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Test #6 Neuro 1


the brain is protected by the ___ and ____ the skull and CSF
______ must be maintained for electrical impulses metabolic stablilty
metabolic stability and electrical impulses are controlled through the ____ and _____ blood-brain barrier and autoregulatory mechanisms
decreased O2 with maintained blood flow...the interruption in the delivery of O2 hypoxia
reduced blood flow...interuption of O2 and glucose and removal of waste products ischemia
one single area; collateral circulation may develop to compensate focal ischemia
entire brain; no collateral global ischemia
in ischemia the gluose reserve is used up in ___ 2-4 minutes
in ischemia the ATP reserve is used up in ___ 4-5 minutes
excess ___ in the tissue leads to edema Na
energy depletion leads to shifts in __, ___, and ___ Na, K, Ca
increase in tissue colume do to fluid accumulation cerebral edema
two types of cerebral edema vasogenic and cytotoxic
results from an increase in extracellular fluid surrounding the brain cells vasogenic cerebral edema
vasogenic cerebral edema may cause damage which may impairs the ____ blood brain barrier
vasogenic cerebral edema mainly occurs in ___ white matter
swelling of the brain cells cytotoxic cerebral edema
cytotoxic cerebral edema mainly occurs in ___ grey matter
rise in the pressure(>15 mmHg) of CSF that maintains the subarchnoid space between the skulll and the brain > intracranial pressure
as volume of one compartment increases, volume of another decreases, to a limit Monro-Kellie Hypothesis
monro-kellie hyopthesis is controlled by ____ autoregulation
cerebral arterioles change diameter to maintain bl flow when ICP increases autoregulation of monro-kellie hypothesis
in the monro-kellie hypothesis ___ is unable to compensate, but the ___ is able to compensate to a limit brain tissue.....blood compartment
____ and _____ occurs when the brain is unable to compensate past its limit ischemia and hypercapnia
cushing's triad/reflex is ___, ____, and ____ elevates systolic blood pressure (SBP), wide pulse pressure, and bradycardia
displacement of a portion of the brain through or around linings of the brain or openings within the intracranial cavity herniation
herniation = brain death
you want to try to preven herniation b/c if not ____ will occur death
FLEXOR posturing indicating corticospinal tract lesions decorticate
EXTENSOR posturing indicating brainstem injury decerebrate
what are the main s/s of increased intracranial pressure HA, N/V, and pupillary changes
seen in head injuries...pupils will constrict and get big, then little, big then little...etc hippus
why do you want to sit a px with increased intracranial pressure in semi-fowlers position? to try to drain some of the fluid (30-60 degree angle)
structural damage to the head and is the leading cause of death in ages <24 tranumatic head and brain injury
can be simple, commuinuted, or depresed and can cause compression ot trauma to the brain tissue skull fx
when bone fragments are imbedded into the tissue depressed skull fx
area of impact in a head injury coup injury
the opposite side of the area of impact in a head injury counter-coup
concurrent rotational movement is ____ a spinal or twisting neck injury
acceleration and forward movement is the ____ coup
deceleration and backward movement is the -___ countercoup
momentary interruption of brain function with or without loss of consciousness concussion
concussions usually recover within ___ 24 hours
primary injury with diffuse microscopic damage to axons in the cerebral hemisphere, corpus callosum, and brain stem; ofter leads to dementia and persistent vegetative state diffuse axonal injury
bruise to the cortical surface of the brain caused by blunt head trauma contusion
contusions cause permanent damage that is ___ the nercrotic tissue is phagocytized leaving scar tissue
vascular injury and bleeding hematoma
hematoma that develops between the skull and the dura epidural hematoma
usually the result of an artery tear leading to rapid compression epidural hematoma
2 types of hematomas epidural and subdural
___ s/s is same sided pupil dialation and opposite side hemiparesis epidural hematoma
epidural hematoma are more common in the ___, why? young...b/c of the inadequate dura attachment
hematoma that develops between the dura and the arachnoid subdural hematoma
usually the result of a tear in the small bridging veins that connect the veins on the surface if the cortex to dural sinuses subdural hematoma
what type of hematoma develops slower subdural hematoma develops slower then the epidural hematoma
3 types of subdural hematomas acute, subacute, chronic
____ subdural hematoma's s/s will occur within 24 hours of injury; progress rapidly; high mortality rate acute
____ subdural hematoma's s/s occur 2-10 days post injury and usually have a period of improvement followed by deterioration subacute
____ subdural hematoms's s/s occur severak weeks post injury; there is a slow leak, hematoma becomes encapsulated by bibroblasts; cells lyse leading to edema in the capsule leading to pressure on the surrounding tissue; s/s < in LOH and HA chronic
rostral to caudal front to back or top to bottom
global brain injuries develop _____ roatral to caudal (front to back or top to bottom depending on location)
arousal and wakefulness are functions of the ____ and the _____ cerebral hemispheres and the reticular activating system
content and cognition are functions of the ___ cerebral cortex
primitive system in the brain stem that recieves input reticular activating system
what does the reticular activating system include (^) brains stem, medulla, pons, midbrain, spinal cord, and thalamus
a change in levels of consciousness indicated a px with the ____ Reticular Activating System or both the RAS and the cerebral hemispheres
Reticular Activating System has a part in ___ and ___ ANS and motor function
____ reflects orientation to person, place, and time LOC- levels of consciousness
consciousness, confusion, delirium, obtundation, stupor, coma is ____ LOC= continum
what are early s/s of < LOC inattention, mild confusion, disorentation, blunted affect (flat emotions)
___ s/s: pupils < reaction to light, with the doll's head response, cold caloric test, posturing (decorticate or decerebrate), apnea, and cheyne-stokes global brain injury
irreversible loss of brain function brain death
what determines brain death after all other px are ruled out and their is No EEG activity 2x...6 hours apart
loss of all cognitive function and unawareness of self and surroundings persistent vegetative state
requires complete nursing attention, unable to interact with others, absence of sustained or reproducible voluntary behavior, lack of language comprehension, and bladder and bowel incontinence persistent vegetative state
what determines being in a persistene vegetative state? having persistent vegetative state s/s for one whole month
what do pts with a persistene vegetative state have that is maintaining life hypothalamic and brainstem function
acute focal neurological deficit from a vascular disorder that injuries brain tissue stroke
leading cause of mortality and morbidity in the US stroke
"brain attack" stroke
what is the most common cause of strokes? HTN especially in Mississippi
most common type of stroke ischemic stroke
local interruption of bl flow caused by thrombus or emboil ischemic stroke
most fatal stroke hemorrhagic stroke
stroke that is often in the eldery and often affects the cortex causing aphasia, hemineglect syndrome, viusl defects, or blindness...occurs with rest or activity and is associated with other atherosclerotic changes large vessel ischemic stoke (thrombotic)
large vessel (thrombotic) iscemic strokes often affect the CORTEX causing ___, ____, ____, and/or _____ aphasia, hemineglect syndrome, visual defects, or blindness
____ is a common site for atherosclerotic plaque large vessels
located in the deeper, noncortical parts of the brain or in the brain stem and will not be picked up by a CT small vessel (lacunar infarct) ischemic stroke
pure motor hemiplegia, pure sensory hemiplegia, and dysarthria with clumsy hand syndrome lacunar syndrome (small vessel stroke)
stoke that starts in teh heart and is caused by a moving blood clot that orginated in the heart cardiogenic embolic ischemic stroke
where do most cardiogenic embolic strokes originate? LEFT side of the heart
stroke that results in edema, brain compression, ot spasms of the surrounding vessels hemorrhagic strokes
who is at highest risk for a hemorragic stroke young african americans with HTN
"ministroke" TIA- Transient Ischemic Attach
focal ischemia cerebral neurologic deficit that last less than 24 hours TIA- Transient Ischemic Attach
considered a warning sign of a stroke, which gives pt the opportunity to tx stroke before it occurs TIA- Transient Ischemic Attach
what are signs of a one-sided acute stroke unilateral weakness of face, arm, and leg...unilateral numbness...and visual changes in one eye
___ strokes are sudden and focal with one sided effects and cause: aphasia, dysarthria, dysphagia, and ataxia acute strokes
why is it important to figure out what type of stroke occured in order to tx a pt bc hemorrhagic strokes cannot be tx with thromboltics
most cerebral aneurysms are ___ berry
what causes an aneurysmal subarachnoid hemorrhage to rupture? growing size, IICP (> intracraniall pressure), controlled HTN
what is the main sign of a brain aneurysm? head ache
complex tangle of abn arteries and veins linked by one or more fistulas (vessels ball up) arteriovenous malformation
lacks a capillary bed arteriovenous malformation
arteriovenous malformation is ____ and may rise from a lack or proper embryonic development congenital disorder
inflammation of the meninges (pia mater and arachnoid membrance) meningitis
meningitis crosses ____ the blood brain barrier
bacterial meningitis gains acess thorugh the ___ blood stream
the bacteria in meningitis releases a ___ that initiates the ____ toxin.....inflammatory response
_____ occurs in bacterial meningitis that leads to infarcts and congestion thrombophebitis
due to the damage of the endothelial cell of the blood brain barrier, fluid, pathogens, neutrophils, and albumin move across capillary membrane into CFS resulting in purulent CSF bacterial meningitis
main s/s of meningitis are ___, ___, ___, and ____ fever, chills, HA, stiff neck
because the meningis are inflammed ____ and ____ signs are present Kernig's and Brudzinski
CSF is normally honey colored in meningitis is it ___ cloudy, purulent, > protein, < glucose, and has presence of bacteria
meningitis that is self-limiting that has CSF with lymphocytes, protein not as high, and normal glucose viral meningitis
generalized infection of the brain and the spinal cord encephalitis
transmission of encephalitis is ___, ___, ___ mosquito bites, animal bites, and vaccines
local necrotizing hemorrhage that spreads; edema; degeneration of the nerve cells encephalitis
s/s of encephalitis neck rigidity, HA, focal paralysis, flaccid paralysis
totall weakness and loss of reflexes flaccid paralysis (in encephalitis)
Created by: TayBay15