NEUROLOGY W4 Flashcards
What are the 3 main functions of CNS?
- Monitor internal/external environment
- Integrate sensory input (understanding-creating sensations)
- Coordinate voluntary/involuntary responses
What is a neuron?
A nerve cell
What are the components of a neuron?
- Nuclei (core)
- Dendrite (receiver/tentacle)
- Axon (transmitter/tail)
What is the function of an afferent nerve cell?
Transports sensory input towards the brain
The autonomic nerve system consists of what to types of response?
Parasymphatic (inhibitor/relaxation)
Symphatetic (Exiter/fight or flight)
Is it true that neurons can divide and renew them selves?
No. Dead neutrons cannot be restored, but their function can be somewhat resumes by other neurons close by
Which molecules are mainly involved in creating action potential?
Sodium (Na) and a smaller amount of potassium (K)
What does the myelin (coating) of the axons achieve?
Nerve impulse travels faster in highly myilated axons
Name 3 types of nerve terminals
- Nerve to nerve
- Nerve to muscle (neuromuscular-terminal)
- Nerve to gland (neuroglandular-terminal)
What happens in the synaptic cleft
Neurotransmitters interact with potsynaptic receptors and excites or inhibits a process
Name 3 different methods in which the body disposes of a neurotransmitter after it has been used
- Diffusion out of the synapsis cleft
- Inactivation/decomposition by enzymes
- Reuptake into the presynaptic knob (reused)
Name the 3 meninges (protective layers) of the brain
- Dura mater
- Arachnoidea
- Pia mater
What are the characteristics of arachnoidea?
Spiderlike connections between the two other meninges. Containing CSF (cerebrospinal fluid)
What are the characteristics of pia mater?
Thin, delicate, highly vascularised layer closest to the brain
What is the normal daily production amount of CSF
500ml
What is the normal constant volume of CSF?
150ml
What is the characteristics of CSF?
- Surrounds the brain and spinal cord
- Transports nutrients and waste
- Acts as shock absorbent
What is a ganglion?
A collection of nerve cell bodies (nuclei)
Name, function and type of CN I
Name: Olfactory
Function: Smelling
Type: Sensory
Name, function and type of CN II
Name: Optic
Function: Vision (sensory)
Type: Sensory
Name, function and type of CN III
Name: Oculomotor
Function: Eye movements (motor)
Type: Motory
Name and function of CN IV
Name: Trochlear
Function: Voluntary eye movements
Type: Motory
Name, function and type of CN V
Name: Trigeminal
Function: Sensation of head and face, movement of mandible
Type: Sensory + Motory
Name, function and type of CN VI
Name: Abducent
Function: Eye movement (lat. rectus)
Type: Motory
Name and function of CN VII
Name: Facial
Function: Taste, Facial expression
Type: Sensory + Motory
Name and function of CN VIII
Name: Vestibulocochlear
Function: Hearing and balance
Type: Sensory
Name, function and type of CN IX
Name: Glossopharyngeal
Function: Control swallowing
Type: Sensory + Motory
Name, function and type of CN X
Name: Vagus
Function: Pharynx, larynx-control + speech
Type: Sensory + Motory
Name, function and type of CN XI
Name: Accessory
Function: Rotation of head, shoulder shrug.
Type: Motory
Name, function and type of CN XII
Name: Hypoglossal
Function: Movement of tongue
Type: Motor
How many peripheral nerve pairs do a human body have?
31 pairs
What is a dermatome?
An area of the skin a given nerve serves. Therefor the nerve can be tested for function at this given area.
What is a myotome?
A muscle that is served by a given nerve. Therefor the nerve can be tested for function at this given muscle
What is the plexus?
A structure found many places in the body were several efferent and afferent fibres of nerves merge to form peripheral nerves that innervate a specific muscle or skin area
What is a reflex?
A rapid and automatic response to a specific stimulus that happens in the spinal cord
What are the most common and easy recognizable signs and symptoms of meningitis?
Fever
Stiff neck
Headache
What is brudzinzki’s sign?
The “test” were you bend the patients neck upwards. If the patient flexes the hip upwards due to pain and swollen meninges it is a sign of meningitis.
When should you always perform neurological examination?
- Suspected head or spinal injury
- Complaints of neurological deficits
What are the to causes of stroke?
- Ischemia (85%)
- Haemorrhage (15%)
Name some of the signs & symptoms of stroke
- Sensory deficit
- Motory deficit
- Aphasia (speech problems)
- Blindness
- Dizziness
- Decreased LOC
- Thunderclap headache (sudden onset, high pain)
Name some causes for seizure
- Structural disease (e.g. tumor, postinchemic, post traumatic)
- Infection
- Hypoglycaemia (low blood sugar)
- Cerebral edeema from trauma or heat stroke
Name the to types of seizures
- Localised
- Globalised
Name the to types of globalised seizures
- Tonic (stiff muscles)
- Clonic (movement of muscle) - shaking
What are the risks of seizuring?
- Head trauma
- Biting tongue - bleeding
- Hypoxia - damage to nerve cells
On the GCS score what would these responses score?
-Eyes open upon speech (eye)
-Gives confused answers (verbal)
-Localizes pain (motor)
3 + 4 + 5 = 12
If the patient has closed eyes but opens them when you talk to him. How do you rate him on AVPU?
V (verbal)
A patient has open eyes but makes no sense when he speaks. How do you rate him on AVPU?
A (alert)
Name the 5 senses
- Touch/pain
- Smell
- Hearing
- Taste
- Seight
What is typically indicated with traumatic injuries and GCS <8 ?
Patient usually cannot keep airway patent at this point. Intubation may be necessary
What does AEIOUTIPS stand for?
A: Altitude
E: Environment (hypo/hyperthermia)
I: Infections
O: Overdose (drugs, alcohol)
U: Underdose (lack of sleep)
T: Toxins/trauma
I: Insulin (hypoglycemia
P: Poison
S: Stroke, seizure, shock
What does somnolent mean?
Patient is sleepy, but can easily be woken
What does stupor mean?
Patient is in a sleeplike-state, can be woken but it takes some time
What does coma mean?
Patient is deep unconscious and does not respond to pain
What are the qualitative changes to consciousness that we can assess?
- Disorientation (time, space, situation, personal credentials)
- Confusion (hallucination, dillusion)
What are the 3 causes for syncope?
- Neural (reflex of e.g. the vagus nerve) 45%
- Orthostatic (fall in BP when moving) 10%
- Cardiogenic (heart issues) 20%
What does prodromal symptoms mean?
Prodromal means “early sign or symptom leaning up to a disease or incident”
Name some prodromes (symptoms leading up to) of syncobe
- Light-headed
- Dizziness
- Blurred vision
- Impaired hearing
- Palpitations (feeling of heart pumping hard)
- Chest pain
Name some informations of the patient which could be used to diagnose cardiogenic syncope
- Known cardiovascular diseases or family history
- Feeling of cardiac arrhythmia or chest pain before syncobe accured
- Syncobes happens when supine or durin physical activity
What is primary injury (TBI)
Traumatic injury (structural damage) to the scalp, scull, meninges, brain and vessels
What is secondary injury regarding TBI
Injuries to structures in the brain caused by pathology of the primary TBI
Name some secondary TBI injuries
- Mass effect
- Herniation
What are the causes of meningitis?
Infection on meninges and/or brain
1. Viral (e.g. tick born abovirus)
2. Bacterial (e.g. meningococci)
Normal ICP (inter cranial pressure)
15mmhg
What is CPP?
Cerebral perfusion pressure
The pressure in which the blood perfuses the brain
CPP=MAP-ICP
Why do we hyperventilate a TBI with signs of herniation?
To lower ICP and keep the brain from herniating. This causes vasoconstriction in the brain which sadly also leads to hypoxia
What happens with ICP if a mass emerges in the cranium due to traumatic injury?
ICP increases. To maintain cerebral perfusion MAP pressure must increase as well (causing hypertension)
What happens to ICP in decompensated state?
ICP rises beyond normal values. To maintain 70-80 mmhg CPP in the brain, only MAP pressure can now increase (causing systemic hypertension)
CPP=MAP-ICP
Types of mass effects?
- Epidural hematoma
- Subdural hematoma
- Subarachnoid hematoma
- Intracerebral hematoma
What are the characteristics of epidural hepatoma?
- Arterial bleed between the cranium and the dura mater.
- Often caused by blunt head trauma (e.g. by falling)
What are the characteristics of a subdural hematoma?
- Venous bleed between dura mater and arachnoidea
- Slowly evolving symptoms
What are the characteristics of subarachnoid hematoma?
- Aneurism rupture causing arterial hemorrhage
- Often at circle of Wilis
- Bleeding into sulk and gyri of the brain
Signs of herniation
- Pupils not equal
- Flexion/extension of arms/wrists
- Extension of legs
- Abnormal breathing (cheyne-stoke, Biot)
- Cushings phenomenom
What is the signs of cushings phenomenom?
- Systemic hypertension >200mmhg
- Bradicardia
- Abnormal breathing patterns
Signs of TBI (HEADS)?
H: Headache
E: Ears ringing
A: Amnesia
D: Double vision
S: Something feels wrong
Visual signs of TBI?
- Battlesigns
- Raccon eyes
- CSF leaking out of ear or nose
- Dilated pupils
Classifications of TBI (GCS)
Mild: GCS 13-15
Moderate: GCS 9-12
Severe: GCS 3-8
What is the most predictive component of GCS for determining neurological outcome?
Motory function
2 important interventions when dealing with TBI patients? (per TCCC)
- Disarm
- Remove or disconnect communication/radio
What are the preferred BP for TBI?
100-110 mmhg
What can you do as last resort when dealing with TBI were signs of herniation occurs?
- Elevate upper body 30 degrees
- Administer Hypertonic saline (250ml 3-5%)
- Hyperventilate (RR 20 ETCO2 30-35 mmhg)
TSI severity depends on what?
- Region of injured spine
- How much of the spinal cord that is affected
What is primary spinal injury?
Initial trauma/structure damage
What is secondary spinal injury?
Injury that worsens neurological deficit. Can be caused by manipulation/movement of a fractured spine.
Types of spinal injury?
- Complete (both sides of the body affected)
- Incomplete (one-sided sensory/motory deficits)
What is spinal shock?
Acute loss of motory/sensory functions distal typically due to trauma. Reversible over time.
What is neorogenic shock and what happens?
- A type of distributive shock
- Vasodilation distal to fracture due to loss of parasymphathetic function. This causes hypotension.
- Bradycardia can be present if fracture is in the cervical segment
What is worst per GCS motory function: Abnormal flexion or abnormal extension?
Abnormal extension (1 point)
What does encephalon mean?
Brain
Cerebellum means
Small brain
Signs & symptoms of mild TBI?
Headache, fatigue, difficulty concentrating, loss of balance, nausia, Insomnia, vision changes, sensivity to light and noise
What are the names of the 4 arteries supplying the brain?
- Carotid arteries (internal left and right)
- Vertebral arteries (left and right)
What is the function of a efferent nerve?
Transports motory signals from the brain towards the muscles
What are the characteristics of dura mater?
Thick, fibrous (connective tissue), contains vessels and nerves. Protects the brain. Lies closest to the cranium of all meninges
Name 3 types of noxious stimuli?
- Mechanical (pressure, stretching)
- Chemical (acid, inflammation)
- Thermal (cold, heat)
What is a nociceptor?
A nerve ending that can react to noxious stimuli
What is the physiology of pain perception?
- Nocicepter reacts (potential dangerous stimuli)
- Transduction of stimuli to electrical impulse
- Impulse goes via nerves to different parts of the brain for interpretation
- A subjective sensation of pain is generated
What is referred pain?
Typical visceral pain (pain from organs) can be felt as pain in other parts of the body.
Example: Heart muscle ischemia can be felt as pain in the left arm.
Name the 3 types of systemic analgesia
- Opiod (i.e. fentanyl, morphine)
- Non-opiod (i.e. paracetamol)
- Modulation (i.e. ketamine)
What is true regarding mixing of analgesia-types?
- You can treat with a mix of opioids, non-opioids and modulation-drugs
- You shouldn’t treat with a mix of different types of opioids together
How does local anaesthesia work?
By blocking transmission of the nerves locally (and distal from injection)
Which nerves are thickest and requires higher concentration of local anesthetia to work?
Nerves in charge of movement (motory)
What is a digital nerve block?
A local anaesthesia of a finger or a toe
What are the most common substances for local anesthesia?
Xylocain or Lidocain
Talk through the procedure of digital nerve block
- Assess perfusion of finger/toe
- Prep equipment (alcoswap, draw up xylocain into syringe, apply injection needle)
- Identify and disinfect injection point
- Advance the needle into the area around the dorsal nerve.
- Aspirate to check for blood
- Inject xylocain (0,5-1ml)
- Advance to palmar digital nerve
- Aspirate to check for blood
- Inject xylocain (0,5-1ml)
- Place needle in sharp box when done.
How does opioids work?
Blocks the feeling/perception of pain in the brain
How does non-opioids work?
Usually they prevent nociceptors of feeling stimuli. In example NSAIDS decreases the inflammation processes and causes pain relief.
What are the physiological responses of pain?
- Reflex (happens in the spinal cord)
- Agitation (sympathetic activity increases)
- Syncobe (the brain shuts your consciousness off to prevent you from percieving huge pain)
Phrenic nerve paralysis can be caused by injury to what level of vertebrae?
C3-C5
What are the 3 “high-risk factors” which mandates immobilization
- Age >65
- Dangerous mechanism
- Numbness or tingeling in extremeties
Abnormal flexion is also called (GCS)
Decorticate
Abnormal extension is also called (GCS)
Decerebrate
