diffuse brain injury
types:
-Classic concussion:
Transient cessation of respiration can occur with brief periods of _____, and a _____ in blood pressure occurs, lasting _____ seconds or less. Vital signs stabilize within a _____ to within normal limits.
bradycardia
decrease
30
few seconds
mild concussion
- Temporary _____ disturbances, causing _____ and _____ deficits but no _____ in grades I and II
- Grade I—Confusion, _____, and momentary _____, resolving within _____ minutes
- Grade II—Momentary _____ and retrograde _____
- Grade III—Confusion with retrograde and anterograde amnesia upon and after _____; _____ for seconds or minutes
axonal attention memory loss of consciousness disorientation amnesia 15 confusion amnesia impact loss of consciousness
classic cerebral confusion
- Grade IV
- -_____ and _____ dysfunction without substantial _____ disruption
- -Loss of consciousness (_____ hours)
- -Anterograde and retrograde _____
- -_____ (no focal injury)
- -_____ (focal injury)
physiologic neurologic anatomic <6 amnesia uncomplicated complicated
diffuse axonal injuries (DAIs)
-Focal brain injuries account for more than _____ of head injury deaths; DAIs accounts for less than one third.
-However, more severely disabled survivors, including those in an unresponsive state or reduced _____, have DAIs.
two-thirds
level of consciousness
older adults
-Because of _____ disorders, older adults are particularly at risk for minor trauma, resulting in serious _____ injury, especially from _____.
preexisting degenerative vertebral
spinal cord
falls
spinal cord injury
- Primary spinal cord injury (cont’d)
- -Most common locations are cervical (_____, _____, _____) and thoracic-lumbar (_____) vertebrae.
-Loss of _____, causing the body to assume air temperature
1, 2, 4-7
T1-L2
thermal control
upper cervical cord after spinal cord injury
-In the cervical region, spinal cord swelling may be life threatening because of the possibility of resulting impairment of the _____ function (phrenic nerves exit _____).
diaphragm
C3-C5
faulty control of sweating
- A spinal cord injury results in disturbed thermal control because the _____ is unable to regulate a damaged _____.
- This damage causes faulty control of _____ and _____ through _____.
hypothalamus sympathetic nervous system sweating radiation capillary dilation
The most likely rationale for body temperature fluctuations after cervical spinal cord injury is
-Spinal cord injuries result in disturbed thermal control because the _____ is damaged.
sympathetic nervous system
clinical manifestations immediately noted after a spinal cord injury
-A complete loss of _____ function in all segments _____ the level of the lesion characterizes a spinal cord injury. Severe impairment below the level of the lesion is obvious; it includes _____ and _____ in muscles, absence of sensation, loss of bladder and rectal control, transient drop in _____, and poor _____ circulation.
reflex below paralysis flaccidity blood pressure venous
degenerative disorders of the spine
-_____
herniated intervertebral disk
L5-S1 motor and sensory changes of the lateral lower legs and soles of the feet
-Clinical manifestations of posterolateral protrusions include _____ pain exacerbated by _____ and _____ (medial calf suggests _____; lateral calf suggests _____ root compression).
radicular movement straining L5 S1
cerebrovascular accident
-greatest risk factor: _____
hypertension
embolic ischemic stroke
-High-risk sources for the onset of embolic stroke are _____ (15% to 25% of strokes),_____ or _____, _____, recent _____, rheumatic valvular disease, mechanical prosthetic valve, nonbacterial thrombotic endocarditis, _____, patent _____, and primary intracardiac tumors.
atrial fibrillation left ventricular aneurysm thrombus left atrial thrombus myocardial infarction bacterial endocarditis foramen ovale
cerebrovascular accident
clinical manifestations
-depend on the artery affected
–contralateral weakness in _____, _____, and/or _____
arms
legs
face
Symptoms of an embolic stroke in only the right anterior cerebral artery
-Would include _____-sided contralateral _____ or _____ (greater in the foot and thigh) and mild _____ weakness with mild contralateral lower extremity sensory deficiency with loss of _____ and/or position sense and loss of _____.
left paralysis paresis upper extremity vibratory two-point discrimination
cerebrovascular accident:
lacunar stroke
-due to occlusion of _____
-classic syndromes:
–_____: posterior limb of internal capsule or basis pontis
–_____: posterior limb of IC/basis pontis and corona radiata
–_____: basis pontis
–_____: ventrolateral thalamus
–_____: thalamus and posterior limb of IC
- management- as for stroke
- px better: 3/4 independent at _____ year
deep penetrating arteries pure motor hemiparesis ataxic hemiparesis dysarthria/clumsy hand pure sensory mixed sensorimotor
lacunar stroke
-_____ is smaller than 1 cm in diameter and involves the occlusion of the _____.
- Microinfarcts resulting in pure _____ or pure _____ deficits
- Because of the _____ location and small area of _____, these strokes may have pure motor and sensory deficits.
Microinfarction small perforating arteries motor sensor subcortical infarction
migraine headache
-Migraine is diagnosed when it is not attributable to any other disorder and when any two of the following features occur: _____ head pain, _____ pain, pain worsening with _____, moderate or severe pain intensity; and at least one of the following: _____ or _____, or both, or _____ and _____
unilateral pulsating activity nausea vomiting photophobia phonophobia
headache syndromes
cluster headache
-The cluster headache attack usually begins without warning and is characterized by severe, unilateral _____, _____, _____, and retrobulbar or _____ pain lasting _____ minutes to _____ hours
tearing burning periorbital temporal 30 2
meningitis- inflammation of the brain or spinal cord
- _____ (TB)
- clinical manifestations
- -bacterial:
- –_____, _____
tubercular
Kernig sign
Brudzinski sign
Tubercular (TB) Meningitis
-Tubercular meningitis is the most common and serious form of _____
central nervous system (CNS) tuberculosis
Kernig sign, Brudzinski sign,
signs of meningism
-kernigs test:
–performed with the patient _____ or in a chair
–the hip and knee are flexed to _____ and attempt is made to _____ the knee
–the test is positive if the maneuver causes pain in the _____ or _____
brudzinskis test
-_____ of the neck causes flexion of the _____ and _____
supine 90 degrees extend neck back flexion hips knees
abscess
Abscesses may occur in association with a contiguous spread of _____, such as the _____, _____ cells, _____ cavity, and nasal _____.
infection middle ear mastoid cells nasal sinuses
