Neuro Flashcards
1
Q
Pressure of blood flowing into the brain
A
cranial perfusion pressure (CPP)
2
Q
Totality of all pressures in the brain (BP, CSF, brain tissue)
A
intracranial pressure (ICP)
3
Q
Concept map of imbalance of pressure (ICP or CPP)
A
ineffective perfusion > ischemia > cellular hypoxia > cell injury/death > increase cellular permeability > cerebral edema & increased ICP > further loss of effective perfusion
4
Q
The main culprit in causing increased ICP
A
cerebral edema
5
Q
Any disruption of normal blood flow to any part of the brain resulting in damaged brain tissue
A
brain attack/Stroke
6
Q
Most common etiologies of BA
A
atherosclerosis of incoming arteries
HTN
Brain aneurysms
Problems of decreased CO
7
Q
Risk factors for Stroke
A
HX of atherosclerosis or HTN Old age Family HX Diabetes Lifestyle (smoking & high fat diet)
8
Q
Underlying mechanism(s) of stroke
A
Ischemia
Hemorrhage
9
Q
80% of all stroke are ___ in nature
A
ischemic
10
Q
Ischemic strokes are usually related to ___ and other processes that cause ___
A
atherosclerosis; arterial wall damage & plaque formation
11
Q
Ischemic strokes may be __ or __ in nature
A
thrombotic or embolic
12
Q
Risk of ischemic stroke increases X5 with ___
A
Hx of afib
13
Q
Thrombotic or Embolic events that cause stroke:
A
Carotid atherosclerosis
Air emboli
Clots around mitral/aortic valve prosthesis
Intracranial artery plaque (circle of Willis)
14
Q
BA that resolves within 24 hours with no neurologic deficits
A
TIA
15
Q
Usually caused by a blood clot that leaks out directly onto brain tissue
A
Hemorrhagic stroke
16
Q
Causes of Hemorrhagic stroke
A
HTN pressures Weakened arterial walls Aneurysms Congenital vascular malformations Bleeding into a tumor Coagulation disorders
17
Q
S/S of stroke depend on __
A
where the stroke is occurring
18
Q
3 regions where stroke can occur
A
Hemispheres
Cerebellum
Brain stem
19
Q
Abnormalities in sensorimotor findings occur ___
A
contra-laterally to where the bleed is occurring
20
Q
Normal sensorimotor findings should be __
A
symmetrical
21
Q
Visual deficit that indicates cerebral edema around the CN II
A
homonymous hemianopia (visual deficit in left halves of both eyes)
22
Q
Sensorimotor findings below the shoulders indicate perfusion status of ___
A
corticospinal & spinothalmic tracts
23
Q
Focal lesions in the spinal tracts would present with ___
A
asymmetric changes on the contralateral side of the body
24
Q
Flexion of the big toe in response to stroking the plantar surface of the foot
A
positive Babinski’s sign
25
Cerebellar stroke occur due to occlusion of ___
vertebral-basilar arteries
26
Some S/S of cerebellar stroke
```
balance problems/falls
loss of coordination
vertigo
nystagmus
N/V
```
27
Typical S/S of a cerebral hemispheric stroke
Sensorimotor deficits
| Deficits based on special functions of that hemisphere
28
Left hemisphere specific stroke deficits
Speech
| Cognitive ability
29
Left hemisphere specific stroke deficits affecting speech
aphasia/dysphasia, comprehension, expression
30
Left hemisphere specific stroke deficits affecting cognitive ability
math, organization, reasoning, analysis
31
Right hemisphere stroke deficits:
```
Spatiality
left-sided neglect
Insight (introspect)
Creativity
Face recognition
Musical ability
```
32
Hemorrhagic stroke typically causes the PT to experience
intense headaches
Neck pain
Light sensitivity
N/V
33
Immediate nursing interventions for BA
O2
manage BP
Monitor/control cerebral edema (head of bed @ 30º
34
S/S of bacterial meningitis
```
Meningeal edema
Increased ICP
Photophobia
Headache
Restlessness
Decreased LOC
N/V
Neck stiffness
```
35
bacterial meningitis can present with these skin conditions
Petechiae, Purpura
36
Types of Alzheimer's dz
Familial Alzheimer's (FAD)
| Sporadic (non-hereditary)
37
3 assessment points for stroke
LOC/VS (autonomic)
Sensorimotor status
Reflexes
38
Alzheimer's is thought to be caused by:
genetic mutation of amyloid proteins that results in abnormal amyloid accumulation which forms plaque-like material
39
Plaque-like material formed by abnormal accumulation of amyloid in Alzheimer's patients
senile plaques
40
Formation of twisted microtubules of brain neurons
neurofibrillary tangle
41
Senile plaques & neurofibrillary tangle combine and ___
disrupt normal nerve impulses in the brain
42
Clinical manifestation of Alzheimer's
dementia
| Motor changes if posterior frontal lobe involvement
43
Parkinson's dz involves negative effects on this anatomical structure ___
extrapyramidal motor tracts
44
the Extrapyramidal system is responsible for:
fine motor movements
45
Normal basal ganglia function depends on ___
ACh (acetylcholine) & dopamine
46
Acetylcholine has an ___ effect on ACh receptors that initiate movement
excitatory
47
An excitatory effect of a neurotransmitter is also called a ___ effect
Cholinergic
48
Dopamine has a __ effect on ACh receptors that initiate movement
inhibitory
49
Parkinson's is a ___ dysfunction
basal ganglia
50
The cause of Parkinson's is thought to be:
genetic, viral, or environmental toxin-induced depletion of dopamine
51
A decrease in dopamine disrupts ___ causing ___
the balance of neurotransmitter effects, causing acetylcholine to have a stronger effect
52
Increased __ effects of dopamine depletion causes the S/S of Parkinson's
cholinergic
53
S/S of Parkinson's are related to ___
hypertonia & dyskinesia
54
S/S of Parkinson's are dubbed "___"
Parkinsonianisms
55
Inability of Parkinson's PTs to adjust posture when tipping or falling results in what is termed ___
Basal Ganglion gait
56
Medications that treat S/S of Parkinson's include medications that:
contain Dopamine to counter the neurologic decrease;
| have anti-cholinergic effects (Benadryl)
57
Common autoimmune disorder with onset between ages 20-50, that effects women 2X more than men
Multiple Sclerosis
58
The name "Multiple Sclerosis" is based on the pathology of MS, in which:
T cell attacks causes demyelination in multifocal ("multiple") locations, which heals by forming scar tissue that hardens over time (sclerosis)
59
___ are effected by the scarring & hardening of MS
neuroglia
60
Demyelinated nerve axons transmit impulse ____ compared to normal axons
10X slower
61
Hemorrhagic stroke is caused by ___
the effects of blood leaking directly onto brain tissue, causing inflammatory processes
62
A diffuse brain/brain stem stroke is caused by an event that causes ___
the whole brain to become hypoxic and edematous with increased ICP
63
S/S of MS
Paresthesias
Asymmetrical weakness
balance/coordination issues if cerebellum involved
64
Severe episodic headaches that occur in a typical pattern
Migraines
65
Common pattern of a migraine
Prodrome
Headache
Postdrome
66
Migraines are thought to be caused by
a trigger event in genetically predisposed people
67
Triggers of migraines can include:
chemicals in certain foods (cheese, wine, chocolate)
| or stressful events, smells, sounds, etc.
68
Medication taken at the first sign of a migraine prodrome
Immitrex (abortive drugs)
69
Define Dementia
chronic dysfunction of memory and/or function that develops over time
70
Types of events that can contribute to a thrombotic or embolic stroke
Afib
Carotid atherosclerosis
air emboli
clots around mitral/aortic valve prosthesis
Development of intracranial artery plaque
71
The corticospinal tracts function to:
carry impulses that produce voluntary skillful movement from the brain
72
Define Nystagmus
rhythmic, involuntary, unilateral or bilateral movement of the eyes
73
Sudden, explosive, disorderly discharge of brain neurons that cause transient alteration in brain function
seizure
74
Seizures can be caused by ___
congenital seizure disorder (epilepsy)
or
an acute problem
75
Examples of acute problems that can cause seizures
head injury
| stroke
76
Infection/inflammation of the meninges
meningitis
77
___ meningitis almost never causes sepsis
viral
78
Meningitis is most commonly caused by:
viruses or bbacteria
79
Most common cause of bacterial meningitis
meningococcus & pneumococcus
80
___ meningitis causes worse S/S and clinical picture than ___
bacterial; viral
81
S/S of meningeal inflammation around the brain
```
photophobia
blurred vision
headache
restlessness
irritability
decreased LOC
```
82
S/S of meningeal inflammation around the spinal chord
neck stiffness
| positive Brudzinski's and/or Kernig's signs
83
Other more generalized S/S of meningitis
fever
leukocytosis
petechiae & purpura
84
Petechiae & purpura in meningitis is caused by
bacterial toxins inflaming subdermal vasculature
85
Diagnosis of meningitis is done by ___
CSF analysis via spinal tap
86
CSF is analysis when suspecting meningitis would bee focusing on looking for:
high WBC
high protein count
lower than normal glucose
Blood
87
The synapse between the neuron & the effector muscle
neuromuscular junction
88
NMJ functions involve:
balance of events that result in muscle movement
89
Some functions of the NMJ resulting in muscle movement include:
releasing ACh
binding ACh to ACh receptors
Releasing cholinesterase
90
Cholinesterase functions to __
break down leftover ACh that isn't used
91
anything that decreases ____ and/or increases ___ results in muscle weakness
ACh production/reception
| Cholinesterase production
92
___ is an example of a disorder of the NMJ
Myasthenia Gravis
93
Thymic tumor or other changes in the thymus are sometimes associated with this autoimmune dz
Myasthenia Gravis
94
The causative action in Myasthenia gravis
self-produced antibodies block, alter, or destroy ACh receptors
95
S/S of Myasthenia Gravis
Progressive muscle weakness that increases during periods of activity & decreases during rest
96
Pathology of progressive muscle weakness during motor activity (Myasthenia Gravis)
Autoantibodies destroy ACh receptors, so even normal reductions in ACh quickly result in inability to complete the nerve transmission
97
Muscle weakness in Myasthenia Gravis can include muscles that control ___
eye/eyelid movement, facial expressions, chewing, talking, swallowing, and neck/limb movements
98
Medication based TX for Myasthenia gravis include:
Anti-cholinesterase drugs
| Steroids
99
Pupillary dilation upon exposure to less light
mydriasis
100
Mydriasis results from ___
the sympathetic nervous system secreting norepinephrine & stimulating alpha-1 adrenergic receptors
101
Mydriasis is a(n) ___ effect
adrenergic
102
Pupillary constriction
miosis
103
Miosis results from ___
parasympathetic nerve fibers in CN II releasing ACh
104
Miosis is a(n) ___ effect
cholinergic
105
"same side" effect
ipsilateral
106
Double vision
diplopia
107
Inflammation/edema of the optic nerve
Papilledema
108
Papilledema is caused by
blockage of veinous return from the retina, mainly from increased ICP
109
Protein coagulation in the lens of the eye
Cataracts
110
Age-related increase in intraocular pressure
Glaucoma
111
#1 cause of blindness
Glaucoma
112
S/S of this include painless, slow loss of peripheral vision
Open angle glaucoma
113
"Acute glaucoma"
Closed angle glaucoma
114
Severe, irreversible loss of central vision due to destruction of a central part of the eye
Macular degeneration
115
Risk factors for Macular degeneration include
HTN
Smoking
Caucasian race
Diabetes
116
S/S of Macular Degeneration
clear peripheral vision with black spots in central vision
117
Posturing (decerebrate/decorticate) in a stroke victim is caused by
brain stem involvement
118
Breathing pattern change seen in brain stem stroke PTs
Cheyne Stokes breathing
119
Cerebellar strokes may present with problems including
balance, vertigo, incoordination
120
Mydriasis occurs in response to:
the SNS releasing Norepinephrine
121
Externally visible S/S of a diffuse stroke
bilaterally weaker sensation, muscle tone, movement, strength, and reflexes
122
Pressure required to get oxygenated blood to perfuse the cells of the brain
Cerebral perfusion pressure
123
Possible S/S of Alzheimer's
Dementia
behavioral changes
emotional upset
possible motor/gait changes
124
Unequal pupils cann indicate
neuro disorder such as increased ICP or intracranial hemorrhage
125
Damage to CN III will cause what?
Abnormal pupil dilation due to loss or diminishing of pupillary constriction abilities
126
What rules sensorimotor status below the shoulders?
Corticospinal and spinothalmic tracts
127
What rules sensorimotor status above the shoulders?
12 cranial nerves
128
Typical S/S of a cerebellar stroke
Problems with coordination & balance
129
Pathological changes of a focal lesion of the motor tracts will be
unilateral & contralateral
130
Crossing over of nerve fibbers from the motor tracts
decussation
131
Acute state of confusion due to problems such as high fever, electrolyte imbalances, etc.
delirium
