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159 Cards in this Set
- Front
- Back
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when do neurons fire action potentials
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during depolarization
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where do vertebral arteries supply blood
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through spinal column
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where do basilar arteries provide blood
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for the brainstem and cerebellum
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where do the anterior cerebral arteries supply blood
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medial surfaces of frontal and parietal lobes
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where do posterior cerebral arteries supply blood
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occipital lobe
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where do middle cerebral arteries supply blood
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lateral surfaces of the hemispheres
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where does the circle of willis supple blood
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probides collateral flow in some individuals
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what is autoregulation
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mechanism that attempts to maintain supply of necessary metabolic substrates
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what factors effects cerebral blood flow
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blood pressure, carbon dioxide concentration, oxygen concentration and hydrogen ions
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what does elevated CO2 levels do
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cause vasodilation
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when increases cerebra blood flow
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increasing PCO2 levels, increasing H+ ions, increasing O2 levels and increased blood pressure
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what is the Pia mater
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connective tissue layer that follows the convolutions of the brain
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what is the subarachnoid space
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contains the CSF
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what is the arachnoid
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delicate layer that loosely encloses the brain
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what is the subdural space
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potential space
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what is the dura mater
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inelastic fibrous membrane that lines the interior of the skull
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what is the epidural space
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potential space
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where is the frontal lobe and what is is responsible for
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anterior to the central fissure, involved in motor function and abstract thought
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where is the parietal lobe and what is it responsible for
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posterior to the central fissure, involved in sensation, sensory function, and contains Broca's area for speech
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what is the temporal lobe responsible for
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primary auditory receptive area and contains Weirnecke's area for language comprehension. Also used in memory
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what is the occipital lobe responsible for
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primary receptive area for vision
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where is the basal ganglia located and what is it responsible for
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in substantia nigra and has control of fine body movements, particularly the hands and lower extremities. Substantia nigra makes dopamine to this is responsible for parkinsons
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where is the hypothalamus and what is it responsible for
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part of the diencephalon, a major division of the cerebrum and it is involved in basic drive such as thirst, hunger and also involved in temp regulation
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What does the brain stem do
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controls environment of the body
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what are the parts of the brain stem
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midbrain, pons, medulla
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what is the midbrain hold
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cranial nerve 3 & 4 and cortical spinal tract. cranial nerve 3 dilates pupils
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what are the pons and medulla responsible for
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respiratory rate, heart rate, blood pressure
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what is the cerebellum responsible for
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coordination of muscle groups, control of fine movement, control of balance
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what happens when there are problems with cerebellum
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ataxia and gate (wobbling)
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what do upper motor neurons do
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send signals from brain to brain or brain to spinal cord. When CNS injury occurs, reflexes are still intact, but pt. has no control over them
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what do lower motor neurons do
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send signals from spinal cord to muscles, problems include a herniated disc
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is the motor system afferent or efferent
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efferent
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is the sensory system afferent or efferent
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afferent
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what does the sensory system do
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sends impulse traveling back to brain, allows us to sense pain, temp, light touch
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what does the autonomic nervous system do
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maintains homeostasis in body. Usually has two never system pre and post ganglionic neurons
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what are the parts of the ANS
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sympathetic and parasympathetic nervous system
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what does the sympathetic nervous system do
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fight or flight response. Increase heart rate, dilate pupils, blood goes to muscles
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what are the neurotransmitters in the SNS and what do they release
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Pre-ganglionic neurotransmitter- acetylcholine
Post-ganglionic neurotransmitter- norepinephrine/epinephrine |
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what does the PNS do
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conservation restoration functions- decreases heart rate, stimulates GI activity
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what are the neurotransmitters in the PNS and what do they release
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Pre-ganglionic and Post-ganglionic neurotransmitter- acetylcholine
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what is the normal ICP
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0-15 mmHG
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what makes up ICP
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blood, CSF, Brain tissue
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what is the Monro-Kellie hypothesis
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if one the the factors of ICP changes, another will change to compensate to keep the ICP the same.
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what is cerebral perfusion pressure
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amount of pressure to perfuse the brain, blood pressure for brain. Mean arterial pressure - ICP. (MAP= systolic +2(diastolic)/3) normal is 70-100
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What are the manifestations of elevated ICP
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Decreased level of consciousness, pupillary abnormalities, visual disturbances, motor dysfunction, headache, aphasia, changes in respiratory pattern, changes in vital signs, brain death, brain herniation
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what happens with decreased level of consciousness in elevated ICP
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Reticular Activating system breaks down, which allows you do be awake, you can go into a coma.
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what is decorticate coma
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abnormal flexion with arms held at sides with elbows, wrists, and fingers flexed which has a high level of brain function
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what is a decerebrate coma
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brain stem problems, low level of brain function, usually right before death. Characterized by extended arms, clenched jaw, forearms pronated and wrists and fingers flexed
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what is the glasgow coma scale
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scale of LOC that if you score less than 8= severe head injury. has eye opening response, verbal response and motor response
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what Pupillary abnormalities happen in elevated ICP
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dilated pupils mean the ocular nerve in the brain is damage
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what visual disturbances occur with elevated ICP
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double vision can occur. called diplopia
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what motor dysfunctions occur with elevated ICP
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hemiparesis- weakness on one side
hemiparalysia- paralysis |
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what will the patient describe as their headache as
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the worst they ever had
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what is the aphasia effected by elevated ICP
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receptive aphasia-wernikes area affected (language comprehension)
expressive aphasia-broccas area affected (speech) |
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what are the changes in respiratory pattern in elevated ICP
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this is a late sign of ICP, includes hypoventilation, apnea, change stokes
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what are the changes in vital signs of elevated ICP
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cushing reflex- decreased heart rate, increased blood pressure, widened pulse pressure
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How can you tell that there is brain death associated with ICP
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EEG-look at brain activity without on medications. Check eyes for dolls eye response. Use apnea test- remove from ventilator and test CO2 levels to see if they breathe on their own
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what are brain herniations associated with ICP
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Supraentorial herniations, transtentorial herniation,
Infratentorial herniation |
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what is Supratentorial Herniation
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Herniation is above tentorium, upper lobes of brain. There is a subfalcine, which is a midline shift
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what is a transtentorial herniation
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tissue moves from above to below tentorium and vice versa. Uncal herniation is an example where part of the uncal moves down temporal notch and compresses cranial nerve 3 so pupil dilation occurs
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what is a infratentorial herniation
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tissue from tentorial goes down foramen magnum
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what are the etiologies of increased ICP
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brain swelling, epidural hematoma, subdural hematoma, subarachnoid hemorrhage, intracerebral hematoma, hydrocephalus, craniocerebral trauma, brain injury, skull distortion
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what is brain swelling
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increase in brain tissue volume
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what is an epidural hematoma
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an arterial bleed in the space between the skull and the dura layer
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what is the etiology of epidural hematoma
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skull fracture
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what is the mechanism of an epidural hematoma
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a tear of middle meningeal artery
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what are the manifestations of epidural hematoma
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lucid interval- brief moment of unconsciousness, happens for an hour and then they wake up mine and then they go bad. Increased ICP
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what is a subdural hematoma
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tearing in bridging vessels, usually venous in origin between the dura and arachnoid layers.
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what causes a subdural hematoma
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fall or car crash
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what are the types of subdural hematoma
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acute, subacute, chronic
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what is an acute subdural hematoma
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occurs up to 24 hours after injury. Headaches, drowsiness, hemiparysis
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what is a subacute subdural hematoma
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occurs 2-10 days after injury
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what is a chronic subdural hematoma
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occurs 2 weeks-2 months after injury. in older pts.
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what is a subarachnoid hemorrhage
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bleeding into subarachnoid space
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what is the etiology of a subarachnoid hemorrhage
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ruptured cerebral aneurysm, trauma
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what are the mechanisms of a SAH
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irritation of the dura because of blood in cerebral spinal fluid
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what are the manifestations of a SAH
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increase in ICP, photophobia, nuchal rigidity (stiff neck) communicating hydrocephalus (plugging of arachnoid villa) meningeal irritation, diplopia
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what is an intracerebral hematoma
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bleeding in the brain tissue
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what are the etiologies of an intracerebral hematoma
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often uncontrolled hypertension
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what are the manifestations of intracerebral hematoma
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altered level of consciousness, coma can occur, elevated ICP
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What it a hydrocephalus
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increase in the amount of fluid in the brain
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what are the types of hydrocephalus
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communicating and noncommunicating
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what is communicating hydrocephalus
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difficulty with reabsorption of CSF
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what is the etiology of communicating hydrocephalus
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plugging of arachnoid villa. subarachnoid hemorrhage, meningitis, thrombus, head trauma
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what is noncommunicating hydrocephalus
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blockage in the CSF drainage system because there is a problem with the pathway. It is a congenital malformation
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what is the etiology of noncommunicating hydrocephalus
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tumor, inflammation, infection of 3rd or 4th vessel
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what is craniocerebral trauma
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head injury
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what areas of the brain are injured the most in brain injury
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frontal lobe and temporal tips
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what are the classifications of head injury
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rotation, acceleration, classification of forces
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what is a rotation head injury
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side to side twisting, blows to side of the head causes brain to hit side of skull. ex. boxing
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what is an acceleration head injury
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deceleration ex. MVA. brain hits front of skull from sudden stop
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what are the classification of forces head injuries
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compression, tension, shearing
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what is a compression head injury
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under area of input
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what is tension head injury
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pulling away of tissue
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what is a shearing head injury
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one part of the brain is moving at a different rate then the other. Searing at corpus collusium.
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what are the types of brain injuries
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diffuse, focal, primary and secondary
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what are the types of diffuse injuries
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concussions, post concussion syndrome, diffuse axonal injury, hypoxic brain injury
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what is a concussion
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when the brain is shaken. there is a momentary loss of brain function with or without consciousness
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what are the manifestations of a concussion
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momentary loss of reflexes, arrest of respirations, antegrade or retrograde anmesia, headache, dizziness, confusion, visual disturbances, gait disturbances, nausea, vomiting
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what is a post concussion syndrome
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occurs until 6 months after concussion. characterized by headache, dizziness, insomnia, decreased cognitive abilities
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what is a diffuse axonal injury
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brain injury due to shearing force, prognosis is poor. Anatomic area often involved in corpus callosum
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what is a hypoxic brain injury
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example: cardiac arrest or respiratory arrest. If brain usually has more the 6 min without O2 is it dead.
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what are the types of focal injuries
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cerebral contusions, cerebral lacerations, missile injuries, brain stem injuries, primary vs. secondary injury
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what is a focal injury
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frontal lobes and temporal tip injury
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what is a cerebral contusion
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bruising of brain
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what is the etiology of a cerebral contusion
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head injury
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what is the mechanism of a cerebral contusion
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anatomic site often involved in frontal and temporal lobes
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what are the manifestations of a cerebral contusion
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loss of consciousness,loss of reflexes, stop breathing for a moment, decrease in HR and BP
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what is a cerebral laceration
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tear of the brain tissue
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what is a missile injury
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damage dependent upon size, velocity of missile
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what are the brain stem injuries
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decerebrate posterioring, autonomic dysfunction and non reactive pupils
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what is decerebrate posturing
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an abnormal body posture that involves the arms and legs being held straight out, the toes being pointed downward, and the head and neck being arched backwards
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what is autonomic dysfunction
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trouble maintaining BP, HR, RR
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what is primary vs. secondary
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primary is a gunshot wound, secondary occurs from mediators, 48-72 hours after primary injury such as edema and inflammatory response, loss of autonomic function
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what is a skull distortion
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skull and facial frcture
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what are the types of skull fractures
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linear, comminuted, depressed, basilar skull fracture
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what is a linear skull fracture
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resembles a line, often moves through base of skull
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what is a comminuted skull fracture
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fragmentation of the bone
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what is a depressed skull fracture
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inward depression of bone fragments
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what is a basilar skull fracture
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base of the skull fracture, base of the skull, through sinuses. If they traverse the sinuses there is a risk of infection
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what are the manifestations of a basilar skull fracture
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CSF leak, which comes out nose and ears, potential for meningitis and ecomosis which is bruising around eyes and mastoid process
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what are the alterations in cerebral blood flow
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transient ischemic attack, strokes
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what is a transient ischemic attack
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Focal neurological deficient for 24 hours. increased risk of stroke. (stroke symptoms for 24 hours or less)
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what is a stroke
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ischemic injury, cerebral blood flow disturbance
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what is the etiology of a stroke
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a thrombus, embolic, intracerebral hemorrhage
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what is a thrombus
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blocks blood flow distal to blockage in the internal carotid artery or anterior cerebral artery
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what are the risk factors of a thrombus stroke
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hypertension, hyperlipidemia (high cholesterol), diabetes mellitus, male, old, smoker, obesity
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what is an embolic stroke
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blood clot travels from other part of the body and blocks blood flow in the cerbrovasculature. Occurs during the day with activity in the middle cerebral artery
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what are the risk factors for an embolic stroke
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atrial fibrillation (abnormal rhythm of heart) and left ventricular aneurysm
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what is an intracerebral hemorrhage clot
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bleeding into brain tissue related to hypertension
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what are the clinical manifestations of a stroke
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motor deficits, aphasia and communication.
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what are the motor deficits of a stroke
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hemiparesis, hemiplaysia, problems with mobility, problems with swallowing, dysphasia, problems with self care, dysarthria (slurred speech)
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what is unilateral neglect or hemi-inattention
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ignore one site of body
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what are clinical manifestations related to an anterior vessel stroke
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paralysis of contralateral foot and leg. Paralysis of contralateral arm, impaired gait, sensory loss cognitive impairment
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what are clinical manifestations related to a middle cerebral vessel stroke
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contralateral sensory loss and paralysis, aphasia, hemonomus heminopia - lose half of visual field, and hemi-inattention
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what are clinical manifestations related to a posterior cerebral vessel stroke
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posterior occipital, visual deficit, lose concentration, colorblindness, memory loss
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what are clinical manifestations related to a basilar and vertebral vessel stroke
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visual disturbances, diplopia, vertigo, ataxia, bilateral and motor deficit in all extremities
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what are the stages of sleep
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Non REM:
Stage I- high frequency brain waves Stage II- lower frequency Stage III- slower frequency Stage IV- deepest sleep |
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what does cortisol do
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anti-sleep hormone and goes down during night. levels rise before we wake up again
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what is absent in sleep of individuals of 70 or older
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stage 4 sleep
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what are the exogenous pyrogens of fever
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bacteria, viruses, fungus, tissue injury (myocardial infarction), antibody-antigen complex. trauma and post op. patients are most common
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what are the endogenous pyrogens of fever
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cytokines, interleukin, tumor necrosis factor, interferon
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what are nociceptors
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pain receptors stiumulated by tissue injury
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what is pain threshold
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point at which stimuli perceived as pain
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what is acute pain
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associated with tissue injury and enxety
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what is chronic pain
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pain lasting at least 6 months
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what is perceptual dominance
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area with most pain
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what are the mediators related to pain
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substance P and prostaglandins
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what are the opiod receptors
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Mu, delta, and kappa
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what are the mu receptors
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modulate effects of analgesia, respiratory depression and GI effects of opioids
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what are the kappa receptors
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modulate effects of sedation, analgesia , and the diuretic effect
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what are the delta receptors for
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modulate effects of analgesia
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what are A delta axons
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myelinated axons for fast pain
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what are C fibers
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unmeylinated axons for slow pain
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what is the endogenous opioid system
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for stress
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what is cutaneous pain
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pain on superficial structures that is well localized
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what is somatic pain
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pain in the muscles and tendons
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what is visceral pain
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pain in the visceral organs
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what are the physiologic responses to pain
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increased heart rate, increased blood pressure, increased respiratory rate, dilated pupils, pallor and perspiration, nausea and vomiting, urine retention, elevated blood glucose
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