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CNS Flashcards

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0
Q

What is the key learning point for neurons?

A

Neurons do not regenerate - lack of oxygen leads to permanent cellular death. There is no ability to store O2 in the CNS tissues, and the central neurons do not undergo mitosis.

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1
Q

What colour are myelinated cells?

A

white

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2
Q

What are the types of neuroglial cells?

A 
astrocytes
oligodentroglia
ependyma
microglia
Schwann cells
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3
Q

What are the basic characteristics of astrocytes?

A
  • part of the blood brain barrier, nutrition
  • support brain framework (neurons and capillaries)
  • largest and most numerous
  • synaptic conductivity
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4
Q

What are the basic characteristics of oligodendroglia?

A

helps form myelin sheath in the CNS

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5
Q

What are the basic characteristics of the ependyma?

A
  • forms choroid plexus
  • secretes cerebrospinal fluid
  • lines the ventricles and spinal cord
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6
Q

What are the basic functions of the microglia?

A

eliminates waste by phagocytosis

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7
Q

Describe the polarity of the neuron at rest.

A

inside cell membrane negative (K+ in cell)

outside cell membrane positive (Na)

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8
Q

What is the minimum threshold to achieve action potential?

A

-60mV

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9
Q

What are the steps of impulse transmission?

A

slow influx of sodium (RMP changes from -70mC to -35mV), rapid sodium influx (sodium channels open, RMP +70 to +90mV), depolarization: K+ channels open (K+ efflux promotes onset of repolarization), repolarization: sodium-potassium pump: re-establish RMP

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10
Q

What is the target for acetylcholine?

A

motor nerves to muscles

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11
Q

What does a lack of dopamine in the brain lead to?

A

parkinsons

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12
Q

What does norepinephrine do?

A

increase heart rate, and stimulates fight or flight

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13
Q

What are the characteristics of the cranium?

A
  • inside is jagged
  • eight flat irregular shaped bones fused together during childhood
  • solid, non-expanding
  • function to protect the brain
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14
Q

What is the foramen magnum?

A

opening at the base to allow brainstem to project and connect to the spinal cord

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15
Q

What are the layers of the meninges and where are they located?

A

Dura mater - outermost, tough, adhered to the skull, covers brain and spinal cord to S2
Arachnoid - delicate, fragile, vascular, spiderweb, spongy, connects dura to pia, acts as a cushion
Pia mater - adheres directly to brain tissue

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16
Q

Describe the characteristics of the neural ventricals.

A

lateral ventricles - foramen of monroe
third ventricle - aqueduct of sylvius
fourth ventricle - foramen of lushka, foramen of magendie

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17
Q

Describe the pathway of CSF

A

lateral ventricles - foramen of monroe - third ventricle - cerebral aqueduct - fourth ventricle - central canal or subarachnoid via foramen of lushka and mangendie - reabsorbed by arachnoid villi into venous system

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18
Q

What are the basic functions of the frontal lobe?

A

logical thinking, short term memory, personality and judgement

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19
Q

What are the functions of the parietal lobes?

A

sensory receiving and interpreting, speech, grammar, and hand skills

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20
Q

What are the functions of the temporal lobe?

A

auditory receiving and interpretation, emotion, personality, behaviour, memory storage

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21
Q

What is the function of the Wernicke area?

A

understanding spoken and written word

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22
Q

What is the function of the occipital lobe?

A

visual receiving and interpretation

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23
Q

What are the functions of the thalamus?

A

consciousness, pain, attention span, damage can mean permanent coma, sorts information that goes to cerebral cortex (auditory, visual, taste, touch)

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24
What are the functions of the hypothalamus?
thermostat, internal homeostatsis, controls autonomic nervous system, afferent impulses, uses pituitary for communication.
25
What are the characteristics of the pituitary gland?
attached to the hypothalamus at the base of the brain, the master gland, secretes 9 hormones, controls/influences all other endocrine glands, growth, metabolic rate, sexuality
26
What are the characteristics of the cerebellum?
surrounds the brainstem helps provide smooth, coordinated body movement, motor planning muscle memory fine movement balance through feedback loops no initiation of movement - send/receive impulses for muscle activity
27
Your patient has an injured Cerebellum. What physical findings would you see in ataxia?
preservation of motor strength, lack of coordination, staggering gait, lack of ocntrol, injury, parkinsons, alzheimers
28
What are the characteristics of the midbrain?
located below the cerebrum and above the pons, contains cranial nerve 3 and 4 and the visual reflex, functions to relay stimuli involved in voluntary movement.
29
What are the characteristics of the pons?
a bridge - connects midbrain with the medulla contains respiratory centres - pneumotaxic control (breathing patterns) Regulates consciousness cranial nerves 5, 6, 7,8
30
What are the characteristics of the medulla?
- most inferior part of the brainstem - connects higher levels of the brain to the spinal cord - not life sustaining without stimuli - swallow, gag, sneeze - crossing of voluntary motor fibres occurs here - cranial nerves 9, 10, 11, 12
31
Describe the characteristics of the reticular activating system
functions: -sensation -movement -regulates arousal (consciousness) -regulates sleep-wake transitions controls overall central nervous system activity sorting through white noise for pertinent information
32
Damage to the reticular activating system will have what effect on your patient?
altered LOC, impaired sleep-wake cycle, impaired attention span
33
Describe the characteristics of the blood-brain barrier
a physiological mechanism that alters permeability of the brain capillaries permeable to water, oxygen, carbon dioxide and glucose regulates transport of ions and waste products
34
What are the requirements to allow a substance to pass through the blood brain barrier?
particle size, lipid solubilit, protein-binding potential
35
Describe the blood supply to the brain.
- internal carotids and verebral arteriers (anterior and posterior sections, branch off the aortic arch, connect at the circle of willis) - anterior circulation: internal carotids (provide 80% blood to cerebral hemispheres - brain uses 20% total cardiac output (required flow 750ml/min)
36
What are the functions of the circle of willis?
connects anterior and posterior circulation - anterior and posterior cerebral arteries (back to front) - anterior and posterior communicating arteries (side to side) - vertebral arteries
37
What type of nerve is in the dorsal root?
afferent
38
What type of nerve is in the ventral root?
efferent
39
What is the GCS scale for Best "eye" opening
4 - spontaneously 3 - to speech 2 - to pain 1 - none
40
What is the GCS for best "verbal" response?
``` 5 - oriented 4 - confused 3 - inappropriate words 2 - mumbled/incoherent 1 - none ```
41
What is the GCS best "motor" response?
``` 6 - obeys command 5 - localize 4 - flexion withdrawal 3 - abnormal flexion 2 - abnormal extension 1 - none ```
42
How would you differentiate between localizing and withdrawal to painful stimuli?
local - crosses midline to attempt to remove painful stimulus withdraw - moves body away
43
What are some intracranial causes of altered LOC?
- space occupying lesions - head injury - seizures, epilepsy - infections - degenerative conditions - secondary insult
44
What are some extracrainial causes of altered LOC?
- metabolic causes - respiratory involvement - cardiovascular instability - sepsis, shock and trauma - liver, renal and endocrine dysfunction - pharmacologic agents - multi-organ dysfunction - fluid/electrolyte imbalance - acid/base imbalance
45
What is central pontine demyelination?
too rapid sodium correction - locked in syndrome - can be permanent - decreases nerve ability to communicate - requiring ventilation and inotropes until reversed, if possible
46
What is the monro-kellie doctrine?
- three components of the cranial vault - blood (10%) brain (80%) CSF (10%) - increase in volume of one intracranial element must be compensated by a decrease in one or more of other components - total volume remains fixed - dynamic equilibrium
47
What are the compensatory mechanisms of the monro-kellie doctrine?
- displacing CSF to lumbar cistern - increasing CSF absorption - compression low-pressure venous system
48
What is brain compliance?
adaptive capacity of the brain to maintain intracranial equilibrium in response to both physiologic and external changes -measure of brain stiffness
49
What is normal ICP?
0-15
50
When do we treat ICP?
greater than 20 ICP
51
Describe the characteristics of central perfusion pressure?
- blood pressure gradient across the brain - prevent extension of brain injury due to ischemia - formula: CPP=MAP-ICP - goal 60-80
52
What is the rationale for active cooling?
decreases cerebral oxygen demand decrease intracranial pressure suppresses the inflammatory response -reduce intracellular acidosis
53
What are the clinical findings for a basal skull fracture?
- fragility of the bones in the sinuses make them susceptible to breaking which can lead to meningeal or dural tears - bleeding can occur with basal skull fracture and manifests as racoon eyes and battle's sign
54
Describe racoon eyes
always bilateral, venous blood pooling as a result of fracture
55
Describe Battle's sign
unilateral, boggy, behind one ear, could affect cranial nerve, Bell's palsy and hearing
56
What is the significance, symptoms, and type of CSF leaks in a basal skull fracture?
nuchal rigidity, headaches, nausea, otorrhea (ear drum must be ruptured also), rhinorrhea
57
Describe the primary and secondary traumatic brain injury
Primary injury - neurons and glial cells are directly damaged Secondary injury - cerebral edema, biochemical/inflammatory responses, tissue hypoxia/decreased cerebral blood flow
58
Describe the characteristics of a diffuse axonal injury?
generalized axonal shearing (stretching and tearing) of axons mild - GCS 13-15 moderate - GCS 9-12 Severe - GCS 3-8 May not be visible on a CT or MRI unless there is a bleed because it is electrical hyperexcitability of neurons severe form of concussion
59
What are the four goals of patient management of ischemic stroke?
restore cerebral blood flow prevent thrombolysis neuroprotection supportive care
60
Why are dextrose solutions contraindicated in acute brain injury?
because the brain will quickly remove the glucose from the solution, leaving a lot of free water, which will then follow osmotic pressure to move into the tissues, increasing edema and ICP
61
Describe the characteristics of spinal shock
occurs immediately or within several hours of original insult occurs with SCI above T6 loss of motor, sensory, reflex, and autonomic function below the level of injury instant, flaccid paralysis can last up to 6 weeks
62
Describe the characteristics of neurogenic shock
loss of sympathetic input to the heart and decreased peripheral vascular resistance hypotension bradycardia loss of ability to sweat below the injury IV fluids needed no fight or flight response
63
What is the disability associated with a spinal cord injury at C1-2
usually fatal
64
What is the disability associated with a spinal cord injury at C3
quadrapalegia
65
What is the disability associated with a spinal cord injury at C4-5?
variable function, neck, arms, shoulder, muscles, diaphragm impairment. C3, 4, 5 keeps the diaphragm alive
66
What is the disability associated with a spinal cord injury at T1-12
paraplegia, respiratory issues, upper thoracic innervates the intercostals (T6 and above)
67
What is the disability associated with a spinal cord injury at L1-5?
paraplegia | mixed picture of motor and sensory loss
68
What is autonomic dysreflexia?
a medical emergency - occurs after the acute (shock) phase of SCI patient is susceptible for life stimulation of sensory receptors below the level of injury triggered by noxious stimuli below injury (T6 or above)
69
What are the signs and symptoms of autonomic dysreflexia?
``` throbbing headache hypertension stimulation of vagus nerve flushing blurred vision seizure and stroke ```
70
What are the steps of autonomic dysreflexia?
1. noxious stimuli 2. afferent input 3. massive sympathetic response 4. widespread vasoconstriction 5. baroreceptors in the blood vessels detect hypertensive crisis 6. bradycardia
71
How is brain death diagnosed?
lack of corneal reflex lack of oculocephalic reflex (dolls eyes) lack of oculovestibular reflex (eyes moving towards ear being stimulated with flush of water) apnea testing for 3 minutes, 6 minutes, 10 minutes with ABGs Ancillary testing - cerebral blood flow studies (anything past the circle of willis?)

OPACCA (8 decks)

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