Clinical Correlations- Exam 2 Flashcards by Alex Ramos

Scalp Laceration

Loss of structural support
Aponeurosis tone loss
Profuse bleeding
Staples used to close wound

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Peri-Orbital Ecchymosis

(Scalp Infection)

Infection spread via Emissary Veins causing Meningitis (inflammation of intracranial structures)
Occipitofrontalis muscle inserts onto skin, allowing infection to enter eyelids and nose

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Calvaria Fracture

Four types:

Simple Linear (most common)
Depressed
Comminuted
Basilar

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Berry (Saccular) Aneurysm

Vessels are weakest at their branching points

Berry aneurysm at the Posterior Cerebral Artery can impinge CN III and affect pupillary constriction
Aneurysm may rupture causing a Subarachnoid bleed

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Uncal Herniation

Epidural bleed increases intracranial pressure causing Uncus to be pushed through the Tentorium Cerebelli

-Affects CN III leading to a fixed, non-dilated pupil

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Arnold-Chiari Malformation

Hernation of the Cerebellar Tonsil through the Foramen Magnum

Caused by a neural tube development disorder (Spina Bifida)
May cause Hydrocephalus by closing off the 4th Ventricle

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Hydrocephalus

Excess CSF accumulation causing Ventricles to dilate

-Imbalance of reabsorption (or blockage) within the Ventricular system

Treated with a Ventriculoperitoneal Shunt to draw CSF out of Ventricles and into the abdomen

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Papilledema

Swelling of CN II and the Optic Disc due to increased intracranial pressure from:

Hydrocephalus
Tumor
Trauma
Intracranial Hypertension

Symptoms:
-Headache, Vision Loss, Blindness

Treatment:
-Optic Nerve Sheath Fenestration

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Middle Cerebral Artery (MCA) Stroke

-Most common stroke (approximately 50% of cases)

Complete MCA Syndrome:
Losing sensation/movement on the opposite side of the body from where the Brain was injured

Contralateral hemiplegia (paralysis)
Contralateral hemianesthesia (sensory)

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Orbital Blowout Fracture

Anterior trauma to the Orbital Rim
-Involves Maxillary bone

Blowout occurs medially and inferiorly
-Causes Eye to drop down into maxillary sinus

Symptoms:

Double vision
Eye drooping
Protruding eye

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Glaucoma

Leading cause of blindness in the world

Causes:

Obstruction to aqueous humor outflow
Build up of fluid in anterior chamber increases pressure on the Eye and CN II

Symptoms:

Blurry vision
Severe eye pain
Halo’s around the eyes

Can damage CN II and lead to permanent vision damage

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H Test

Testing Individual Eye Muscles

Following movements of the examiners finger, the pupil is moved in H-patterns to test individual extraocular muscles and the integrity of their nerves

Only the actions of the medial and lateral rectus are tested starting from the primary position
Other muscles must be tested from an abducted or adducted position

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Occulomotor Nerve Palsy

Injury to CN III
-Lateral Rectus and Superior Oblique unaffected, all other muscles are paralyzed

-Characterized by a dilated, non-reactive pupil that is fixed laterally (“Down and Out”)

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Pupillary Light Reflex

Rapid contriction of the pupil due to light
-When light enters one eye, both pupils constrict

Pathway:

CN II
CN III
Ciliary ganglia
Short ciliary nerves
Pupil constriction

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Trochlear Nerve Lesion

Lesion of CN IV leads to paralysis of Superior Oblique causing the extorsion of the Eye

Symptoms:

Vertical diplopia
Weakened downward gaze

Treatment:
-Head tilted to opposite side of affected eye to compensate for extorsion

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Abducent Nerve Lesion

A lesion to CN VI causes paralysis of the Lateral Rectus muscles

Affected eye cannot move laterally
Affected eye stays adducted at rest

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Horner’s Syndrome

Interruption of the Cervical Sympathetic Trunk manifested by the absence of sympathetically stimulated functions on the same side of the face as the lesion (ipsilateral)

Can be caused by a Pancoast Tumor
-Tumor of the apex of the lung which compresses the Cervical Sympathetic Trunk

Symptoms:

Miosis (constricted pupil)
Ptosis (drooping eyelid)
Annhydrosis (absence of sweating)

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Inferior Alveolar Nerve Block

Anesthetizes:

Mandibular nerve
Skin/mucous membrane of the lower lip
Labial alveolar mucosa and gingiva
Skin of the chin

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Dens Fracture

Fracture of the Dens and/or part of the C2 vertebral body

-Caused by hyperextension of the cervical spine with the head of C1 forced backwards

Common in:

Elderly falls
Traumatic accidents

Type 1: Fracture of only the apex of the Dens
Type 2: Fracture of the Dens where it meets the vertebral body
Type 3: Fracture of the Dens that extends into the vertebral body

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Hangman’s Fracture

Bilateral fracture of the Pars Interarticularis of C2 with C2/C3 subluxation (misalignment)

Hyperextension injury where the head is snapped upwards and backwards
Severe subluxation can impinge the upper cerivcal spinal cord leading to injury

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Congenital Torticollis

Damage to the Sternocleidomastoid during gestation that leads to fibrosis (shortening) of the muscle

-Head tilts towards (and face tilts away from) the affected side

Treatments:

Gentle stretching
Infant stimulation to encourage movement
Torticollis collar

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Erb’s Point (Cervical Plexus Block)

Site for regional anesthesia

-Located in the posterior triangle of the neck

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Carotid Endarterectomy

Removal of atherosclerotic plaque from the Carotid Arteries (usually at bifurcation)

Nerves to protect during procedure:

CN IX
CN X (Superior Laryngeal Nerve branch)
CN XI
CN XII

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Central Line Placement

Catheter placed into vein to administer medication/fluids or measure central venous pressure

Vein commonly used:

Internal Jugular Vein
Subclavian Vein
Femoral Vein

-Precautions must be taken to not pierce the Common Carotid Artery

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Retropharyngeal Abcess

Swelling of retropharyngeal space due to spread of upper respiratory/oral infection Symptoms: - Difficulty swallowing - Difficulty breathing Treatment: - IV antibiotics - Intubation - Surgical abcess drainage

Thyroidectomy

Surigcal removal of part or all of the Thyroid gland Hypothyroidism: - Low energy - Weight gain - Feeling cold Hypoparathyroidism: -Low blood calcium leading to muscle spasms and tremors Surgical complication: -Injury to Recurrent Laryngeal Nerve leading to a monotone voice and trouble breathing

Tracheotomy

Incision between the 3rd and 4th Tracheal rings to establish a long-term airway Risks: -Dependant on the size/position of Thyroid and its vasculature

Cricothyrotomy

Incision through the Cricothyroid membrane to establish an emergency airway

CSF Rhinorrhea

Fracture to the Cribiform plate may damage CN I -Since CN I is covered by meninges, damage to it will cause a leak of CSF into the nose Clinical presentation: -Blood from the patient's nose will have a "halo" around it indicating the presence of CSF

Hypoglossal Nerve Lesion

Paralysis of the tongue muscles on the side of the lesion - Deviation of protruded tongue towards the affected side - "Lick you lesion" Tongue will appear wrinkled and shrunken due to atrophy

A. Cingulate (Subfalcine) Herniation

Intracranial pressure pushes Cingulate Gyrus underneath the Falx Cerebri -Can impinge both Anterior Cerebral Arteries causing an infarction

B. Uncal Herniation

Increased intracranial pressure pushes the Uncus through the Tentorial Notch -Can impinge CN III and the Posterior Cerebral Artery

C. Central Herniation

Increased intracranial pressure pushes the Temporal lobe down through the Tentorial Notch -Can obstruct the Cerebral Aqueduct and cause Hydrocephalus

Communicating Hydrocephalus

Issue with reabsorption at the Arachnoid Granulations -CSF can flow through ventricles normally but cannot leave the skull

Non-Communicating (Obstructive) Hydrocephalus

Issue with a blockage of CSF

Corneal Reflex

Examiner tries to ellicit a blink by touching cotton to the Cornea Afferent: Absence of reflex indicates a lesion to Nasociliary branch of CN V₁ Efferent: Absence of reflex indicates a lesion to CN VII which innervates the Orbicularis Oculi

Trigeminal Neuralgia (Tic Douloureux)

Sensory disorder of the sensory root of CN V due to demyelination Symptoms: - Sudden attacks of excruciating, lightning-like jabs of facial pain - Initiated by touching a trigger point or by eating - Can be caused by pressure from an aberrant artery (artery pressing on Trigeminal ganglia) - CN V₂ most affected, then CN V₃, and least affected is CN V₁

Gag Reflex

Sensory (Afferent): CN XII -General sensation to posterior 1/3 of the tongue, tonsils, oropharynx, soft palate Motor (Efferent): CN X -Triggers a reverse peristalsis to the central visceral tube, esophagus, stomach, and duodenum

Transmucosal Absorption

-Quick drug administration - Nitroglycerin is a vasodilator - Treatment for Angina Pectoris -Thin mucosa allows drug to enter Deep Lingual Veins in less than one minute

Epistaxis (Nosebleeds)

Causes: - Infection - Hypertension - Dry mucosal membrane - Trauma to Kiesselbach area

Fracture of the Cribiform Plate | (Lesion to CN I)

- Anosmia (loss of smell) - CSF rhinorrhea

Fracture involving Optic Canal | (Lesion to CN II)

-Loss of pupillary constriction

Pressure on optic pathway | (Lesion to CN II)

Visual field defect

Laceration or intercerebral clot in the Temporal, Parietal, or Occipital lobes of the Brain (Lesion to CN II)

Visual field defects

Pressure from Uncal Herniation | (Lesion to CN III)

- Dilated pupils - Ptosis - Eyes turn "down and out" - Pupillary reflex on side of lesion is lost

Fracture involving Cavernous Sinus | (Lesion to CN III)

- Dilated pupils - Ptosis - Eyes turn "down and out" - Pupillary reflex on side of lesion is lost

Stretching of nerve during its course around the Brainstem (Lesion to CN IV)

Inability to look down while affected eye is adducted

Fracture of the orbit | (Lesion to CN IV)

Inability to look down while the eye is adducted

Injury to Trigeminal branches in the roof of the Maxillary Sinus (Lesion to CN V)

- Loss of pain and touch sensations - Paresthesia - Mandible deviation to side of lesion with gaping mouth

Pathological processes affecting the Trigeminal Ganglia (Lesion to CN V)

- Loss of pain and touch sensations - Paresthesia - Mandible deviation to side of lesion with gaping mouth

Fracture involving Cavernous Sinus/Orbit (Lesion of CN VI)

- Eye fails to move laterally - Diplopia on lateral gaze

Laceration or contusion in Parotid region (Lesion to CN VII)

Paralysis of facial muscles

Fracture of Temporal bone | (Lesion to CN VII)

- Paralysis of facial muscles - Dry cornea - Loss of taste

Intracranial hematoma | (Lesion to CN VII)

- Paralysis of facial muscles - Forehead wrinkles because of loss of innervation to Frontalis muscle

Tumor of nerve | (Lesion to CN VIII)

- Tinnitus - Progressive unilateral hearing loss

Brainstem lesion | (Lesion to CN IX)

- Loss of taste to posterior 2/3 of tongue - Loss of palate sensation on affected side

Deep laceration of neck | (Lesion of CN IX)

- Loss of taste to posterior 2/3 of tongue - Loss of palate sensation on affected side

Brainstem lesion | (Lesion to CN X)

- Sagging of soft palate - Uvula deviation - Paralysis of vocal cord (hoarse voice)

Deep laceration to the neck | (Lesion to CN X)

- Sagging of soft palate - Uvula deviation - Paralysis of vocal cord (hoarse voice)

Laceration of the neck | (Lesion to CN XI)

- Drooping of shoulder - Paralysis of Sternocleidomastoid - Paralysis of Trapezius

Basal Skull fractures | (Lesion to CN XII)

Protruded tongue deviates toward the affected side

Clinical Correlations- Exam 2 Flashcards

(61 cards)