Neurological System Disorders Flashcards
Pressure required to get oxygen into brain to perfuse cells of brain
Cerebral Perfusion Pressure (CPP)
Decreased CPP are caused by?
- Hypovolemia
- Hypotension
- Hypertension
- Blockage of arterial flow into brain
Increased ICP is caused by?
- Head injury
- Brain tumor
- Brain Attack (Stroke)
Abnormal CPP resulting in IICP
Hypotension, Hypovolemia, atherosclerosis of carotid arteries -> Ischemia & hypoxia of brain -> Cerebral edema => increased ICP
Caused of Increased ICP
Hemorrhage, infection, acidosis -> Cerebral edema -> Increased ICP => Decreased oxygenated blood going into brain arteries (CPP decreases)
General sequela (S/s of IICP)
- Change of LOC
- Pressure on respiratory centers (Cheyne stokes) -> Pressures other parts of brain stem -> Decerebrate & Decorticate posturing (Only Comatose pt’s)
- Affected reflexes (Babinski - plantar reflex)
Autonomic, LOC, Mental status manifestation as a result of brain/brain stem stroke
- Diminished LOC
- HR & BP changes due to (pressure on medulla)
- Breathing changes (Apnea or Cheyne-stroke)
Sensorimotor Manifestations seen as a result of brain/brain stem abnormalities
- Sensations, muscle tones, movement & strength weakness
- Pt’s are often comatose (Abnormal motor responses to stimuli) (Decerebrate & Decorticate posturing)
- Mixed degree of CN abnormalities (Both pupils either fixed or dilated, fixed, or pinpoint)
Reflex Manifestations seen as a result of Brain/Brain Stem Abnormalities
- Protective reflexes (Sneezing, coughing, gagging, & Swallowing) diminished or lost
- Reflexes weaker (Symmetrically)
- Bilateral (Postive Babinski)
Left hemispheric CVA (S/s)
- Dysphasia or aphasia (Speech)
- Inability to comprehend, integrate, & express language
Right hemispheric CVA (S/s)
- Left-sided neglect (Completely ignores the environment on left side)
- Seat of insight (Creativity, face recognition, muscle ability, etc)
Expected Level of Consciousness (LOC)
- Being alert or arousable to alertness if asleep
- Being oriented x4 (self, time, place, events)
- Following command
- Normal speech
- Conversing appropriately
Focal cerebral edema around right CN 7 that innervates a smile
- What would you expect to see?
Facial drooping on left side of mouth
Focal cerebral edema around right CN 2 that transmits visual image to brain
- What would you expect to see?
Visual defects in two left halves of both eyes (Homonymous hemianopia)
When assessing pupillary response (CN 2 & CN 3) what would you expect to see?
- Both pupils should equally respond to light
- Both pupils should constrict to the same size
Pyramidal tracts carrying impulses that produces voluntary movements of purpose & skill from brain (via: Spinal cord)
- (Descending Tract)
Corticospinal tracts
Carries sensation of pain, temperature, crude & light touch from body to brain (thalamus) for processing
- (Ascending tract)
Spinothalamic tracts
If there is a focal/lesion related to corticospinal or spinothalamic tract in the brain
- What would you expect to see?
- Asymmetric sensorimotor changes
- Unilateral on (Contralateral side) due to decussation
Stroking plantar surface of foot makes the big toe flex (“Upgoing toe”)
Postive Babinski
If there is focal pressure (Lesion, edema, etc) on motor tracts, what would likely occur?
- Paresis (Reflex changes) on contralateral side of body below the neck (Opposite of where the brain lesion is
If there is focal pressure on cranial nerves, what would likely occur?
- Abnormalities in facial movement, visual disturbance and pupillary response to light
Treatments for Brain disorders
- Keep head of bed up @ (30 degrees)
- Keeping BP not too high or too low
- Giving diuretics (to decrease cerebral edema)
Hemorrhagic brain attack (S/s)
- Intense headache
- Neck pain
- Light intolerance
- Nausea & Vomiting
- High mortality rate
Dx & Tx for Brain attack (Stroke) BA
BEFAST
B- Balance (sudden loss of balance
E- Eyes (Vision loss)
F- Face (uneven smile)
A- Arms (one arm weaker)
S- Speech (Slurred speech)
T- Time (Call 911 ASAP)
