The Nervous System and Altered Mental Status Flashcards
(141 cards)
1
Q
4 Functions of the nervous system
A
Motor
Senstation
Regulation
Cognitive and intregative functions
2
Q
Functionality of the nervous system includes what two types of nervous system?
A
Somatic (voluntary)
Autonomic (involuntary)
3
Q
Voluntary Nervous system
A
Somatic
4
Q
Involuntary nervous system
A
Autonomic
5
Q
The autonomic nervous system includes the ___ and ____ systems
A
Sympathetic and parasympathetic
6
Q
CSF is produced in the ____ of the brain
A
ventricles
7
Q
Large vessels run where?
A
Between the dura and the brain
8
Q
CSF drains out through ducts to the _____
A
Subarachnoid space
9
Q
The largest part of the brain. Made up of two hemispheres.
A
Cerebrum
10
Q
Flip flop of the signals from the hemispheres that occurs in the spinal cord
A
Contralaterally
11
Q
Ribbon like strip of tissue that runs on the underside of the cerebrum. Allows the hemispheres to “chat.” Neural pathways between the left and right hemispheres.
A
Corpus callosum
12
Q
Frontal lobe is responsible for:
A
Personality, behavior, higher thought, executive function, speech, certain motor functions, intellect, emotion, “what makes you, you.”
13
Q
The ____ is in the frontal lobe and takes more time to develop than the rest of the brain. Why teenagers may not make good decisions.
A
Pre-frontal cortex
14
Q
The parietal lobe is responsible for:
A
Sensory response (except sight)
15
Q
The occipital lobe is responsible for:
A
Vision, language, coordination
16
Q
The _____ allows information from the right eye to go to the left brain and visa vera. Allows for depth perception and shading. In the occupital lobe.
A
Optic and chiasma
17
Q
The temporal lobe is responsible for:
A
Hearing, smell, memory, language coordination
18
Q
The cerebellum is responsible for:
A
Position, balance, coordination (proprioception)
Muscle memory
Pathways between hemispheres
19
Q
Proprioception
A
Positioning. Comes from eyes, inner ears and sometimes joints
20
Q
Where is the cerebellum?
A
Posterior, inferior aspect of the brain
21
Q
The diencephalon is where? And contains what?
A
On the top of the brainstem
Thalamus
Hypothalamus
22
Q
Information from the spinal cord goes through here. A type of spinal relay
A
Thalamus
23
Q
The hypothalmus is responsible for:
A
Homeostasis; hormones; emotions
Takes nerve impulses and starts interpreting them
Endocrine gland
24
Q
Connects the hemispheres (communicates via the corpus callosium)
Sensory processing
Reflexes
LOC
A
Midbrain
25
Respiration, pathways to cord, coordinates with cerebrum
Pons
26
Vital functions
Vasomotor center
Cardiac Center
DRG, VRG
Medulla
27
The Reticular activating system contains what two nerves? What are their functions?
Excitatory nerves-wakefulness,
| Inhibitatory nerves-sleepiness
28
To have consciousness, need to have:
Intact RAS and one functioning hemisphere
29
The brain needs a constant supply of:
O2 and glucose
30
Blood vessels that bring nutrients and blood to the brain. Run on underside of right and left hemispheres
Circle of Willis
31
The circle of willis creates____
Redundancy
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What artery in the circle of willis is where "shit can go bad" if there is a blockage?
Basilar artery
33
Arteries in the circle of willis
```
2 internal carotid
2 anterior cerebral
2 vertebral
1 basilar
2 posterior cerebral
```
34
Spinal nerve ends where?
Mid lumbar area
| Around L2/L3
35
Nerves that exit distal to the end of the spinal nerve (L2/L3) are the _____
Cauda equina
36
C
T
L
S
C=7
T=12
L=5
S=5
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When the spinal root exits the spinal cord it becomes:
Spinal nerves
38
Point of attachment for the vertebrae?
Transverse process
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Communication in the nerve roots occurs via
electrical and chemical changes
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Sensory nerves that send information to the CNS
Afferent
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Sends information from the CNS out
Efferent
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Dermatomes
Each spinal layer corresponds to a particular level of motor and sensory function. This can give us an guessimtate about where you may be affected in your brain based upon what is affected
43
```
Dermatomes corresponding to:
C7
T4
T10
L4-L5
S2-S3
```
```
Index finger
Nipple line
Umbilicus
Medial and lateral lower leg
Genitals
```
44
Cervical nerves innervate what?
Everything from the clavicles up
45
Cervical nerve that is the major parasympathetic player in the body?
Vagus nerve
46
The autonomic nervous system regulates:
```
Heart rate
Breathing rate
Blood pressure
Body temperature
Organ functions
```
47
Mental status assumption
If someone is altered, assume that normally is alter and oriented unless someone tells us otherwise
48
Altered mental status: subjective terms
Lethargy: Sleepy, sluggish, easily aroused
Stupor: Decreased responsiveness, noxious stimulus
Semi coma: Unresponsive, noxious stimulus
Coma: Unresponsive, unarousable
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Glasgow Coma Scale: Eye opening
Alert
Verbal
Painful
Unresponsive
50
Glasgow Coma Scale: Speech
```
Oriented (who, what, where, when, why)
Confused
Inappropiate
Incoherent
None
```
51
Glasgow Coma Scale: Motor function
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Obedience
Purposeful
Withdrawel
Flexion (decorticate)
Extension (decerebrate)
None
```
52
The Glasgow Coma Scale, unlike subjective terms is____. Why is used to evaluate altered mental status.
quantifable
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Flexion (decorticate) and extension (decerebrate) indicate____
Brain injury
54
Under what number is the glascow coma scale concerning?
8
55
Structural causes and indicators of an altered mental status
Usually rapid/sudden onset
| Usually present asymmetrically or signs are focal
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Metabolic causes and indicators of an altered mental status
Gradual onset
| Signs are generalized and symmetric
57
Altered mental status causes
```
Alcohol (M), acidosis (M)
Environmental (M) , epilepsy (S)
Infection (M)
Overdose (M)
Urema (M)
Trauma (S)
Insulin (M)
Psychogenic (M)
Stroke(S)
```
58
Constriction of pupils may be a result of:
Cholinergics
Pontine bleed
Opoid overdose
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Types of strokes
Occulsive Event
Hemorrhagic event
Transient event
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____ of strokes are occulsive events
| ____ of strokes are hemorrhagic events
80-85%
| 15-20%
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Adjacent parts of the brain control ____ of the body
Adjacent
62
Risk factors for a stroke
```
Atrial fibrillation
Smoking
Hypertension
Stimulants
High cholesteral
Age-Arterioscelerosis
Diabetes
Dialysis (b/c prone to hypertension, may throw clots)
Sickle Cell
```
63
Of the occulsive events, ____ of those will be thrombic
| and ___ of those will be the result of embolus
60%
| 40%
64
Narrowing of the cerebral arteries
Thrombosis
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Thrombosis
Narrowing of the cerebral arteries
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Is there typically pain and seizure associated with thrombosis?
No, gradual narrowing
67
Sudden occulusion of the cerebral artery from a clot
Embolus
68
ELVIS
Emergent Large Vessle Ischemic Stroke
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Why is a first time seizure in an adult concerning?
The seizure may be due to a CVA-occulsive event resulting from an embolus
70
Why do embolus result in seizures?
Because sudden occlusions result in an electrical activity issue
71
Clots for CVA embolus result from
Carotid artery, heart (from left side)
Fat (maybe from a long bone fracture)
Tumor
Air (diver)
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Onset and signs of CVA-embolus
Rapid onset, seizures common
73
Ischemic tissue that is not dead
Penumbra
74
Clot busting drugs that dissolve clots
Thrombolytics
75
Window for thrombolytics
5-6 hours
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Vessels that result from gradual narrowing of the cerebral vessels due to Thrombosis
Collateral vessels
77
Cautious about giving O2 for CVA because of a potential:
re-perfusion injury
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Increasing ICP is associated with a ____ event not a ____ event
Hemorrhagic
| Occulsive
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CVA, hemorrhagic event that results from a ruptured vessel
Aneurysm
80
An aneurysm can evolve overtime as a consequence of ____. Aso can be a result of a congential issue called ____
Abteriovenous malformation
81
Weakened wall of the artery. Like a balloon
Aneurysm
82
Ruptured vessel in the Intracerebral space versus subararachnoid space
Intracerebral is within the brain tissue. Subarachnoid is in the subarachnoid space
83
Which is worse, a ruptured vessel in the intracerebral space or subararachnoid space
Intracerebral space
84
A hemorrhagic event signs:
Sudden onset
Evolving focal signs
Severe headache-"thunderclap"
85
Signs of ICP:
Unequal pupils (ipsilateral pupil)
Posture-decorticate, decerebrate
Seizure
Cushing's response (hypertension, bradycardia, cheynes stokes respirations)
86
Unequal pupil
Ipsilateral pupil
87
Signs and systems similar to a cerebral vascular accident, but resolves within 24 hours of onset. Warning sign of things to come.
Transient ischemic Attack
88
Etiology of a TIA
Plaque, embolus, spasm
89
RIND and what it is associated with
Reversible ischemic neurologic deficit
| TIA
90
Signs and symptoms of a CVA
```
Aphasia (random words)
Dysarthria (slurred speech)
Facial droop
Dysphagia (difficulting swallowing)
Sensorium (changes are unilateral-visual changes, tactile changes, hearing in one ear)
Hemi or mono plegia or paresis involving the grip or gait
Neglect
Balance (vertigo)
```
91
Why may a stroke patient's balance be affected?
The cerebellum is affected
92
Random words
Aphasia
93
Slurred speech
Dysarthria
94
Difficulty swallowing
Dysphagia
95
Inflammation of the facial nerves. Unable to raise eyebrow or furrow forehead
Bell's Palsy
96
What position do you want to put a stroke patient in if they cannot manage secretions?
Lateral recumbent
97
FAST ED can help determine if there is a ____
Large Vessel Occulsive (LVO) stroke
98
LVO can have what type of intervention?
Surgical
99
Large Vessel Occulsions
Middle cerebral artery (MVA)
Anterior cerebral artery (ACA)
Posterior cerebral artery (PCA)
Basilar artery
100
Middle cerebral artery (MCA) signs:
```
Aphasia (left)
Neglect (right)
Hemiparesis
Deviated gase
Visual field deficit
```
101
Anterior cerebral artery (ACA) signs:
Hemiparesis
102
Posterior cerebral artery (PCA) signs:
Visual field deficit
103
Basilar artery signs:
Vertigo (because blockage in the cerebral artery will result in blockage in the cerebellum)
Dysconjugate gaze
Coma
Respiratory changes (perfusion to pons going down as well due to blockage)
104
FAST ED
Facial palsy: normal or minor droop=0, partial or complete droop=1
Arm weakness: Normal, no drift=0, drift/some effort=1, no effort against gravity=2
Speech deficit: normal=0, mild/moderate=1, severe asphsia=2
Time
Eye deviation: Normal/absent=0, partial=1, forced deviation=2
Denial/neglect: Normal/absent=0, extinction to bilateral stimulaneous stimulation in only 1 sensory modality=1, does not recognize own affected limb or orients only to one side=2
105
Benign headaches
Tension headache
Migraine
Cluster headache
106
Why is it important to ask about the onset of a migraine?
Most of the time a migraine's onset will follow the individual's predictable pattern. Goot to know because onset is similar to that of a stroke
107
Serious headache signs/symptions
Fever and neckstiffness-Meningitis
Sudden onset/thunderclap
Change in mental status
Change in neurologic function/change in focal deficits
New headache, different headache
Underlying disease: HIV, cancer, pregnancy
108
Why is a headache with HIV concerning?
Possible brain abscess due to bacterial infection
109
Why is a headache with cancer concerning?
Space occupying lesions lead to increased pressure in the skull
110
Why is a headache when pregnant concerning?
Hormonal changes, prone to emboli
111
What is a seizure?
Chaotic discharge of electricity int he brain
112
Presentation of a seizure:
Varies by where the chaotic activity in the brain is occuring-focal event
- follows a predictable pattern for each person
- if changes, indicates something is different and is a cause for concern
113
Causes of seizures:
```
Epilepsy-congenital
Head injury (recent or remote)
Tumor
Hypoxia
Hypoglyemia
Infection (abscess, meningitis)
Febrile
OD/poisons
EtOH withdrawl
Electrolytes (hypernutremia)
Pregnancy (eclampsya)
```
114
Primary seizures tend to be ____. Example:
Idiopathetic
| Epilepsy
115
If an alcohalic, DT's can start around ___ hours after your last drink
9
116
Seizures due to a remote head injury
Have persistent seizures due to a head injury from the past. Scar tissue due to injury may not resolve
117
Generalized seizures and sequence
```
Involve both hemispheres of the brain, usually involve loss of posture and/or consciousness, involves the RAS
Sequence:
Aura
Loss of consciousness
Tonic-hypertonic
Convulsion
Post ictal
```
118
Tonic seizure
Increased muscle tone, sudden onset, short duration (1/2 minute-minute), no LOC
119
Clonic seizure
Alternating contraction and relaxation of muscles. LOC varies
120
Myoclonic seizure
Sudden brief muscle spasm (when falling asleep or waking up)
121
Atonic seizure
Sudden loss of muscle tone, "drop" seizure, no LOC
122
What is the most common type of seizure?
Tonic and clonic or some combination
123
What type of seizures generally involve the RAS?
Generalized, why you are unconsious
124
Signs of generalized seizure
Loss of consciousness, oral trauma, trismus, incontinence
125
Treatment of generalized seizure
OPA/NPA
Protect patient
High flow oxygen
Lateral recumbent (if no trauma)-left lateral is best
126
Seizure where patient is "daydreaming"
Short duration
Altered mental status but no loss of posture
Absence, petit mal
127
Absence, petit mal seizures are common in what population?
Children
128
Simple partial, focal
Seizure where there is no loss of posture or consciousness. Isolated body part but seizure will begin to spread to adjacent body parts as adjacent areas in brain are affected. Jacksonian march.
129
Jacksonian "march"
When focal event spreads to adjacent part of body. Can (rarely) jump to other hemisphere and become a generalized seizure
130
Complex partial, psychomotor seizure
More of a behavioral component. Altered mental status. May be combative
Automatisms
131
Automatisms
Repetitive behavior, stuck in loop
| Lip smacking
132
Pseudoseizure
Psychogenic non-epileptic seizure
Purposeful behavior
Responds to voice
Not a post ictal period, no incontinence, will not accept an OPA or hurt themselves
133
Status epilepticus
Prolonged seizure activity (more than 5 minutes)
| More than one seizure without a lucid period
134
Consider what for status epilepticus
Aggressive airway management
Ventilation
ALS
Entry note
135
Medications for seizures
```
Dilatin (phenytoin)
Depakote
Phenobarbital
Keppra
Tegretol (Carbamazapine)
Topamax (Toperamate)
Neurontin
Lamictal (Lamotragine)
```
136
Neuromuscular disorders
```
Cerebral palsy
Multiple sclerosis
ALS
Muscular dystrophy
Parkinsons
```
137
Cerebral palsy
Congenital-due to some abnormality of developing brain
Higher likelihood in pre-term births
Variable presentation
Variable cause; prematurity, low birth weight, intrauterine infection, placental pathology, hypoxia (during development)
138
Multiple sclerosis
```
Autoimmune demyelinating disease
Women, child bearing age, Northern European
Average 30 years old
Highly variable
Changes in symptoms in time and in place
Weakness, numbness, blindness
Progressive or intermittent
Myline sheath covers nerves, as it degenerates, ability to conduct electricity and have neuromuscular interfaces decreases
```
139
Amyotrophic lateral sclerosis (ALS)
```
Progressive, incurable
Weakness, muscle atrophies
Spascity, no change in sensaton
Most commonly present in 60-70s
M=W (men and women in equal proportion)
Respiratory failure, inability to swallow
Death 3-5 years after diagnosis
Muscular atropy because neuromascular junctions are not working very well
```
140
Muscular Dystrophy
```
Family of genetic/inherited disorders
Progressive muscle weakness
Most commonly present in childhood
M>F
Weakness (of muscle), cardiomyopathy
Death in early 20s and 30s
More prone to CHF and other cardiac events
```
141
Parkinsons disease
```
Some genetic genetic predispositions
Chronic progressive disease
Movement disorder
Resting tremor
Rigidty
Slow movements
Gait distrurbance
Average age 70 year old
Neurotransmitters in brain, usually dopamine (decrease in dopamine)
Lose control of muscle group
```
