w4 content

Question 1

2 types of cerebrovascular diseases

Answer 1

TIA
stroke/CVA (ischemic and hemorrhagic)

“cerebral vascular accident”

Question 2

ischemic vs hemorrhagic stroke
_________ Patho:

1. large area effected - bleeding into the brain tissue can affect a large area, leading to significant damage
2. increase in ICP - The accumulation of blood increases ICP and causes inflammation, compressing surrounding brain structures.
3. herniation - This can result in life-threatening herniation, where brain tissue is shifted and compressed against the skull.
4. death - Unrelieved herniation, particularly of the brainstem, can cause respiratory arrest and death.

_________ Patho
1. decreased blood supply (from occlusion)
2. oxygen deprivation
3. neuro deficits w/in 1 min
4. continued loss of supply leads to irreversible damage

Answer 2

hemorrhagic

ischemic

Question 3

Patho _______
1. infection of arachnoid mater and CSF
2. inflammatory response and pus secretion
3. increase in CSF production
4. increase in ICP

Answer 3

meningitis

Question 4

Patho of ALS
1. ____________ in the brainstem and spinal cord gradually degenerate/die
2. can no longer produce or transport _________ to muscles
3. electrical and chemical messages from the _______ don’t reach the muscles

Answer 4

Patho
1. motor neurons in the brainstem and spinal cord gradually degenerate/die
2. can no longer produce or transport signals to muscles
3. electrical and chemical messages from the brain don’t reach the muscles

Question 5

TIA vs stroke

__________ s/s
- varies between people, reoccurences look similar
- onset and recovery are abrupt
- s/s associated with location of defect
- s/s follow the effected vessel and whatever that vessel supplies blood to

Ex:
s/s carotid artery affected:
- weakness
- heaviness in contralateral arm, leg, or face
- numbness
- dysphagia – difficulty swallowing
- ipsilateral monocular visual loss - vision loss in one eye on the same side as the brain injury

s/s Vertebrobasilar area (back of brain) affected:
- dim or blurry vision
- vertigo
- dysphasia – difficulty speaking
- ataxia - lack of coordination and unsteadiness
- motor or sensory changes
- Ipsilateral face - same side of body as the brain injury
- Contralateral body - opposite side of the body from the brain injury

____________ s/s
- numbness/weakness on one side of body (face, arm, leg)
- sudden confusion
- trouble speaking
- dysarthria – slurred speech
- trouble seeing
- ataxia - lack of coordination and unsteadiness
- severe h/a

Answer 5

TIA
Stroke

Question 6

Acute inflammation of the meningeal tissues of the brain and spinal cord

• meningeal tissue – made up of three meningeal layers (dura, arachnoid, pia) provide protection, cushioning, and a pathway for blood vessels supplying the central nervous system

Outer to inner:
1. dura mater
2. arachnoid
3. pia mater

Answer 6

Meningitis

Question 7

TIA Diagnosis
- H&P
- Pattern
- History
- Vascular problems
- CT scan
- Rule out ________ stroke
- r/o Lacunar infarcts (small ischemic lesions)
- MRI/MRA
- r/o ___________
- carotid doppler studies
- can detect carotid stenosis
- echocardiogram
- assess for cardiac source

Answer 7

Diagnosis
- H&P
- Pattern
- History
- Vascular problems
- CT scan
- Rule out hemorrhagic stroke
- r/o Lacunar infarcts (small ischemic lesions)
- MRI/MRA
- r/o aneurysms
- carotid doppler studies
- can detect carotid stenosis
- echocardiogram
- assess for cardiac source

Question 8

ischemic stroke Patho
1. __creased blood supply (from occlusion)
2. ______ deprivation to the brain
3. ______ deficits w/in 1 min
4. continued loss of supply leads to _________ damage

Answer 8

ischemic stroke Patho
1. decreased blood supply (from occlusion)
2. oxygen deprivation
3. neuro deficits w/in 1 min
4. continued loss of supply leads to irreversible damage

Question 9

Treatment GBS
- cure?
- drugs
- steroid therapy
- high dose immunoglobulin therapy (IV) – shortens severity, duration, and length of stay

goal of drugs = reduce severity and accelerate recovery

Answer 9

Treatment
- no known cure
- drugs
- steroid therapy
- high dose immunoglobulin therapy (IV) – shortens severity, duration, and length of stay
- goal of drugs = reduce severity and accelerate recovery

Question 10

stroke Complications/long term
1- _________ - eval for aspiration before giving anything PO, swallow study with barium and xray
2- Motor deficits and Sensory-perceptual problems
3- ________ on contralateral side - days to weeks after the stroke, the affected limbs are limp
4- ________ – within 6 weeks after stroke, the affected limbs have increased muscle tone and stiffness.
5- contractures
6-________ impairment (contralateral field blindness/homonymous hemianopia)

Answer 10

1- dysphagia - eval for aspiration before giving anything PO, swallow study with barium and xray
2- Motor deficits and Sensory-perceptual problems
3- Flaccidity on contralateral side (opposite side of the body from the brain injury) - days to weeks after the stroke, the affected limbs are flaccid/limp
4- spasticity – within 6 weeks after stroke, the affected limbs have increased muscle tone and stiffness.
5- contractures
6- visual impairment – contralateral field blindness/homonymous hemianopia - The visual field defect affects the opposite side from the brain injury

Question 11

ischemic stroke etiology
__________ - blood clot that forms within an artery supplying blood to the brain. This causes an ischemic stroke by obstructing blood flow.

___________ – clot/debris that travels through the bloodstream from another part of the body and lodges in a cerebral artery, causing an ischemic stroke.

Answer 11

• thrombus
• embolus

Question 12

________ stroke –
occlusion/clot stops blood supply to an area of the brain (cerebral artery)
- the area of the brain supplied by clogged vessel loses blood supply

_______ stroke –
blood leaks into brain tissue (parenchyma)
- associated with long standing, sever HTN

which is most common?

Answer 12

Ischemic

hemorrhagic

ischemic

Question 13

stroke treatment
hemorrhagic vs ischemic
1. ABCs
2. CT scan

________ stroke treatment:
- reverse anticoagulation = antidotes
- manage HTN
- manage elevated ICP
- Raise HOB
- Give antipyretics if febrile
- Neutral position head

__________ stroke treatment:
- Alteplase
- penumbra procedure

Answer 13

hemorrhagic
ischemic

Question 14

etiology
ischemic stroke vs hemorrhagic stroke?
1. thrombus
2. aneurysm
3. embolus
4. associated with long standing, sever HTN
5. mural thrombus
6. atrial fibrillation
7. venous clots (if there is an atrial septal defect or patent foramen ovale)
8. thrombus of vegetation on heart valve
9. Carotid plaque rupture

Answer 14

1. I
2. H
3. I
4. H
5. I
6. I
7. I
8. I
9. I

Question 15

stroke
BEFAST
B –
E –
F –
A –
S –
T –

Answer 15

B – balance – loss of balance, h/a, dizzy
E – eyes – sudden loss of vision
F – face – asymmetrical face
A – arm – weakness
S – speech – difficulty talking
T – Time – time is tissue, time to call 911

Question 16

Acute ascending polyneuritis

Answer 16

Guillain-Barre Syndrome
GBS

Question 17

Rare progressive neuro disorder characterized by the loss of motor neurons (upper and lower)

Acute inflammation of the meningeal tissues of the brain and spinal cord

auto immune disorder characterized by myelin sheath damaged caused by autoantibodies

acute inflammation of the brain

Accumulation of pus within the brain tissue

Answer 17

ALS

meningitis

GBS

encephalitis

Brain abscess

Question 18

CT scan comparison
Ischemic stroke
- __________is darker on CT scan

Hemorrhagic stroke
- _________is lighter on CT scan

Answer 18

damaged tissue

blood

Question 19

stroke treatment:
Treatment
- w/in __ hours is goal
- recognize s/s and get therapy

1st -

2nd -

initiate hemorrhagic or ischemic stroke treatment

Answer 19

Treatment
- w/in 3 hours is goal
- recognize s/s and get therapy

1st
ABC’s
- airway
- Airway obstructions
- breathing
- Check if person is breathing
- circulation
- Check for pulse (we want to know if heart is pumping blood around body)

2nd
- CT scan w/out contrast –r/o hemorrhage (determines if ischemic or hemorrhage stroke)
- MRI provides better image/detail but it takes longer

initiate hemorrhagic or ischemic stroke treatment

Question 20

stroke Complications/long term
7- ______– issues with speaking or comprehending speech
8- ________ – impaired speech
9- ________ – imperfect speech sounds, word finding issues, incorrect use of words
10- _________ aphasia – comprehension intact but can’t express/communicate
11-_________ aphasia – can express/communicate but can’t comprehend/receive
12- depression
13- memory problems – names, words, objects
14- behavioral problems – emotional response, slow reaction times, hesitant, cautious, apathetic, confused, disoriented, doesn’t know own abilities

Answer 20

7- aphasia – issues with speaking or comprehending speech
8- dysphasia – impaired speech
9- dysarthria – imperfect speech sounds, word finding issues, incorrect use of words
10- expressive aphasia – comprehension intact but can’t express/communicate
11- receptive aphasia – can express/communicate but can’t comprehend/receive
12- depression
13- memory problems – names, words, objects
14- behavioral problems – emotional response, slow reaction times, hesitant, cautious, apathetic, confused, disoriented, doesn’t know own abilities

Question 21

TIA

Risk factors
(1)

Complications
(1)

Answer 21

Risk factors
- male

Complications
- increased risk for stroke after TIA (highest risk within 1 month of TIA)

Question 22

thrombus ischemic stroke vs embolus ischemic stroke

s/s and treatment is ________

etiology and prevention is________

Answer 22

similar

different

Question 23

etiology
- viral
- West Nile ______ (from mosquitos)
- Measles, chicen pox, mumps
- HSV1 – herpes simplex virus (Herpetic _______ is a potentially life-threatening viral infection of the brain caused by the herpes simplex virus (HSV), s/s occur rapidly)

Etiology –
- unknown
- excitotoxicity hypothesis (theory)

Etiology
- infection from various places cross the BBB
- lungs
- bloodstream
- penetrating wounds
- bacterial infections
- strep. Pneumoniae (pneumococcus)
- Neisseria meningitidis (meningococcus)
- viral infections
- Enteroviruses

etiology
- viral infection – most common
- bacterial infection – campylobacter jejuni – food borne illness
- post surgery

Etiology
- local or systemic infection
- most common: (b/c close to brain from bacteria to gain access)
- Ear infection
- Tooth infection
- Sinus infection
- Mastoid infection
- most common organizations:
- Streptococci
- Staph aureus (found on skin)

Answer 23

encephalitis

ALS

meningitis

GBS

brain abscess

Question 24

3 classic s/s
- fever!!
- h/a!!
- stiff neck!!

what does positive kernig sign and positive Brudzinski sign indicate?

Answer 24

meningitis

meningitis

Question 25

Treatment of ______
- need to drain brain
- abx

Answer 25

brain abscess

Question 26

subarachnoid hematoma
– bleed between arachnoid membrane and the pia matter
- what type of fluid is here
- rupture of cerebral aneurysm – ______ aneurysm big risk
- _____________ junction malformation – creates high BP which weakens walls and promotes vessel rupture
- _______ blood in CSF with spinal tap = subarachnoid hemorrhage

Answer 26

CSF
berry
aterio-venous junction malformation
continued

Question 27

Treatment goal ischemic stroke
- salvage __________ (injured/ischemic area this is still viable tissue around the dead tissue)

Answer 27

penumbra

Question 28

Risk factors
- age 40-70
- gender – male
- genetics
- smoking

Risk factors
- age – older adults
- people in populated/close living arrangements
- College students
- Prisoners
- Army barracks

Risk factors
- hypertension
- hyperlipidemia – high cholesterol
- tobacco use
- DM
- race – black
- oral contraceptives
- age – OA
- gender – men
- sickle cell anemia – clotting risk
- hx of TIA
- atrial fibrillation – blood pooling promotes blood clot which can travel to brain and cause a stroke
- obesity
- ETOH abuse
- family hx
- physical inactivity
- Arterial disease
- drug abuse – IV, cocaine
- HF

Risk factors
- male

Risk factors
- age 30-60
- associated with long standing, sever HTN

Answer 28

ALS

meningitis

stoke

TIA

hemorrhagic stoke

Question 29

these embolus (from cardiac sources) can cause an ischemic stroke

___________ - thrombus (blood clot) that forms along the wall of a blood vessel, particularly in areas of low blood flow or disturbed flow patterns (heart chambers)

To get to the brain (stroke) the embolus/clot has to be on the left side of the heart b/c it goes out to the brain/body that way

_________- – left atrial thrombus, blood becomes stagnant in a quivering (non-contracting) atrium
________ - (if there is an atrial septal defect or patent foramen ovale so the clot can get from the right side of heart to the left side of heart)
____________- mitral valve common b/c its on the left side, mechanical valves at risk

Answer 29

• Mural thrombus
• Atrial fibrillation
• Venous clots
• Thrombus of vegetation of valves –

Question 30

meningitis s/s
- positive ________ sign – knees can’t/resist leg extension/straighten when the hip is flexed/bent (causes pain)
- positive ________ sign – neck flexion/bend causes hip and knee flexion/bend (and pain)

Answer 30

kernig

Brudzinski

Question 31

_________ - facilitates rapid and efficient transmission of electrical signals along the PNS and CNS, essential for proper nerve conduction and its damage or loss, can lead to impaired neurological function

Answer 31

myelin sheath

Question 32

Types of intracranial hemorrhage:

________ hematoma – bleed between skull and dura
- skull fracture
- arterial injury
- injury is less severe

_______ hematoma– bleed below dura
- bridging veins affected – smaller, outer veins that connect to larger veins
- brain moves within skull, vessels don’t
- rapidly decline, severe injury
- onset 2-10 days

________ hematoma – bleed between arachnoid membrane and the pia matter
- CSF is here
- rupture of cerebral aneurysm – berry aneurysm big risk
- aterio-venous junction malformation – creates high BP which weakens walls and promotes vessel rupture
- continued blood in CSF = subarachnoid hemorrhage

subdural
Epidural
subarachnoid

Answer 32

Epidural hematoma – bleed between skull and dura
- skull fracture
- arterial injury
- injury is less severe

subdural hematoma– bleed below dura
- bridging veins affected – smaller, outer veins that connect to larger veins
- brain moves within skull, vessels don’t
- rapidly decline, severe injury
- onset 2-10 days

subarachnoid hematoma – bleed between arachnoid membrane and the pia matter
- CSF is here
- rupture of cerebral aneurysm – berry aneurysm big risk
- aterio-venous junction malformation – creates high BP which weakens walls and promotes vessel rupture
- continued blood in CSF = subarachnoid hemorrhage

Question 33

Treatment encephalitis
(it’s a _______ infection)
1. acyclovir (used for which viral infection?)
- Reduces mortality
- Does not reduce neurological complications
2. anti________ meds
- Increased ICP and inflammation = seizure risk
3. other s/s supportive drugs too

Answer 33

Treatment
(it’s a Viral infection)
- acyclovir (used for HSV infection)
- Reduces mortality
- Does not reduce neurological complications
- antiseizure meds
- Increased ICP and inflammation = seizure risk
- other s/s supportive drugs too

Question 34

stroke s/s
B - ataxia - lack of coordination and unsteadiness, and sudden confusion, and severe h/a
E - trouble seeing
F - numbness/weakness on one side of body (face, arm, leg)
A - numbness/weakness on one side of body (face, arm, leg)
S - trouble speaking, dysarthria (slurred speech)
T - time to call 911

specific s/s of ischemic or hemorrhagic stroke?
- severe h/a
- rapid change in LOC
- irritation of meninges – nuchal rigidity/neck pain, similar to meningitis
- photophobia

Answer 34

hemorrhagic stroke

Question 35

Treatment: subarachnoid hematoma
- activity level?
- strict ___ maintenance
- clipping of aneurysm – surgery
- prophylactic anti_________
- CCB
- risk of re-bleeding high within ______ hours
- triple H to keep brain _______
(The goal is to prevent cerebral vasospasm and ischemia by improving blood flow and oxygen delivery to the brain after the initial bleeding event from the ruptured aneurysm.)

• Hyp__tension
• Hyp___volemia
• Hemo_____tion

Answer 35

Treatment: subarachnoid hematoma
- bedrest
- strict BP maintenance
- clipping of aneurysm – surgery
- prophylactic anticonvulsant
- CCB
- risk of re-bleeding high within 1st 24 hours
- triple H to keep brain perfused - The goal is to prevent cerebral vasospasm and ischemia by improving blood flow and oxygen delivery to the brain after the initial bleeding event from the ruptured aneurysm.

• Hypertension - Induced hypertension using vasopressors like phenylephrine or dopamine to increase mean arterial pressure.
• Hypervolemia - Volume expansion with crystalloid or colloid solutions to increase blood volume.
• Hemodilution - Lowering blood viscosity through hemodilution to improve blood flow to the brain.

Question 36

these contribute to thrombus formation and ischemic strokes

• __________ – damaged vessel, plaque formation and rupture
• _________ – body makes clots easier (cancer, bc pills)

Answer 36

Atherosclerosis
Hypercoagulable state

Question 37

Complications of meningitis or encephalitis
- septic micro emboli
- limb loss

Answer 37

meningitis

Question 38

Where does ________ occur:
- pia matter
- subarachnoid space
- ventricular system
- CSF

When does meningitis occur:
(2)

Meningitis often follows or is associated with:
T/F
- Otitis (ear infection)
- sinusitis (sinus infection)
- Pneumonia
- Immunocompromised state
- The bacteria causing these preceding infections can enter the bloodstream and cross the blood-brain barrier to infect the meninges and cerebrospinal fluid, leading to meningitis.

Answer 38

meningitis

• fall
• winter

T- Otitis (ear infection)
T- sinusitis (sinus infection)
T- Pneumonia
T- Immunocompromised state
T- The bacteria causing these preceding infections can enter the bloodstream and cross the blood-brain barrier to infect the meninges and cerebrospinal fluid, leading to meningitis.

Question 39

prognosis
ALS =
GBS =

Answer 39

not good, death likely to occur within 3 years of diagnosis (r/t respiratory failure)

good, most survive 95%, most completely recover 75%

Question 40

________ side (opposite side of the body from the brain injury)

_________ side- same side of body as the brain injury

Answer 40

contralateral side (opposite side of the body from the brain injury)

Ipsilateral side- same side of body as the brain injury

Question 41

stroke Complications/long term consequences
- ________ sided brain injury issues with:
- communication – verbal and writing
- analytical/logical thinking
- ________ sided brain injury issues with:
- imagination
- music
- art

Answer 41

Left
Right

Question 42

s/s
- upper extremity weakness (sometimes begins in legs)
- muscle wasting
- spasticity
- dysarthria – imperfect speech sounds, word finding problems, incorrect use of verbs/nouns
- dysphagia – speech impairment
- drooling
- cognitive/behavioral changes
- constipation
- sleep problems
- breathing problems

s/s
- onset days-weeks following a infection (viral – most common)
- weakness/tingling in LE (first sign)
- ascending pattern – most common (descending pattern – possible, less common)
- severity of s/s increases in hours-weeks
- potentially life threatening if respiratory muscles are involved
- uncoordinated movements
- numbness/decreased sensation
- loss of bowel/bladder control
- blurred vision
- difficulty breathing, swallowing, chewing

s/s
- signs appear 2-3 days after infection
- ranges from mild changes in mental status to coma
- fever
- h/a
- n/v
- other CNS changes like seizures
- s/s vary – all CNS, neuro related issues

s/s
- fever!!
- h/a!!
- stiff neck!!
- n/v – r/t increased ICP
- altered mental status – r/t increased ICP
- Ranging from drowsiness to coma
- Seizures
- photophobia
- skin rash (bacterial)
- petechiae (bacterial)
- positive kernig sign – resistance to leg extension (causes pain)
- positive Brudzinski sign – neck flexion causes hip/knee flexion (and pain)

s/s
- similar to meningitis and encephalitis
- h/a
- fever
- n/v
- drowsy, confusion, seizures = increased ICP
- focal s/s may indicate area of issue

Answer 42

ALS

GBS

encephalitis

meningitis

brain abscess

Question 43

TIA treatment
- depends on ________
- anticoagulation therapy
- ______ (no benefit of high vs low dose) – antiplatelet drug
- _______ (calcium channel blocker) – antiplatelet drug
- _____ and _____ (if cardiac related) – anticoagulants
- carotid ____________ (opens artery. By removing plaque) – indicated with >70% stenosis
- carotid ____________ – balloon procedure

Answer 43

treatment
- depends on etiology (think of ischemic stroke causes)
- anticoagulation therapy
- ASA (no benefit of high vs low dose) – antiplatelet drug
- Clopidogrel (calcium channel blocker) – antiplatelet drug
- Heparin and warfarin (if cardiac related) – anticoagulants
- carotid endarterectomy (opens artery. By removing plaque) – indicated with >70% stenosis
- carotid angioplasty – balloon procedure

Question 44

__________ stroke treatment:
- reverse anticoagulation = antidotes
- manage HTN
- manage elevated ICP
- Raise HOB
- Give antipyretics if febrile
- Neutral position head

___________ stroke treatment:
- Alteplase
- penumbra procedure – go in and try to remove the clot

Answer 44

Hemorrhagic stroke treatment:
- reverse anticoagulation = antidotes
- manage HTN
- manage elevated ICP
- Raise HOB
- Give antipyretics if febrile
- Neutral position head

Ischemic stroke treatment:
- Alteplase
- penumbra procedure – go in and try to remove the clot

Question 45

Amyotrophic lateral sclerosis
(AKA Lou Gehrig Disease)

Answer 45

ALS

Question 46

Patho of ________
1. motor neurons in the brainstem and spinal cord gradually degenerate/die
2. can no longer produce or transport signals to muscles
3. electrical and chemical messages from the brain don’t reach the muscles

Answer 46

ALS

Question 47

an embolus from a rupture of plaque in the ________ artery can cause an ischemic stroke

A carotid _______ is an abnormal sound heard over the carotid artery in the neck, often indicating ________ blood flow from atherosclerotic ______ buildup or stenosis.

The presence of a carotid bruit can signify an increased risk of carotid artery disease and subsequent ________ stroke.

Answer 47

carotid

A carotid bruit is an abnormal sound heard over the carotid artery in the neck, often indicating turbulent blood flow from atherosclerotic plaque buildup or stenosis.

The presence of a carotid bruit can signify an increased risk of carotid artery disease and subsequent ischemic stroke.

Question 48

Treatment for meningitis:
_________ meningitis –
- aggressive abx therapy
- IV
- Multiple drugs used – we start all of them and d/c when labs come back if not necessary
- Bacterial or viral drugs? = ceftriaxone and vancomycin
- Bacterial or viral drugs? = acyclovir
- steroid therapy – reduce inflammation
- vaccine?

Answer 48

Treatment
Bacterial meningitis –
- aggressive abx therapy
- IV
- Multiple drugs used – we start all of them and d/c when labs come back if not necessary
- Bacterial drugs = ceftriaxone and vancomycin
- Viral drugs = acyclovir
- steroid therapy – reduce inflammation
- prophylaxis vaccines – available for meningococcus, pneumococcus, H. influenzae = leading bacterial causes of meningitis

Question 49

hemorrhagic Prognosis depends on:
- Age - better prognosis with _______ b/c _________
- location – ________ hemorrhagic stroke = bad prognosis
- size – ________ hemorrhagic stroke = better prognosis
- how rapidly the bleed causes brain distortion and shift – if bleeding on one side causes ________ shift = bad prognosis

Answer 49

Prognosis depends on:
- Age - better prognosis with older adults b/c the brain atrophies with age so when the brain swells with a stroke, there is more space and less compression of the brain against the skull
- location – brain stem hemorrhagic stroke = bad prognosis
- size – smaller hemorrhagic stroke = better prognosis
- how rapidly the bleed causes brain distortion and shift – if bleeding on one side causes midline shift = bad prognosis

Question 50

Etiology –
- unknown
- excitotoxicity hypothesis (theory)
- too much glutamate (excitatory neurotransmitter) leads to neuron death
- in people with _____, high levels of glutamate levels found in the CSF
- anti-glutaminergic drug (Riluzole) is found to improve survival

Answer 50

ALS

Question 51

Bell’s Palsy vs TIA
Presents similar

1 paralysis of facial nerve
2 recovers more quickly
3- droopy face

Answer 51

BP 1- paralysis of facial nerve
TIA 2- recovers more quickly
BP 3 - droopy face

Question 52

2 types of meningitis

Acute_________
- most common, most severe form
- high fatality rate w/out quick treatment
- long term s/e = hearing loss, seizures, brain damage
- petechia and skin rash only manifests with this type

Acute ________
- milder form
- no long term s/e

Answer 52

bacterial
viral

Question 53

hemorrhagic stroke Patho
1. ________ area effected - bleeding into the brain tissue can affect a large area, leading to significant damage
2. ___crease in ICP - The accumulation of blood __creases ICP and causes inflammation, compressing surrounding brain structures.
3. herniation - This can result in life-threatening herniation, where brain tissue is_____ and _________ against the skull.
4. death - Unrelieved herniation, particularly of the brainstem, can cause respiratory arrest and death.

Answer 53

hemorrhagic stroke Patho
1. large area effected - bleeding into the brain tissue can affect a large area, leading to significant damage
2. increase in ICP - The accumulation of blood increases ICP and causes inflammation, compressing surrounding brain structures.
3. herniation - This can result in life-threatening herniation, where brain tissue is shifted and compressed against the skull.
4. death - Unrelieved herniation, particularly of the brainstem, can cause respiratory arrest and death.

Question 54

stroke: Risk factors
- _____tension
- hyper________
- _________ use
- DM
- race – ________
- oral __________
- age – _____
- gender – ________
- __________ anemia – clotting risk
- hx of _______
- atrial _________– blood pooling promotes blood clot which can travel to brain and cause a stroke
- obesity
- ETOH _______
- family ____
- physical _________
- Arterial ________
- drug abuse – IV, cocaine
- HF

Answer 54

Risk factors
- hypertension
- hyperlipidemia – high cholesterol
- tobacco use
- DM
- race – black
- oral contraceptives
- age – OA
- gender – men
- sickle cell anemia – clotting risk
- hx of TIA
- atrial fibrillation – blood pooling promotes blood clot which can travel to brain and cause a stroke
- obesity
- ETOH abuse
- family hx
- physical inactivity
- Arterial disease
- drug abuse – IV, cocaine
- HF

Question 55

meningitis Etiology
- infection from various places cross the _____
- lungs
- bloodstream
- penetrating wounds
- _________ infections
- strep. Pneumoniae (pneumococcus)
- Neisseria meningitidis (meningococcus)
- ________ infections
- Enteroviruses

Answer 55

Etiology
- infection from various places cross the BBB
- lungs
- bloodstream
- penetrating wounds
- bacterial infections
- strep. Pneumoniae (pneumococcus)
- Neisseria meningitidis (meningococcus)
- viral infections
- Enteroviruses

Question 56

Cerebrovascular disease
TIA vs stroke
1. Transient ischemia attack
2. Transient episode of neuro dysfunction w/out acute infarction
3. neurological deficits lasting >24 hours
4. acute focal cerebral insufficiency lasts <24 hours, usually <1 hour
5. no residual effects
6. “mini-stroke”
7. It is caused by a temporary blockage of blood flow to the brain, resulting in stroke-like symptoms that resolve within 24 hours, usually within minutes to an hour.
8. serious warning sign that the person is at high risk for a full stroke in the near future.
9. “cerebral vascular accident” CVA
10. problem with blood supply to brain

Answer 56

1. T
2. T
3. S
4. T
5. T
6. T
7. T
8. T
9. S
10. S

Question 57

Patho of meningitis
1.________ of arachnoid mater and CSF
2. ___________ response and pus secretion
3. ___crease in CSF production
4. ___crease in ICP

Answer 57

Patho
1. infection of arachnoid mater and CSF
2. inflammatory response and pus secretion
3. increase in CSF production
4. increase in ICP

Question 58

ischemic stroke Complications:
- _________ __________ - bleeding that occurs within the area of an ischemic stroke, essentially turning the ischemic stroke into a hemorrhagic stroke.

hemorrhagic stroke complications
- _____ morbidity and mortality – mins to hours
- serious _________

Answer 58

• Hemorrhagic conversion - bleeding that occurs within the area of an ischemic stroke, essentially turning the ischemic stroke into a hemorrhagic stroke.
• high morbidity and mortality – mins to hours
• serious disabilities

Question 59

stroke treatment
hemorrhagic vs ischemic
1. ABCs
2. CT scan

Hemorrhagic stroke treatment:
- reverse ________ = antidotes
- manage ___
- manage elevated ____
- raise HOB

• Give antipyretics if febrile
• Neutral position head

Ischemic stroke treatment:
- drug = _________
- _________ procedure – go in and try to remove the clot

Answer 59

stroke treatment
hemorrhagic vs ischemic
1. ABCs
2. CT scan

hemorrhagic stroke treatment:
- reverse anticoagulation = antidotes
- manage HTN
- manage elevated ICP
- Raise HOB
- Give antipyretics if febrile
- Neutral position head

ischemic stroke treatment:
- Alteplase
- penumbra procedure

Question 60

meninges layers
outer to inner
1.
2.
3.

Answer 60

skull
1. dura mater
2. arachnoid
3. pia mater