Neurological Disorders

Question 1

Increased ICP

Answer 1

pressure greater than 20 mmHg

Question 2

Cerebral perfusion pressure (CPP)

Answer 2

amount of blood flow from the systemic circulation to provide adequate perfusion to brain tissue - 50-70 mmHg

Question 3

Mean arterial pressure (MAP)

Answer 3

the average pressure during the cardiac cycle, range from 70-110 mmHg

Question 4

Describe the Cerebral Hemodynamic relationship

Answer 4

CPP = MAP - ICP

Question 5

How does the brain adapt to increases in ICP?

Answer 5

a. displacement of CSF into spinal canal
b. reduction of blood volume - alters brain metabolism
- leads to hypoxia and ischemia
c. displacement of brain tissue - herniation

Question 6

Brain herniation

Answer 6

occurs when the brain shifts across structures within the skull such as the falx cerebri, the tentorium cerebelli and the foraman magnum; occurs late in the course of increased ICP; always constitutes an emergency

Question 7

Cerebral edema

Answer 7

An increase in the fluid content of brain tissue

Its harmful effects are caused by distortion of the blood vessels, displacement of brain tissues and eventual brain herniation

Question 8

Describe what can and cannot permeate blood brain barrier

Answer 8

a. O2, CO2, H2O and glucose can easily pass
b. Electrolytes, dyes and organic substances pass more slowly
c. Toxic substances, plasma proteins and other large substances cannot permeate through BBB

Question 9

Cushing’s Triad

Answer 9

a. Increased SBP with widening pulse pressure
d. Abnormal respiratory patterns
c. Bradycardia

Question 10

Name the different locations to measure ICP

Answer 10

Ventricular, subarachnoid, intraparenchymal, epidural, subdural

Question 11

Management of Shock (ABCDEFGHI)

Answer 11

Airway

Blood pressure

Calm

Dim the lights

Elevate the head/Eyes

Fluid and electrolytes/Food/Family

Glasgow Coma Scale

Hyperthermia/Hip flexion

ICP monitoring

Question 12

Head injuries are most often caused by

Answer 12

Falls
Motor vehicle crashes (MVC)
Sports related injuries
Gun shot wounds

Question 13

Types of Head Injury

Answer 13

a. Penetrating
b. Coup Contrecoup
c. Scalp injuries
d. Skull fractures
e. Concussions
f. Intracranial hemorrhages

Question 14

second impact syndrome

Answer 14

a 2nd concussion occurs before the first has healed; rapid and severe brain swelling

Question 15

Which head injury can cause the following symptoms?

headache, dizziness, vomiting, nausea, lack of coordination, difficulty balancing, may or may not lose consciousness

Answer 15

Concussion

Question 16

arteriovenous malformation (AVM) is likely to cause which type of bleeding?

Answer 16

Subarachnoid

Intracerebral

Question 17

Types of Intracranial Hemorrhage

Answer 17

a. epidural
b. subdural
c. subarachnoid
d. intracerebral
e. intraventricular

Question 18

Penumbra

Answer 18

zone of hypoperfusion around the infarcted area; depends on the amount of collateral circulation present

Question 19

Primary neuronal injury

Answer 19

cells in the centre of stroke area (core ischemic zone) die almost immediately

Question 20

What are the two kinds of ischemic stroke?

Answer 20

Thrombotic

Embolic

Question 21

The extent of an ischemic stroke depends on which 3 things?

Answer 21

a. location of occluded artery
b. size of the occluded artery
c. adequacy of collateral circulation

Question 22

What causes hemorrhagic stroke?

Answer 22

rupture of weakened blood vessels, commonly caused by aneurysms and AVM

Question 23

What are some general findings of stroke?

Answer 23

Headache
Vomiting
Seizures
Changes in mental status
Motor changes
Communication

Question 24

Management of stroke

Answer 24

a. Identify stroke early
b. Maintain cerebral
c. oxygenation
d. Restore cerebral blood flow
e. Prevent and manage complication
f. Prevent recurrence
g. Rehabilitation

Question 25

Clinical manifestation specific to ischemic stroke

Answer 25

Transient hemiparesis
Loss of Speech
Hemisensory loss

Question 26

Clinical manifestation specific to hemorrhagic stroke

Answer 26

Severe occipital and nuchal headaches
Vertigo or syncope (passing out)
Paresthesias and transient paralysis

Question 27

How does ischemic and hemorrhagic stroke differ in symptom onset?

Answer 27

Ischemic symptoms develop slowly over minutes to hours or days

Hemorrhagic symptoms occur rapidly, typically whilst awake

Question 28

Transient Ischemic Attack (TIA)

Answer 28

sudden, brief episode of neurologic dysfunction caused by temporary cerebral ischemia