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Flashcards in Neuro 1 Deck (79):
1

Reticular activating system

large network of diffuse nuclei that control vital reflexes, such as those controlling cardiovascular function and respiration; maintains the state of wakefulness

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Full consciousness

state of full awareness of oneself and environment

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Arousal

individual's level of awakeness

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Vegetative state

crude waking state characterized by loss of cerebral function

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Alterations in arousal

structural
metabolic
psychogenic

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Breathing patterns

Categorized as hemispheric or brain stem patterns

rate, rhythm and pattern are evaluated

types include:
-Cheyne-Stokes breathing (hemespheric)
-Central neurogenic hyperventilation
-Apneusis
-Cluster breathing
-Ataxic breathing

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Pupillary changes

indicated brain stem dysfunction and level of brain stem function

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Oculomotor responses

are the resting, spontaneous and reflexive eye movements

if there is metabolic dysfunction patient may still retain normal eye movement

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dolls eyes

indicated brain stem dysfunction

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Ad-

coming into body

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Ab-

moving outward from body

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Decorticate posturing

flexion of arms, wrists and fingers

adduction of upper extremities

extension, internal rotation and plantar flexion of lower extremities

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Decerebrate posturing

all four extremities in rigid extension

hyperpronation of forearms (hands turned out)

Plantar extension of feet (toes turned out)

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Brain death

damage complete...never recover

homeostasis not maintained

cessation of function, including brainstem and cerebellum
declared legally dead when flat EEG for 6-12 hours (but not when brain death was caused by drugs or alcohol..only when caused by metabolic or structural issues)

15

Cerebral death

AKA irreversible coma

death of brain, NOT including brainstem and cerebellum

brain may be able to maintain homeostasis

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Awareness

includes all cognitive functions plus of self, environment, moods, etc.

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Retrograde amnesia

can't remember past personal or factual memories

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Anterograde amnesia

can't form new personal or factual memories

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Image processing

higher memory function which allows for concept formation, meaning assignment and abstract thought

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Alterations in image processing

inability to form concepts, assign meaning, or reason...thinking becomes very concrete

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Seizure

results from sudden, explosive, disorderly discharge of cerebral neurons

characterized by sudden, transient alterations in brain function, usually involving motor, sensory, autonomic, or psychic manifestations

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Convulsion (term sometimes used for seizure)

jerky, contract-relax (clonic-tonic) movement associated with some seizures

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Epilepsy

seizure activity with no underlying, correctable cause

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Classification of seizures

Partial and generalized

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Partial seizures

simple
complex
secondarily generalized

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Generalized seizures

absence
myoclonic
clonic
tonic
tonic-clonic
atonic
unclassified

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Simple/partial

no loss of consciousness but motor, sensory and autonomic signs displayed

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Complex/partial

impairment of consciousness

may be precipitated by simple/partial seizure

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Secondarily generalized/partial

evolves into Generalized Tonic-clonic seizure

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Tonic phase of seizure

muscle contraction with increased muscle tone

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Clonic phase of seizure

alternating contraction and relaxation of muscle

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Data processing deficits

are the problems associated with recognizing and processing sensory information

include agnosia, dysphasia and acute confusional states

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Agnosia

defect in pattern recognition - failure to recognize form and nature of objects

can be tactile, visual or auditory - one at a time usually

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Dysphasia

impairment of comprehension or production of language with impaired communication

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Expressive dysphasia

expressive deficits, but may also include verbal comprehension deficits

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Receptive dysphasia

comprehension deficits

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Aphasia

severe form of dysphasia and an inability to communicate

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Phases of Generalized Seizures

*Aura (partial seizure that immediately precedes onset of general seizure)
*Prodroma (early...can occur hours to days before..warns of coming seizure with changes in BP, headache and changes in blood glucose)
*Tonic Phase
*Clonic Phase
*Postictal phase (immediately after seizure...altered LOC for 5-30 mins)

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Acute confusional states (ACS)

Delirium
Hypokinetic

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Delirium

-overactivity of nervous system; hyperconfusion; this will improved over time
-lasts 2-3 days

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Hypokinetic

under activity of nervous system

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Dementia

progressive failure of many cerebral functions which will worsen over time

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Alzeimers Disease

one of the most common causes of severe cognitive dysfunction in older persons

leading cause of dementia

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Patho of Alzeimers

Complex

linked to three genes on chromosome 21

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Hydrocephalus

various conditions characterized by excess fluid in the cerebral ventricles, subarachnoid space, or both

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Types of Hydrocephalus

-noncommunicating - gradual
-communicating - gradual
-acute - rapid

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Patho of hydrocephalus

obstruction of CSF flow produces increased pressure and dilation of ventricles proximal to obstruction

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Noncommunicating hydrocephalus

aka intraventricular hydrocephalus
most often seen in children
is obstruction within ventricular system

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Communicating hydrocephalus

more often seen in adults
is defective resorption of CSF

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Acute hydrocephalus

develops a couple of hours after head/brain injury
contributes to significant increase in ICP

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Normal muscle tone

-involves a slight resistance to passive movement
-throughout the range of motion, the resistance is smooth, constant and even

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Alterations in muscle tone

Hypotonia
Hypertonia

both of these lead to muscle atrophy d/t decreased use

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Hypotonia

-decreased muscle tone
-passive movement of muscle occurs with little or no resistance
-causes cerebellar damage

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Hypertonia

-increased muscle tone
-passive movement of muscle occurs with resistance (more than normal level of resistance)

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Alterations in movement

Paresis/paralysis
Hemiparesis/hemiplegia
Paraparesis/paraplegia
Quadriparesis/quadriplegia
Areflexia (loss of reflexes)

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Paresis/paralysis

Paresis is partial paralysis with incomplete loss of muscle power
Paralysis is loss of motor function so that muscle group can't overcome gravity

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Hemiparesis/hemiplegia

is paresis/paralysis of the upper and lower extremities on one side

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Paraparesis/paraplegia

is weakness/paralysis of the lower extremities

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Quadriparesis/quadriplegia

paresis/paralysis of all 4 extremities

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Upper Motor Neuron Syndromes

Associated with spastic muscle tone, contributing to the loss of function

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Lower Motor Neuron Syndromes

Associated with flaccid motor tone. Impairs both voluntary and involuntary movement.

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Areflexia

loss of tendon reflexes

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Fibrillation

isolated contraction of a single muscle fiber due to metabolic changes in denervated muscle not visible clinically.

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Cerebral Hemodynamics

movement of blood in brain, includes:
-cerebral blood flow (CBF)
-cerebral perfusion pressure (CPP)
-cerebral blood volume (CBV)
-cerebral oxygenation

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Cerebral blood flow

normally maintained at rate that matches local metabolic needs of the brain

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Cerebral perfusion pressure

70-90 mm.Hg pressure required to perfuse cells of brain

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Cerebral blood volume

amount of blood in the intracranial vault at a given time

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Cerebral oxygenation

critical factor and it's measured by oxygen saturation in internal jugular vein

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Alterations in CBF

may be related to three injury states:
-inadequate cerebral perfusion (cerebral oligemia)
-normal perfusion with an elevated intracranial pressure
-excessive cerebral blood volume (cerebral hyperemia)

70

Intracranial pressure

normally at 1-15 mm Hg

will increase due to increase in intracranial content such as tumor growth, edema, excess CSF or hemmorhage

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Cerebral Edema

increase in flue content of brain tissue

3 types:
-Vasogenic
-Cytotoxic
-Intersitital

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Vasogenic edema

most important type; caused by increase in permeability of capillary endothelium of brain after injury to vascular structures

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Cytotoxic

toxins directly affect brain's cellular elements, specifically transport of K and Na; cell walls lose K and gain Na and H2O

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Interstitial

seen in noncommunicating hydrocephalus; caused by movement of CSF

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Huntington Disease

Rare
Hereditary
Hyperkinetic movement disorder

Patho: severe degeneration of basal ganglia in brain

no treatment to halt progression

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Chorea

irregular, uncontrolled, excessive movement

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Athetosis

writhing movement

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Ballism

Flinging movment

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Parkinson Disease

common
disorder of movement

Patho: unknown except for degeneration of basal ganglia with loss of dopamine producing neurons (think story of Rachel in Dev. Psych)