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Pathophysiology > Pathophys ch22 Acute Neuro Disorders > Flashcards

Pathophys ch22 Acute Neuro Disorders Flashcards

1
Q

Skull

A
  • rigid bone connected by sutures
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2
Q

Meninges

A
  • three continuous CT membranes covering the brain and spinal cord
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3
Q

Cerebrospinal fluid (CSF)

A
  • clear liquid that provides a cushion for the brain and spinal cord
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4
Q

Blood-brain barrier and blood-CSF barrier

A
  • impermeable capillaries in the brain limit the passage of potentially damaging materials into the brain and controls the delicate balance of electrolytes, glucose, and proteins in the brain and CSF
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5
Q

Prefrontal area

A
  • Functional area
  • Frontal lobe
  • intellectual function and personality (thinking)
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8
Q

Premotor cortex

A
  • Functional area
  • Frontal lobe
  • skilled movements (back of frontal lobe)
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11
Q

Motor cortex

A
  • Functional area
  • Frontal lobe
  • voluntary movements
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14
Q

Broca’s area

A
  • speech (expression, formation of words)

- located on the left side usually

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15
Q

Parietal lobe

A
  • sensation (touch, pain etc.)
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16
Q

Occipital lobe

A
  • vision (back of head)
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17
Q

Auditory cortex

A
  • Temporal lobe - hearing
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19
Q

Olfactory cortex

A
  • Temporal lobe - smell
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21
Q

Wernicke’s area

A
  • Temporal lobe - comprehension of speech or memory
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23
Q

Cerebellum

A
  • balance, position, coordinated movement
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24
Q

Medulla oblongata

A
  • control and coordinating centers for life sustaining functions (ie. breathing and HR)
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25
Q

Hypothalamus

A
  • maintains homeostasis
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26
Q

Thalamus

A
  • sensory sorting and relay center
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27
Q

Basal nuclei

A
  • coordination and control of body movement
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28
Q

Reticular activating system

A
  • arousal and awareness
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29
Q

Limbic system

A
  • emotional response
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30
Q

Spinal Cord

A
  • the cord consists of nerve fibers or tracts or surrounding nerve cell bodies
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31
Q

Anterior horns

A
  • spinal cord - cell bodies of motor neurons whose axons leave the spinal cord (efferents) to innervate skeletal muscle
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33
Q

Posterior horns

A
  • spinal cord - association (interneurons) neurons
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35
Q

Ascending fibers

A
  • spinal cord - sensory nerve fibers (afferents)
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37
Q

Descending fibers

A
  • spinal cord - motor nerve fibers
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39
Q

Reflexes

A
  • automatic or rapid or involuntary response to a stimulus.
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40
Q

Reflex pathway

A
  • Sensory stimulus receptor ==> afferent nerve fiber ==> synapse in spinal cord ==> efferent never fiber ==> response at effecter site
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41
Q

Reflex pathophysiology

A
  • absent, weak or abnormal responses may indicate the presence of a neurologic problem in the brain or spinal cord
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42
Q

Neurons

A
  • are specialized nonmitotic cells that conduct impulses throughout the CNS and PNS - (cell bodies do not mitose)
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44
Q

Neuron architecture

A
  • Consists of cell body, dendrites and axons
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45
Q

Glial cells

A
  • support and protect the neurons
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46
Q

Local (focal) effects

A

signs related to the specific area of the brain or spinal cord in which the lesion is located

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47
Q

Left hemisphere damage

A

loss of logical thinking ability or analytical skills or other intellectual abilities and communication skills

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48
Q

Right hemisphere damage

A

impairs appreciation of music and art and causes behavioral problems or spatial orientation (what is going on around you)

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49
Q

Consciousness centers

A

The cerebral cortex and the RAS in the brainstem determine the level of consciousness

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50
Q

Consciousness – supratentorial lesions

A

Extensive supratentorial lesions must be present in the cerebral hemispheres to cause loss of consciousness

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51
Q

Consciousness – infratentorial lesions

A

Small lesions in the brainstem can affect the RAS (reticular activation system)

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52
Q

Consciousness – blood pathophysiology

A

Acidosis or hypoglycemia can depress the CNS reducing the level of consciousness (ie diabetes)

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53
Q

Coma

A

Person does not respond to painful or verbal stimuli and the body is motionless with some reflexes present (can come out of it)

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54
Q

Vegetative state

A

loss of awareness and mental capabilities resulting from diffuse brain damage although the brainstem continues to function (can not come out of it)

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55
Q

Lock-in syndrome

A

person is aware and capable of thinking but is paralyzed and cannot communicate

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56
Q

Brain death criteria

A

Cessation of brain function, absence of brainstem reflexes, absence of spontaneous respiration, (medulla oblongata function absent), independent establishment of certainty of irreversible brain damage by two Dr at two times.

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57
Q

Motor dysfunction – upper motor neurons

A

Damage to UPPER MOTOR NEURONS in the frontal lobe or to the corticospinal tracts in the brain causes weakness or paralysis on the opposite side of the body, muscle tone and reflexes may be increased

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58
Q

Motor dysfunction – lower motor neurons

A

Damage to lower motor neurons causes weakness or paralysis on same side of the body, muscles are flaccid (limp) and reflexes are absent

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59
Q

Sensory dysfunction

A

loss of touch, pain, temperature, position or special senses

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60
Q

Visual loss (hemianopia)

A
  • loss of visual field depends on the site of damage in the visual pathway
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61
Q

Expressive aphasia

A

Language disorders - cannot speak or write fluently; motor problem

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63
Q

Receptive aphasia

A

(Language disorders) unable to understand written or spoken word

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64
Q

Global aphasia

A

(Language disorders) cannot express self or comprehend other’s language; both speaking and understanding

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65
Q

Fluent aphasia

A

(Language disorders) pace of speech is normal but contains made-up words and sentences that do not make sense, ie. stroke

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66
Q

Nonfluent aphasia

A

(Language disorders) slow and labored speech with short phrases

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67
Q

Dysarthria

A

(Language disorders) words cannot be articulated clearly (difficult speech due to cranial nerve damage)

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68
Q

Agraphia

A

(Language disorders) impaired writing ability

69
Q

Alexia

A

(Language disorders) impaired reading ability

70
Q

Agnosia

A

(Language disorders) loss of recognition or association (a=without or gnosia=knowledge)

71
Q

Seizures

A
  • spontaneous excessive discharge in the brain (over working of the brain)
72
Q

Increased intracranial pressure (ICP)

A

Results in decreased blood flow to the area compressed causes tissue necrosis. ICP due to inflammation, blood leakage, tumor, etc. in the brain. Common in many neurologic problems

73
Q

Increased intracranial pressure (ICP) - Early signs

A

severe headache, vomiting, papilledema

74
Q

Increased intracranial pressure (ICP) - Vital signs

A

increasing BP, slowed HR, reduced respiratory rate

75
Q

Herniation

A

brain tissue is displaced by blood clot or tumor (pushed out of place)

76
Q

Brain tumors

A

Tumors, both benign and malignant, are space-occupying lesions that cause increased ICP and localized dysfunction related to their location

77
Q

Primary malignant brain tumors

A

do not have well-defined margins but are invasive and have irregular projections into adjacent tissue

78
Q

Secondary brain tumors

A

metastasize from breast or lung tumors

79
Q

Brain tumors - Signs and Symptoms

A

Increased ICP, morning headache, vomiting, seizures

80
Q

Vascular disorders affecting the CNS

A

hemorrhagic or ischemic in origin

81
Q

Vascular disorders – pathophysiology

A

Interference with blood supply to a specific area of the brain results in local damage and manifestations depending on the particular cerebral artery involved

82
Q

Transient ischemic attacks (TIAs)

A

Temporary localized reduction of blood flow in the brain

Recovery within 24 hours

83
Q

Transient ischemic attacks (TIAs) – Etiology

A

atherosclerosis, embolus, vascular spasm, or local loss of autoregulation

84
Q

Transient ischemic attacks (TIAs) – S&S

A

Intermittent short episodes of impaired function

85
Q

Cerebrovascular accident (stroke)

A

infarction of brain tissue that results from lack of blood (ischemia)

86
Q

Cerebrovascular accident (stroke) – Seriousness

A

five minutes or less of ischemia causes irreversible cell damage

87
Q

Cerebrovascular accident (stroke) – Pathophysiology

A

A central area of necrosis develops surrounded by an area of inflammation. Function in this area is lost immediately. The tissue liquefies leaving a cavity in the brain

88
Q

Cerebrovascular accident (stroke) – Etiology, 3 types

A
  • occlusion by atheroma
  • obstruction by an embolus
  • an intracerebral hemorrhage by a ruptured artery
89
Q

Cerebrovascular accident (stroke) – S&S

A

weakness, numbness, loss of vision or speech, severe headache, dizziness or unsteadiness

90
Q

Cerebral aneurysms

A

localized dilation of an artery – often at the points of bifurcation on the circle of Willis

91
Q

Cerebral aneurysms – Pathophysiology

A

Enlarge over the years until compression of nearby structures causes clinical signs or rupture. Rupture often results from a sudden increase in blood pressure during exertion

92
Q

Cerebral aneurysms – affect of blood

A

blood causes inflammatory response and irritation of nerve roots

93
Q

Cerebral aneurysms – S&S

A

visual disturbances, headache, photophobia, periods of dysfunction or nuchal rigidity

94
Q

Meningitis

A

infection of the meninges of the CNS

95
Q

Meningitis – pathophysiology

A

Inflammatory response to the infection leads to increased ICP. Purulent exudates covers the surface of the brain and is present in the CSF. Blood vessels on the surface of the brain appear dilated.

96
Q

Meningitis – S&S

A

severe headache or back pain or photophobia or nuchal rigidity

97
Q

Brain abscess

A

localized infection, frequently in the frontal or temporal lobes

98
Q

Brain abscess – pathophysiology

A

Necrosis of the brain tissue and an area of edema

99
Q

Brain abscess – etiology

A

It usually results from ear, throat, lung, or sinus infection

100
Q

Encephalitis

A

viral infection of the CT in the brain and spinal cord

101
Q

Encephalitis – pathophysiology

A

Necrosis and inflammation develop in the brain tissue

102
Q

Encephalitis – S&S

A

severe headache, stiff neck, lethargy, vomiting, seizures, fever

103
Q

Rabies

A

Viral infection from the bite of a rabid animal

104
Q

Rabies – pathophysiology

A

It causes severe inflammation and necrosis of the brainstem and basal ganglia

105
Q

Rabies – S&S

A

headache, fever or neuron hyperirritability

106
Q

Tetanus

A

SPORE-FORMING Bacterial infection – spores can survive for years in soil

107
Q

Tetanus – pathophysiology

A

Produce an exotoxin that enters the nervous system and causes tonic muscle spasms

108
Q

Tetanus – S&S

A

S&S - jaw stiffness, difficulty swallowing, stiff neck, muscle spasm

109
Q

Poliomyelitis

A

VIRAL infection that attacks motor neurons of the spinal cord and medulla and results in minor flulike effects to paralysis

110
Q

Herpes zoster (shingles)

A

A VIRAL infection in adults seen years after chickenpox

111
Q

Herpes zoster (shingles) – pathophysiology

A

Usually affects one cranial nerve or one dermatome on one side of the body

112
Q

Herpes zoster (shingles) – S&S

A

pain, paresthesia and vesicular rash

113
Q

Postpolio syndrome

A

occurs 10-40 years after recovering from polio with progressive and debilitating fatigue, weakness, pain, and muscle atrophy

114
Q

Reye’s syndrome

A

linked to viral infections in young children that have been treated with aspirin

115
Q

Reye’s syndrome – pathophysiology

A

Noninflammatory cerebral edema develops and an enlarged liver

116
Q

Reye’s syndrome – S&S

A

lethargy, headache, vomiting, disorientation, hyper-reflexia

117
Q

Guillain-Barre syndrome

A

inflammatory condition of the peripheral NS

118
Q

Guillain-Barre syndrome – Etiology

A

Abnormal immune response precipitated by a viral infection or immunization

119
Q

Guillain-Barre syndrome – pathophysiology

A

Local inflammation, accumulated lymphocytes, demyelination, and axon destruction.

120
Q

Guillain-Barre syndrome – Course of disease

A

Inflammation begins in the legs and ascends to the trunk and neck or ascends to involve the diaphragm and respiratory muscles. Reversible if treated early.

121
Q

Guillain-Barre syndrome – S&S

A

progressive muscle weakness and areflexia beginning in legs

122
Q

Concussion

A

reversible interference with brain function from sudden excessive movement of the brain disrupting neurologic function and leading to loss of consciousness

123
Q

Contusion

A

bruising of brain tissue with rupture of small blood vessels and edema

124
Q

Closed head injury

A

skull is not fractured but brain tissue is injured and blood vessels may be ruptured

125
Q

Open head injury

A

fracture of the skull or penetration of the brain by missiles or sharp objects

126
Q

Contrecoup injury

A

area of the brain contralateral to the site of direct damage is injured as the brain bounces off the skull

127
Q

Primary brain injury

A

direct injury such as laceration or crushing of the neurons, glial cells and/or blood vessels of the brain

128
Q

Secondary brain injury

A

result from effects of cerebral edema, hemorrhage, hematoma, cerebral vasospasm or infection and ischemia

129
Q

Head injuries

A

Any trauma to the brain causes loss of function in the part of the body controlled by that area of the brain

130
Q

Head injuries – pathophysiology

A

Cell damage and bleeding lead to inflammation or necrosis and tissue replaced by scar tissue or a cyst

131
Q

What is a hematoma?

A

Collection of blood in the tissue that develops from rupture of blood vessels. ie. bruise

132
Q

Epidural hematoma

A

bleeding between the dura and skull

133
Q

Subdural hematoma

A

bleeding between the dura and arachnoid

134
Q

Subarachnoid hemorrhage

A

bleeding between the arachnoid and pia

135
Q

Intracerebral hematoma

A

bleeding inside the cerebrum

136
Q

Effect of hematomas.

A

Bleeding leads to local pressure on the tissue and increased ICP

137
Q

Head injuries - S&S

A

seizure, cranial nerve impairment, otorrhea, rhinorrea, or otorrhagia

138
Q

Cervical spine injuries - hyperextension or hyperflexion

A

hyperextension or hyperflexion of the neck with possible fracture along with damage to the disc and ligaments leading to dislocation or loss of alignment of vertebrae and compression or stretching of the spinal cord

139
Q

Cervical spine injuries – Dislocation

A

Dislocation of vertebrae may crush or compress the spinal cord and compromise blood supply

140
Q

Compression fracture (Spinal cord injuries)

A

great force is applied to the top of the skull or to the feet and is transmitted down or up the spine, shattered bone is compressed and protrudes, exerting pressure against the cords

141
Q

Penetration injuries (Spinal cord injuries)

A

stab or bullet wound

142
Q

axon

A

Neuron cell bodies in the spinal cord do not regenerate but __________ regrowth may occur

143
Q

transection or crushing

A

Complete __________ of the cord causes irreversible loss of sensory and motor function at and below the level of injury

144
Q

Effect of prolonged ischemia and necrosis

A

permanent cell and tissue damage

145
Q

Spinal cord injuries - (S&S) During spinal shock

A
  • Flaccid paralysis or sensory loss at or below the injury

- Absence of all reflex responses and loss of central control of autonomic function

146
Q

Spinal cord injuries - (S&S) Recovery

A

Gradual return of reflex activity below the injury

Hyper-reflexia develops

147
Q

Cervical spine injury may result in autonomic dysreflexia

A

sensory stimulus triggers a massive sympathetic reflex response that can’t be controlled by the brain

Pathophysiology (6 decks)

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