Neurological Disorders Flashcards

1
Q

Why is oxygen needed in the brain?

A
  • needed to break down glucose into carbon dioxide and water

- need a continuous feed of supply

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2
Q

What areas are particularly vulnerable to oxygen loss?

A
  • subcortical nuclei, limbic system, frontal lobes and cerebellum
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3
Q

What is anoxia and hypoxia?

A
  • an absence of oxygen

- a deficiency in oxygen

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4
Q

What is an ischemic accident?

A
  • loss of blood flow
  • can be transient
  • happen in the internal carotid, middle cerebral or the vertebral cerebral arteries
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5
Q

How do ischemic accidents affect stroke?

A
  • higher risk of stroke by 20-35%
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6
Q

What is a hemorrage?

A
  • escaping blood from a ruptured blood vessel
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7
Q

What is an embolism or embolic occlusion?

A
  • a temporary block that clears with pressure
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8
Q

What are the symptoms of a transient ischemic attack?

A
  • tingling or numbness in one side of the face
  • confusion
  • loss or impairment of speech
  • slurring of speech and dizziness
  • blurry or double vision
  • other cognitive changes
  • weakness on one side of body (arm or leg)
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9
Q

What is infarction?

A
  • (obstruction of blood flow)

- cell death caused by occlusion of a blood vessel

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10
Q

What are infarctions mostly caused by?

A
  • thrombotic or embolic vascular occlusion mostly caused by atherosclerosis
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11
Q

What artery is particularly vulnerable to infarction?

A
  • middle cerebral artery (left hemisphere)
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12
Q

What are infarctions in small vessels called?

A
  • lacunar infarctions
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13
Q

What is a thrombotic vascular occlusion?

A
  • full block of an artery
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14
Q

What is a hemorrage and what are they commonly caused by?

A
  • rupture of the vessel producing hematomas

- can be caused by aneursyms

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15
Q

What is a hematoma?

A
  • collection of blood outside of blood vessels
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16
Q

What is an aneurysm?

A
  • an abnormal enlargement in a blood vessel

- causing thinning in the walls

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17
Q

What areas are particularly vulnerable to hemorrhages?

A
  • putamen, white matter, thalamus, pons, cerebellum, and caudate nucleus
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18
Q

What are the types of aneurysms?

A
  • saccular aneurysm

- fusiform aneurysm

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19
Q

What is coiling?

A
  • insert microcatheter into femoral artery and feed wire up to aneursym
  • fill aneursym with coiled wire
  • decreases chances of rupture
  • but risk of embolism during procedure
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20
Q

What is a intracerebral hemorrhage stroke?

A
  • vessel rupture
  • increased intracranial pressure (ICP)
  • neuronal death
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21
Q

What is a subarachnoid hemorrhage stroke?

A
  • rupture occurs within the subarachnoid space

- increased intracranial pressure (ICP)

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22
Q

What is arteriovenous malformation?

A
  • too much branching of capillaries producing thin and weak walls
  • tangle of abnormal blood vessels
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23
Q

What are the neuropsychological effects (of stroke)?

A
  • impaired inhibitory control
  • impaired attention and attentional control
  • motor and sensory impairments
  • memory impairments
  • deficits in abstract reasoning
  • emotional and behavioural changes
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24
Q

What are characteristics of brain tumors?

A
  • atypical, uncontrolled growth of cells
  • cells do not serve a functional purpose
  • tumor grows at the expense of healthy cells
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25
What are infiltrating tumors?
- take over and "invade" neighbouring areas of the brain and destroy surrounding tissue
26
What are non-infiltrating tumors?
- encapsulated, well differentiated and non-invasive
27
What are malignant tumors?
- indicates that the properties of the tumor cells invade other tissue and that there is a propensity for regrowth
28
What are benign tumors?
- describes abnormal cell growth that is usually surrounded by a fibrous capsule and is non-infiltrative - a much smaller probability for regrowth
29
What is grading?
- a classification system of tumor growth | - grading is in order of increasing malignancy from Grades 1 to 4
30
What types of brain tumors are infiltrating?
- gliomas - glioblastoma multiforme - astrocytomas - oligodendrogliomas
31
What types of brain tumors are non-infiltrating?
- meningiomas
32
What are gliomas?
- a malignant tumour of glial tissue
33
What is a neuroma?
- begnign growth of nerve tissue between the toes
34
Why are traumatic brain injuries a big deal?
- number one killer of young Canadians - annual cost about 3 billion - 50, 000 Canadians annually - high correlation with homelessness and prison
35
What are the leading causes of TBI?
- motor vehicle accidents - sports injuries - falls - alcohol involved in 1/3 of all TBIs
36
Why is the brain vulnerable to TBIs?
- brain is consistency of congealed oatmeal - skull is roughly as thick as 3 pennies - technology has advanced faster than evolution
37
What are the different types of trauma?
- penetrating - crush - open - closed
38
How does a penetrating trauma occur?
- by a hard object, such as bullet, scissors or knife
39
What are the primary and secondary risk of penetrating trauma?
- primary risk: depends on location | - secondary: infection and hemorrhaging
40
What causes crush trauma?
- skull and brain are crushed between two hard surfaces
41
What is open trauma?
- skull is fractured and there is an opening causing the brain to be exposed
42
What is a closed head injury?
- rapid acceleration and deceleration shake the brain in the skull (like jello) - no direct impact is needed
43
What is acceleration and deceleration?
- acceleration: significant physical force propels it quickly from stationary to moving - deceleration: brain is in motion then stopped abruptly
44
What are the primary effects of a closed head injury?
- coup: a contusion at the site of impact | - contra-coup: a contusion on the opposite site of impact
45
What is diffuse axonal injury?
- common and most likely at frontal lobes and temporal poles due to uneven "sandpaper-like" surface of the tentorial plates that hold them in place - physical forces shear, tear and rupture nerves, blood vessels and covering of the brain
46
What are complications of diffuse effects?
- neuronal disruption, ischemia, hemorrhaging and edema
47
Why are frontal lobes vulnerable to TBI?
- bone shape on top of skull | - result in anosmia (inability to smell)
48
What is tensile strength?
- minimum stress required to rupture axon
49
What is retrograde degeneration?
- axon degenerates back to cell body resulting in cell death
50
What is anterograde degeneration?
- damaged cell bod leads to axon fibre degeneration
51
What is the Glasgow Coma Scale?
- standard rapid, reliable measure of coma depth | - assesses language, consciousness, motor, etc.
52
What do scores >13 say?
- mild confusional state
53
What do scores <5 say?
- deep coma
54
What scores mean the patient is in a coma state?
- 8 or less | - can't open eyes, make recognizable sounds or follow commands
55
What scores predict good recovery?
- >8
56
What secondary effects can there be with closed head injury?
- edema - herniation - extradural and subdural hemorrhage - intracranial bleeding - skull fractures - post traumatic epilepsy
57
What is edema?
- swelling of the brain after trauma - main cause of death - brain swells and becomes compressed, blocking arteries
58
What is herniation?
- hemorrhages, tumours or infections displace and deform the brain
59
What is transtentorial herniation?
- swelling causes the brain stem to protrude through the opening at the base of the skull - called coning and is often fatal - compromises the brainstem which controls vital functions
60
What treatment is done to monitor transtentorial herniation?
- intracranial pressure monitored with catheter into ventricles or subarachnoid space
61
How is intracranial pressure controlled?
- blood pressure ca be reduced medically or with hyperventilation - extreme cases are put in a pharmacologically induced coma - last resort: sunt or removal of a lobe to make room
62
What is subdural hematoma?
- between dura and arachnoid space | - frequent and very dangerous but difficult to detect
63
When can subdural hematoma occur?
- 1 hour to 1 week after injury
64
What exactly occurs during a subdural hematoma?
- initial period of unconsciousness followed by normal conscious functioning - bleed enlarges and pushes brain laterally and downward causing herniation and consciousness deteriorates quickly
65
What are the symtpoms of subdural hematoma?
- contralateral hemiparesis, ipsilateral pupil dilation, changes in consciousness
66
What is extradural hematoma (epidural hematoma?
- between dura and skull - uncommon (1-3%) - usually caused by rupture of an artery
67
How is a extradural hematoma treated?
- by drilling burr holes over parieto-occipital and temporal regions to drain blood before it coagulates
68
What is intracranial bleeding?
- bleeding within the brain | - difficult to remove
69
What occurs in 15% of fatal injuries (related to intracranial bleeding)?
- space-occupying clots
70
What is the most frequent cause of intracranial bleeding?
- microscopic hemorrhages formed by torn blood vessels
71
What may be required to treat intracranial bleeding?
- surgery to relieve pressure caused by a clot
72
What are the two types of skull fractures?
- linear fracture: benign, distinct straight line | - depressed: fragments of skull driven into dura and brain
73
What are the risks of skull fractures?
- infection, CSF leaks, bleeding | - can rupture meningeal arteries or venous sinuses resulting in epidural and subdural hematomas
74
When are post-traumatic epilepsy symptoms more likely?
- after penetrating head injuries (40%) than closed head wounds (10%) because they are related to presence of scar tissue - onset can be delayed for up to 2 years
75
What precaution is taken against post-traumatic epilepsy?
- patients given anticonvulsant medication to control for possibility
76
What are acute treatments of TBI?
- ABCs (airways, breathing, circulation) - control ICP with ventilation/diuretics - steroid therapy to prevent edema - temperature control to control metabolic rate