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intracranial reg
pathophysiology NUR 304
| Question | Answer |
|---|---|
| With a cerebral injury, presentation often is seen on what side of the body? | opposite |
| What does the CNS consist of | brain and spinal cord |
| What does the PNS of | cranial and spinal nerves |
| What two types of neurons does the spinal cord contain? | motor neurons(movement), sensory neurons(sensory input) |
| motor neurons go which way? | descending |
| sensory neurons go which way? | ascending |
| Define the autonomic nervous system (ANS) | the part of the peripheral nervous system that controls involuntary biological functions (breathing and heartbeat) |
| Define the corticospinal tract | connections between brain and spine |
| Define the corticobulbar tract | Controls all voluntary movement for speech production. Descends from motor cortex through internal capsule but terminates at cranial nerves. |
| Define the spinothalamic tract | Contains sensory fibers that transmit the sensations of pain, temperature, and crude or light touch. |
| What does the Cerebrum consist of? | consists of a right and left hemisphere and a corpus callosum; the largest part of the brain |
| What does the corpus callosum consist of? | a broad band of nerve fibers joining the two hemispheres of the brain. |
| What does the Brain Stem consist of? | consists of the midbrain, medulla, and pons; responsible for involuntary and voluntary life sustaining bodily functions |
| What is the Cerebellum? | A large structure of the hindbrain that controls fine motor skills. |
| What is aphasia? | difficulty in speaking or understanding language (seen a lot in stroke patients) |
| Explain Broca's area aphasia | Controls language expression, expressive aphasia |
| Explain Wernicke's Aphasia | unable to understand language; receptive aphasia (WORD SALAD) |
| where does cerebral blood supply come from? | Carotid vertebral arteries |
| What doe the the carotid arteries directly supply? | anterior cerebral artery and the middle cerebral artery |
| Where are ischemic strokes are often seen? | middle cerebral artery |
| middle cerebral artery vascularizes what percent? | 80 |
| What do vertebral arteries unite to form? | basilar artery |
| Define the Circle of Willis | A structure at the base of the brain that is formed by the joining of the carotid and basilar arteries; provides collateral circulation to the brain in event of occlusion of major artery |
| How many pairs of cranial nerves are there | 12 |
| the brain uses what percentage of the body's O2 | 20 |
| What does lack of cerebral blood flow cause? | cerebral ischemia |
| what are the three types of neurons? | sensory, motor, interneurons |
| What do neurons consist of? | cell body, dendrites, an axon terminal, and an axon |
| What are neurotransmitters | chemical messengers that cross the synaptic gaps between neurons |
| What is acetyocholine? | a neurotransmitter that slows the HR |
| Define serotonin | A neurotransmitter that affects mood. |
| Define dopamine | influences movement, learning, attention, behavior, cognitions, motivation, and working memory |
| What is Gamma-aminobutyric acid (GABA)? | a neurotransmitter that controls muscle tone, anti-convulsion, and relaxation |
| What is glutamate? | A major neurotransmitter; involved in memory, cognition, and learning |
| What is a condition where myelin is damaged? | multiple sclerosis and ALS |
| What is the Midbrain? | it is important for hearing and sight, eye movement, and body movement |
| What does the pons control? | sleep and arousal |
| What is the medulla oblongata? | Part of the brainstem that controls vital life-sustaining functions such as heartbeat, breathing, blood pressure, and digestion. |
| What is the frontal lobe of cerebrum? | front regions of each of the cerebral hemispheres. They are used for reasoning, emotions, judgment, and voluntary movement. |
| What does the parietal lobe of cerebrum control? | movement, orientation, recognition, perception of stimuli |
| What is the occipital lobe of cerebrum? | A region of the cerebral cortex that processes visual information |
| What does the temporal lobe of cerebrum control? | contains centers of hearing and memory |
| Define Cerebellum | Balance and coordination and fine muscle control |
| What does the Diencephalon do? | houses thalamus and hypothalamus; relays sensory information between hemispheres, connects with limbic and endocrine systems |
| What is the Hypothalamus? | A neural structure lying below the thalamus; it directs several maintenance activities (eating, drinking, body temperature), helps govern the endocrine system via the pituitary gland, and is linked to emotion and reward. |
| What is the thalamus? | the brain's sensory control center, located on top of the brainstem; it directs messages to the sensory receiving areas in the cortex and transmits replies to the cerebellum and medulla |
| What is the normal intracranial pressure? | 5-15 mmHg |
| The cranial compartment consists of ___% brain tissue, ___% CSF, and ___% blood volume? | 80, 10, 10 |
| What are the Signs of increased ICP? | cushing's triad, decreased loc, pupil dilation, vomiting, papilledema(swelling of optic nerve) |
| Define Cushing's triad | irregular respiratory rate(decreased respirations), bradycardia, hypertension |
| Define cerebral autoregulation | he ability of the brain to maintain constant cerebral blood flow despite changes in systemic arterial pressure; when CO2 increased, cerebral vessels constrict, when TCO2 decreases, cerebral vessels dilate |
| Define Cerebral Perfusion Pressure (CPP) | determines if individual is able to adequately oxygenate brain tissue (70-90 mmHg in an avg adult) |
| Define stroke | brain injury resulting from death of brain tissue or rupture of cerebral blood vessels |
| Define ischemic stroke | a type of stroke that occurs when the flow of blood to the brain is blocked by an embolus or thrombus |
| ischemic stroke is the result of? | cerebral infarction |
| What is the percentage of ischemic strokes? | 85 |
| What are the most common causes of ischemic strokes? | atherosclerosis, Afib, carotid stenosis |
| Define Atrial Fibrillation (A-Fib) | cardias dysrhythmia in which the atria do not contract effectively and causes the blood to pool in the atria forming clots that then can travel directly to the brain |
| What is an cardioembolic event? | the travel of a clot from the left atrium to the brain causing a stroke |
| Define carotid stenosis | arteriosclerosis of the carotid artery, common cause of ischemic stroke; leads to thrombus formation |
| Describe Transient Ischemic Attacks (TIA) | "mini stroke": brief episode of loss of blood flow to the brain, usually caused by a partial occlusion that results in temporary neurologic deficit (impairment); no permanent injury, but is a WARNING SIGN of a future stroke |
| What are some risk factors for transient ischemic attack? | smoking, uncontrolled diabetes mellitus, and uncontrolled HTN |
| Define Lacunar infarcts | small areas of ischemia that have no lasting major symptoms |
| What is a hemorrhagic stroke? | a stroke where a cerebral blood vessel has ruptured; causes compression and toxicity of brain cells, loss of cerebral blood flow, cerebral edema and intracranial pressure increase |
| What is anoxic encephalopathy? | brain damage caused by lack of oxygen (hemorrhagic stroke) that leads to global impairments of memory and loc changes |
| What are some risk factors for hemorrhagic stroke? | uncontrolled HTN, oral anticoagulants, cerebral aneurysm |
| What is the percentage for hemorrhagic strokes? | 15 |
| What are some S/S for Stroke? | slurred speech, loss of gag reflex, facial droop, hemiparalysis (weakness of extremities on one side of body), hemiparalysis, vision loss in one or both eyes, field vision problems, aphasia, headache, lapse of attention or consciousness, loss |
| What are some risk factors for stroke? | HTN, hyperlipidemia, diabetes, smoking, obesity, lack of exercise, afib, oral contraceptives, excess alcohol, family hx, age 55+, gender(male higher risk), ethnicity(african american higher risk than caucasian), sickle cell disease |
| whats the first thing you want to do to treat a stroke patient? | CT scan to see what kind of stroke it is |
| What is the treatment for ischemic strokes? | tPA (clot busting drug) or thrombectomy(clot retrieval) |
| How should you treat hemorrhagic stroke? | clipping or coiling- craniotomy |
| What is a seizure? | a sudden, abnormal, disorderly discharge of neurons within the brain that results in sudden transient alterations in brain function |
| What is a focal seizure | localized seizure often affecting one hemisphere |
| Generalized seizures | a seizure that affects both sides of the brain |
| Define Epilepsy | chronic seizure disorder that requires a diagnosis after 2 unprovoked seizures at least 24 hours apart |
| What is epileptogenesis? | transformation of a normal neuronal region into one that is hyper-excitable; typically occurs after brain injury(stroke or head trauma) |
| What are some causes of seizures? | brain tumors, cerebrovascular disease, congenital malformation, alzheimer's, head trauma, genetics, developmental disorders, infections, hyponatremia, hypoglycemia, respiratory alkalosis, birth trauma(hypoxic |
| What are some symptoms of seizures? | tonic (tense rigid muscles), clonic(sustained rhythmical jerking of muscles), atonic muscles(weak limp muscles), myoclonus(brief muscle twitching), epileptic spasms, absence seizure, aura(unique sensations preceding the seizure), icta |
| How do you manage a seizure? | protect from injury, place client on left side after seizure to prevent aspiration if postictal vomiting occurs, oxygen/suction if available, time seizure activity. (only seek emergency assistance when it is uncommon for som |
| Define Traumatic Brain Injury (TBI) | sudden physical damage to the brain |
| What are the types of TBIs? | Blunt traumas, penetrating injury, blast injury, and acceleration-deceleration injury |
| What is a blunt force TBI? | object hits skull forcefully and may cause skull fractures or damage to underlying tissue |
| What is a Penetrating TBI? | foreign object penetrates the brain and it produces localized damage |
| What causes a blast TBI? | caused by explosion |
| What is an acceleration-deceleration TBI? | skull moving forward and stops abruptly causing brain to rebound off opposite side of skull |
| What are some clinical manifestations of TBI? | bony step off, CSF rhinorrhea, CSF otorrhea, hemotympanum, battles sign, raccoon eyes, decreased loc |
| What is a Diffuse axonal injury? | occurs over widespread area of brain, and is a major cause of unconsciousness after head injury; severe neurologic impairment(vegetative state), hemorrhage or laceration of the corpus callosum |
| What is a concussion? | a mild tbi that is physiological disruption in brain function caused by trauma, will usually resolve in less that 10 days |
| What are some symptoms of concussion? | headache, temporary LOC, confusion, amnesia surrounding the traumatic event, dizziness or "seeing stars", nausea, slurred speech, poor balance, |
| What is post concussion syndrome? | lingering symptoms from a concussion that last for an extended period of time(> 3 weeks) |
| What are some symptoms of post concussion syndrome? | headache, fatigue, irritability, impaired memory, dizziness, insomnia, and imbalance |
| Define cerebral contusion | the bruising of brain tissue as the result of a head injury that causes the brain to bounce against the rigid bone of the skull |
| What does cerebral contusion has a high risk of? | cerebral edema |
| What are some symptoms of brain contusion? | severe headache, nausea, dizziness, vomiting, unilateral pupil changes, sudden unilateral weakness, restlessness |
| Define epidural hematoma | collection of blood above the dura mater and below the skull bone that is a common result of ruptured meningeal artery bleeding into epidural space. NEUROSURGICAL EMERGENCY |
| What are some symptoms of epidural hematoma? | severe headache, vomiting, seizures, pupil changes, decreased loc, unilateral paralysis, decerebrate posturing, pos. babinski reflex |
| What is a subdural hematoma? | pertaining to below the dura mater and above the arachnoid membrane that results from tearing of veins in subdural space |
| Where does a subarachnoid hemorrhage normally occur? | circle of willis |
| What are the three types of skull fractures? | linear, depressed, and basilar |
| What happens with a linear skull fracture? | It does not affect brain tissue. may cause a tear in the meninges |
| What is a depressed skull fracture? | Inward indentation of the skull with possible pressure/ penetration on brain |
| What is a basilar skull fracture? | A fracture at the base of the skull |
| What is the formula for cerebral perfusion pressure? | CPP=MAP-ICP |
| What is the CPP normal range for an adult? | between 70-90 mmHg |
| What is the CPP range for someone who may have a severe TBI? | 5-60 mmHg |
| Who has a greater risk for developing strokes? | African Americans |
| Who has a greater risk for developing sickle cell disease? | African Americans |
| Define tonic | tense, rigid muscles during a seizure |
| Define clonic | sustained rhythmic jerking during a seizure |
| Define atonic | weak, limp muscles during a seizure |
| Define myoclonus | brief muscle twitching during a seizure |
| Define epileptic spasms | repeated flexion and extension of the whole body |
| Define absence seizure | predominantly non-motor symptoms; the patient is unaware of seizure activity |
| Define aura | unique sensations preceding the seizure like strange odors, flash of light, and confusing thoughts |
| What is the ictal period of a seizure? | active seizure activity |
| What is the postictal state of a seizure? | period immediately following seizure activity |
| What is status epilepticus? | seizure activity lasting longer than five minutes or multiple seizures occurring within five minutes without full return to baseline |
| Define CSF Rhinorrhea | CSF leakage from the nose |
| Define CSF Otorrhea | CSF leakage from the ears |
| Define hemotympanum | blood visible behind the tympanic membrane |
| What is battle's sign? | dark blood visible in the skin overlying mastoid process; behind the ear |
| What are raccoon eyes? | dark bruising around the eyes |
| Define decorticate posturing | stiff with flexed arms; the arms go toward your core |
| Define decerebrate posturing | shoulders and neck arched; the arms go straight out and the toes are pointed down |
| Who is most at risk for a subdural hematoma? | The elderly and patients who take anticoagulants |
Created by:
keiondraharden
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