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Patho Exam 3 > Neuro > Flashcards

Neuro Flashcards

1
Q

Neurons

A

Generate action potentials

Transmitter cells

Carry messages to and from the brain and spinal cord.

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2
Q

Glial Cells

A

Support and protect neurons.

Do not generate action potentials but have a resting potential

CNS: Astrocytes, Microglia, Oligodendroglia, Ependymal cells.

PNS: Schwann Cells (myelin), Satellite cells

Produce cerebral spinal fluid.

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3
Q

Neurons can synapse with

A

neurons, muscle, glands

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4
Q

Synaptic Transmission

A

A small burst of neurotransmitters is released

The neurotransmitters stimulate or inhibit action potentials

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5
Q

Neurotransmitters

A

either destroyed by enzymes or reabsorbed

recycled for the next transmission

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6
Q

Electrical impulses

A

Info passed between neurons by chemicals

Can be excitatory or inhibitory

Along the axons, the information passes electrically

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7
Q

Neurons cont

A

Do not have the ability to divide

Losses due to aging or injury cannot be replaced

Not all cell death results in loss of functioning

Undamaged neurons in the brain will assume functions of damaged neurons (“plasticity”)

require constant oxygen and glucose supply

vulnerable to hypoxia and hypoglycemia

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8
Q

Myelin

A

Lipoprotein

Increases speed of conduction, large axons:

  • Are “insulation”
  • Prevent leakage of electric current
  • Layers w/spaces (nodes of Ranvier) between cells
  • Impulse “jumps” from node to node

“Unmyelinated” axons – smaller, slower

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9
Q

The Neurological System Consists of three main components

A

spinal cord, brain, peripheral nerves

Central Nervous system: Brain and spinal cord

Peripheral nervous system: nerves

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10
Q

Peripheral nervous system

A

Autonomic nervous system: sympathetic (fight or flight) nervous system and parasympathetic (rest and digest)

Somatic nervous system: sensory nerves and motor nerves

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11
Q

Cerebrum

A 
includes lobes
Frontal
Parietal
Occipital lobe
Temporal lobe
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12
Q

Diencephalon

A

thalamus

hypothalamus

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13
Q

Cerebellum

A

balance and coordination

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14
Q

Brain stem

A

midbrain, pons, medulla oblongata

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15
Q

3 meninges

A

Dura mater, arachnoid mater, pia mater

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16
Q

Dura mater

A

outer, lines skull

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17
Q

Arachnoid mater

A

middle, contains blood vessels

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18
Q

Pia mater

A

inner, covers brain

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19
Q

3 potential spaces

A

epidural, subdural, subarachnoid

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20
Q

epidural

A

outside dura

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21
Q

subdural

A

between dura and arachnoid

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22
Q

subarachnoid

A

deep to arachnoid, filled with CSF

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23
Q

Cerebrospinal Fluid (CSF)

A

Made in choroid plexuses (roofs of ventricles)
Filtration of plasma from capillaries through ependymal cells (electrolytes, glucose)

Cushions and nourishes brain

Useful for diagnosing meningitis, bleeds, MS

Hydrocephalus: excessive accumulation of CSF

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24
Q

Blood supply to the brain

A

Supplied by the internal carotid and vertebral arteries

Arterial circle (circle of Willis) helps ensure flow

800 to 1000 mL per minute

CO2 level affects CNS blood flow

Increases in CO2 will increase cerebral blood flow & arterial blood pressure.

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25
Q

Circle of Willis

A

Anterior Cerebral Artery, middle cerebral artery, posterior cerebral artery, lenticulostriate arteries

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26
Q

Anterior Cerebral artery

A

supplies frontal lobes

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27
Q

Middle Cerebral Artery

A

Artery-frontal lobe
& the lateral surface of the temporal and parietal lobe (includes motor, sensory, speech)

*Most frequently occluded artery in a stroke.

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28
Q

Posterior Cerebral Artery

A

temporal & occipital lobes of cerebral hemispheres.

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29
Q

Lenticulostriate arteries

A

small, deep penetrating arteries known as the lenticulostriate arteries branch from the middle cerebral artery

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30
Q

How does autoregulation of cerebral blood flow work?

A

The arteries that comprise the circle of Willis in the brain normally maintain a constant flow of blood within the brain

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31
Q

Autoregulation

A

means that the cerebral arteries constrict or dilate to keep the CPP between 50-150mmHg

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32
Q

CPP (cerebral perfusion pressure)

A

the pressure required to perfuse the brain with blood

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33
Q

MAP (mean arterial pressure)

A

it is the average blood pressure in the arteries. MAP is a more accurate way to measure “blood pressure” in the vessels.

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34
Q

ICP

A

intracranial pressure

35
Q

Autoregulation is achieved by

A

combination of 4 factors:

  1. BP (MAP)
  2. Metabolic– CO2, others
  3. Autonomic receptors (smaller role)
  4. Arterial oxygen level
36
Q

BP (MAP)

A

the cerebral arteries constrict or dilate in response to changes in BP (ie. MAP) or intracranial pressure (ICP)

37
Q

Metabolic–CO2

A

CO2 is a potent vasodilator

increased CO2/decreased BP –> vasodilation decreased CO2/increased BP–> vasoconstriction

38
Q

Arterial oxygen level

A

low arterial oxygen tension has profound effects on cerebral blood flow. When PO2 falls below 50mmHg there is a rapid increase in cerebral blood flow (CBF) and arterial blood volume.

39
Q

Cranial nerves

A

12 of cranial nerves branch directly from the base of the brain.

some carry sensory fibers, others only carry motor fibers
some carry both

each nerve travels from the brain through the foramen ovale to its destination

40
Q

On old olympus towering tops, a finn and german viewed some hops

A

Some say marry money but my brother says bad business marry money

41
Q

white matter

A

comprised of nerve fiber tracts/ pathways

42
Q

Gray matter

A

neurons

43
Q

ascending fibers/afferent tracts

A

carry sensory information the body back to the brain

44
Q

descending fibers/efferent tracts

A

carry motor impulses from the brain to the PNS

45
Q

nerves

A

bundles of nerve fibers. Each fiber is part of the neuron

works like an information highway

46
Q

31 spinal nerve pairs

A

8 cervical, 12 thoracic, 5 lumbar, 5 sacral and 1 coccygeal

47
Q

ganglia

A

collections of nerve cell bodies outside the CNS

48
Q

Spinal nerves

A

arise from dorsal and ventral surfaces of the spinal cord

49
Q

Spinal nerve

A

comprised of a dorsal root adn a ventral root. Each root formed from 6-8 rootlets

50
Q

Somatic

A

voluntary
31 pairs of spinal nerves
12 pairs of cranial nerves

51
Q

Automatic

A

involuntary
smooth muscle
cardiac muscle
glands

52
Q

Check and balance system

A

Sympathetic nervous system

Parasympathetic nervous system

53
Q

Sensory nerves

A

afferent nerves

input: sensory
afferent: to brain

54
Q

motor nerves

A

efferent nerves

output: motor
efferent: from brain

55
Q

interneurons

A

connect the sensory and motor neurons in the spinal cord

56
Q

Dermatome

A

area of the skin innervated by a given pair of spinal sensory nerves

57
Q

What can be fixed in nervous system:

A

severed peripheral nerves:

- can regenerate to a point to reestablish connections

58
Q

What cannot be fixed in the nervous system:

A

severed brain and spinal cord axons

- results in paralysis and loss of sensation below the area of damage

59
Q

Autonomic nervous system

A

controls smooth muscles

unconscious response that affects such activities as heart rate, blood pressure, intestinal motility

60
Q

sympathetic nervous

A

fight or flight response
aided by adrenal medulla via epinephrine and norepinephrine secretion

stimulates the adrenergic receptors

61
Q

parasympathetic nervous system

A

rest and digest response
stimulates the cholinergic receptors

The two subdivisions have an antagonistic effect with each other

62
Q

Adrenergic (SNS) & Cholinergic (PNS) receptors

A

These receptors are found in certain target organs:

The heart, lungs, gastrointestinal tract, the bladder, and the muscles.

63
Q

Order of Neurological Assessment

A 
Mental status
cranial nerves
motor system
sensory system
reflexes
64
Q

Assessing Consciousness

A

alert, confused, delirious, lethargic, obtunded, stuporous, comatose

65
Q

Glasgow Coma Scale (GCS)

A

Evaluates neurological functioning.
Used after TBI or other neurological injuries.
Looks at purposeful response to the environment in 3 areas:
Eye opening
Motor response
Verbal response

66
Q

Increased Intracranial Pressure (ICP)

A

Increased ICP is increased volume in the cranial.

Skull: rigid, does not expand in adults.
Brain occupies 80% of the skull.
Monro-Kelli hypothesis

Volume increase: compensated for by shifts in CSF & blood volume.
Causes: traumatic brain injury, tumor, hydrocephalus, cerebral edema, and hemorrhage

67
Q

Monro-Kelli hypothesis

A

increase in volume of one component must be compensated by a decrease in volume of another

68
Q

Fontanelles

A

close by age 3 years usually

69
Q

Increased ICP compensatory mechanisms

A

autoregulation, Cushing’s reflex, Cushing’s triad

70
Q

Autoregulation (normal response)

A

the blood vessels dilate to increase blood flow and constrict if ICP increases. This acts up to a certain point.

71
Q

Cushing’s reflex (normal response)

A

the hypothalamus increases sympathetic stimulation when the mean arterial pressure drops below the ICP.
Causes vasoconstriction, increased cardiac contractility, and increased cardiac output.

72
Q

Cushing’s triad (what you see when things go bad…..very very bad)

A

increased blood pressure, bradycardia, and Cheyne-Stokes respiratory pattern.

73
Q

Cushing’s Triad 3 primary signs that often indicate an increase in intracranial pressure (ICP)

A

increase systolic BP
decrease in pulse
decrease in respiration

74
Q

Symptoms of increased ICP are opposite of SHOCK

A

decrease in BP
increase in pulse
increase in respiration

75
Q

Cushing’s syndrome

A

a disease state resulting from the elevated levels of blood cortisol

76
Q

Herniation

A

Feared complication of increased ICP

Refers to displacement of brain tissue

77
Q

transtentorial (central) herniation

A

cerebral blood flow, CSF, reticular activation system, and respirations are impaired

78
Q

Uncal herniation

A

puts pressure on cranial nerve III, the posterior cerebral artery, and the reticular activation system

79
Q

Cerebellar, or tonsillar (intrafratentorial), herniation

A

compresses the brain stem and vital centers, causing death

80
Q

Manifestations of Increased ICP

A 
Decreasing level of consciousness
Vomiting  (often projectile)
Rising blood pressure 
Increasing pulse pressure
Bradycardia
Papilledema
Fixed and dilated pupils
Posturing
81
Q

Increased ICP diagnosis

A

History & physical exam
Glasgow Coma scale
Head CT, MRI
ICP monitoring

82
Q

Increased ICP treatment

A 
depends on cause (bleed, tumor, hydrocephalus, meningitis).
Respiratory support
Semi-Fowler’s positioning
Decrease edema, swelling
Prevent seizures
Reduce brain metabolism
No activities that increase ICP 
Control glucose level
Stress ulcer prevention
83
Q

Cerebral perfusion pressure

pressure in brain

A

the pressure required to “perfuse” all of the tissue of the brain with blood.

Without sufficient blood perfusion any living tissue dies

84
Q

Homeostasis in the Cranium

A

CCP= MAP-ICP

Where, CPP is cerebral perfusion pressure
MAP is mean arterial pressure
ICP is intracranial pressure

If MAP decreases then CPP decreases
If ICP increases then CPP decreases

we do not want CPP to decrease in most circumstances

Patho Exam 3 (2 decks)

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