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Neuro-McCance
Ch 16, 17
| Question | Answer |
|---|---|
| arousal | state of awakeness that an individual exhibits, attentional system, mediated by reticular activating system in conjunction with cerebral cortex |
| Structural causes of alt arousal | 1-supratentorial, 2-infratentorial, 3-subdural, 4-extracerebral, 5- intracerebral |
| supratentorial | above the tentorium cerebella; < LOC from encephalitis (diffuse); brainstem trauma, CVA(bilateral); impairment of hypthalamic activating system by mass/CVA (localized) |
| infratentorial | below the tentorium cerebella by direct destruction of RAS/pathways or impairment of blood supply to RAS. < arousal by CVA, myelination disease, neoplasm, granulomas, ascessess, destruction of brainstem from head trauma |
| most common cause of direct destruction of RAS | CVA (causes intratentorial disorder) |
| Extracerebral disorders | "diffuse" bilateral cortical dysfunction, neoplasm, closed-head trauma w/bleeding; subdural empyema |
| Intracerebral disorders | within the brain, primarily masses-include bleeding, infarcts, emboli, tumor |
| Metabolic causes of < arousal | encephalopathy, interference with neuronal metabolism, liver failure, renal failure. interruption of energy-hypoglycemia, hypoxia, ischemia. alt. excitability: drugs, ETOH, anesthesia, epilepsy |
| Psychogenic unresponsiveness | apparent unconsciousness, but physiologically awake and neurologic exam normal |
| confusion | loss of ability to thin rapid/clearly; impaired judgement, decision making |
| disorientation | beginning LOC, disorient to 1-time, then place, last self |
| lethargy | limited spontaneous speech, easy arousal with speech/touch, may not be oriented, but usually are |
| obtunded | mild to moderate reduction in arousal, fall asleep unless stimulated, answers question minimally |
| stupor | deep sleep-eye open with vigorous stimulation. withdrawal or grab at pain |
| coma | no verbal/stimuli response. deep pain, suction yield motor response |
| light coma | purposeful mvt on stimuli |
| coma | nonpurposeful mvt only on stimuli |
| deep coma | unresponsiveness |
| brain death | irreversible brain damage, destruction of brainstem, cerebellum |
| cerebral death | irreversible coma, death of cerebral hemisphere, but intact brainstem-maintain homeostasis |
| central reflex hyperpnea | sustained, deep rapid regular respirations, midbrain damage, > ICP, blunt head trauma |
| apneusis | prolonged ispiratory cramp, alt end-inspiratory/expiratory pause, pontine level damage. hypoglycemia, anoxia, menengitis |
| cluster breathing | lower pontine/upper medulla, disordered breathing |
| ataxic breathing | irregular, lower pon, upper medulla |
| gasping | failing medulla |
| assympetric reflexes, posturing, babinski | structural induced coma |
| PERRL, symmetric motor/tone, no babinski | metabolic induced coma |
| oculvestibular abnormalities with sudden onset coma, bizarre respirations | infratentorial mass of destruction |
| supraventricular mass compressing of diencephalon or brainstem | initiating signs of cerebral dysfunction, progress from rostral to caudal,assymetric motor signs |
| rostral to caudal LOC changes | see p. 105 of study guide |
| seizure | abnormal hypersynchronous discharge of CNS neurons, sudden transient alt in brain function |
| decorticate | flexion of arms and fingers with extension of lower extremities (diencephalon) |
| decerebrate | all 4 extremities in extension, worsening sign-brainstem |
| partial seizure | unilateral, no LOC unless it spreads to other hemisphere (secondary generalization). focal onset |
| generalized seizure | both hemisphere, LOC c postictal state. subcortical, deeper brain focus-usually no local onset |
| status epileptic | repeat seizure before person regains full consciousness (still postictal) |
| epilepsy | no correctable cause of seizures |
| dysphagia | impairment of comprehension or production of language., written or verbal. CVA middle cerebral artery, left cerebral hemisphere, frontotemperal region. nonfluent-cant find the right word. or fluent-meaningless/wrong words |
| aphasia | loss of comprehension or production of language |
| normal ICP | 5-15mmHg or 60-180cm H2) |
| cerebral edema | increased fluid content in brain. intra/extracellular. net accumlation of water. >ICP |
| vasogenic cerebral edema | increased permeability of capillary endothelium of brain after injury to vascular structure-disrupt blood/brain barrier. focal neurologic deficit. change in LOC, resolve by slow diffusion |
| cytotoxic edema | metabolic cerebral edema. not blood-brain barrier but failure of transport system. cells loss K/gain Na (H20 follows Na), occurs in gray matter |
| interstitial edema | noncommunicating hydrocephalus. brain fluid volume > around ventricles, increase hydrostatic pressure of white matter |
| hydrocephalus | excess fluid in cranial vault and/or subarachnoid space. interference with CSF flow by > fluid vol, obstruct of ventricle, defective reabsorption. |
| noncommunicating hydrocephalus | internal. ventricular obstruction, > CSF, often seen in children. atrophy of cerebral cortex, degenerate white matter tract, selective preservation of gray matter. |
| communicating hydrocephalus | without obstruction, seen in adults |
| acute hydrocephalus | rapid > ICP, without quick treatment, person becomes comatose. |
| stage 3 intracranial hypertension | ICP approach aterial pressure, hypoxia, hypercapnia. Cheyne-Stokes respirations, pupils become sluggish and dilate. widen pulse pressure, bradycardia. severe hypoxia and acidosis of brain tissue |
| Stage 4 intracranial hypertension | herniation. from compartment of greater pressure to lower pressure. |
| Stage 1 intracranial hypertension | vasoconstriction/external compression of venous system to < ICP. subtle symptoms, confusion, drowsiness, slight pupil and respiratory changes |
| Stage 2 intracranial hypertension | pressure compromising neuronal oxygenation. systemic blood pressure elevates to overcome > ICP. |
| focal brain injury | specific, grossly observable brain lesion seen in cortical contusion, epidural hemorrhage, subdural hematoma, intracerebral hematoma, open-head trauma |
| contusion | bruise on the brain. smaller the area of impact-greater severity of injury. can include immediate LOC, loss of reflexes, transient cessation of respirations, bradycardia, drop in BP- with stabilize VS, reflex return, regain consciousness (min.to days) |
| coup | direct impact |
| countrecoup | opposite line of force |
| Subdural hematoma | tearing of bridging VEINS, subdural space fills with blood. Falls, MVA. elderly, alcoholics |
| acute subdural hematoma | headache, drowsiness, restless-agitated...LOC change in respiration, pupils. |
| chronic subdural hematoma | progressive dementia with generalize rigidity, gelatinous blood require surgical evacuation |
| extradural hematoma | epidural hematoma. ARTERIAL bleed. may also have skull fx. assoc MVA, falls, sport accidents. LOC with lucid period (hrs/days). > h/a, vomiting, change in consciousness. good prognosis if intervene before bilat. dilation of pupils |
| Diffuse Brain injury | DAI (diffuse axonal injury) shaking effect, high level of accel/decel. shearing, tearing, stretchin of nerv fibers. |
| mild DAI | decerebrate/decorticate posturing, prolonged stupor or restlessness |
| moderate DAI | prolonged coma; last days or weeks. recovery is often incomplete. |
| severe DAI | immediate autonomic dysfunction-braistem sign. > ICP 4-6 days p injury. pulm complication. uncoordinated mvt, inability to learn/reason or modulate behavior |
| spinal cord injury | usually at 1-2C, 4-7T, 12T-2L: most mobile portion of vertebrae. size makes injury to spinal cord easy. initial edema(swelling r/t degree of dysfunction) followed by meninge thickening/scarring with healing. |
| spinal shock | complete loss of reflex function below level of lesion. skeletal muscles, bladder, bowel, sexual function, autonomic control. thermal regulation problems. last 7-20 days. |
| autonomic hyperreflexia | sudden, dangerous HTN. stimulate below level of injury-ANS to > BP-baroreceptors conteract w/PNS to < HR, but lower level vessels don't dilate lesion T6 or above. distended bladder/bowel/sensory stimulation can cause. |
| neurogenic shock | loss of sympathetic outflow, vasodilation, hypotension, bradycardia, hypothermia |
| meningitis | infection of meninges, bacterial, fungi, parasites, viral, toxins p. 121, study guide |
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