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