Topic 8.1 - General and Acute Neurological Dysfunction

Question 1

What structures are in the brainstem?

Answer 1

Medulla, pons, midbrain

Question 2

What structures are in the diencephalon?

Answer 2

The thalamus and hypothalamus

Question 3

What structures are found in the cereberum?

Answer 3

The basal ganglia and cerebral cortex

Question 4

Which spaces does CSF flow through?

Answer 4

Through ventricles and subarachnoid space

Question 5

What are some early signs of increase intracranial pressure?

Answer 5

–> LoC changes
–> Decreased PERRLA Reflex
-> Severe headache due to stretching of dura and blood vessels
–> Vomiting due to stimulation of emetic center in medulla
–> Papilledema due to swelling on optic disk

Question 6

What is papilledema?

Answer 6

Swelling of the optic disks
–> Blurred vision, double vision, or complete loss of vision

Question 7

How and why do the vitals change during increase in ICP?

Answer 7

ICF leads to cerebral ischemia:
Systemic vasoconstriction tries to provide more blood to the brain –> systemic BP rise
Baroreceptors respond to increase BP by slowing heart
Chemoreceptors respond to low CO2 levels by reducing RR.

Question 8

How are issues with ICF diagnosed?

Answer 8

Specimen taken from lumbar puncture
–> Test for increased pressure
–> Presence of blood (pink)
–> Presence of WBCs (yellow)
–> Abnormal proteins (Neoplasm)

Question 9

What is transtentorial hernia?

Answer 9

The movement of brain tissue from one intracranial compartment to another.

Question 10

What is an uncal herniation?

Answer 10

Rising intracranial pressure due to herniation of uncus.

Question 11

What are space occupying lesions?

Answer 11

Neurological diseases/masses/lesions that cause secondary damage by occupying space at the expense of the brain tissues and its blood supply.

Can lead to herniation

Question 12

What kinds of issues can cause space occupying lesions?

Answer 12

Intracranial hemorrhage, increased CSF, edema, Intracranial abscess and tumors.

Question 13

What is the most common brain tumour in children? How is it graded?

Answer 13

Astrocytoma - in cerebellum, occurs in childhood
Graded from type I-IV

Question 14

What kind of brain tumors are commons in young children?

Answer 14

Cerebellar and brainstem tumors

Question 15

What kind of brain tumors are most common in adults and emerge in mid-life?

Answer 15

Gliomas

Question 16

What are the most aggressive and common primary tumors in the adult brain?

Answer 16

Glioblastoma

Question 17

Where do glioblastomas usually develop? What symptoms’ do they cause? What is the prognosis?

Answer 17

Usually develop in the cerebral white matter - cause seizures, nausea, vomiting, headache

Infiltrates into other brain tissues, very difficult to operate on. Poor prognosis.

Question 18

Why are brain tumors so difficult to treat?

Answer 18

–> They are resistant to conventional radiation and chemo
–> They are difficult to remove by surgery
–> At time of diagnosis they are already quite large, and have likely migrated.

Question 19

Brain tumors are difficult to treat. What methods an be effective?

Answer 19

–> Angiogenesis inhibitors
–> Emergence of tumor treatment fields (electrical fields to disrupt tumor cell division)
–> Neutralize tumor with immune system

Question 20

What percentage of cardiac output does the brain use at rest?

Answer 20

20%

Question 21

What vessel circuit can compensate for a blocked internal carotid artery and prevent stroke?

Answer 21

The arterial circle of Willis

Question 22

What causes Transient Ischemic Attack?

Answer 22

Temporary localized reduction of blood flow to brain
–> Patrial occlusion of artery
–> Atherosclerosis
–> Small embolus
–> Vascular spasm

Question 23

What are the symptoms of a TIA?

Answer 23

Symptoms may be directly related to location of ischemia
–> Muscle weakness in arm/leg
–> Visual disturbances
–> Numbness
–> Transient aphasia or confusion

Question 24

How are TIAs treated?

Answer 24

Thrombolytic agents

Question 25

What is CVA?

Answer 25

A cerebrovascular accident is an infarction in the brain tissue that results in a lack of blood (stroke)

Question 26

_ minutes of ischemia can lead to irreversible nerve cell damage.

Answer 26

5

Question 27

What are the three kinds of strokes?

Answer 27

--> Occlusion by atheroma in large artery --> Sudden obstruction caused by embolus lodged in a cerebral artery --> Intracerebral hemorrhage due to severe HTN

Question 28

What kinds of conditions can predispose an individual to CVA?

Answer 28

Diabetes, hypertension, atherosclerosis, history is TIAs, aging, heart disease

Question 29

What lifestyle factors can predispose an individual to CVA?

Answer 29

Sedentary lifestyle, oral contraceptives, nicotine/tobacco

Question 30

What kind of cerebral aneurism is most common?

Answer 30

Berry Aneurism --> At bifurcation point of circle o Willis

Question 31

How are cerebral aneurisms treated?

Answer 31

Surgical treatment - high risk procedure, required early screening

Question 32

What might cause cerebral edema? What are the biggest concerns with this kind of edema?

Answer 32

--> Infectious agents are often to blame --> Increased pressure, disruptions in BBB and ischemic stroke are main concerns.

Question 33

What is meningitis?

Answer 33

Infection that results in swelling on the meninges.

Question 34

How can meningitis be detected in an CSF specimen?

Answer 34

Exudate from infection contains cell proteins, and other abnormal solid materials.

Question 35

Different age groups are susceptible to meningitis due to different causative organisms. What usually causes meningitis in neonates?

Answer 35

E. Coli

Question 36

Different age groups are susceptible to meningitis due to different causative organisms. What usually causes meningitis in young children?

Answer 36

H. influenzae

Question 37

Different age groups are susceptible to meningitis due to different causative organisms. What usually causes meningitis in children and young adults?

Answer 37

N. meningitides or meningococcus

Question 38

Different age groups are susceptible to meningitis due to different causative organisms. What usually causes meningitis in older adults?

Answer 38

S. pneumoniae

Question 39

What are some symptoms of meningitis?

Answer 39

--> Severe headache --> Back pain --> Photophobia --> Nuchal (neck) rigidity --> Vomiting, irritability, lethargy, fever, chills --> Progression of fever --> Kernig and Brudzinski's signs

Question 40

What might cause brain abscesses? Where might they spread to?

Answer 40

Localized infection area of necrosis surrounded by edema, or the site of injury or surgery. May spread to ear, throat, lung, or sinuses

Question 41

What kind of infection usually causes encephalitis?

Answer 41

Usually one of viral origin

Question 42

What is encephalitis?

Answer 42

infection of parenchymal or connective tissue in the brain and spinal cord, which leads to necrosis and inflammation.

Question 43

What are the early signs of encephalitis?

Answer 43

Headache, neck stiffness, lethargy, vomiting, seizures, and fever

Question 44

Western Equine Encephalitis: How is it spread? When is it more frequent? Who does it usually affect?

Answer 44

Spread by mosquitos - more common in summer months Common in young children

Question 45

St. Louis Encephalitis - which demographic does it affect most?

Answer 45

More serious for elders than for younger individuals

Question 46

What causes and spreads West Nile Fever?

Answer 46

A kind of encephalitis caused by flavivirus and spread by mosquitos

Question 47

Lyme Disease: Caused by which bacterium? Transmitted by what? Symptoms?

Answer 47

Spread by ticks carrying Borrelia burgdorferi. Symptoms include sore throat, dry cough, fever, headache, cardiac arrythmias, and neurological abnormities. Also causes encephalitis.

Question 48

What kind of HSV causes encephalitis?

Answer 48

Herpes Simplex I can cause encephalitis and extensive necrosis and hemorrhage in the brain.

Question 49

Ameobic Meningeocephalitis: Caused by which microorganism? Where is this found? Prognosis?

Answer 49

Caused by Naegleria flowleri amoeba, often found in warm water habitats. Rare but fatal.

Question 50

How does rabies reach the CNS?

Answer 50

By travelling up the neuron

Question 51

What are are the symptoms of rabies?

Answer 51

Headache, fever, respiratory failure, death. The virus also causes issues swallowing.

Question 52

Concussion: Cause? Symptoms?

Answer 52

Caused by sudden excessive movement of the brain from blow to head or whiplash type injury Can lead to amnesia and headaches, but usually recover within 24 hours.

Question 53

What is a contrecoup injury?

Answer 53

Bruising contralateral to primary concussion injury - may be secondary to accelerating or deceleration accidents.

Question 54

What is an epidural hematoma? When do symptoms usually arise?

Answer 54

Bleeding between the dura and the skull - symptoms arise within a few hours of injury

Question 55

What is a subdural hematoma?

Answer 55

Bleeding between the dura and arachnoid mater. A tear in the arachnoid will results in ICP

Question 56

What is a subarachnoid hemorrhage?

Answer 56

Bleeding between the arachnoid and pia mater - blood mixes with CSF

Question 57

What kind of hematoma is associated with traumatic bleeding from BVs at the base of the brain?

Answer 57

A Subarachnoid hemorrhage.

Question 58

What causes intracerebral hematoma?

Answer 58

Results from contusion or shearing injuries - may develop days after injury.

Question 59

What are some common causes for hematomas?

Answer 59

Automobile or motorcycle accidents, sports injuries, falls.