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Pathophysiology > Neuro > Flashcards

Neuro Flashcards

1
Q

Pressure of blood flowing into the brain

A

cranial perfusion pressure (CPP)

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2
Q

Totality of all pressures in the brain (BP, CSF, brain tissue)

A

intracranial pressure (ICP)

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3
Q

Concept map of imbalance of pressure (ICP or CPP)

A

ineffective perfusion > ischemia > cellular hypoxia > cell injury/death > increase cellular permeability > cerebral edema & increased ICP > further loss of effective perfusion

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4
Q

The main culprit in causing increased ICP

A

cerebral edema

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5
Q

Any disruption of normal blood flow to any part of the brain resulting in damaged brain tissue

A

brain attack/Stroke

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6
Q

Most common etiologies of BA

A

atherosclerosis of incoming arteries
HTN
Brain aneurysms
Problems of decreased CO

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7
Q

Risk factors for Stroke

A 
HX of atherosclerosis or HTN
Old age
Family HX
Diabetes
Lifestyle (smoking & high fat diet)
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8
Q

Underlying mechanism(s) of stroke

A

Ischemia

Hemorrhage

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9
Q

80% of all stroke are ___ in nature

A

ischemic

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10
Q

Ischemic strokes are usually related to ___ and other processes that cause ___

A

atherosclerosis; arterial wall damage & plaque formation

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11
Q

Ischemic strokes may be __ or __ in nature

A

thrombotic or embolic

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12
Q

Risk of ischemic stroke increases X5 with ___

A

Hx of afib

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13
Q

Thrombotic or Embolic events that cause stroke:

A

Carotid atherosclerosis
Air emboli
Clots around mitral/aortic valve prosthesis
Intracranial artery plaque (circle of Willis)

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14
Q

BA that resolves within 24 hours with no neurologic deficits

A

TIA

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15
Q

Usually caused by a blood clot that leaks out directly onto brain tissue

A

Hemorrhagic stroke

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16
Q

Causes of Hemorrhagic stroke

A 
HTN pressures
Weakened arterial walls
Aneurysms
Congenital vascular malformations
Bleeding into a tumor
Coagulation disorders
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17
Q

S/S of stroke depend on __

A

where the stroke is occurring

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18
Q

3 regions where stroke can occur

A

Hemispheres
Cerebellum
Brain stem

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19
Q

Abnormalities in sensorimotor findings occur ___

A

contra-laterally to where the bleed is occurring

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20
Q

Normal sensorimotor findings should be __

A

symmetrical

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21
Q

Visual deficit that indicates cerebral edema around the CN II

A

homonymous hemianopia (visual deficit in left halves of both eyes)

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22
Q

Sensorimotor findings below the shoulders indicate perfusion status of ___

A

corticospinal & spinothalmic tracts

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23
Q

Focal lesions in the spinal tracts would present with ___

A

asymmetric changes on the contralateral side of the body

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24
Q

Flexion of the big toe in response to stroking the plantar surface of the foot

A

positive Babinski’s sign

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25
Q

Cerebellar stroke occur due to occlusion of ___

A

vertebral-basilar arteries

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26
Q

Some S/S of cerebellar stroke

A 
balance problems/falls
loss of coordination
vertigo
nystagmus
N/V
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27
Q

Typical S/S of a cerebral hemispheric stroke

A

Sensorimotor deficits

Deficits based on special functions of that hemisphere

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28
Q

Left hemisphere specific stroke deficits

A

Speech

Cognitive ability

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29
Q

Left hemisphere specific stroke deficits affecting speech

A

aphasia/dysphasia, comprehension, expression

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30
Q

Left hemisphere specific stroke deficits affecting cognitive ability

A

math, organization, reasoning, analysis

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31
Q

Right hemisphere stroke deficits:

A 
Spatiality
left-sided neglect
Insight (introspect)
Creativity
Face recognition
Musical ability
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32
Q

Hemorrhagic stroke typically causes the PT to experience

A

intense headaches
Neck pain
Light sensitivity
N/V

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33
Q

Immediate nursing interventions for BA

A

O2
manage BP
Monitor/control cerebral edema (head of bed @ 30º

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34
Q

S/S of bacterial meningitis

A 
Meningeal edema
Increased ICP
Photophobia
Headache
Restlessness
Decreased LOC
N/V
Neck stiffness
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35
Q

bacterial meningitis can present with these skin conditions

A

Petechiae, Purpura

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36
Q

Types of Alzheimer’s dz

A

Familial Alzheimer’s (FAD)

Sporadic (non-hereditary)

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37
Q

3 assessment points for stroke

A

LOC/VS (autonomic)
Sensorimotor status
Reflexes

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38
Q

Alzheimer’s is thought to be caused by:

A

genetic mutation of amyloid proteins that results in abnormal amyloid accumulation which forms plaque-like material

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39
Q

Plaque-like material formed by abnormal accumulation of amyloid in Alzheimer’s patients

A

senile plaques

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40
Q

Formation of twisted microtubules of brain neurons

A

neurofibrillary tangle

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41
Q

Senile plaques & neurofibrillary tangle combine and ___

A

disrupt normal nerve impulses in the brain

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42
Q

Clinical manifestation of Alzheimer’s

A

dementia

Motor changes if posterior frontal lobe involvement

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43
Q

Parkinson’s dz involves negative effects on this anatomical structure ___

A

extrapyramidal motor tracts

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44
Q

the Extrapyramidal system is responsible for:

A

fine motor movements

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45
Q

Normal basal ganglia function depends on ___

A

ACh (acetylcholine) & dopamine

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46
Q

Acetylcholine has an ___ effect on ACh receptors that initiate movement

A

excitatory

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47
Q

An excitatory effect of a neurotransmitter is also called a ___ effect

A

Cholinergic

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48
Q

Dopamine has a __ effect on ACh receptors that initiate movement

A

inhibitory

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49
Q

Parkinson’s is a ___ dysfunction

A

basal ganglia

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50
Q

The cause of Parkinson’s is thought to be:

A

genetic, viral, or environmental toxin-induced depletion of dopamine

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51
Q

A decrease in dopamine disrupts ___ causing ___

A

the balance of neurotransmitter effects, causing acetylcholine to have a stronger effect

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52
Q

Increased __ effects of dopamine depletion causes the S/S of Parkinson’s

A

cholinergic

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53
Q

S/S of Parkinson’s are related to ___

A

hypertonia & dyskinesia

54
Q

S/S of Parkinson’s are dubbed “___”

A

Parkinsonianisms

55
Q

Inability of Parkinson’s PTs to adjust posture when tipping or falling results in what is termed ___

A

Basal Ganglion gait

56
Q

Medications that treat S/S of Parkinson’s include medications that:

A

contain Dopamine to counter the neurologic decrease;

have anti-cholinergic effects (Benadryl)

57
Q

Common autoimmune disorder with onset between ages 20-50, that effects women 2X more than men

A

Multiple Sclerosis

58
Q

The name “Multiple Sclerosis” is based on the pathology of MS, in which:

A

T cell attacks causes demyelination in multifocal (“multiple”) locations, which heals by forming scar tissue that hardens over time (sclerosis)

59
Q

___ are effected by the scarring & hardening of MS

A

neuroglia

60
Q

Demyelinated nerve axons transmit impulse ____ compared to normal axons

A

10X slower

61
Q

Hemorrhagic stroke is caused by ___

A

the effects of blood leaking directly onto brain tissue, causing inflammatory processes

62
Q

A diffuse brain/brain stem stroke is caused by an event that causes ___

A

the whole brain to become hypoxic and edematous with increased ICP

63
Q

S/S of MS

A

Paresthesias
Asymmetrical weakness
balance/coordination issues if cerebellum involved

64
Q

Severe episodic headaches that occur in a typical pattern

A

Migraines

65
Q

Common pattern of a migraine

A

Prodrome
Headache
Postdrome

66
Q

Migraines are thought to be caused by

A

a trigger event in genetically predisposed people

67
Q

Triggers of migraines can include:

A

chemicals in certain foods (cheese, wine, chocolate)

or stressful events, smells, sounds, etc.

68
Q

Medication taken at the first sign of a migraine prodrome

A

Immitrex (abortive drugs)

69
Q

Define Dementia

A

chronic dysfunction of memory and/or function that develops over time

70
Q

Types of events that can contribute to a thrombotic or embolic stroke

A

Afib
Carotid atherosclerosis
air emboli
clots around mitral/aortic valve prosthesis
Development of intracranial artery plaque

71
Q

The corticospinal tracts function to:

A

carry impulses that produce voluntary skillful movement from the brain

72
Q

Define Nystagmus

A

rhythmic, involuntary, unilateral or bilateral movement of the eyes

73
Q

Sudden, explosive, disorderly discharge of brain neurons that cause transient alteration in brain function

A

seizure

74
Q

Seizures can be caused by ___

A

congenital seizure disorder (epilepsy)
or
an acute problem

75
Q

Examples of acute problems that can cause seizures

A

head injury

stroke

76
Q

Infection/inflammation of the meninges

A

meningitis

77
Q

___ meningitis almost never causes sepsis

A

viral

78
Q

Meningitis is most commonly caused by:

A

viruses or bbacteria

79
Q

Most common cause of bacterial meningitis

A

meningococcus & pneumococcus

80
Q

___ meningitis causes worse S/S and clinical picture than ___

A

bacterial; viral

81
Q

S/S of meningeal inflammation around the brain

A 
photophobia
blurred vision
headache
restlessness
irritability
decreased LOC
82
Q

S/S of meningeal inflammation around the spinal chord

A

neck stiffness

positive Brudzinski’s and/or Kernig’s signs

83
Q

Other more generalized S/S of meningitis

A

fever
leukocytosis
petechiae & purpura

84
Q

Petechiae & purpura in meningitis is caused by

A

bacterial toxins inflaming subdermal vasculature

85
Q

Diagnosis of meningitis is done by ___

A

CSF analysis via spinal tap

86
Q

CSF is analysis when suspecting meningitis would bee focusing on looking for:

A

high WBC
high protein count
lower than normal glucose
Blood

87
Q

The synapse between the neuron & the effector muscle

A

neuromuscular junction

88
Q

NMJ functions involve:

A

balance of events that result in muscle movement

89
Q

Some functions of the NMJ resulting in muscle movement include:

A

releasing ACh
binding ACh to ACh receptors
Releasing cholinesterase

90
Q

Cholinesterase functions to __

A

break down leftover ACh that isn’t used

91
Q

anything that decreases ____ and/or increases ___ results in muscle weakness

A

ACh production/reception

Cholinesterase production

92
Q

___ is an example of a disorder of the NMJ

A

Myasthenia Gravis

93
Q

Thymic tumor or other changes in the thymus are sometimes associated with this autoimmune dz

A

Myasthenia Gravis

94
Q

The causative action in Myasthenia gravis

A

self-produced antibodies block, alter, or destroy ACh receptors

95
Q

S/S of Myasthenia Gravis

A

Progressive muscle weakness that increases during periods of activity & decreases during rest

96
Q

Pathology of progressive muscle weakness during motor activity (Myasthenia Gravis)

A

Autoantibodies destroy ACh receptors, so even normal reductions in ACh quickly result in inability to complete the nerve transmission

97
Q

Muscle weakness in Myasthenia Gravis can include muscles that control ___

A

eye/eyelid movement, facial expressions, chewing, talking, swallowing, and neck/limb movements

98
Q

Medication based TX for Myasthenia gravis include:

A

Anti-cholinesterase drugs

Steroids

99
Q

Pupillary dilation upon exposure to less light

A

mydriasis

100
Q

Mydriasis results from ___

A

the sympathetic nervous system secreting norepinephrine & stimulating alpha-1 adrenergic receptors

101
Q

Mydriasis is a(n) ___ effect

A

adrenergic

102
Q

Pupillary constriction

A

miosis

103
Q

Miosis results from ___

A

parasympathetic nerve fibers in CN II releasing ACh

104
Q

Miosis is a(n) ___ effect

A

cholinergic

105
Q

“same side” effect

A

ipsilateral

106
Q

Double vision

A

diplopia

107
Q

Inflammation/edema of the optic nerve

A

Papilledema

108
Q

Papilledema is caused by

A

blockage of veinous return from the retina, mainly from increased ICP

109
Q

Protein coagulation in the lens of the eye

A

Cataracts

110
Q

Age-related increase in intraocular pressure

A

Glaucoma

111
Q

1 cause of blindness

A

Glaucoma

112
Q

S/S of this include painless, slow loss of peripheral vision

A

Open angle glaucoma

113
Q

“Acute glaucoma”

A

Closed angle glaucoma

114
Q

Severe, irreversible loss of central vision due to destruction of a central part of the eye

A

Macular degeneration

115
Q

Risk factors for Macular degeneration include

A

HTN
Smoking
Caucasian race
Diabetes

116
Q

S/S of Macular Degeneration

A

clear peripheral vision with black spots in central vision

117
Q

Posturing (decerebrate/decorticate) in a stroke victim is caused by

A

brain stem involvement

118
Q

Breathing pattern change seen in brain stem stroke PTs

A

Cheyne Stokes breathing

119
Q

Cerebellar strokes may present with problems including

A

balance, vertigo, incoordination

120
Q

Mydriasis occurs in response to:

A

the SNS releasing Norepinephrine

121
Q

Externally visible S/S of a diffuse stroke

A

bilaterally weaker sensation, muscle tone, movement, strength, and reflexes

122
Q

Pressure required to get oxygenated blood to perfuse the cells of the brain

A

Cerebral perfusion pressure

123
Q

Possible S/S of Alzheimer’s

A

Dementia
behavioral changes
emotional upset
possible motor/gait changes

124
Q

Unequal pupils cann indicate

A

neuro disorder such as increased ICP or intracranial hemorrhage

125
Q

Damage to CN III will cause what?

A

Abnormal pupil dilation due to loss or diminishing of pupillary constriction abilities

126
Q

What rules sensorimotor status below the shoulders?

A

Corticospinal and spinothalmic tracts

127
Q

What rules sensorimotor status above the shoulders?

A

12 cranial nerves

128
Q

Typical S/S of a cerebellar stroke

A

Problems with coordination & balance

129
Q

Pathological changes of a focal lesion of the motor tracts will be

A

unilateral & contralateral

130
Q

Crossing over of nerve fibbers from the motor tracts

A

decussation

131
Q

Acute state of confusion due to problems such as high fever, electrolyte imbalances, etc.

A

delirium

Pathophysiology (7 decks)

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