Neuro Flashcards
The skull contains the brain in a contiguous enclosure with the exception of these two anatomical features?
Transtentorial notch- not an actual hole but sharp outcropping of tentorium cerebelli that separates the…
Foramen magnum –how brain stem and spinal cord get into skull
Which cranial nerves do not originate from the brainstem? Where do they originate from?
I, II originate from cerebrum
What does a well developed Circle of Willis provide to the brain?
Collateral blood supply
What is the first sign of a neurological problem?
A change in LOC
In an exception to the rule of a change in LOC being the first sign of a neuro problem, what type of neuro issue may elicit pupillary changes prior to a change in LOC?
Epidural hematoma
Describe the parts of the Reticular Activating system and their function.
Upper - Awareness
Lower – sleep-wake cycle
Describe two types of aphasia and their lobe dominance.
Expressive (Broca) - frontal lobe
Receptive (wenicke) - temporal lobe
What is the crossing of motor fibers called, where does it take place and what physical manifestation does it create?
Decussation
occurs in medulla
motor issues are contralateral to the injury or issue
Describe the association between pupillary response and brain injury or issue?
pupillary response occurs ipsilateral to injury
Describe babinksi reflex, what is positive or negative and what is normal?
babinski reflex - fanning of toes upward and outward in response to plantar stimulation
upward/outward fanning in adults is a POSITIVE sign and is ABNORMAL
Describe “Doll’s eye reflex”? What is a normal finding?
When the head is rapidly rotated side to side, the eyes move opposite the head.
This finding is normal
If the eye move with the head, this is abnormal
What components make up Cushing’s triad?
increased SBP, with widening pulse pressure
decreased HR
decreased RR (cheyne-stokes)
What might Cushing’s Triad be caused by?
Brain herniation
If a patient has an injury to the midbrain, how may this affect respirations?
Hyperventilation
If a patient has an injury to the Potine, how may this affect respirations?
Apneustic
“Apneustic respiration (a.k.a. apneusis) is an abnormal pattern of breathing characterized by deep, gasping inspiration with a pause at full inspiration followed by a brief, insufficient release”
If a patient has an injury to the medulla, how may this affect respirations?
Ataxic
“Ataxic respiration is an abnormal pattern of breathing characterized by complete irregularity of breathing, with irregular pauses and increasing periods of apnea. As the breathing pattern deteriorates, it merges with agonal respiration”. Sometimes called Biot’s
The difference between obtunded and stuporous
obtunded- can speak but mumbles
stuporous - cannot speak, may groan or grimace
Homonymous hemianopsia
loss of vision in half of each visual field
Bitemporal hemianopsia
loss of visual filed to the outer half of each eye
left hemaniapsia
loss of half the visual field to the left half of the eye
In a brain pathology, in which direction will the eyes deviate?
towards the pathology
In relation to a injury or issue which side will changes occur for the following:
pupil changes
vision changes
motor changes
positive Babinski reflex
pupil changes – ipsilateral
vision changes – contralateral
motor changes – contralateral
positive Babinski reflex – contralateral
What is Uncal herniation?
Displacement of TEMPORAL lobe against brain stem compressing the 3rd/oculomotor nerveleading to pupil dilation
What is a very common cause of Uncal herniation?
EPIDURAL hematoma
Signs and symptoms of Uncal herniation? (3)
- compression of parasympathetic innervation to AFFECTED side (“which may affect the parasympathetic input to the eye on the side of the affected nerve, causing the pupil of the affected eye to dilate and fail to constrict in response to light as it should.”
- Blown pupil on same side, often seen prior to LOC
- slight contralateral weakness
What often causes central herniation?
bilateral swelling and downward displacement of both hemispheres
usually develops slowly
In a RIGHT sided stroke, how will the following be affected,
eye deviation
weakness
hemianopsia
Babinski reflex
eye deviation – rightward
weakness – left side
hemianopsia – left side
Babinski reflex – left side
labile emotions
Left sided stroke, how will the following be affected,
eye deviation
weakness
hemianopsia
Babinski reflex
eye deviation –leftward
weakness – right side
hemianopsia– right side
Babinski reflex– right side
aphasia
What is a common cause of subdural hematoma
middle cerebral artery aneurysm
How are Subdural hematoma graded?
Hunt & Hess score grades I-V
Documentation of the first Hunt and Hess scale that was done at this hospital. The Hunt and Hess scale is a grading system used to classify the severity of a subarachnoid hemorrhage based on the patient’s clinical condition. The scale ranges from a score of 1 to 5. It is used as a predictor of prognosis/outcome with a higher grade correlating to a lower survival rate.
Grade - Description
1 (I) - Asymptomatic, mild headache, slight nuchal rigidity
2 (II) - Moderate to severe headache, nuchal rigidity, no neurologic deficit other than cranial nerve palsy
3 (III) - Drowsiness / confusion, mild focal neurologic deficit
4 (IV) - Stupor, moderate-severe hemiparesis
5 (V) - Coma, decerebrate posturing
What are the signs and symptoms of the Subdural hematoma
Acidosis has what effect on ICP?
Causes vasodilation which causes ICP to increase
How does Alkalosis affect affect ICP
causes vasoconstriction which decreases cerebral blood flow which deceases ICP
GCS/TBI severity grade
GCS
0-8 Severe
9-12 Moderate
13-15 Mild
Where does epidural bleeding occur?
Above the dura matter
which is between the dura and skull
What is a major cause of epidural bleeding?
tearing of the meningeal artery from temporal bone trauma
Where does subdural bleeding occur?
Bleeding between the dura matter and arachnoid space
Compare and contrast symptoms of epidural and subdural bleeding?
SDH is similar to EDH but w/ less vomiting and pupil changes
What is a basilar skull fracture?
A linear fracture on the floor of the cranial vault. results in meningeal tears, requires more force than other fractures
Signs and Symptoms of a basilar skull fracture?(5)
- racoon eyes
- battle sign
- cranial nerve I
- risk of meningitis
- otorrhea / rhinorrhea
Seizure versus status epilecticus
Sze last more than 5 minutes OR several seizures w/o regaining consciousness
Normal CSF measurements
60% glucose
25-45 mg/dl protein
opening pressure 80-180 cmH20
Viral versus bacterial meningitis
VIRAL
opening pressure > 180 cm H20
purulent color
DECREASED glucose
Bacterial
opening pressure normal
clear color
normal glucose
INCREASED protein
INCREASED WBC
Meningitis signs and symptoms
- nuchal rigidity
- brudzinski sign - when chin to chest, legs raise
- kernigs sign – knee flexion causes leg and neck pain
Brain death apnea test
PaCO2 > 60mmHg, PaO2 > 20mmHg
What is the cause of Gullain - bare syndrome?
Autoimmune process
antibodies attack on myelin on lower motor nerves
affects spinal and cranial nerves
ascending paralysis
Gullain -bare tx
steroids
IVIG for 2-5 d
plasma pheresis exchange – removes circulating antibodies
What is Myasthenia gravis?
Autoimmune process that attacks neuromuscular junction
What is a Myasthenic crises caused by and diagnostic test?
caused by Acetocholine deficiency
caused by acute exacerbation or undertreatment
TENSILON 2m g IV causes an improvement of symptoms
Cholinergic crises
Caused by overtreatment w/ mestinon
too much acetocholine
TENSILON 2 mg IV causes muscle weakness and SLUDGE
Salivation
lacrimation
urination
Defecation
GI upset
Emesis
