CNS Disorders Flashcards by Jennifer Vu

A critical factor in determining neuronal cell fate after injury

ATP depletion

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Ischemia & Hypoxia
-decreased____at the ____level
-results in ___neurologic dysfunction due to ____

-O2; cellular level
-immediate; inability to generate ATP

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2 mechanisms that can cause brain cell death

anaerobic metabolism
deterioration of ion gradient

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Cellular energy failure
-how long w/o O2 for irreversible brain damage

5-10 min

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Excess glutamate (an excitotoxin) stimulates

neurons that take up large amounts of injurious calcium ions – calcium overload injury = cytotoxic edema and swelling

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Reperfusion Injury and free radicals?
free radicals:

when O2 reenters cells; produces reactive O2 products that behave as free radicals: hydroxyl radicals,superoxide,peroxide

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Increased intracranial pressure (ICP) normal levels

0-15mmHg

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primary brain injury

a direct result of initial insult

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secondary injury

progressive damage resulting from body’s physiological response to the initial insult

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clinical manifestations of ICP

-headache, vomiting, decreased consciousness (drowsiness)
-blurry vision, edema of the optic disk (papilledema)

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Herniation

result of increased ICP
protrusion of brain tissue through opening of brain – DEADLY

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papilledema

edema of optic disk

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Diagnostic test for brain injury

CT or MRI

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general treatment for brain injury

focus on managing cerebral oxygenation
-surgery, CPP (cerebral perfusion pressure) > 60mmhg for no ischemia

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Coma

Complete loss of consciousness

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indicator of altered brain function

Change in level of consciousness

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Glasgow coma scale evaluation

eye opening
motor response
verbal response

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Somnolent

excessive drowsiness, only responds to stimuli with incoherent mumbles + disorganized movement

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Glasgow Coma Scale: Evaluation component:

Mild (>12), moderate (9 to 12), to severe (<8)

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Most important eval in Glasgow coma scale

motor response

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Manifestaions of Brain injury: Pupil reflex
indicates function of the brainstem and cranial nerves _ and _

2 and 3

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which cranial nerves control eye movements

CN 3,4,6

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Oculovestibular reflex

impaired reflex implies brainstem dysfunction

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Doll’s eye movement

eyes move in opp direction to head rotation

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Cold calorics

injection of cold water into ears. Normal response: tonic deviation of both eyes towards water

Leading cause of death and disability in the U.S

TBI (traumatic brain injury)

Primary injury

initial injury on brain cells

focal injuries (coup)

localized site of impact

polar injuries (coup contracoup)

accel-decel movement of brain in skull

Mechanisms of TBI

Concussion, contusion, intracranial hematoma

contusion

CT or MRI reveals an area of brain tissue damage (necrosis, laceration, bruising)

3 types of intracranial hematomas

1. epidural 2. subdural 3. subarachnoid

intracranial hematoma

localized collection of blood within the cranium

location of epidural

caldevia bone + dura mater, middle meningeal A

location of subdural

dura + arachnoid membrane

location of subarachnoid

arachnoid + pia mater

Epidural hematoma

-collection of blood between dura and skill -involves arterial injury --> rapid onset of symptoms

Manifestations of epidural hematoma

brief disturbed consciousness followed by normal cognition (lucid interval), then rapid decrease in consciousness

Treatment for epidural hematoma

surgery

Acute subdural hematoma symptom onset

24 hrs after injury

subarachnoid hemorrhage

rupture of bridging veins commonly associated with rupture of cerebral aneurysms or arteriovenous malformations

Treatment for subarachnoid hemorrhage

-cardiopulmonary stabilization -- cerebral oxygenation -maintain body temp (mild hypothermia, PaCo2, serum glucose, intravascular volume

treatment for acutely elevated ICP

administer mannitol (osmotic diuretic) sedation hypothermia mild hyperventilation barbiturate coma

treatment for severely high ICP

diuretics, hypertonic saline, moderate hyperventilation, and barbiturate coma

open head injury treatment

prophylactic antibiotics

Base skull fracture

fracture of temporal, occipital, sphenoid, frontal, ethmoid bone

Halo Test

CSF can seep out as clear fluid from ears or nose

black eyes "raccoon signs"

bilateral periorbital hematomas

Battle's signs

bruising under ear

Cerebrovascular disease and stroke epidemiology

Transient ischemic attacks (TIA), ischemic stroke, hemorrhagic stroke

most common form of stroke

ischemic

ischemic stroke

sudden occlusion of cerebral artery secondary to thrombus formation or emboli

clinical manifestations of ischemic stroke

contralateral hemiplegia, hemisensory loss, contralateral visual field blindness

treatment for ischemic stroke

salvage penumbra, anticoagulants, antiplatelet, endarterectomy, angioplasty TREATMENT MUST BE INSTITUTED WITHIN 3 HRS OF SYMPTOM ONSET

Transient ischemic attack Nuerologic symptoms last _____, but may last ____. Symptoms may resolve ____ without evidence of ____.

only minutes; 24 hrs completely; neurologic dysfunction

Treatment for TIA

daily aspirin

TIA are important warning signs

of thrombotic disease and carry a significant risk for subsequent stroke

Hemorrhagic stroke usually occurs secondary to ____

severe, chronic hypertension

hemorrhagic stroke occurs in

basal ganglia or thalamus

treatment for hemorrhagic stroke

blood pressure management

Motor and Sensory Deficits initially motor deficits occur as ____or ______; recovery of motor function occurs with ____

flaccidity; paralysis; onset of spasticity

Sensory disturbances occur in same locations as ____ and may involve ____

motor paralysis; neglect or visual impairment

Aphasia Brain damage to ____ and can involve ___ language modalities

language deficit, dominant cerebral hemisphere; all language modalities

Broca Aphasia (Verbal motor, expressive) Consists of ___ articulation and ___ vocabulary

poor; sparse

Evidence of cognitive deficits

language impairment, impaired spatial relationship skills, short-term memory, poor judgement, concentration, memory, reasoning impairment

CNS infection risk factors

immunocompromised, debilitation, poor nutrition, radiation, steroid therapy, contact w/ vectors

Meningitis -- bacterial or viral infection

bacterial

encephalitis -- bacterial or viral

usually viral

Most common bacteria for meningitis

streptococcus pneumonias

classic s/s of meningitis

headache, fever, stiff neck (meningismus), signs of cerebral dysfunction (confusion, delerium)

Encephalitis -- inflammation of brain caused by ____

west nile virus, western equine encephalitis, herpes simplex

S/S of herpes

fever, headache, seizure, confusion, stupor, coma

Brain abscess -- localized collection of ___

pus within brain parenchyma

CNS Disorders Flashcards

(73 cards)