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BNKN602 Exam > Week 4 - Neurology > Flashcards

Week 4 - Neurology Flashcards

1
Q

What are some causes of Neurological Deterioration?

A
  • Alcohol
  • Epilepsy
  • Insulin
  • Opiates
  • Uraemia
  • Tumour
  • Injury
  • Psychiatric
  • Stroke
  • Sepsis

(AEIOU TIPSS)

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2
Q

What is the difference between Localised and Diffused Brain Injury?

A
  • Localised/focal:
    • Coup = direct impact
    • Countercoup = secondary damage away from injury site
  • Widespread/diffuse:
    • Diffuse axonal injury (brain stem, closed head injury) coma, mortality 33-50%
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3
Q

What is Increased intra-cranial pressure (ICP)?

A

Occurs when there is an imbalance inside the cranium, following brain injury or other medical conditions that cause an increase in pressure inside the skull.

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4
Q

What are the main elements generating ICP?

A

Brain tissue, blood volume and cerebrospinal fluid (CSF)

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5
Q

What is the patho of raised ICP?

A

A rise in ICP greater than cerebral perfusion pressure, (CPP), results in reduced blood flow to the brain as vessels are squashed from the pressure
Reduced blood flow = reduced oxygen and glucose delivery which results cerebral ischaemia.

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6
Q

What is the Monro-Kellie Hypothesis?

A

States that the sum of volumes of brain, cerebrospinal fluid (CSF) and intracerebral blood is constant

An increase in one should cause a reciprocal decrease in either one or both remaining two

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7
Q

What is Cushings Triad?

A
  • Rise in ICP greater than CPP causes reduced blood flow to the brain. Reduced blood flow means less O2/glucose delivery to tissue causing cerebral ischaemia.
  • Cerebral ischaemia stimulates a sympathetic response (adrenaline release to increase BP & HR) in order to increase blood flow and therefore O2 delivery
  • Parasympathetic response initiated by increase BP is detected by baroreceptors. This results in an attempt to reduce BP by decreeasing HR
  • Ongoing increased BP causes further rise in ICP and further restriction of blood flow. A switch of aerobic cellular respiration to anaerobic respiration results in decreased ATP production for cellular function (cerebral ischaemia)
  • Breakdown of Na+/K+ pump causes water to enter the cell, resulting in cell death. As cerebral oedema worsens, the brainstem is compressed causing irregular respirations before death is imminent
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8
Q

What are the early signs of raised ICP?

A

Confusion
Drowsiness
Headache
Forgetfulness
Limb weakness
Nausea
Photophobia
Diplopia
Oval pupils (from round)
Impaired extra-ocular movement

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9
Q

What are the late signs of raised ICP?

A

Projectile vomiting
Seizures
Fixed and dilated pupil/s
Loss of gag reflex
Abnormal flexion/extension of upper and lower limbs
Hypertension (widening pulse pressure)
Bradycardia
Irregular respiratory pattern

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10
Q

How would someone’s LOC be with raised ICP?

A

Drowsiness
Lethargy
Dizziness

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11
Q

How would someone’s speech be with raised ICP?

A

Slurred (dysarthria)
Delayed
Word finding difficulty (expressive/receptive dysphasia)
No speech (aphasia)

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12
Q

How would someone’s motor strength be with raised ICP?

A

Mild/mod/severe weakness
Hemiplegia (one sided arm/leg/face weakness)
Sensation changes
Swallowing difficulties (dysphagia)
Uncoordinated

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13
Q

How would someone’s behaviour be with raised ICP?

A

Disinhibition
Personality change
Emotional

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14
Q

How would someone’s pupils be with raised ICP?

A

Unequal
Sluggish
Oval
Pinpoint

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15
Q

How would someone’s cognition be with raised ICP?

A

Poor memory
Inability to sequence
Change in comprehension
Confusion

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16
Q

What are the two priority assessments you would preform to assess neurological function?

A

AVPU
GCS

17
Q

What are some other assessments you would preform to assess neurological function?

A
  • Nervous system assessment
    - Cranial nerves (CNI – XII)
    - Spinal nerves (C1-8, T1-12, L1-5, S1-5, Co1)
    - Reflexes
    - Sensation
    - Strength
  • Coordination and balance
  • Gait
  • Mini mental state examination(MMSE)
  • Speech and language
18
Q

Why is it important to continue assessments and documentation?

A

So that alterations can be detected early and prompt treatment can be initiated

19
Q

Sympathetic VS Parasympathetic Nervous system

A

Cerebral ischaemia stimulates the sympathetic nervous system to, ↑BP & HR, to increase cerebral perfusion and thus increase oxygen and glucose delivery.

Baroreceptors detect the rise in BP and activate the parasympathetic nervous system to lower BP by reducing the HR.

Without intervention this cycle continues. The sympathetic nervous system continues to activate an increase in BP to increase perfusion and the parasympathetic nervous system continues to activate a decrease in HR to lower the increasing BP.

Continued ↑ BP causes a further ↑ in ICP and therefore an ↑ in cerebral Ischaemia.

The increasing pressure inside the cranium leads to compression of the brainstem causing irregular breathing.

Following this death is imminent.

20
Q

What does the brain need to function?

A

Oxygen and glucose
- when body is resting brain uses 20-25% of oxygen & glucose

Blood flow
- interruption causes irreversible damage within 3-8 minutes

Electrical conduction
- relay and process information

21
Q

What is autoregulation?

A

A way of maintaining brain blood flow despite changes in cerebral perfusion pressure (the pressure required to deliver adequate oxygen and glucose)

Once cerebral perfusion pressure (CPP) is outside the range of 60-160mmHg, autoregulation is lost

22
Q

What happens if auto-regulation is lost?

A

If autoregulation is lost, the brain relies on mean arterial pressure (MAP) to maintain it’s blood supply

This means that if there is injury to the brain and a patient’s blood pressure is too low, there is not enough pressure to drive the blood around the brain

↓ oxygen ↓ glucose = brain tissue hypoxia and death

23
Q

What is a hypoxic Brain injury?

A

Insufficient oxygen and glucose supply to brain tissue caused by:

Smoke inhalation
Carbon monoxide poisoning
Cardiac arrest
Strangulation
Drowning
Drug overdose
Traumatic birth
Stroke
Electrocution

24
Q

What is the patho of a brain injury?

A
  1. Brain suffers traumatic injury
  2. Brain swelling or bleeding increased intracranial volume
  3. right cranium allows no room for expansion of contents so ICP raises
  4. Pressure on blood vessels within brain causes blood flow to the brain to slow
  5. Cerebral hypoxia and ischaemia occur
  6. ICP continues to rise, brain may herniate
  7. Cerebral blood flow caeses
  8. Tissue hypoxia results
25
Q

What is the damage to the brain stem in a traumatic brain injury?

A

Loss of consciousness
Interruption of normal breathing
Interruption of cardiac function
Fixed dilated pupils

26
Q

What is the aetiology of a traumatic brain injury?

A

Closed (blunt) brain injury

Open brain Injury

Concussion

Contusion

Diffuse axonal injury (DAI)

Focal injury

27
Q

What are some signs and symptoms of a traumatic brain injury?

A

Confusion, drowsiness, headache, limb weakness, nausea, photophobia, impaired extra-ocular movement, seizures, loss of consciousness, projectile vomiting, loss of gag reflex, hypertension, bradycardia, irregular resp pattern

BNKN602 Exam (17 decks)

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