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NURS 2220 Neuro#1

neuro Exam #1

QuestionAnswer
aneurysm abnormal widening or ballooning of a portion of an artery due to weakness in the wall of the blood vessel
Babinski reflex positive (abnormal) Babinski reflex is dorsiflexion of the big toe and fanning of the other toes when a pen is run firmly up the sole of the foot
gaze preference only moves eyes in one direction
corneal reflex blink when something lightly touches the cornea
consensual reflex reaction of both pupils when only one pupil is exposed to a change
delirium transient loss of intellectual function, usually due to systemic problems
doll's eyes Eyes remain fixed when head is turned side to side.
dysconjugate eyes don't move together. could be cross-eyed or lazy eye
flaccid lacking muscle tone, limp, floppy
foramen magnum hole at the base of the skull through which the spinal cord exits
hemiplegia paralysis of one side of the body
hemianopsia loss of vision in one half of the visual field
neuralgia sharp shocking pain that follows the path of a nerve due to damage or irritation to the nerve
nuchal rigidity stiffness of the neck, often seen in patients with meningitis
nystagmus involuntary shaking type of movement of the eyeballs. May be seen with MS, cerebellar CVA and with some drugs
obtunded dulled response. May be confused once aroused.
otorrhea discharge from the ear
paraplegia paralysis of the lower extremities
quadriplegia paralysis of all four extremities
rhinorrhea discharge from the nose
spasticity sustained increase in tension of a muscle when it is passively lengthened or stretched
stupor generally unresponsive state. May be aroused by repeated stimuli but incoherent. Moves spontaneously.
neurogenic bladder bladder dysfunction that results from a disorder or dysfunction of the nervous system; may result in urinary retention or bladder overactivity
decorticate posture for a coma patient, arms contract over core of body after painful stimulus
decerebrate for a coma patient, arms extend and externally rotate after painful stimulus
skull fracture crack or break in one of the bones of the cranium
cerebral edema swelling. abnormal accumulation of water of fluid in the intracellular spaces, extracellular spaces, or both
cerebral bleeding bleeding within the brain itself
concussion temporary loss of neurological function
contusion bruising of the brain accompanied by small, diffuse venous hemorrhages.
spinal cord injury damage or severing of the spinal cord, resulting in loss of function to areas below the point of injury
carotid endarterectomy surgical procedure used to prevent stroke, corrects stenosis in the carotid artery
subdural hematoma most common complication of head injury. Bleeding is usually venous in origin.
epidural hematoma caused by a meningeal artery rupturing between the dura and the cranium after a blow to the head
ventricular shunting used when the flow of CSF becomes obstructed. A synthetic tube is placed into the brain ventricles, tunneled under the skin from the scalp to the abdomen and inserted into the peritoneum to drain.
tentorial herniation pushing of the brain downward through the tentorial notch. Can compress the brain stem and the third cranial nerve
subarachnoid hemmorhage bleeding in the subarachnoid space
benign brain tumor noncancerous, about 50%
malignant brain tumor cancerous, about 50%. 10-15% of all malignant disease.
Ativan (lorazepam) Sedative. May help control restlessness and agitation.
Decadron (dexamethasone) Corticosteroid. Decreases inflammation within brain tissue. Reduces vasogenic edema caused by brain tumors, craniocerebral trauma, abscesses, infarctions and hemorrhage.
Dilantin (phenytoin) Antiseizure drug. Doesn't decrease ICP, but does prevent seizures. Seizures can decrease PaO2 and increase Co2 which results in cerebral vasodilation and edema.
Lasix (furosemide) Loop diuretic. Reduces overall body water.
Mannitol (osmitrol) osmotic diuretic. Elevates osmolarity of blood plasma and increases water flow from tissue to plasma. Fluid is eliminated via kidneys.
Zantac (ranitidine) To treat gastric ulcers caused by steroids.
Gliomas arise from brain cells and spinal cord cells. 60% of all primary tumors. Difficult to remove and rarely curable.
Meningiomas Arise from the meninges. Slow growing and benign.
Acoustic Neuromas Arises from cranial nerves. Slow growing, bening. Compress trigeminal and facia nerves. Removed surgically through the hear and cause deafness.
Pituitary tumors 10% of brain tumors. Can be hormone secreting tumors. Treated with transphenoidal microsurgery.
Interventions that decrease ICP elevate HOB 30-45 deg. Avoid flexion of head and neck. Log roll to turn. Monitor ABG, keep PaCO2 slightly low (hyperventilate). Manage constipation. Discourage coughing. Restrict fluids. Monitor ICP. Diuretics, corticosteroids. Limit activity.
Primary intracranial tumor originates in the brain
Secondary intracranial tumor originates elsewhere in the body, metastisizes to the brain from another area.
Types of skull fractures linear, depressed, basilar, comminuted
spinal shock total sensory and motor loss and loss of all reflexes for a period of 24 hours - several weeks following a spinal injury. Reflexes return gradually. Severity of the injury determines whether damage is permanent.
cranial volumes 78% intracellular and extracellular fluids 12% arterial, venous and capillary network 10% CSF
Normal ICP 0 to 15 mmHg
Increased ICP due to increase in CSF pressure or increased pressure within the brain matter because of lesions, tumors or traumatic injury
Factors that influence ICP/CBF systemic BP, metabolic demands (ie, exercise), intracranial pressure, blood viscosity, pH, PaCO2, hypoxemia, posture/positioning
Autoregulation ability of the cerebrovascular system to regulate itself in response to varying pressures and metabolic needs of the brain. Includes arterial pressure, venous pressure, intrathoracic/intra-abdominal pressure, temperature
Arterioles dilate to increase cerebral blood flow metabolic needs of the brain increase; systemic blood pressure decreases (shunting); ICP increases
arterioles constrict to decrease cerebral blood flow metabolic needs of the brain decrease; systemic blood pressure increases
Effect of blood viscosity on CBF arterioles dilate when blood viscosity increases; arterioles construct when blood viscosity decreases
How CO2 affects CBF Hypercapnia causes arterioles to dilate. Hypocapnia causes arterioles to constrict. Effect is dependent on changes in pH.
How position and posturing affects ICP increased venous congestion can increase ICP; extreme hip flexion increases intra-abdominal pressures which can ultimately increase ICP; neutral neck alignment and elevated HOB promotes venous drainage
Situations where ICP temporarily increases coughing, sneezing, straining to move the bowels, etc.
Physiologic response to ICP 1) CSF system - can increase absorption of CSF and displace into subarachnoid space; 2) Cerebrovascular system - veins collapse, arterioles constrict; 3) Paremchyma - dura can compress slightly to handle additional pressure
Cascade of events related to ICP ICP increases -> blood flow decreases -> tissue hypoxia/decrease in pH/increase in CO2 -> cerebral vasodilation from too much CO2 -> edema -> greater increase in ICP
Causes of increased ICP CNS trauma, hemorrhage, infection, hypoxemia/ischemia of tissues, hydrocephalus, space occupying lesions
Signs and symptoms of ICP decreased LOC, changes in behavior, vomiting, headache, neuro defecits, seizures, change in pupil size/reaction, rising systolic BP, respiratory changes, slowing pulse
Cushing's triad bradycardia, rising systolic BP, dypnea
drugs that decrease ICP osmotic diuretics, loop diuretics, corticosteroids, antiseizure medications, barbiturates, neuromuscular blocking agents, sedatives, calcium channel blockers
complications related to intracranial tumors cerebral edema, cerebral blood vessel compression, ruptured blood vessels, seizures (33%), hydrocephalus, severe fluid and electrolyte imbalances
how tumors are classified malignant or benign, then location, then origin
open head injury skull fracture that exposes the dura to the outside
closed head injury no open wound, integrity of the skull is not violated
linear skull fracture crack in one of the bones of the cranium, no bone movement involved
basilar skull fracture fracture at the base of the skull. Hallmark signs include rhinorrhea, otorrhea, raccoon eyes, redness
depressed skull fracture bones of the skull forcefully displaced downward and are embedded into the brain tissue
Comminuted skull fracture multiple fractures, fragmentation of bone tissue
compound skull fracture bone break that also pierces the skin and allows contaminants to reach the brain
signs of dural tear or CSF leak rhinorrhea, otorrhea, "halo" sign with blood tinged discharge, post-nasal drip of CSF
tests to determine whether leakage is CSF "halo" sign, glucose test (present in CSF), beta 2 interferon test (more accurate)
Diffuse axonal injury widespread shearing and rotations forces axonal damage throughout the brain tissue. Prolonged coma, poor prognosis.
coup-contra-coupe pattern brain hits the skull, then recoils and hits the opposite side.
Craniotomy surgical procedure that involves entry into the skull
causes of spinal cord injuries diving, MVA, GSW, falls
Complete vs. incomplete complete - severing of the cord, total loss of function below the level of injury; incomplete - damage to the cord, may allow some function or movement below the level of the injury
primary spinal cord injury initial insult or trauma
secondary spinal cord injury results from metabolic and cellular events that occur due to the primary injury that lead to spinal cord ischemia. If treated within 4-6 hours, usually reversible.
semicomatose state in which one does not move spontaneously. Unresponsive, though painful stimuli might result in stirring or moaning without arousal
comatose state in which one has no verbal or motor response to any sort of stimuli
receptive aphasia inability to understand speech
expressive aphasia inability to speak and form words
Glasgow coma scale Measures eye movement, verbal response, motor response. Scale is 3-15, the lower the number the greater the impairment
Cushing's response increase in arterial pressure that results from increased ICP. Results in hypertension, bradycardia and bradypnea.
burr holes holes drilled into the skull to allow for removal of hematoma or abscess, or accessing the brain
neurogenic shock complication of spinal cord injury caused when there is loss of ANS function below the level of injury.
Created by: pinklrt98