Patho Exam 2 spring 2015 - everything Flashcards
1
Q
meningitis is
A
Inflammation of the meningitis (Layers over the CNS)
1
Q
Causes of meningitis
A
Infection- viral, bacterial, fungus (other bugs- worms)
1
Q
inflammation of the meningitis- scarring
A
~There is CSF in the area, so it if there is too much scaring, may have a block of the CSF~Hypercyphale~ s/s: Headache, confusion, vomiting, loss of cons, loss of function
1
Q
Encephalomyelitis
A
~Inflammation of brain and spinal cord~Everything is inflamed~Flexion will cause an extreme about of pain (SLR too)~Pt will usually be put in a coma ~This is all very similar to the other two, but all put together
1
Q
what happens to athletes twho get a concussion?
A
Concussion testing battery baseline
retest before they can return to play after concussion
Free of symptoms counts as day 1 (still might not be exactly where they were before)
1
Q
At what ranchos levels would you probably want to use the Glasgow-Coma scale too?
A
Definately levels I and II
possibly level III
1
Q
Details on NP
A
masters level degree
Responsibilities are a lot like a Physicians Assistant
must be a Registered Nurse prior to becoming a NP
1
Q
Eschemic Cascade process (5)
A
- •Excess neurotransmitter substances
- •Limits energy production
- •Influx of calcium ions with neuronal membrane pump failure
- •Free radical formation
- •Inflammatory factors
1
Q
Medical Management of stroke (Treatment)
considerations besides pharma or surgery (10)
A
Doctor will assess and treat the following
- •Blood flow
- •Blood pressure
- •Cardiac output
- •Fluid/electrolyte balance
- •Blood glucose
- •Seizures (seizures not too common)
- infections
- •ICP - pressure monitor
- we need to know how low to stay and monitori it. Highest is 20
- •Bladder and Bowel
- constipation and incontinance etc
- •Skin
1
Q
what are some risk factors for stroke?
(three main ideas)
A
Risks (similar to Heart Disease)
- minorities
- age 65 or older
1
Q
what is the severity of the stroke/CVA dependant upon? (4)
A
- –Location of ischemia
- –Size
- –Structures injured
- –Availability of collateral circulation
2
Q
What is the difference between a craniotomy and craniectomy?
A
What is the difference between a craniotomy and craniectomy?
Both procedures involve removing a portion of the skull, usually to perform surgery on the brain. The difference is that after a craniotomy the bone is replaced and after a craniectomy the bone is not replaced immediately.
http://www.phoenixchildrens.org/medical-specialties/barrow-neurological-institute/programs-services/neurotrauma/faqs-neurosurgery
2
Q
Vetebrobasilar Artery Srroke potentially involves which three structures
A
- Vertebral Artery
- Basialr ARtery
- Circle of Willis
- supplies blood to the Posterior Cerebral ARtery if possible
3
Q
Homonymous hemianopsia definition
A
Homonymous hemianopsia, or homonymous hemianopia, is hemianopic visual field loss on the same side of both eyes.
3
Q
what can a Vertebrobasilar ARtery Stoke in the Vertebral artery effect?
A
cerebelum
medulla
4
Q
Hemorrhagic stroke: typical attributes of pt (risk factors) (3)
A
- pts tend to be younger
- HTN
- anatomical malformations
- arteriovenous malformations
- can cause lack of blood flow??
- arteriovenous malformations
4
Q
how long does it take to reach maximum cerebral edema?
A
Max accumulation in 3-4 days
4
Q
What forms the extracranial blood supply? (2 pairs)
A
Internal carotid arteries
Vertebral arteries
5
Q
why might a craniotomy or craniectomy be performed?
A
to relieive pressure in the cranium and make room for swelling
5
Q
What are some different areas of stroke? (4)
A
Different areas of stroke
- Anterior Cerebral Artery
- Posterior Cerebral Artery
- Middle Cerebral Artery
- Homunculus
5
Q
Medical Management of stroke (Treatment)
Three Pharmacology options
A
•Pharmacology options
- –Anticoagulant
- –Antiplatelet
- –Antihypertensives
6
Q
is the carotid artery easy or hard to fix?
A
easier to fix
the vessels in the brain are much harder
7
Q
coma
A
a coma is a state that lacks both awareness and wakefulness.
is a state of unconsciousness lasting more than six hours in which a person: cannot be awakened; fails to respond normally to painful stimuli, light, or sound; lacks a normal sleep-wake cycle; and, does not initiate voluntary actions.[1] A person in a state of coma is described as being comatose.
http://en.wikipedia.org/wiki/Coma
7
Q
what are two types of pts that the FIM can be used for for prognosis and as an evaluation meausre?
A
Stroke patienst
TBI patients
8
what is anterograde amnesia?
antrograde (can’t learn new things)
8
Details about CNA
Helps pt go to batheroom, etc.
Could be your best freind
Is overseen by RN or LPN
Do not need a degree (must go to an intensive course)
8
what is the etiology of stroke? (6-ish)
Similar to Cardiac
1. Atherosclerotic narrowing of arteries
2. Ischemic issues, clot growing or staying stationary
3. Thromboembolic formation
4. breaking free and flowing downstream
5. blocking anything distal to where clot is
6. Ischemia etc.
9
what is considered normal ICP (for shappy)?
•Normal ICP 4 to 15 mmHg
10
Myasthenia gravis
~grave muscle disease~takes on average 2 years to diagnosis ~autoimmune- don’t know the cause~problem at the NM junction
10
Ischemic Cascade happens in what time frame?
3-4 hours
11
What can be used to assess cognitive state?
glascow coma scale
12
why is it good to look at any images we can get our hands on in the hospital?
The more we see these images along with symptoms, the more we understand them and we can develop expertise
13
What is CIP also called?
SIRS- systematic inflammatory response syndrome
14
Viral meningitis
~If it’s just alcohol, it will not make a superbug; ~you have to get to the doc within 24 hours to stop the virus; if you get there after, it will just suppress~Let it runs its course in healthy inds~Pools are great places to get meningitis (more on the viral- they like the warm)
14
what is a craniotomy?
Craniotomy = removal of scull
14
What is a cranioplasty?
Cranioplasty is a surgical repair of a defect or deformity of a skull.
14
what does IADLs stand for?
Instrumental Activities of Daily Living
14
Is a stroke preventable?
yes the same old lifestyle stuff
14
What could be a risk from cervical manipulations?
a hemorrhagic stroke
but it is not well documented because it doesn't happen immediately
15
what is a brain hematoma?
A bleed on the brain
15
what does DAI stand for?
Diffuse Axonal Injury
15
what is left negelct?
a neuropsychological condition in which, after damage to one hemisphere of the brain is sustained, a deficit in attention to and awareness of one side of space is observed.
http://en.wikipedia.org/wiki/Hemispatial\_neglect
16
what is CIDP?
~Different form GBS because GBS is acute; this is the recurrent form of GBS ~Will have a more spontaneous healing process than GBS~Will treat all these type of pts the same
16
what is declarative memory?
Declarative memory: the ability to recall facts and previous events. Language based. can tell you facts and information. (I think they could tell you a procedure even if they can't do it: like I might be able to tell you the steps of how to do a back handspring, but I cannot do one)
\_\_\_\_\_\_\_
Declarative memory consists of facts and events that can be consciously recalled or "declared." Also known as explicit memory, it is based on the concept that this type of memory consists of information that can be explicitly stored and retrieved.
Declarative memory differs from procedural memory, which encompasses skills such as the use of objects or movements of the body that are deeply embedded and are performed without being aware.
http://www.livescience.com/43153-declarative-memory.html
16
explain testing for Lacunar Syndrome
There are different diagnostic techniques for Lacunar Syndrome diagnosis
Sometimes it fails and we can’t find it but we treat the symptoms anyway
16
if outpoutches are found in the brain do they ever prophylactically clip them?
yes
17
MOI for SCI
(three motions, four results)
some sort of method of acceleration/deceleration where the brain tissue smashes into the cranium
1. Accerleration
2. Deceleration
3. Rotation
If any of these causes:
1. Shearing,
2. tearing,
3. compression, or
4. displacement of brain tissue
some method of trauma
Head doesn't actually have to hit something, but brain must slosh agains something
brain can rotate into scull
18
What are two types of strokes?
which is most common and by how much?
1. Thromboembolic strokes: 80% of strokes (most common)
2. Hemorrhagic (pts call it an aneurism): 20% of strokes
19
19
how many pts with strokes oare found in Inpatient Rehab Units (IRUs)?
Stroke pts are the largest percent of people admitted into IRUs
19
What is a lacunar stroke?
Dr. Shappy said: "A stroke caused by clots in the more distal vessels"
So I think she meant the penetrating arteries, but also closer to the surface
Wikipedia says:
Lacunar stroke or lacunar infarct (LACI) is a type of stroke that results from occlusion of one of the penetrating arteries that provides blood to the brain's deep structures. Patients who present with symptoms of a lacunar stroke, but who have not yet had diagnostic imaging performed, may be described as suffering from lacunar stroke syndrome (LACS).
http://en.wikipedia.org/wiki/Lacunar\_stroke
20
Vetebrobasilar Artery Srroke potentially involves which three structures
1. Vertebral Artery
2. Basialr ARtery
3. Circle of Willis
* supplies blood to the Posterior Cerebral ARtery if possible
21
Hemorrhagic stroke: typical attributes of pt (risk factors) (3)
1. pts tend to be younger
2. HTN
3. anatomical malformations
* arteriovenous malformations
* can cause lack of blood flow??
22
Locked in Syndrome
Damage to Basilar Artery (Vertebrobasilar Artery STroke)
1. •Bilateral ventral Pons damage
2. •Tetraplegia
3. •CN V-XII involved
4. •Vertical eye movements and blinking remain
5. •Consciousness and sensation intact only
24
do we work with pts with myasthenia gravis?
~We will not work with this pt~We can have this type of pt referred and we would referred them to the doc
24
what happens after ischemic cascade?
Cerebral Edema
24
What type of stroke is FAST made for?
Middle Cerebral Artery Syndrome
| (specifically on the left - speech)
26
Ischemic Cascade happens in what time frame?
3-4 hours
27
Levels of Consciousness Again (all the way to alert)
1. Alert
2. Lethargic (bringman: pt may fall asleep during eval)
3. Obtunded (bringman: pt may fall asleep during transfers): Seep often. Delayed reaction or reduced interests
4. Stupor: Brief time of arousal
5. Minimally Consicous: barely not in vegetative state. localized response. may respond to something held out to them.
6. Vegetatie state: eyes open but cannot follow commands (may have wake/sleep cycle)
* Persistant Vegetative State (3 months?)
7. Coma: state that lacks both awareness and wakefullness
28
myasthenia gravis- NM junction
~ACh crosses~Our body will make antibodies against his one site- Will block the ACh receptor site~This is not a strength issue- we cant make them better~They are weak bc there is no ACh to make the muscle fire ~Cholinesterase inhibitor: Mestinon; Helps to increase the amount of ACh in the cleft~If you remove the thymus, it can somehow help
29
Encephalitis- uncal herniation
~Brain stem comes through the foreman magnum~Probably won’t recover; this will kill you
29
Sequelae of TBI: Inderect impairments
•Indirect impairments
* –Other systems effected by same trauma, etc. or as a result of condition
I think Heterotrophic ossification was given as an example
29
How would the decision be made about prophylactically clipping anurisms?
weigh the risks and benefits
how distal is the aneurism?
how hard is it to reach?
what does the pt want to do?
29
is the carotid artery easy or hard to fix?
easier to fix
the vessels in the brain are much harder
30
Homonymous hemianopsia definition
Homonymous hemianopsia, or homonymous hemianopia, is hemianopic visual field loss on the same side of both eyes.
31
A stroke effecting what side of the body will clue you in to probable speech problems?
A stroke that effects the right side of the body
(because Broca's and Wernickie's areas are on the left side of the brain)
32
what is a Carotid Endarterectomy?
rotor-rooter procedure for corotid artery
33
What is a lacunar stroke?
Dr. Shappy said: "A stroke caused by clots in the more distal vessels"
So I think she meant the penetrating arteries, but also closer to the surface
Wikipedia says:
Lacunar stroke or lacunar infarct (LACI) is a type of stroke that results from occlusion of one of the penetrating arteries that provides blood to the brain's deep structures. Patients who present with symptoms of a lacunar stroke, but who have not yet had diagnostic imaging performed, may be described as suffering from lacunar stroke syndrome (LACS).
http://en.wikipedia.org/wiki/Lacunar\_stroke
34
Fungal meningitis
~Where to get it- a dirty env~Not easy to get~A steroid has become tainted with the fungus- BAD (500 got it, 40 died)
35
how does encephalitis start?
~Usually will not start with encephalitis~Usually have an infection in a different part of the body
35
describe/draw the circle of willis
36
Encephalitis- do you have to be in the hospital?
YES~If we get to them soon enough, we may need to drain some CSF~CSF tap~reduce Intracranial pressure (ICP)~normal values range from 1-15/20~Can do a bolt: It is a short term VCP shunt; Used in very bad cases; Need to be at level of the head
37
What are three things that can be used to manage a high ICP?
1. Intraventricular catheter
2. Subural screw
3. Epidural sensor
38
which is worse: bacterial or viral meningitis?
Bacterial is worse than viral
39
what kinds of deficits do strokes cause?
(name two that we shouldn't forget about)
All kinds of stuff (she had us come up with several, but I couldn’t write fast enough)
Don’t forget **autonomic functions**
**Proprioception**
40
TBI: Most common age group injured
young males
41
A stroke effecting what side of the body will clue you in to probable speech problems?
A stroke that effects the right side of the body
(because Broca's and Wernickie's areas are on the left side of the brain)
43
Locked in Syndrome
Damage to Basilar Artery (Vertebrobasilar Artery STroke)
1. •Bilateral ventral Pons damage
2. •Tetraplegia
3. •CN V-XII involved
4. •Vertical eye movements and blinking remain
5. •Consciousness and sensation intact only
44
are you likely to see Lacunar Syndrome patients in rehab?
not unless they have had lots of them
my be more likely to see in outpatient
(because their impairments are usually not as severe)
44
Medical Management of stroke (Treatment)
surgery options (2)
•Surgery options
1. –Endarterectomy
2. –Hemorrhagic
46
s/s of meningitis
~Headache~Fever~Malaise ~Fatigue~Nausea (that means that the pressure is really high~Neck flexion can replicate the symptoms
47
Where do PTs come in during medical management of SCI?
After the emergency is managed and pateint is stable
We do our own neuro eval, check ICP, etc.
48
Medical Management of stroke (Treatment)
Three Pharmacology options
•Pharmacology options
1. –Anticoagulant
2. –Antiplatelet
3. –Antihypertensives
49
Medical Managment of TBI: Patient Stable(3)
1. –Neurologic evaluation
2. –Surgical evacuation
3. –ICP
51
Six cognitive states
1. Coma
2. Vegetative State
3. Persistant Vegettative state
4. Minimally Conscious
5. Stupor
6. Obtunded Phase
53
myelitis
inflammation of the spinal cord
54
what is a focal injury?
–Area of impact
–Can result in bruising (hematoma), swelling (edema), Slicing/laceration/tearing of brain, coup-contra coup effect.
From Wikipedia:
Focal and diffuse brain injury are ways to classify brain injury: focal injury occurs in a specific location, while diffuse injury occurs over a more widespread area. It is common for both focal and diffuse damage to occur as the result of the same event; many traumatic brain injuries have aspects of both focal and diffuse injury.[1] Focal injuries are commonly associated with an injury in which the head strikes or is struck by an object; diffuse injuries are more often found in acceleration/deceleration injuries, in which the head does not necessarily contact anything, but brain tissue is damaged because tissue types with varying densities accelerate at different rates.[2]
http://en.wikipedia.org/wiki/Focal\_and\_diffuse\_brain\_injury
55
How would the decision be made about prophylactically clipping anurisms?
weigh the risks and benefits
how distal is the aneurism?
how hard is it to reach?
what does the pt want to do?
57
Where do strokes fall in leading causes of death in the USA? (are they common or not?)
what is a demographic who is at greater risk?
Strokes are Third leading cause of death in the United States (not a test number)
* strokes are in abundance
* millions of people who have had a stroke at some level
* minorities are at greater risks (2x higher)
* probably because of preventative care
58
what is Heterotrophic ossification?
Heterotopic ossification (HO) is the process by which bone tissue forms outside of the skeleton.
http://en.wikipedia.org/wiki/Heterotopic\_ossification
60
describe FIM & FAM scale
7. Complete Independence (timely, safely)
6 Modified Independence (extra time, devices)
5 Supervision (cuing, coaxing, prompting)
4 Minimal Assist (performs 75% or more of task)
3 Moderate Assist (performs 50%-74% of task)
2 Maximal Assist (performs 25%-49% of task)
1 Total Assist (performs less than 25% of task)
61
What could be a risk from cervical manipulations?
a hemorrhagic stroke
but it is not well documented because it doesn't happen immediately
62
Middle Cerebral Artery Syndrome (7)
1. •Frontal, Parietal and Temporal Lobes
2. •Second main branch off internal carotid
3. •Lateral aspect of cerebral hemisphere and subcortical
4. •Contralateral symptoms
5. •Sensory and motor
* –Face, UE greater than LE
6. •Left hemisphere
* –Broca’s area- speech production, expressive aphasia
* –Wernicke’s area- speech comprehension, receptive aphasia
7. •Right hemisphere
* left neglect
63
what percentage of stroke pts will end up in a nursing home in the first year?
25% stroke pts will end up in nursing home
* if you have a stroke and you are older, not as many people want to take you home, or they may not be able to take you home
* number is probably a lot higher after a year
65
explain testing for Lacunar Syndrome
There are different diagnostic techniques for Lacunar Syndrome diagnosis
Sometimes it fails and we can’t find it but we treat the symptoms anyway
67
what are IADLs?
(It stands for Instrumental Activities of Daily Living)
More advanced ADLs
Example: writing checks or grocery shopping (more than just basic self-care in the home. They require more complex reasoning)
68
what percentage of stroke pts will end up in a nursing home in the first year?
25% stroke pts will end up in nursing home
* if you have a stroke and you are older, not as many people want to take you home, or they may not be able to take you home
* number is probably a lot higher after a year
69
if outpoutches are found in the brain do they ever prophylactically clip them?
yes
71
what are IADLs?
(It stands for Instrumental Activities of Daily Living)
More advanced ADLs
Example: writing checks or grocery shopping (more than just basic self-care in the home. They require more complex reasoning)
72
Internal Carotid Artery Syndrome (2)
Massive symptoms
MCA & ACA involved
73
Details on Recreational Therapist
Recreational Therapist
- Bad part of rec therapy is that they are not reimbursed, so they are usually only in outstanding rehab centers
- They do great things that are more fun
74
how long can you continue to have cerebral edema
2-3 weeks
76
How To diagnose a Stroke (4 things - practice thinking of details if you want)
1. •History
2. •Physical Exam
3. •Tests
* blood tests
* clotting time
* CBC
* Urinalysis
* Lumbar puncture
* EKG
4. •Imaging
* CT
* MRI
* Ultrasound (dopplar)
* echocardiogram
77
What are two types of strokes?
which is most common and by how much?
1. Thromboembolic strokes: 80% of strokes (most common)
2. Hemorrhagic (pts call it an aneurism): 20% of strokes
78
Imagine the parts of the cerebrum that are supplied by the anterior, middle, and posterior cerebral arteries
79
what kinds of deficits do strokes cause?
(name two that we shouldn't forget about)
All kinds of stuff (she had us come up with several, but I couldn’t write fast enough)
Don’t forget **autonomic functions**
**Proprioception**
80
What are some different areas of stroke? (4)
Different areas of stroke
1. Anterior Cerebral Artery
2. Posterior Cerebral Artery
3. Middle Cerebral Artery
4. Homunculus
82
what is done for aneurisms (hemmorhagic strokes)?
What do they do with aneurysms?
* surgery - clip it
* metal clips that stay in there
83
What is the actronym taught for stroke detection to the general public?
What does it mean?
FAST acronym
1. face
1. look for drooping on one side
2. arms
* look for one lagging when held out
3. speech
* slurred
4. time
* can use clot-buster if caught in time (I think 1 hour window)
83
what is a uniqe problem of hemorrhatic strokes?
Blood getting into the brain can also cause its own problems
84
what does Dura Mater man?
Dura Mater = “tough mother”
85
transverse myelitis
~The majority of pts will have full or some return~It usually does not show up again~Age between 10-40 ~Btw 1500-2000 new cases each year~Harder to diagnosis that a normal SC pt~Have to rule out other diagnoses: GBS, atraumatic SC injury, SC stroke, MS~Usually people start to get better btw 2-12 weeks (How much scaring, etc)
87
what percentage of stored bones "take" when they are replaced into the head?
about 70%
88
Medical Managment of TBI: Emergency Management (3)
1. –Cardiovascular
2. –Respiratory
3. –Vital signs
88
Name the people that may be part of an Interdiciplinary Team necessary for treating TBI (10 main)
1. •Patient and Family
2. •Physician’s
* –Neurologist
* –Physiatrist
3. •Speech-language Pathologist
4. •Occupational Therapist
5. •Physical Therapy
6. •Rehabilitation Nurse
* –NP, RN, LPN, CNA
7. •Case Manager/Team Coordinator
8. •Medical Social Worker
9. •Neuropsychologist
10. •Other
* –Respiratory Therapy
* –Recreational Therapist
89
What does IRF-PAI stand for?
Inpatient Rehabilitation Facility
Patient Assessment Instrument
91
What is the difference between hemiplegia vs hemiparesis?
Hemiplegia vs Hemiparesis
**Hemiparesis** is weakness of the entire left or right side of the body.
**Hemiplegi**a is its most severe form, complete paralysis of half of the body.
(http://en.wikipedia.org/wiki/Hemiparesis)
Dr. Shappy's lecture:
* Plegia = complete loss
* paresis = half loss
92
what is the goal for Intracranial Pressur eto be able to do rehab?
•Below 20 mmHg- goal
93
what is significant about the 3-week mark after a stroke?
Return of Function in the First three weeks gives us a pretty good prediction of recovery
(anything)
* sensory
* motor
* autonomic
95
Prosopragnosia definition
Prosopragnosia = difficulty identifying people
96
what can be done to fix a hemorrhagic stroke?
put metal clips on the vessel
98
What are early warning signs of stroke? (10)
Early warning signs
1. FAST, etc.
* doesn’t have to have all FAST symptoms
* FAST is more for middle cerebral artery stroke
2. numbness
3. weakness
4. facial droop
5. trouble speaking
6. gait/balance disturbances
7. sudden severe headache (hemorrhagic)
8. nausea/vomiting
9. anxiety
10. Faint/syncope/coma
100
What is something that is given to people with viral meningitis that shouldn't be?
~Lot of pt will want an antibiotic~There is no point if you taking them if you have a virus!~Make super bugs- can’t get rid of them
101
What type of stroke is FAST made for?
Middle Cerebral Artery Syndrome
| (specifically on the left - speech)
102
Details on the Medical Social Worker
Medical Social worker (a more specific type of social worker)
- Could be Something besides the case worker
- Could be more working on home care
103
What category does exectuvie function usually fall into?
Executive function: usually falls into the category of IADLs (Instrumental activities of daily living) = above the most basic levels of function; planning etc.
104
What are early warning signs of stroke? (10)
Early warning signs
1. FAST, etc.
* doesn’t have to have all FAST symptoms
* FAST is more for middle cerebral artery stroke
2. numbness
3. weakness
4. facial droop
5. trouble speaking
6. gait/balance disturbances
7. sudden severe headache (hemorrhagic)
8. nausea/vomiting
9. anxiety
10. Faint/syncope/coma
105
describe FIM & FAM scale
7. Complete Independence (timely, safely)
6 Modified Independence (extra time, devices)
5 Supervision (cuing, coaxing, prompting)
4 Minimal Assist (performs 75% or more of task)
3 Moderate Assist (performs 50%-74% of task)
2 Maximal Assist (performs 25%-49% of task)
1 Total Assist (performs less than 25% of task)
106
Describe what happens during Cerebral Edema/ Due to Cerebral edema: (5)
1. •Fluid accumulation
2. •Inflammatory mediators and blood factors
3. •Increased ICP
4. •Brainstem herniation
5. •Cell death
108
what are five deficits in memory that are part of sequelae of TBI?
1. –Amnesia
2. –Declarative memory
3. –Procedural memory
4. –Post-traumatic
5. –Impaired attention
109
where are three common places that hematomas can happen in the brain?
1. –Epidural
* •above the dura
2. –Subdural
* •Below the dura
3. –Intracerebral
* •Between hemispheres
111
expain the difference in hemorrhagic stroke vs Ischemic stroke
Clotting stroke is called Ischemic even though both could technically have ischemia
112
what is post-traumatic amnesia?
Post-truamatic: the time between injury and when your memory returns
* used as a predictor for prognosis
113
What is a TIA
A vascular syndrome with no neurological eficits
Any effects last less than 24 hours
115
describe/draw the circle of willis
116
Prognosis and goal setting: who should be invovled?
117
Describe 4 different spots where the Anterior Cerebral Artery may be blocked and what the difference in effect might be.
limbic versus _______ (look it up and fix this card)
(( tried to look it up and can't find anything besides that "Profound albulia, a delay in verbal and motor response, is common. Akinetic mutism also can result in significant disability" - our patho textbook)
119
Mortalitiy numbers:
What percentage of people with a stroke will die within a year?
what percene will die in 8 years?
(these should not be on the exam)
Mortality
* About 25% of those with a stroke will die within a year
* About 50% will die in 8 years
120
What is the actronym taught for stroke detection to the general public?
What does it mean?
FAST acronym
1. face
1. look for drooping on one side
2. arms
* look for one lagging when held out
3. speech
* slurred
4. time
* can use clot-buster if caught in time (I think 1 hour window)
121
can angiogenesis happen in the brain?
yes
collateral arteries can grow more blood supply to an underperfused area
usually only is stimulated by ischemia as a result of pathology
122
What is a TIA
(Transient Ischemic Attack)
Symptoms Last less than 24 hours
* pt may not even know it happened
* pt may never seek medical attention for these symptoms
123
FIM stands for
FAM stands for
what is it?
who uses it?
FIM = Functional Independence Measure
FAM = Fucntional Assessment Measure
(it is a functional outcome tool)
everyone involved has a treatment has a say
124
Persistent Vegetative State
From wikipedia
A persistent vegetative state is a disorder of consciousness in which patients with severe brain damage are in a state of partial arousal rather than true awareness. It is a diagnosis of some uncertainty in that it deals with a syndrome. After four weeks in a vegetative state (VS), the patient is classified as in a persistent (or 'continuing') vegetative state. This diagnosis is classified as a permanent vegetative state (PVS) some months after a non-traumatic brain injury (3 months in the US, 6 months in the UK, or one year after traumatic injury).
http://en.wikipedia.org/wiki/Persistent\_vegetative\_state
125
What is a test to provoke meningitis?
the slump test
126
what is regrograde amnesia?
retrograde (can’t remember before a certain time)
127
what are three types of amnesia?
1. retrograde amnesia
2. antrograde amnesia
3. Post-truamatic amnesia
128
expain the difference in hemorrhagic stroke vs Ischemic stroke
Clotting stroke is called Ischemic even though both could technically have ischemia
130
what does CIP stand for?
chronic illness polyneuropathy
131
Bacterial meningitis
~Antibiotics- have to take it for a long time~Hard to get to the brain because of the BBB~Massive antibiotics doses; will be in hospital for a while to get rid of it
131
what is left negelct?
a neuropsychological condition in which, after damage to one hemisphere of the brain is sustained, a deficit in attention to and awareness of one side of space is observed.
http://en.wikipedia.org/wiki/Hemispatial\_neglect
132
what can be done to fix a hemorrhagic stroke?
put metal clips on the vessel
133
what is DAI?
Diffuse Axonal Injury
134
what are signs that a rehab center is a good discharge destination for a patient?
-Usually will be headed in good direction to tolerate 3 hrs of rehab/day (the amount of PT they can tolerate is usually a good indicator)
136
Details on the neuropsychologist
Neuropsychologist should understand neural disease process better
-More often role is filled by a regular psychologist
137
Frontal strokes do what to personality
may change it
not neccessarily better or worse
hard to deal with the fact they are different
139
Describe 4 different spots where the Anterior Cerebral Artery may be blocked and what the difference in effect might be.
limbic versus _______ (look it up and fix this card)
(( tried to look it up and can't find anything besides that "Profound albulia, a delay in verbal and motor response, is common. Akinetic mutism also can result in significant disability" - our patho textbook)
140
inflammation in meningitis
~5 cardinal signs of inflammation~can occasionally cause scarring~will need to put in a shunt to decompress
141
Hemorrhagic stroke: large or small?
could be either
blood can clot and brain can heal, resulting in a small attack
* cell injury (not death)
* cell death - no regeneration
142
At what level on the Rancho scale could you start using the FIM-FAM?
Probably Ranchos level IV
142
what might you get with a stroke effecting the left side of the body
left neglect
142
Eschemic Cascade process (5)
1. •Excess neurotransmitter substances
2. •Limits energy production
3. •Influx of calcium ions with neuronal membrane pump failure
4. •Free radical formation
5. •Inflammatory factors
143
What is the difference between hemiplegia vs hemiparesis?
Hemiplegia vs Hemiparesis
**Hemiparesis** is weakness of the entire left or right side of the body.
**Hemiplegi**a is its most severe form, complete paralysis of half of the body.
(http://en.wikipedia.org/wiki/Hemiparesis)
Dr. Shappy's lecture:
* Plegia = complete loss
* paresis = half loss
144
details on Casem Manager/Team Coordinator
- Could be social worker
- Could be other
- Responsible for insurance stuff
- Coordinating DC
145
Vegetative State
eyes open but cannot follow commands or speak, but they may have some sort of cycle of sleep time and awake time. May have some type of reflexive movement
146
Middle Cerebral Artery Syndrome (7)
1. •Frontal, Parietal and Temporal Lobes
2. •Second main branch off internal carotid
3. •Lateral aspect of cerebral hemisphere and subcortical
4. •Contralateral symptoms
5. •Sensory and motor
* –Face, UE greater than LE
6. •Left hemisphere
* –Broca’s area- speech production, expressive aphasia
* –Wernicke’s area- speech comprehension, receptive aphasia
7. •Right hemisphere
* left neglect
147
what is significant about the 3-week mark after a stroke?
Return of Function in the First three weeks gives us a pretty good prediction of recovery
(anything)
* sensory
* motor
* autonomic
148
what does CIDP stand for?
chronic inflammatory demyelination polyneuropathy
150
Posteiro Cerebral Artery Syndrome (8)
1. •Branch off Basilar Artery
2. •Occipital lobe, temporal lobe, upper brainstem
3. •Hemi anesthesia
4. Homonymous Hemianopsia
5. •Visual Agnosia
6. •Prosopagnosia
7. •Dyslexia
8. •Memory deficits
151
what are the different types of rehab nurses? (list in order of education)
1. NP = Nurse Practitioner
2. RN = Registered Nurse
3. LPN = Liscenced Practical Nurse
4. CNA = Certified Nursing Assistant
153
The longer amount of time spend at higher ICP, the ______ the outcome
The longer amount of time spend at higher ICP, the worsethe outcome
154
how is the cerebral blood flow regulated?
it is autoregulated
155
what does ICP stand for?
Intracrainial Pressure
156
Anterior Cerebral Artery Syndrome
1. •First terminal branch of internal carotid
2. •Medial aspect of hemisphere
3. •Contralateral symptoms
4. •LE greater than UE
* –Sensory and motor
157
what is a uniqe problem of hemorrhatic strokes?
Blood getting into the brain can also cause its own problems
158
What does SPECT stand for?
SPECT = Single Photon Emission Computerized Tomography
159
MCA stands for
Middle Cerebral Artery Sndrome
160
The higher the ICP gets, the \_\_\_\_\_\_ the outcome
The higher the Intracranial pressure gets, the worse the outcome
162
transverse myelitis- causes
~We don’t know what causes this; probably autoimmune ~They come on very rapidly~Presentation can be scattered
164
What is a TIA
A vascular syndrome with no neurological eficits
Any effects last less than 24 hours
165
Lacunar Syndrome (8)
1. •Penetrating artery disease
2. •Small and specific regions affected
3. •Pure motor lacunar stroke
4. •Pure sensory lacunar stroke
5. •Dysarthria/clumsy hand syndrome
6. •Ataxic hemiparesis
7. •Sensory/motor
8. •Dystonial/involuntary movements
167
FIM stands for
FAM stands for
what is it?
who uses it?
FIM = Functional Independence Measure
FAM = Fucntional Assessment Measure
(it is a functional outcome tool)
everyone involved has a treatment has a say
169
who is usually the head fo the rehab hospital?
a Physiatrist (an MD)
- Similar to a “hospitalist” in the acute setting
- Hospitalist is in an acute care hospital setting
170
What would be an example of a pt that we will send to SNF at discharge instead of a Rehab Center?
-SNF: older more frail person who cannot tolerate as much rehab time each day
171
MCA stands for
Middle Cerebral Artery Sndrome
172
What is CIP?
~They are weak, on bed rest for a long time; they can develop CIP~We used to just say that these pts were weak; now we are finding out why they weak ~½ will get full recovery; ½ will get most back~Huge risk for bed sores (skin); pneumonia ~Exercise them (if 3/5 or better); they have so much that they need to work on, want to make sure they are getting better, not getting worse
174
Imagine the parts of the cerebrum that are supplied by the anterior, middle, and posterior cerebral arteries
176
what is Precedural memory?
Procedural memory is a part of the long-term memory that is responsible for knowing how to do things, also known as motor skills. As the name implies, procedural memory stores information on how to perform certain procedures, such as walking, talking and riding a bike. Delving into something in your procedural memory does not involve conscious thought.
http://www.livescience.com/43595-procedural-memory.html
177
What should we be sure to consider when doing an eval on a SCI pt?
Be sure to consider discharge on the eval (what is their outcome going to be)
178
How can we treat meningitis?
Antivirals, antibiotics, antifungal
179
what are three ways to classify a brain injury?
1. Focal Injjury
2. Diffuse Axonal Injury (DAI)
3. Hypoxic Ischemic Injury
180
what is post-traumatic amnesia used as?
used as a predictor for prognosis
182
what is the etiology of stroke? (6-ish)
Similar to Cardiac
1. Atherosclerotic narrowing of arteries
2. Ischemic issues, clot growing or staying stationary
3. Thromboembolic formation
4. breaking free and flowing downstream
5. blocking anything distal to where clot is
6. Ischemia etc.
184
what is the severity of the stroke/CVA dependant upon? (4)
1. –Location of ischemia
2. –Size
3. –Structures injured
4. –Availability of collateral circulation
185
what can a Vertebrobasilar ARtery Stoke in the Vertebral artery effect?
cerebelum
medulla
187
which types of TBI have bad outcomes?
DAI & Hypoxic injury = bad outcomes
188
Lacunar Syndrome (8)
1. •Penetrating artery disease
2. •Small and specific regions affected
3. •Pure motor lacunar stroke
4. •Pure sensory lacunar stroke
5. •Dysarthria/clumsy hand syndrome
6. •Ataxic hemiparesis
7. •Sensory/motor
8. •Dystonial/involuntary movements
189
What guides prognosis and goal setting?
The interdiciplinary team gets together and evaluates scores on outcome measures.
All the sequele are potential things to evaluate
190
In answering the question, "What setting will be appropriate for them at discharge?" how helpful would the glasgow-coma scale be? the racho scale?
What setting will be appropriate for them at discharge
Difficult to answer if we are using coma scale
Easier to answer if rancho level above III
191
Details on Bringmans aunt
~Took a nap, woke up and couldn’t move legs~\*we are worried about pressure, clots (thin blood)~Abdominal Bleed out- colon resection~\*did a spinal tap and remove blood for testing~Spinal taps don’t always heal- leaking out CSF~Get s CSF headache due to the loss of CSF- brain will sit on bottom of cranium~Positional headaches- standing, sitting ~Test to see if there a CSF leak if there are positional headaches ~To fix the CSF leak- will do a blood patch (will put the blood in the whole and hope it will clot)~Have recurrent pain~Did not regain B/B~Cath for rest of life~Can walk again, but uses a cane~On blood thinners, has ted hose
193
can angiogenesis happen in the brain?
yes
collateral arteries can grow more blood supply to an underperfused area
usually only is stimulated by ischemia as a result of pathology
194
what outcome measure could we use for prognosis in a pt that could be in a coma?
Glascow-coma
196
what is a brainstem stroke called?
Uncus herniation
197
Medical Management of stroke (Treatment)
surgery options (2)
•Surgery options
1. –Endarterectomy
2. –Hemorrhagic
198
What can brain hematomas cause?
An increase in intracranial pressure
199
where are five places that a ICP cantheter can be placed? (picture it too)
1. Epidulral
2. Intraparencyhmal
3. Subarachnoid
4. Ventricular
5. Subdural
200
what is impaired attention
Impaired attention: Difficulty focusing to facilitate learning. Forget what they are doing mid task.
201
what are some risk factors for stroke?
(three main ideas)
Risks (similar to Heart Disease)
* minorities
* age 65 or older
202
how many pts with strokes oare found in Inpatient Rehab Units (IRUs)?
Stroke pts are the largest percent of people admitted into IRUs
203
Where do strokes fall in leading causes of death in the USA? (are they common or not?)
what is a demographic who is at greater risk?
Strokes are Third leading cause of death in the United States (not a test number)
* strokes are in abundance
* millions of people who have had a stroke at some level
* minorities are at greater risks (2x higher)
* probably because of preventative care
204
what might you get with a stroke effecting the left side of the body
left neglect
205
Sequelae of TBI: Communication
Communication, we talked about before
* broca’s vs Wernike’s
* read write
Also ask, is is dysarthria (speaking problem) or is it a language problem (broca's and wernike's)
206
what does IADLs stand for?
Instrumental Activities of Daily Living
207
Vertebrobasilar artery stroke in basilar artery effects?
causes?
effects
* –Pons,
* Internal ear and
* cerebellum
couases –Locked-in syndrome
208
What are three branches/related arteries of the internal cartotid artery in the brain?
1. •Middle cerebral and
2. anterior cerebral arteries
3. •Anterior communicating
209
which can cause more of a problem: encephalitis or meningitis?
encephalitis
210
Minimally Conscious
: in and out awake/asleep. Improvement now. They will no longer be called persistently vegetative. Evidence of self and environmental awareness. (this is also where family members grab on). Usually more localized response. Can be seen better if we hold out something to them that they want. This is where a lot of pts will be in a TBI unit.
211
why is exercise a risk after someone experiences a TBI?
Exercise increases BP that can increase intracranial pressure
212
do MDs check for anurisms or outpoutches before putting pt on blood thinners for heart problems?
usually not
213
Prosopragnosia definition
Prosopragnosia = difficulty identifying people
214
Medical Managment of TBI: oncomitant Injuries (8)
1. –Long bone or other fractures
2. –Soft tissue wounds
3. –Neurologic problems
4. –GI issues
5. –Genitourinary issues
6. –Respiratory
7. –Cardiovascular
8. –Dermatological
215
what is a Carotid Endarterectomy?
rotor-rooter procedure for corotid artery
216
What forms the extracranial blood supply? (2 pairs)
Internal carotid arteries
Vertebral arteries
217
Mortalitiy numbers:
What percentage of people with a stroke will die within a year?
what percene will die in 8 years?
(these should not be on the exam)
Mortality
* About 25% of those with a stroke will die within a year
* About 50% will die in 8 years
218
how long can you continue to have cerebral edema
2-3 weeks
219
Posteiro Cerebral Artery Syndrome (8)
1. •Branch off Basilar Artery
2. •Occipital lobe, temporal lobe, upper brainstem
3. •Hemi anesthesia
4. Homonymous Hemianopsia
5. •Visual Agnosia
6. •Prosopagnosia
7. •Dyslexia
8. •Memory deficits
220
Hemorrhagic stroke: large or small?
could be either
blood can clot and brain can heal, resulting in a small attack
* cell injury (not death)
* cell death - no regeneration
221
encephalitis
~Inflammation of the brain~Viral or bacterial (Want viral)~Can have a rapid onset ~If there is inflammation, there fluid will not have anywhere to do~Can start to can micro damage on the outside of the brain (lots of boney parts that can cause problems)
221
Diffuse Axonal Injury
–Diffuse damage to neural tissue (axons)
From Wikipedia:
Focal and diffuse brain injury are ways to classify brain injury: focal injury occurs in a specific location, while diffuse injury occurs over a more widespread area. It is common for both focal and diffuse damage to occur as the result of the same event; many traumatic brain injuries have aspects of both focal and diffuse injury.[1] Focal injuries are commonly associated with an injury in which the head strikes or is struck by an object; diffuse injuries are more often found in acceleration/deceleration injuries, in which the head does not necessarily contact anything, but brain tissue is damaged because tissue types with varying densities accelerate at different rates.[2]
http://en.wikipedia.org/wiki/Focal\_and\_diffuse\_brain\_injury
223
Anterior Cerebral Artery Syndrome
1. •First terminal branch of internal carotid
2. •Medial aspect of hemisphere
3. •Contralateral symptoms
4. •LE greater than UE
* –Sensory and motor
224
Describe what happens during Cerebral Edema/ Due to Cerebral edema: (5)
1. •Fluid accumulation
2. •Inflammatory mediators and blood factors
3. •Increased ICP
4. •Brainstem herniation
5. •Cell death
225
Risk factors for stroke (10)
Risk Factors (about the same as cardiac disease)
1. 75%? of those who have stroke have HTN
2. CHF
3. PAD
4. CAD
5. Diabetes
6. Hyperlipidemia
7. Valve disorders in the heart
8. Coronary artery bypass surgery
* during surgery and after
* after because if vessels in the heart have atherosclerosis, then vessels in other places have it too.
9. A-fib (5x more likely to have stroke)
* because blood coagulates in the atria
* Aorta is the first one out
* first sets of arteries go to heart and brain
10. Endocarditis
*
227
Does a mild concussion require imaging?
no
(but I think Dr. Shappy thinks it should)
228
Details on LPN
Usually has associates degree
Primarily responsible for drugs
does wound care
supervises CNA
229
What are three branches/related arteries of the internal cartotid artery in the brain?
1. •Middle cerebral and
2. anterior cerebral arteries
3. •Anterior communicating
230
What are behavioral sequelae of TBI?
Behavioral: could be violent, angry, apathy, frustration, depression, sexual dysfunction, unfiltered comments. Ranchos level 4 contains the sexually inappropriate behaviors. (10 is fully functioning). What do we do for them?
231
Vertebrobasilar artery stroke in basilar artery effects?
causes?
effects
* –Pons,
* Internal ear and
* cerebellum
couases –Locked-in syndrome
232
how severe are strokes?
Severity can range from minute losses to zero function
233
are you likely to see Lacunar Syndrome patients in rehab?
not unless they have had lots of them
my be more likely to see in outpatient
(because their impairments are usually not as severe)
234
What is a TIA a warning sign for?
TIA is warning sign for impending stroke (not as good as angina in the heart)
* 10% of people with TIAs will have a full stroke within 90 days?
* 5% will have strokes within 2 days
In heart we get angina that warns us about impending MI
236
If a stroke is called an "ischemic stroke" what does that mean?
A trhomboembolic stroke is referred to as an ischemic stroke
A hemorrhatic stroke ist not called an ischemic stroke (even though it is technically ischemic too)
237
If a stroke is called an "ischemic stroke" what does that mean?
A trhomboembolic stroke is referred to as an ischemic stroke
A hemorrhatic stroke ist not called an ischemic stroke (even though it is technically ischemic too)
238
Rehab Perspective: What are goals based on?
focused on the location is the patient going to at discharge
239
details about RN
Usually has bachelors degree
Primarily responsible for drugs
(possibly responsible fo same things as LPN, but I did not write that down)
240
s/s of encephalitis
~headaches: sensitivity to sound and light~Fever (temperature regulation ma get out of control)~Loss of function~Visual problems/ no visual~Loss of ability to follow commands/ loss ability to move~Vomiting~Seizure~Stopper to coma
241
What is a TIA
(Transient Ischemic Attack)
Symptoms Last less than 24 hours
* pt may not even know it happened
* pt may never seek medical attention for these symptoms
242
Myasthenia gravis s/s
~ptosis (droopy eyelids)~get really tired really fast
243
what can you use Glascow Coma scale on?
It can be used with anything that could cause pt to be in a coma
245
Obtunded phase
Sleep often. Have delayed reactions or interests. When we arouse them, they are decreased in their alertness.
246
Medical Management of stroke (Treatment)
considerations besides pharma or surgery (10)
Doctor will assess and treat the following
1. •Blood flow
2. •Blood pressure
3. •Cardiac output
4. •Fluid/electrolyte balance
5. •Blood glucose
6. •Seizures (seizures not too common)
7. infections
8. •ICP - pressure monitor
* we need to know how low to stay and monitori it. Highest is 20
9. •Bladder and Bowel
* constipation and incontinance etc
10. •Skin
248
what happens after ischemic cascade?
Cerebral Edema
249
What are 11 Sequelae categories of TBI?
1. •Neuromuscular Impairments
2. •Cognitive
3. •Orientation
4. •Memory
5. •Executive function
6. •Behavioral
7. •Communication
8. •Visual-Perceptual
9. •Dysphagia- swallowing
10. •Dysarthria- speaking
11. •Indirect impairments
250
where is the bone stored after a craniotomy until it is put back into the cranium?
Store cranium in abdomen until pressure goes down and can put it back in head
Usually in the subcutaneous abdominal wall
251
Rehab Perspective: what are five places a patient might be getting discharged to?
1. –Acute care hospital
2. –Nursing home or long-term care facility
3. –Sub-acute rehabilitation or Skilled Nursing Facility (SNF)
4. –Acute rehabilitation
5. –Community settings
252
what does Sequelae mean?
a condition that is the consequence of a previous disease or injury.
253
do MDs check for anurisms or outpoutches before putting pt on blood thinners for heart problems?
usually not
254
what is done for aneurisms (hemmorhagic strokes)?
What do they do with aneurysms?
* surgery - clip it
* metal clips that stay in there
255
What are three cerebral arteries that are supplied by the Vertebral Artries
1. •Basilar
2. •Posterior cerebral
3. •Posterior communicating
257
What is a TIA a warning sign for?
TIA is warning sign for impending stroke (not as good as angina in the heart)
* 10% of people with TIAs will have a full stroke within 90 days?
* 5% will have strokes within 2 days
In heart we get angina that warns us about impending MI
258
Is a stroke preventable?
yes the same old lifestyle stuff
259
Risk factors for stroke (10)
Risk Factors (about the same as cardiac disease)
1. 75%? of those who have stroke have HTN
2. CHF
3. PAD
4. CAD
5. Diabetes
6. Hyperlipidemia
7. Valve disorders in the heart
8. Coronary artery bypass surgery
* during surgery and after
* after because if vessels in the heart have atherosclerosis, then vessels in other places have it too.
9. A-fib (5x more likely to have stroke)
* because blood coagulates in the atria
* Aorta is the first one out
* first sets of arteries go to heart and brain
10. Endocarditis
*
260
Internal Carotid Artery Syndrome (2)
Massive symptoms
MCA & ACA involved
261
what is a hypoxic ischemic injury
•Hypoxic Ischemic Injury
* –Arachnoid damage
* –Other stuff I didn’t get down
From International Brain Injury Association:
Hypoxic-ischemic brain injury is a diagnostic term that encompasses a complex constellation of pathophysiological and molecular injuries to the brain induced by hypoxia, ischemia, cytotoxicity, or combinations of these conditions (Busl and Greer 2010). The typical causes of hypoxic-ischemic brain injury – cardiac arrest, respiratory arrest, near-drowning, near-hanging, and other forms of incomplete suffocation, carbon monoxide and other poisonous gas exposures, and perinatal asphyxia – expose the entire brain to potentially injurious reductions of oxygen (i.e., hypoxia) and/or diminished blood supply (ischemia).
http://www.internationalbrain.org/articles/hypoxicischemic-brain-injury/
263
Prognosis and Goal Setting: Familiarity with outcomes reasearch for which three areas (name the areas)
1. –Severity of Injury
2. –Duration of Coma
3. –Length of Post Traumatic Amnesia
264
How To diagnose a Stroke (4 things - practice thinking of details if you want)
1. •History
2. •Physical Exam
3. •Tests
* blood tests
* clotting time
* CBC
* Urinalysis
* Lumbar puncture
* EKG
4. •Imaging
* CT
* MRI
* Ultrasound (dopplar)
* echocardiogram
265
What is VAP
vent acquired pneumonia~This is like a wound for the skin~They get pneumonia from the vent, we failed them
266
Frontal strokes do what to personality
may change it
not neccessarily better or worse
hard to deal with the fact they are different
267
Stupor
: This may be drug induced post TBI. May have brief time of arousal. May be a temporary period or they may persist in a state of stupor.
268
how long does it take to reach maximum cerebral edema?
Max accumulation in 3-4 days
269
What are three cerebral arteries that are supplied by the Vertebral Artries
1. •Basilar
2. •Posterior cerebral
3. •Posterior communicating
270
what is a brainstem stroke called?
Uncus herniation
271
What does PET stand for?
PET = Positron Emission Tomography
272
What does FMRI stand for?
Functional Magnetic Resonance Imaging
(functional MRI)
clinician tells pt to do something and that area lights up on the MRI
see attached picture
273
how severe are strokes?
Severity can range from minute losses to zero function
274
how is the cerebral blood flow regulated?
it is autoregulated
275
List 7 tests that can be done to diagnose a TBI?
1. •CT scan
2. •MRI
3. •PET scan
4. •SPECT scan
5. •FMRI
6. •EEG
7. •Neuropsychological testing
