Exam 1- Disorders Of The Central And Peripheral Nervous Systems And The Neuromuscular Junction

Question 1

Coup contra-coup

Answer 1

Injury opposite the side of injury.

Usually deceleration injury.

Question 2

Coup injury

Answer 2

Injury directly at or below the site of injury

Question 3

Subdural hematoma

Answer 3

Hematoma below the dura but above the SA space. Well-encapsulated. Blood does not touch the brain. Typically venous.

Question 4

Spinal shock

Answer 4

immediately after cord injury, normal activity of spinal cord cells at and below the level of injury ceases because of loss of the continuous tonic discharge from the brain or brainstem and inhibition of suprasegmental impulses, thus causing spinal shock. characterized by a complete loss of reflex function, flaccid paralysis, sensory deficit, and loss of bladder and rectal control below the level of the lesion. Transient drop in BP, poor venous circulation, and disturbed thermoregulation. This damage causes faulty control of diaphoresis and heat radiation through capillary dilation. The hypothalamus cannot regulate body heat through vasoconstriction and increased metabolism, so the body temperature assumes the temp of the air. May last for a few days to 3 months.

Question 5

Myopic aneurysms

Answer 5

result from arteritis caused by bacterial emboli (bacterial endocarditis). Traumatic (dissecting) aneurysms are caused by weakening of the arterial wall by a fracture line, by a penetrating missile, or after neurosurgical or imaging procedures.

Question 6

Phases of migraine

Answer 6

premonitory phase: neck pain, yawning, and food cravings.
aura phase: lasts from an hour to several days, and is defined as spreading focal, neurologic disturbance manifested as visual, sensory, or motor symptoms
headache phase: includes associated symptoms and lasts 4-72 hours. The genesis of migraine pain is unknown and there is much debate. Trigeminal involvement.
recovery phase: return to normal physiology and may take several hours to days.

Question 7

Saccular (berry) aneurism

Answer 7

occur frequently and are the result of a combination of a congenital abnormality in the arterial wall and degenerative changes. The sac grows over time.

Question 8

Fusiform (giant) aneurysms

Answer 8

> 25mm and make up 5% of all intracranial aneurysms. They occur as a result of diffuse arteriosclerotic changes and are found most commonly in the basilar arteries or terminal portions of the internal carotid arterie

Question 9

Autonomic Dysreflexia

Answer 9

syndrome of sudden, massive reflex sympathetic discharge associated with spinal cord injury at level T5-T6 or above. Imbalance between the sympathetic and parasympathetic systems. It is characterized by paroxysmal hypertension (up to 300 mmHg), bradycardia (30-40 bpm), a pounding headache, blurred vision, sweating above the level of the lesion with flushing of the skin, nasal congestion, nausea, and piloerection caused by pilomotor system. They may occur singly or in combination (syndrome). Often associated with somatic (distended bladder or rectum) or sensory stimulation. It is life threatening and requires immediate treatment because of the risk for CVA. HOB should be elevated and the stimulus should be determined and removed (emptying of the bladder or bowel). Treatment also includes topical nitro and calcium channel blockers.

Question 10

Neurogenic shock

Answer 10

Loss of sympathetic outflow. Within 30 min of cord injury T5 or above. Hemodynamic phenomenon. Lasts up to 6 weeks.
Vasodilation
Hypotension
Bradycardia
Hypothermia

Question 11

Diffuse axonal injury

Answer 11

a type of diffuse brain injury. Involves widespread areas of the brain. Damage to delicate axonal fibers and white matter. Mechanical effects from high levels of acceleration and deceleration and rotation and twisting movements are the primary mechanisms of injury, producing strains and distortions within the brain. Shearing forces on the brain tissues. Stretching and tearing of nerve fibers result in axonal damage. Axonal damage can only be seen on microscope. Secondary brain injury causes acute brain swelling from increased intravascular blood flow within the brain, vasodilation, and increased cerebral blood volume.

Question 12

Subarachnoid hemorrhage

Answer 12

Blood escapes from defective or injured vasculature into the subarachnoid space. Blood produces an inflammatory reaction in the tissues.

Sx: HA, mental status changes, transient motor weakness, and numbness and tingling.

Complications: vasospasm and delayed cerebral ischemia. Treat with calcium channel blockers.

Question 13

Epidural hematoma

Answer 13

Above the dura. Also known as extramural. Usually arterial. Blood not touching the brain

Question 14

Intracerebral hematoma

Answer 14

Blood in the brain tissue. Brain tissue hates blood. Not well defined or encapsulated.

Question 15

Brain contusion

Answer 15

Focal bruise that occurs when blood leaks from an injured vessel.

Question 16

Concussion

Answer 16

Diffuse traumatic brain injury

Question 17

Mass effect

Answer 17

After spinal cord injury. Involves flexor spasms, profuse diaphoresis, piloerection, and automatic bladder emptying.

Question 18

Open brain trauma

Answer 18

Causes brain trauma when break in the dura mater exposes cranial contents to the environment.

Question 19

Basilar skull fx

Answer 19

Battles sign
Raccoon eyes.
Infection is a frequent complication

Question 20

Lacunar infarct

Answer 20

Smaller than 1 cm

Associated with smoking and hypertension

Question 21

Encephalitis

Answer 21

Most common forms are caused by arthropod-borne viruses and HSV.

Question 22

Primary brain injury

Answer 22

Ex: SDH compresses neurons, bullet severe tracts in spinal cord, crushing blow to head compresses neurons and glia.

Question 23

Secondary brain injury

Answer 23

Ex: increased ICP compresses neurons, glutamate excitotoxicity causes neuronal death.

Question 24

Tertiary brain injury

Answer 24

Pneumonia occurs during hospitalization for spinal cord injury.

Question 25

Spinal cord injury

Answer 25

During period of shock: Reflexes disappear, flaccid paralysis, sensory disappears, bladder and bowel atonic.

After return of reflexes: reflexes are hyperactive, spastic paralysis, absent sensory, reflex emptying of bowel and bladder.

Question 26

Myasthenic crisis

Answer 26

Dangerously severe muscle weakness caused by the disease process.

Question 27

Cholinergic crisis in MG

Answer 27

Dangerously severe muscle weakness, diarrhea, intestinal cramping, and other signs of anticholinesterase drug toxicity.

Question 28

Spondylolisthesis

Answer 28

Forward displacement of a vertebra

Question 29

Spondylosis

Answer 29

Degeneration of vertebral structure.

Question 30

Spinal stenosis

Answer 30

Abnormal narrowing of the spinal canal.

Question 31

Radiculopathy

Answer 31

Disorder of spinal nerve root.

Question 32

Spinal shock

Answer 32

Due to acute spinal injury. Loss of reflexes below the level of injury. Flaccid paralysis. Loss of sensation. Lasts from days to months.