CNS Regulation

Question 1

Define the concept of CNS regulation.

Answer 1

Mechanisms or conditions that impact cerebral (intracranial) processing and functioning.

Question 2

What are the metabolic requirements for regulating CNS function?

Answer 2

Metabolic requirements of the brain:
* Adequate blood flow (perfusion)
* Adequate blood oxygen levels (gas exchange)
* Adequate blood glucose levels (metabolic regulation)

Question 3

What are the causes and risk factors for impaired CNS regulation?

Answer 3

Reduced perfusion, altered neurotransmission, insufficient glucose, degeneration, neoplasm, developmental defects.
Risk factors:
* Older adults
* Chronic diseases
* Younger adults
* Drugs
* Risky behavior
* Stressors/mental health

Question 4

What is the function of the primary motor cortex?

Answer 4

Located in the frontal lobe, responsible for motor control.

Question 5

What is the role of the prefrontal cortex?

Answer 5

Responsible for reasoning, planning, problem solving, and judgement.

Question 6

What does the parietal lobe process?

Answer 6

Somatosensory information.

Question 7

What is the function of the temporal lobe?

Answer 7

Understanding spoken/written language and processing auditory information.

Question 8

What is the role of the occipital lobe?

Answer 8

Detection of visual information.

Question 9

What is the function of the cerebellum?

Answer 9

Coordination of movement, posture, and balance.

Question 10

What does the medulla oblongata control?

Answer 10

Control of vital functions.

Question 11

What is the thalamus known for?

Answer 11

Relay station for sending sensory information to the cerebral cortex.

Question 12

What are the major arteries supplying the brain?

Answer 12

vertebral > basilar > PCA

internal carotid > MCA/ACA

Question 13

What is the Circle of Willis?

Answer 13

A structure that diverts blood flow to areas of the brain in case there is a blockage.

Question 14

What is an ischemic stroke?

Answer 14

Caused by cerebrovascular obstruction by thrombosis or emboli.

Question 15

What is the penumbra in relation to stroke?

Answer 15

A band of minimally perfused cells that surround the dead/dying core.

Question 16

What is a TIA?

Answer 16

Temporary stop of blood flow, could be caused by atherosclerotic arteries in the brain.

Question 17

What causes a hemorrhagic stroke?

Answer 17

Rupture of a cerebral blood vessel.

Question 18

What are the symptoms of a hemorrhagic stroke?

Answer 18

Compression of the brain, vomiting, headache.

Question 19

What is an aneurysm?

Answer 19

A bulge at the site of localized weakness in the wall of an arterial vessel.

Question 20

What are common risk factors for stroke?

Answer 20

• Diet
• Exercise
• Obesity
• Smoking
• Stress
• Drugs & alcohol
• HTN
• Dyslipidemia
• Diabetes
• Atrial fibrillation
• Age
• Gender
• Ethnicity

Question 21

What is the role of blood thinners in stroke prevention?

Answer 21

prevent clotting cascade

Question 22

What is the Glasgow Coma Scale?

Answer 22

A scale used to assess consciousness based on eye opening, verbal response, and motor response.

Question 23

What does the NIH stroke scale assess?

Answer 23

Severity of stroke and helps to guide therapy.

Question 24

What is the difference in treatment for ischemic and hemorrhagic strokes?

Answer 24

Ischemic: tPA, repeat CT, endovascular thrombectomy. Hemorrhagic: monitor symptoms.

Question 25

What are antiplatelet agents used for?

Answer 25

To decrease formation of the platelet plug and improve outcomes in TIA patients.

Question 26

What is the mechanism of action of Warfarin?

Answer 26

Inhibits synthesis of vitamin K-dependent clotting factors.

Question 27

What is the significance of a TIA?

Answer 27

It is a warning sign of a potential future stroke.

Question 28

What is the effect of hyperglycemia on ischemic damage?

Answer 28

It can worsen ischemic damage.

Question 29

What is a lacunar stroke?

Answer 29

Small infarcts located in a single deep penetrating artery.

Question 30

What is the management goal for the penumbra in stroke treatment?

Answer 30

Reperfusion therapy aimed at saving the penumbra.

Question 31

Fill in the blank: The primary somatosensory cortex is located in the _______.

Answer 31

parietal lobe.

Question 32

What therapy is strongly recommended over antiplatelets for patients at risk for stroke?

Answer 32

Anticoagulant therapy ## Footnote Anticoagulants are preferred due to the risk of bleeding associated with antiplatelet therapy.

Question 33

For patients with mechanical heart valves, which medication is recommended over DOACs?

Answer 33

Warfarin ## Footnote Warfarin is the standard anticoagulant for patients with mechanical heart valves.

Question 34

What is the first step in the treatment for ischemic stroke?

Answer 34

Get a CT to confirm ischemic stroke ## Footnote CT scans help differentiate between ischemic and hemorrhagic strokes.

Question 35

What are the criteria for administering medication for ischemic stroke?

Answer 35

Criteria: * <4.5 hours since symptom onset * BP <185/110 * Glucose within range * No recent history of bleeding ## Footnote These criteria ensure patient safety and optimize treatment outcomes.

Question 36

What medication can be given if CT confirms an ischemic stroke?

Answer 36

tPA or TKA ## Footnote tPA is tissue plasminogen activator, while TKA is tenecteplase, a modified variant.

Question 37

What is a key difference between TKA and tPA in administration?

Answer 37

TKA requires a single bolus dose ## Footnote tPA requires a bolus followed by a 60-minute infusion.

Question 38

What outcomes does TKA have compared to tPA at 3 months post-treatment?

Answer 38

Better outcomes for reduced disability ## Footnote TKA has shown improved functional recovery in comparison to tPA.

Question 39

What are indicators of adequate CNS regulation?

Answer 39

Indicators: * Able to sit up * Able to move both arms * No slurred speech * Adequate perfusion * Facial symmetry * Movement of both legs * Makes eye contact * Normal sensation * Bilateral grip * Gag reflex present ## Footnote These indicators reflect neurological function and consciousness.

Question 40

What does the acronym FAST stand for in recognizing a stroke?

Answer 40

F- face (droop) A- arms (can they raise both) S- speech T- time (treated quickly) ## Footnote FAST is a quick assessment tool for stroke recognition.

Question 41

How does gas exchange relate to CNS regulation?

Answer 41

Lower SpO2 causes acute confusion ## Footnote Adequate oxygenation is critical for cognitive function.

Question 42

What effect does mobility have on stroke recognition?

Answer 42

Unequal movements indicate a potential stroke ## Footnote Mobility assessments can help identify neurological deficits.

Question 43

What is one of the signs to check for when assessing orientation in a patient?

Answer 43

Are they able to follow directions? ## Footnote This helps assess cognitive function and responsiveness.

Question 44

What should be assessed regarding pupil response during a stroke evaluation?

Answer 44

Equal pupil response ## Footnote Pupil reaction can indicate neurological function.

Question 45

What can be affected by an MCA stroke?

Answer 45

- hand/arm/face control or sensation - Broca's area - Wernicke's area

Question 46

What can be affected by an ACA stroke?

Answer 46

motor/sensation of the feet/legs - reasoning/planning/decision making

Question 47

What can be affected by a PCA stroke?

Answer 47

visual info, learning, memory

Question 48

What can be affected by a basilar/vertebral artery stroke?

Answer 48

balance, coordination, vital reflexes,

Question 49

What are the characteristics of right brain damage?

Answer 49

left sided weakness, left visual field damage, left neglect, lack of awareness of deficits, quick/impulsive behaviours

Question 50

What are the characteristics of left brain damage?

Answer 50

right sided weakness, right visual field damage, aphasia aware of deficits, slow and cautious behaviours