles and speech
164
Dementia
decline in higher brain function (Parkinson’s)
165
Dyskinesia
impaired ability to execute voluntary muscle movement (ALS and Parkinson’s)
166
Sciatica
pain and tenderness in the sciatic nerve. Down the back and around the hip, around the front of the leg, around the inner knee
167
Spondylosis
changes in the disk and vertebral bodies
168
Huntington’s
chronic progressive hereditary disease. Causes jerking and dementia
169
Parkinson’s
- Slow progressive disease: walk with a flexed posture and have a high risk of falling over
- Affects men mor than women
- We do not know the cause, but we know there is a hereditary form
170
Parkinson's Pathophysiology
Degeneration of dopamine storage cells in substantia nigra (SN) in basal ganglia
Loss of dopamine results in more excitation neurotransmitters causing an imbalance that affects voluntary movement
171
Parkinson's Subtypes
Tremor dominant (most other symptoms are absent)
Nontremor dominant (akinetic-rigid and postural instability).
172
Cardinal Symptoms of Parkinson
Tremor
Rigidity, increased tone, stiffness
Bradykinesia / akinesia
Postural instability
173
Complications of Parkinsons
Respiratory and Urinary tract infections
Skin breakdown
Injuries from falls
Dyskinesia
Parkinsonian crisis – Emotional trauma or sudden medication withdrawal
Medication side effects
On/Off response – Rapid fluctuations in symptoms
Loss of medication effectiveness
174
Pharmacological Treatment of Parkinsons
Pharmacological:
Carbidopa-Levidopa (CL)
Catechol-O-Methyltransferase Inhibitor (Entacapone)– Increase duration of action of CL and for advanced disease
175
Nursing Interventions for Parkinsons
Respiratory / cardiac support
Quiet room
Barbiturates w/ anti-parkinsonian drugs
Need to shorten periods between medications / increase doses
2L fluid/day
Increased fiber
Stool softeners/laxatives
Establish a regular bowel time
Encourage ROM
Regular daytime rest
Assist with ADLs
Patient/Family education
Safety measures
Emotional support
176
Amyotrophic Lateral Sclerosis
Loss of motor neurons → muscle atrophy
Involves degeneration of anterior horn cells and corticospinal tracts
Presence of anterior horn cell dysfunction
177
ALS Risk Factors
Age (middle age)
Male
Smoking
Vital infections
Autoimmune disease
Environmental exposures to toxins
Family history
Viral Infections
178
ALS Symptoms
Fatigue
Progressive muscle weakness
Cramps
Fasciculation
Lack of coordination
179
ALS Diagnosis
Clinical Presentation
EMG
Muscle biopsy
MRI
180
ALS Treatment
Supportive therapy only
Therapy and rehabilitation
Feeding tube
Mechanical ventilation
181
ALS Meds
Riluzole – glutamine antagonist
Edaravone
182
Nursing Interventions for ALS
Supportive nursing care
Ongoing assessment
Suggest modifications as disease progresses
Emotional support to patient/family
Conserving energy
Avoid extreme hot/cold
Prevent skin breakdown
Encourage fluid intake
Proper positioning
Discuss advanced directives / end of life care
183
Injury T12 or Above
will affect respiratory function
