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