Neurological Assessment and Dysfunction

Question 1

Three signs of Cushing’s Triad

Answer 1

1. Increasing blood pressure
2. Bradycardia
3. Irregular breathing patterns

Question 2

Red flags for neurological deterioration include:

Answer 2

Increasing headache, decreased conscious state or orientation, confusion or irritability, seizures, slurred speech, neck pain, weakness or numbness, behaviour changes

Question 3

Biot’s breath is…?

Answer 3

Irregular breathing with apnoeic episodes

Question 4

Cushing’s Triad indicates ….?

Answer 4

Late signs of increased ICP and indicate that the brain is about to herniate.

Question 5

Albumin resus in head injured patients

Answer 5

Is contraindicated due to increased mortality and association with increased ICP.

Question 6

What is the sole energy substrate for the brain?

Answer 6

Glucose

Question 7

3 systems responsible for maintain homeostasis

Answer 7

Neurological, endocrine & immune,

Question 8

CNS consists of:

Answer 8

Spinal cord and the brain

Question 9

CNS is responsible for:

Answer 9

Acquire, coordinate and disseminate information about the body and it’s environment.

Question 10

The peripheral nervous system is composed of:

Answer 10

43 pairs of spinal nerves and 12 pairs of cranial nerves that emerge from the base of the brain.

Question 11

How many neurons in the human brain?

Answer 11

100 billion

Question 12

Two main classes of synapses:

Answer 12

Electrical and chemical

Question 13

Function of electrical synapses

Answer 13

Permit direct, passive flow of electrical current from one neuron to another in the form of action potential.

Question 14

Function of chemical synapses:

Answer 14

Enable cell to cell communication via the secretion of neurotransmitters

Question 15

Function of myelin:

Answer 15

Increases conduction velocity

Question 16

Guillian-Barre syndrome:

Answer 16

Demyelination of peripheral nerves, slowing conduction and may result in a conduction block.

Question 17

Neurotransmitters are:

Answer 17

Chemical that act as messengers to relay information between neurons.

Question 18

4 classes of neurotransmitters:

Answer 18

1. Acetylcholine
2. Biogenic amines
3. Excitatory amino acids
4. Neuropeptides

Question 19

3 major divisions of the brain:

Answer 19

1. Paired hemispheres of the cerebrum
2. the brainstem
3. the cerebellum

Question 20

7 components of the brainstem:

Answer 20

1. thalamus
2. hypothalamus
3. epithalamus
4. subthalamus
5. midbrain
6. medulla oblongata

Question 21

3 regions of the brain:

Answer 21

Forebrain, midbrain, hindbrain

Question 22

Cerebrum description:

Answer 22

1. Largest and most uppermost portion of the brain.
2. Two hemispheres.
3. 2x frontal, parietal, temporal and occipital lobes

Question 23

Cerebrum functions:

Answer 23

Cortex (outer layer) is the site of conscious thought, memory, reasoning and abstract mental functions.

Question 24

Diencephalon decription;

Answer 24

Between the cerebrum and the brainstem.

Contains thalamus and hypothalamus

Question 25

Thalamus function:

Answer 25

Thalamus sorts redirects sensory input

Question 26

Hypothalamus function:

Answer 26

Controls visceral, autonomic, endocrine and emotional function and the pituitary gland.

Question 27

Midbrain function:

Answer 27

Reflex centres concerned with vision and hearing.

Question 28

Basal ganglia function:

Answer 28

Planning and coordinating motor movements and posture,

Question 29

Basal ganglia description:

Answer 29

The mass of grey matter in the midbrain beneath the cerebral hemispheres

Question 30

Pons function:

Answer 30

Helps to regulate respiration +?

Question 31

Cerebellum function:

Answer 31

Coordinates voluntary muscles, maintains balance and muscle tone, fine movement, position sense and integration of sensory input.

Question 32

One fixed or dilated pupil may be indicative of

Answer 32

1. An expanding or developing intracranial lesion, compressing the oculomotor nerve on the same side as the effect pupil

Question 33

A sluggish pupil may be :

Answer 33

An early focal sign of an expanding intracranial lesion and raised ICP.

Question 34

Approximate blood flow through the brain

Answer 34

750 mls/min

Question 35

CPP formula:

Answer 35

MAP - ICP = CPP

Question 36

Cerebral perfusion pressure - relationship to cerebral blood flow

Answer 36

CBF is a function of the pressure drop across the cerebral circulation

divided by

cerebral resistance

Question 37

CPP serves as a rough index of

Answer 37

Cerebral blood flow

Question 38

Normal cerebral perfusion pressure

Answer 38

70-100mmHg

Question 39

When ICP and MAP are equal:

Answer 39

CPP is zero and CBF ceases

Question 40

Cerebral autoregulation

Answer 40

Maintenance of constant CBF rate in face of changing MAP and CPP through alterations in cerebral vascular resistance (dilation and constriction of the vessels) within MAP 50-150mmHg

Question 41

Effect of head injury on cerebral autoregulation

Answer 41

Alters vessel reactivity and the relationship between CPP and blood flow.

*CBF becomes passively dependent on changes in blood pressure

Question 42

Effect of CO2 on CBF

Question 43

Effect of O2 on CBF

Question 44

Effect of pH on CBF

Question 45

Effect of temperature on CBF

Question 46

Effect of glucose on CBF

Question 47

Why is oxygen of critical importance in cerebral metabolism?

Question 48

Cerebral oedema

Answer 48

Abnormal accumulation of water or fluid, either local or generalised in the:

• intracellular space
• extracellular space
• or both

Question 49

Cerebral oedema can cause:

Answer 49

Deterioration in brain function through the compression of tissue and blood vessels

Question 50

Compression of cerebral blood vessels

Answer 50

Reduces oxygen delivery to the brain, causing cerebral ischaemia and a decrease in brain function.

Question 51

Cerebral oedema can block the flow of:

Answer 51

CSF, causing an increase in ICP

Question 52

3 main types of cerebral oedema

Answer 52

Vasogenic, cytotoxic, interstitial

Question 53

Vasogenic oedema:

Question 54

Cytotoxic oedema:

Question 55

Interstitial oedema:

Question 56

Preventing secondary injury of a head injury patient aims to:

Answer 56

1. Control ICP
2. Maintain cerebral oxygenation
3. Minimise cerebral oxygen consumption

Question 57

Aim of ICP monitoring:

Answer 57

Detect potentially harmful secondary insults early and apply appropriate preventative interventions.

Question 58

Vasospasm post haemorrhage

Answer 58

Often occurs 4-14 days post haemorrhage, increasing chances of rebleeding

Question 59

Stroke

Answer 59

Descriptive term for the sudden onset of acute neurological deficit persisting for more than 24 hours and caused by interruption of cerebral blood flow

Question 60

Two types of stoke:

Answer 60

Ischaemic and haemorrhagic

Question 61

2 Subtypes of haemorrhagic stroke:

Answer 61

Subarachnoid and intracerebral

Question 62

Ischaemic stroke

Answer 62

Interruption of blood flow due to thrombotic of embolic event

Question 63

Most common cause of cardiac emoboli

Answer 63

Atrial fibrillation

Question 64

Ischaemic injury occurs when:

Answer 64

Cerebral blood flow is reduce to a level insufficient to maintain neuronal viability

Question 65

Cerebral oedema can cause:

Answer 65

Intracranial hypertension

Question 66

Cerebral oedema results from:

Answer 66

Loss of metabolic function of the cells, peaking at 4 days.

Question 67

Common cause of death during the first week after stroke:

Answer 67

Cerebral oedema

Question 68

Major acute complications of ischaemia stroke

Answer 68

1. Secondary haemorrhage at the site of the stroke lesion

2. Seizures

Question 69

Haemorrhagic conversion

Answer 69

Secondary haemorrhage at the site of the stroke lesion

Question 70

Characteristic sign of an ischaemic stroke

Answer 70

Sudden onset of focal neurological signs persisting for more than 24 hours