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Neuromuscular PT 1 > CNS: blood supply and CSF > Flashcards

CNS: blood supply and CSF Flashcards

1
Q

What is important to be in blood flow to the brain

A
  • brain cannot store glucose, oxygen
  • consistent blood supply essential
  • cortex uses more O2 than brainstem
  • cortex more vulnerable to hypoxia
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2
Q

What is the blood brain barrier

A
  • specialized permeability barrier - between CNS capillaries and extracellular space
  • Tight junctions between capillary cells
  • exclude large molecules
  • protects brain from potentially harmful organic substances
  • this can be a problem with medicaiton
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3
Q

Describe the blood brain barrier and its relation to parkinsons

A
  • Dopamine is unable to cross the BBB
  • use L dopa that can cross which is a metabolic precursor
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4
Q

Venous system of the brain

A
  • Cerebral veins drain into dural sinuses => internal jugular vein
  • Superficial veins drain the cortex and adjacent white matter then empty into superior sagittal sinus
  • deep cerebral veins drain the basal ganglia, diencephalon, and nearby white matter, then empty into the straight sinus.
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5
Q

Cerebrospinal Fluid System

function

A
  • Regulates extracellular environment
  • supplies water, amino acids, ions to extracellular fluid
  • removes metabolic waste from CNS
  • protects CNS (buoyancy => shock absorption
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6
Q

Ventricular system within the brain

what are they?

A
  • CSF filled spaces in the brain
  • Lateral Ventricles-paired-one in each cerebral hemisphere
  • 3rd ventricle-narrow slit in midline of diencephalon-walls are thalamus and hypothalamus
  • 4th ventricle-posterior to pons and medulla, but anterior to cerebellum. Continuous with central canal of spinal cord
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7
Q

How do the ventricles form?

A
  • neutral tube forms when neural folds grow toward each other
  • groove zips closed rostrally and caudally leaving open ends (neuropore)
  • Day 28 neural tube expands (embryonic stage of development) to form 3 enlargements - ventricles
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8
Q

What is the Choroid plexus

A
  • Membranous material in the ventricles that secretes CSF
  • network of capillaries embedded in contnective tissue and epithelial cells
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9
Q

What are the types of choroid plexus

A
  • 2 large plexuses: floors of lateral ventricles
  • smaller plexuses: roofs of 3rd and 4th ventricles
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10
Q

Flow of CSF

A
  • cerebrospinal fluid is secreted into the ventricles and flows throughout the subarchnoid space where it cushions the CNS
  • the choroid plexus transports ions and nutrients form the blood into the CSF
  • From the lateral ventricles, third and fourth ventricle, into subarachnoid space surrounding brain and spinal cord. CSF then reabsorbed into the venous sinuses.
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11
Q

CSF absorption

A
  • Midline structures near top of skull.
  • Meninges=dura mater, arachnoid, pia mater-cover brain and spinal cord
  • Arachnoid villi/granulations allow CSF to flow into the sinuses
  • Subarachnoid space filled with CSF
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12
Q

Examples of CSF disorders

A
  • hydrocephalus
  • chiari malformation
  • meningitis
  • hematome
  • brain herniation
  • CSF leak
  • Spina Bifida
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13
Q

What is Hydrocephalus

A
  • CSF circulation blocked = pressure builds up in ventricles
  • infants: ventricles, hemispheres and cranium expand
  • adults: cranium cannot expand and therefore compression of White matter occurs
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14
Q

What are some signs of hydrocephalus in adults

A
  • Gait dysfunction: wide base, shuffling, difficulty starting/stopping
  • balance
  • headache
  • incontience
  • frontal lobe dysfunction
  • cognitive changes

Wobbly: trouble with balance
Wet: incontience
Wacky: cognitive

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15
Q

What are some signs of hydrocephalus in infants

A
  • enlarged head
  • enlarged anterior fontanel
  • difficulty feeding
  • downward looking eyes- sunsetting sign
  • inactivity/regression in function
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16
Q

Causes of

hydrocephalus

A
  • commonly caused by
  • failure of the fourth ventricle foramina to open (communicating hydrocephalus),
  • blockage of the cerebral aqueduct (noncommunicating hydrocephalus),
  • cysts in the fourth ventricle (Dandy-Walker cysts), and Arnold-Chiari malformation
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17
Q

Treatment of hydrocephalus

A
  • Surgical implantation of shunt
  • children or adults
  • ventricle to peritoneal cavity
  • contains valve: prevents reverse flow

Can do a lumbar puncture to see if symtpoms improve with removal of soem CSF - PT may do a TUG before and after this

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18
Q

VP shunt placement Procedure

A
  • while patient is under general anesthesia an incision is made behind ear
  • another smalle surgical cut is made in patients abdomen
  • a small hole is drilled into skull
  • through this opening a catheter is passed into a ventricle
  • a 2nd catheter is placed under the skin behind ear and guided distall usually into abdominal cavity
  • surgeon may make a small cut in neck to help position the catheter
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19
Q

What are the signs of a VP shunt failure

A
  • headache
  • irritability
  • nausea and vomiting
  • changes in arousal and personality (flat affect)
  • loss of motor function
  • visual changes
  • these symptoms can appear quickly and require immediate medical attention
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20
Q

Arnold-Chiari Malformation

A
  • Downard displacement of cerebellar tonsils through foramen magnum
  • the resulting pressure on cerebellum can block flow of CSF causing a range of symptoms including cerebellar and brainstem signs
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21
Q

Types of Arnold-Chiari Malformation

A
  • Arnold-Chiari type I is not associated with defects of the lower neural tube and consists of herniation of the cerebellar tonsils through the foramen magnum into the vertebral canal
  • Type II consists of malformation of the brainstem and cerebellum, leading to extension of the medulla and cerebellum through the foramen magnum.
22
Q

Arnold-Chiari Malformation Symptoms

A
  • Suboccipital headache: initiated/exacerbated by coughing, straining or sneezing
  • loss of pain and temperature sensation on shoulders and lateral upper limbs if upper central spinal cord is abdnormal
  • uncoordinated movements, paresis
  • impaired fine motor control
  • unsteady gait
  • temporary visual distrubances
  • dizziness and vertigo due to brainstem and cranial nerve compression
  • deafness, tongue, fascial muscle and laterla eye movement weakness
  • difficulty swallowing
23
Q

Arnold-Chiari Malformation Treatment

A
  • surgery: Posterior fossa decompression
  • craniectomy (removal of bone in skull) widens the foramen magnum
  • dura overlying the tonsils is opened and a dural path is sewn on to expand the space
24
Q

Meningitis

A
  • Inflammation of membranes that surround the brain and spinal cord
  • bacterial: Contagious via respiratory and throat secretions; can be life threatening- requires immediate medical attention and antibiotics
  • Viral: Spread via respiratory and throat secretions as well as through enteroviruses; doesn’t respond to antibiotics but usually not as serious as bacterial meningitis (in healthy adults).

*can get the virus that causes this without meningitis

25
Q
A
26
Q

Symptoms of meningitis

A
  • Headache
  • fever
  • confusion
  • vomiting
  • neck stiffness
  • pain that may intensify with head movement sneezing or coughing
  • photophobia
27
Q

Epidural Hematoma

A
  • Results from arterial bleeding between the dura mater and skull,
  • Usually occurs when middle meningeal artery is torn by a fracture of the temporal or parietal bone
  • function may be normal at first
28
Q

Epidural Hematoma

symptoms

A
  • develop rapidly due to fast arterial bleeding
  • Headache, vomiting, decreased consciousness, hemiparesis, Babinski’ sign

usually after trauma

29
Q

Subdural hematoma

A
  • Between dura and arachnoid
  • produced by venous bleeding
  • symptoms are more gradual
30
Q

Symptoms of subdural hematoma

A
  • similar to epidural hematoma with congitive issues being more prominent
  • Headache, vomiting, decreased consciousness, hemiparesis, Babinski’ sign
31
Q

Subarachnoid hemorrhage

A
  • Occurs in CFS-filled space between arachnoid and pia which contains the major blood vessels of the brain
32
Q

Types of subarachnoid hemorrhage

A
  • Non-traumatic (spontaneous): aneurysm or AVM (tangles of arteries and veins)
  • Traumatic (more common)
33
Q

Symptoms of subarachnoid hemorrhage

A
  • wide range
  • headache
  • meningeal iritation (nuchal rigidity and photophobia)
  • CN and other neuro deficits
  • decrease consciousness, coma, and death
34
Q

Subarachnoid hemorrhage

prognosis

A
  • mild impairments to death
  • mortatlitiy rate is 50%

worst headahce of my life, may result in secondary hydrocephalus

35
Q

Intracerebral/intraparnchyma hemorhage

A
  • occurs within the brain parenchyma in cerebral hemispheres, brainstem, cerebellum or Spinal cord
  • many causes, both traumatic and non-traumatic
  • tumors, blood coagulation abnormalities, vessel abnormalities
36
Q

Symptoms of intracerebrral/intraparenchymal hemorrhage (ICH)

A
  • depends on which strucutre damaged and to what extent
37
Q

Increase in intracranial pressure

causes

A
  • cerebral edema
  • hydrocephalus
  • tumors
  • space-occupying lesions
38
Q

intracranial pressure symptoms

A
  • vomiting and nausea
  • headahce
  • drowsiness
  • frontal lobe gait
  • ataxia and visual and eye movement problems
39
Q

Brain Herniation types

A
  • Cingulate herniation
  • Uncal herniation
  • Central herniation
  • Tonsillar herniation

Herniation = protrusion of part of the brain

40
Q

Cingulate Hernation

A
  • A mass in one hemisphere displaces the cingulate cortex
  • Cingulate cotex: plays a role in limbic system
  • may cause ACA compression leading to contralateral LE weakness
41
Q

Uncal herniation

A
  • Space-occupying lesion in the temporal lobe displaces the uncus medially
  • compresses the midbrain, intefering with the function of the oculomotor nerve and consciousness
  • consciousness (effects asending eticular activiting system)

Uncal = parahippocampus gyus

42
Q

Central Herniation

A
  • a space-occupying lesion in the cerebrum exerts pressure on the diencephalon, moving the diencephalon, midbrain, and pons inferiorly
  • branches of the basilar artery are stretched
  • results in brain ischemia/edema
  • possible bilateral paraylsis, impaired consciousness and oculomotor control
43
Q

Tonsillar herniation

A
  • Pressure from an uncal herniation, tumor in the brainstem or cerebellum hemorrhage of edema may force the cerebellar tonsils through the foramen magnum
  • brainstem compression interfering with vital signs, consciousness and flow of CSF
44
Q

CSF leak symptoms

A
  • headche esp. back of head
  • headache is moe severe when patient is upright/disappears when patient is lying flat
  • neck discomfort
  • light sensitivity
  • nausea
45
Q

CSF leak

how do they typically occur

A
  • most cases are noted after spinal surgery, lumbar puncture, myelograms, or trauma to head or neck
  • in some cases, there are spontaneous leaks/ruptures in dura
46
Q

Treament of CSF leak

A
  • Bed rest
  • increased fluid intake
  • caffeine
  • epidural blood patch: a syringe of patient’s own blood is injected into spine
  • either at exact site of leak or at a safe location in lumbar spine
  • may need to be repeated several times
47
Q

Spina bifida

A
  • neural tube defect
  • during the first month of pregnancy, the spinal canal does not form completely resulting in a defect in which the spinal cord and meninges protrude
  • inferior neuropore does not close
48
Q

Spina bifida occulta

A
  • one or more vertebrae are malformed
  • occulta means hidden and indicates that a layer of skin covers the malformation or opening in the spine
  • this type of spina difida rarely causes disability or symptoms
49
Q

Meningocele

A
  • meninges covering the spinal cord stick out of the spinal canal
  • but the spinal cord remains in place within the spinal canal
  • may be asymptomatic or have impaired spinal cord function
50
Q

Myelomeningocele

what is it and symptoms

A
  • most common types
  • spinal cord and meninges prrotrude through the defect in the spinal canal
  • causes lower limb paralysis and sensory loss, bladder and bowel dysfucntion
  • intellectual disbaility if hydrocephalus also present

Neuromuscular PT 1 (32 decks)

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