Neuro Flashcards by Ella Coleman

What makes up the CNS?

1) Brain
2) Spinal Cord
3) Cranial Nerves I & II

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What makes up the PNS?

1) CN III - XII & Spinal nerves
2) Peripheral components of autonomic nervous system

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What is responsible for control and integration of body’s activities

Nervous system

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What are the 2 types of cells of the Nervous System?

Neurons & Glial cells

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What are the characteristics of neurons?

1) Excitability
2) Conductivity
3) Influence

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What is the purpose of neurons?

Initiate, receive, and process events inside/outside the body

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What are the structures of the neuron?

1) Cell body
2) Dendrites
3) Axon

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Name the neuronal structure:
Nucleus and cytoplasm

Cell body

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Name the neuronal structure:
Receives impulses

Dendrites

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Name the neuronal structure:
Carry impulses, myelinated/unmyelinated

Axon

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True or False:
Unmyelinated axons transmit action potentials faster that myelinated axons

False- myelinated is faster than unmyelinated

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What is the role of glial cells?

Support, protect, nourish neurons

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What are the types of glial cells?

1) Microglia
2) Macroglia

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What are the types of macroglia?

1) Astrocytes
2) Oligodendrocytes
3) Ependymal cells

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What cells perform phagocytosis?

Microglia

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What cells provide structural support for neurons, and are located in grey matter?

Astrocytes

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What cells provide only structural support for neurons?

Macroglia

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What cells role is the production/regulation of CSF?

Ependymal cells

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What is the junction between neurons?

Synapse

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What are the excitatory neurotransmitters?

1) Epinephrine
2) Norepinephrine
3) Glutamate

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What are the inhibitory neurontransmitters?

1) Serotonin
2) GABA
3) Dopamine

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What is saltatory conduction?

The jumping/hopping to accelerate electrical impulses across the myelin

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What perform saltatory conduction?

Nodes of Ranvier

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What are the components of the CNS?

1) Cerebrum
2) Brainstem
3) Cerebellum
4) Spinal Cord

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What are the components of the brainstem?

1) Midbrain 2) Pons 3) Medulla

What is the function of the brainstem?

Relay signals from brain to the rest of the body

What are the lobes of the cerebrum?

1) Frontal 2) Temporal 3) Parietal 4) Occipital

What are the components of the cerebrum?

1) Right and left hemispheres (4 lobes) 2) Basal ganglia 3) Thalamus 4) Hypothalamus 5) Limbic system

What are the functions of the frontal lobe?

1) Cognitive function 2) Memory retention 3) Voluntary eye movement 4) Voluntary motor movement 5) Motor functions of speech (Broca's area)

What are the functions of the parietal lobe?

1) Interprets spatial information 2) Contains sensory cortex

What are the functions of the temporal lobe?

1) Somatic, visual, and auditory data 2) Wernicke's receptive speech area

What are the functions of the occipital lobe?

1) Processing of sight 2) Contains visual cortex

What is the function of Wernicke's area?

Helps with comprehension of speech

What does the basal ganglia control?

1) Learning 2) Voluntary movements 3) Emotional response 4) Automatic movements

What automatic movements associated with skeletal muscle activity does the basal ganglia control?

1) Swallowing 2) Blinking 3) Swinging arms while walking

What does the thalamus relay?

Sensory input from ... 1) Body 2) Face 3) Retina 4) Cochlear 5) Taste receptors

What does the thalamus connect?

Cerebellum and basal ganglia to frontal cortex

What does the hypothalamus control?

1) Hormone release from anterior pituitary 2) Satiety center and appetite 3) Body temp 4) Water balance 5) Circadian rhythm 6) Expression of emotion

What does the limbic system control?

1) Emotion 2) Aggression 3) Feeding behavior 4) Sexual response

What does the brainstem control?

1) Reticular formation (sleep & arousal) 2) Sneezing 3) Coughing 4) Hiccuping 5) Vomiting 6) Sucking 7) Swallowing

Where are the ascending and descending fibers located?

Brainstem

What does the medulla control?

1) Respiratory 2) Vasomotor 3) Heart

What does the cerebellum coordinate?

1) Voluntary movement 2) Trunk stability 3) Equilibrium

Where does the cerebellum receive info from?

1) Cerebral cortex 2) Muscles 3) Joints 4) Inner ear

What does the cerebellum influence?

Motor activity through... 1) Thalamus 2) Motor cortex 3) Brainstem

How many ventricles are in the brain?

What does CSF do?

Cushions, fluid shifts, carries nutrients

Name the vocab: -Centrally located -Contains cell bodies of various neurons

Gray matter

Name the vocab: -Surrounds gray matter -Contains axons of ascending sensory and descending motor fibers -Surrounded by myeline sheath

White matter

True or False: Ascending tracts are an afferent pathway to the brain

True

True or False: Descending tracts are efferent pathways exiting the brain to the body

True

Name the vocab: Carry impulses responsible for muscle movement

Descending pathways

Name the vocab: Carry sensory information to higher levels of CNS

Ascending tracts

Name the vocab: -Originate in cerebral cortex and project downward -Corticobulbar tract ends in brainstem -Corticospinal tract descends into spinal cord -Influence skeletal muscle tone

Upper Motor Neurons

Name the NS based on the components: 1) Spinal Nerves 2) Cranial nerves III-XII 3) Ganglia 4) ANS

PNS

What are the 2 branches of the ANS?

-Sympathetic -Parasympathetic

What is another name for motor-sensory nerves?

Spinal Nerves

What root brings afferent (sensory) impulses to the spinal cord?

Dorsal root

What root carries efferent (motor) impulses from the cord to the body

Ventral root

Name the vocab: Area of skin innervated by the sensory fibers of a single dorsal root of a spinal nerve

Dermatome

Name the vocab: Muscle group innervated by the primary motor neuron of a single ventral root

Myotome

Where are the preganglionic cell bodies of SNS located?

Spinal Segments T1-L2

Where are the preganglionic cell bodies of the PSNS located?

Brainstem & Sacral spinal segments S2-S4

True or False: In the SNS, your pupils constrict

False- SNS dilates pupils, PNS constricts them

Where is CN I cell body located?

Nasal epithelium

Where is the cell body of CN II located?

Retina

Where is the cell bodies of CN III-XII located?

Brainstem

What is the order of the CNs?

1) Olfactory 2) Optic 3) Oculomotor 4) Trochlear 5) Trigeminal 6) Abducens 7) Facial 8) Vestibulocochlear 9) Glossopharyngeal 10) Vagus 11) Spinal Accessory 12) Hypoglossal

What is CN I?

Olfactory

What is CN II?

Optic

What is CN III?

Oculomotor

What is CN IV?

Trochlear

What is CN V?

Trigeminal

What is CN VI?

Abducens

What is CN VII?

Facial

What is CN VIII?

Vestibulocochlear

What is CN IX?

Glossopharyngeal

What is CN X?

Vagus

What is CN XI?

Spinal Accessory

What is CN XII?

Hypoglossal

What do the internal carotid arteries (anterior circulation) supply?

Anterior & middle cerebrum

What do the vertebral arteries (basilar artery/posterior circulation) supply?

1) Middle & lower temporal lobes 2) Occipital lobes 3) Cerebellum 4) Brainstem 5) Parts of diencephalon

True or False: Collateral circulation is a harmful compensation mechanism

False- it is a good thing

What plays a key role in cerebral blood flow?

Circle of Willis

When does collateral circualtion occur?

When there is damage to a part of the brain & an artery close by provides oxygen/nutrients/circulation to the damaged area

What does the Circle of Willis connect?

Basilar and internal carotid arteries

What agents can easily enter the blood-brain barrier

Lipid-soluble

What agents enter the blood-brain barrier more slowly?

Water-soluble

What are the 3 layers of the meninges?

1) Dura 2) Arachnoid 3) Pia mater

What is the outer most layer of the meninges?

Dura

What is the innermost & most vascular/fragile layer of the meninges?

Pia mater

Name the vocab: -Between arachnoid and pia mater -Filled with CSF -Provides cushioning

Subarachnoid space

How many facial bones are in the skull?

How many cranial bones are in the skull?

What texture is the top and sides of the skull?

Smooth

What texture is the bottom of the skull?

Rigid/uneven

True or False: Pt is more likely to hemorrhage if there is brain trauma at the bottom of the skull

True

Name the vocab: 1) Protects the spinal cord 2) Supports head 3) Flexibility

Vertebral column

What are the purpose of ligaments in the vertebral column?

Attachment & alignment

What are the purpose of discs in the vertebral column?

Cushioning

How many individual vertebrae are in the vertebral column?

How many cervical vertebrae are in the vertebral column?

How many thoracic vertebrae are in the vertebral column?

How many lumbar vertebrae are in the vertebral column?

How many sacral vertebrae are in the vertebral column?

5 (fused)

How many coccygeal vertebrae are in the vertebral column?

4 (fused)

True or False: Pts with dementia and Alzheimer's struggle most with long-term memory

False- they struggle most with short-term memory

What are components of mood & affect that should be assessed when looking at mental status?

1) Agitation 2) Anger 3) Depression 4) Euphoria 5) Appropriateness of mood

What is the function of CN I, and is it sensory or motor?

Sensory --> smell

How do you assess CN I?

1) Close one nostril at a time 2) Identify easily recognizable odors

What is the function of CN II, and is it sensory or motor?

Sensory --> vision

How do you assess CN II function?

1) Visual fields --> peripheral vision (stand at side or behind) 2) Visual acuity --> Snellen Chart (recommend using index card instead of hand to cover eye)

What is the function of CN III, and is it sensory or motor?

1) Motor --> eye movement 2) Parasympathetic --> smooth muscle of eye

What is the function of CN IV, and is it sensory or motor?

Motor--> eye movement

What is the function of CN VI, and is it sensory or motor?

Motor--> eye movement

How do you assess CN II, IV & VI?

1) 6 cardinal positions of gaze 2) Pupillary constriction -- shine light into both pupils ***Normal pupil response = constriction of both pupils

What is the function of CN V?

1) Opthalamic branch 2) Maxillary branch 3) Mandibular branch

How do you assess CN V?

1) Close eyes and identify bilateral light touch and pinprick in each division 2) Clench teeth and palpate masseter muscle (should be strong bilaterally) 3) Corneal (blink) reflex --> pt looks up & away, put cotton wisp on the cornea and look for blink reflex

What is the functionn of CN VII, and is it sensory or motor?

1) Motor--> facial muscle/expression & cheek muscle 2) Sensory --> taste

How do you assess CN VII function?

1) Raise eyebrows, close eyes tightly, purse lips, exaggerate smile, frown

What is the function of VIII, and is it sensory or motor?

Sensory --> equilibrium, auditory, hearing

How do you assess CN VIII?

1) Cochlear --> close eyes, rustling of fingers next to ears 2) Consider Weber & Rhine tests

True or False: Vestibular is not normally tested unless vertigo, dizziness, unsteadiness & auditory dysfunction

True

What is the function of CN IX, and is it sensory or motor?

1) Sensory --> taste 2) Motor --> pharyngeal muscle

How do you assess CN IX & X?

1) Gag reflex 2) Have pt say "ahhh"

What is the function of CN X, and is it sensory or motor?

1) Sensory --> thorax & abdomen 2) Motor --> larynx & pharyngeal muscles 3) Parasympathetic --> heart, lungs, digestive system

What is the function of CN XI, and is it sensory or motor?

Motor --> neck muscles

How do you assess CN XI?

1) Shoulder shrug and head turn vs resistance

What is the function of CN XII, and is it sensory or motor?

Motor --> tongue muscles

What is the strength scale for the motor system & resistance

0-5

Name the resistance grading: No detection of muscular contraction

0/5

Name the resistance grading: Barely detectable flicker or trace of contraction with observation of palpation

1/5

Name the resistance grading: Acitve movement of body part with elimination of gravity

2/5

Name the resistance grading: Active movement against gravity only and not against resistance

3/5

Name the resistance grading: Active movement against gravity and some resistance

4/5

Name the resistance grading: Active movement against full resistance without evidence of fatigue

5/5

What is the following testing for: 1) Have ot close their eyes & hold arms out - palms up for 30 secs 2) Watch for rotation or fall of hand/arm

Pronator drift

What are abnormal motor system assessment findings?

1) Hypotonia 2) Hypertonia 3) Involuntary movemetns (tics, tremors, myoclonus) 4) Athetosis 5) Chorea 5) Dystonia

Name the vocab: Flaccidity

Hypotonia

Name the vocab: Spasticity

Hypertonia

Name the vocab: Slow, writhing, involuntary movements

Athetosis

Name the vocab: Involuntary, purposeless, rapid motions

Chorea

Name the vocab: Impaired muscle tone

Dystonia

What do the following tests assess for: 1) Posture while standing/pace/gait/ambulation 2) Finger-to-nose 3) Heel-to-shin 4) Shallow knee bend

Balance and coordination (cerebellar function)

What sensory test is the following: Have pt close eyes and move their finger up/down -- pt has to name direction

Position sense

What sensory test is the following: Write a simple number or letter in their hand and they must guess what is was

Graphesthesia

What is the following sensory test: Place basic object in pt hand & have them guess what it is

Stereognosis

What is the reflex grading scale on?

0-5

What are the sites that reflexes can be tested at?

1) Biceps 2) Triceps 3) Brachioradialis 4) Patellar 5) Achilles

Name the reflex grade: No response

Name the reflex grade: Weak, seen only with reinforcement

Name the reflex grade: Normal response

Name the reflex grade: Brisk response

Name the reflex grade: Hyperreflexia with non-sustained clonus (trembling)

Name the reflex grade: Hyperreflexia with sustained clonus

True or False: If you test for pain, you do not have to test for temp because they are on the same sensory tract

True

What different diagnostics tests are done for the nervous system?

1) LP 2) Cerebral Angiography 3) CT 4) MRI 5) Skull & spine x-rays 6) EEG 7) EMG

Name the diagnostic test: Getting CSF sample

Name the diagnostic test: Inject dye, looking at bloodflow

Cerebral Angiography

Name the diagnostic test: Very detailed imaging, takes longer than CT

MRI

Name the diagnostic test: Looking for fractures

Skull & Spine X-Rays

Name the diagnostic test: Looking for seizure activity

EEG

What are the 3 essential volume components for intracranial regulation?

1) Brain tissue 2) Blood 3) CSF

What is the normal ICP range?

5-15

What are the influential factors of ICP?

1) BP 2) Intra-abdominal/intrathoracic pressure 3) Posture 4) Temp 5) Blood gases, esp CO2

What ICP value is concerning?

>/= 20 mm Hg

Name the vocab: If one component (of 3 components) increases, another must decrease to maintain ICP **Only applicable to in tact skull

Monro-Kellie Doctrine

Where can you measure ICP with a transducer?

1) Ventricles 2) Subarachnoid space 3) Subdural space 4) Epidural Space 5) Brain tissue

Name the vocab: Amount of blood in mL passing through 100g of brain tissue in 1 minute

Cerebral blood flow

True or False: Women have bigger brains than men

False- Men have bigger brains (1300g) than women (1200g)

What 2 factors does the brain rely on?

Oxygen & glucose

What is the normal cerebral blood flow (CBF)?

50 mL/min per 100g of brain tissue

What is the normal MAP range?

70-150 mmHg

What does a MAP < 70 or > 150 indicate?

Autoregulation of vessels in the brain doesn't work well

What is the normal Cerebral Perfusion Pressure (CPP)?

60-100 mmHg

Name the vocab: Pressure needed to ensure blood flow to the brain

CPP

How do you measure CPP?

MAP - ICP

What does a CPP

Ischemia & neuronal death

What does a CPP

Ischemia & incompatible with life

What can cause increased ICP?

1) Injury 2) Tumors 3) Infection 4) Inflammatory disorders

Name the type of injury r/t increased intracranial pressure: Impact for initial trauma resulting in displacement, bruising, and damage

Primary

Name the type of injury r/t increased ICP: Result of hypoxia, ischemia, hypotension, edema, and increased ICP

Secondary

How soon after initial injury does a secondary injury occur r/t increased ICP?

Hours to days

What are the 3 types of cerebral edema?

1) Vasogenic 2) Cytotoxic 3) Interstitial

Name the vocab: Increased accumulation of fluid in extravascular spaces of brain tissue

Cerebral Edema

What is the most common type of cerebral edema?

Vasogenic

What does vasogenic cerebral edema result from?

Disruption of the blood-brain barrier

What are sx of vasogenic cerebral edema?

1) HA 2) ALOC 3) Unresponsiveness/coma

Name the type of cerebral edema: -Mainly in white matter -Disruption of the blood-brain barrier -Caused by tumors, injury, trauma, toxins -Fluid leaks from intravascular to extravascular space

Vasogenic cerebral edema

True or False: The blood brain barrier is damaged in cytotoxic cerebral edema

False- it remains in tact

Name the type of cerebral edema: 1) Disruption of cell membrane integrity 2) Secondary to destructive lesions or trauma to brain tissue 3) Blood-brain barrier remains in tact 4) Edema occurs from fluid & protein shift from extracellular to intracellular space

Cytotoxic

Name the type of cerebral edema: -Usually result of hydrocephalus -Tx with centriculostomy or shunt

Interstitial

What can cause intersititial cerebral edema?

1) Excess CSF production 2) CSF flow obstruction 3) Inability to reabsorb CSF

How does a VP shunt work?

Shunts CSF from ventricles in peritoneal space

What is an early sign of increased ICP?

1) LOC changes 2) Restless & anxious

What are S&S of increased ICP?

1) LOC changes/restlessness 2) Cushioning's triad 3) Ocular signs 4) Decreased motor function 5) HA 6) Projectile vomiting

What kinds of decreased motor function may you see with increased ICP?

1) Contralateral hemiparesis or hemiplegia 2) Decorticate posturing 3) Decerebrate posturing

What are the 3 components of Cushing's triad?

1) Increased SBP with widening pulse pressure 2) Bradycardia with full bounding pulse 3) Irregular respirations

Name the type of posturing: All four extremities in rigid extension with hyperpronation of forearms and plantar flexion of feet

Decerebrate

Name the type of posturing: 1) Flexion of arms, wrists, and fingers with adduction in upper extremities 2) Extension, internal rotation, and plantar flexion in lower extremities

Decorticate

Name the type of posturing: 1) Bridging/arching back with hyper reflexivity of muscles 2) Can indicate damage to the midbrain

Opisthotonic

True or False: Cerebral herniation is irreversible

True

What are the 3 types of cerebral herniation?

1) Tentorial 2) Uncal 3) Cingulate

What scale is used to monitor ICP?

Glasgow Coma Scale

What are sx of cerebral herniation?

1) Ischemia 2) Edema 3) ALOC 4) Cushionings Triad

What is the range of the GCS?

3-15

What score is concerning for GCS?

< 8

What is the normal amount of drainage of CSF?

5-15 mm Hg

What are tests are indications of altered ICP?

1) GCS

What is the normal rate for drainage of CSF?

30-120 secs

What amount of drainage of CSF is concerning?

> 20 mm Hg

True or False: Quick drainage of CSF can lead to cerebral herniation d/t quick pressure change

True -- want to be continuous (slow) or intermittent

Name the type of tool used to monitor ICP: 1) Sensor transducer found in catheter tip placed in ventricle 2) Direct measurement of brain pressure

Fiberoptic catheter

Name the type of tool used to monitor ICP: Air filled pouched that measures ICP

Air pouch/pneumatic technology

Name the test used to monitor ICP: 1) Speacialized catheter inserted ito ventricle with transducer 2) Directly monitors pressure within the ventricles 3) Facilitates removal and/or CSF sampling 4) Most used in hospital/ GOLD STANDARD

Ventriculostomy

What does the transducer have to be level with in a ventriculostomy?

Level with foramen of Monro

What do you need to do when repositioning pt with ventriculostomy?

1) Re-zero system 2) Clamp when moving

Name the test used to monitor cerebral oxygenation: 1) Placed in cerebral white matter (healthy tissue) 2) Measures brain temp

LICOX or Neurovent catheters

What is the normal range for LICOS/Neurovent catheters?

20-40 mm Hg

Name the test used to monitor cerebral oxygenation: 1) Measures global O2 extraction 2) Placed in internal jugular vein

Jugular venous bulb oximetry

What is the normal range for jugular venous bulb oximetry?

60-75%

What diagnostic test cannot be completed when measuring ICP because is decreases the ICP which could lead to herniation?

Lumbar puncture

What diagnostic studies can be done for ICP?

1) CT scan 2) MRI 3) EEG 4) Cerebral angiography 5) Transcranial doppler studies

What 2 main drugs are given for ICP alterations?

1) Mannitol 2) Hypertonic saline (3% saline)

Name the drug: 1) Plasma expansion & increases cerebral bloodflow/oxygen delivery 2) Osmotic effect 3) Given IV (w/ filter needle/tubing d/t crystallization)

Mannitol (Osmitrol)

Name the drug: 1) Moves water out of cells & into vessels 2) High alert med (can be fatal if given incorrectly)

Hypertonic saline

What needs to be monitored for a patient on mannitol?

F/e (by UO, Na+, and osmolality)

What needs to be monitored for a pt on hypertonic saline?

1) BP 2) Serum Na+

What side effect can occur from hypertonic saline?

Intravascular fluid volume excess

True or False: Mannitol is more effective at treating ICP than hypertonic saline

False- they are equally as effective

What corticosteroid can also be given to treat altered ICP?

Dexamethasone

What is the most important lab to monitor for a patient on dexamethasone?

Glucose q6h (verify no hyperglycemia)

What are 3 types of anti-seizure meds?

1) Diazepam 2) Lorazepam 3) Clonazepam

What are 2 types of antipyretics?

1) Acetaminophen 2) Ibuprofen

What are 2 types of sedatives that can be given?

1) Diazepam 2) Lorazepam

What are 2 types of barbiturates?

1) Pentobarbital 2) Thiopental

What do barbiturates do?

Decrease metabolic demand

True or false: Seizures and pain can increase ICP

True

True or False: Hypermetabolic and hypercatabolic state decrease the need for glucose

False- they increase the need for glucose

True or False: In pts with increased ICP, IV 0/9% NaCl is preferred

True

True or False: 0.9% NaCl can decrease serum osmolality in a pt with increased ICP

False- D5W can decrease serum osmolality

What 3 factors does the GCS scale look at?

1) Eyes open (1-4) 2) Best verbal response (1-5) 3) Best motor response (1-6)

What is a normal result for oculocephalic (doll's eye) reflex?

Eyes stay looking up/centered

What patient's should you avoid doing the doll's eye reflex on?

Pts with cervical injuries

Name the test: 1) Put syringe of ice water into pt's ear 2) Normal response = pts eyes should move to corresponding ear

Oculovestibular (cold caloric) reflex

What med is usually used to manage anxiety and sedation with pts who have increased ICP?

Propofol

If giving paralytics, what else needs to be done

1) Intubation 2) Sedation 3) Analgesics

Are males or females more likely to experience head injuries?

Males --> d/t risk taking personailities

What are the biggest complications of scalp lacerations?

Blood loss & infection

True or False: The scalp is highly vascular, so a small lac can bleed profusely

True

Name the type of skull fracture: Crack, but still in line

Linear

Name the type of skull fracture: Part of bone separates from rest of skill & goes into brain tissue

Depressed

Name the type of skull fracture: Typically seen in depressed fractures

Compound

Name the type of skull fracture: Multiple linear fractures

Comminuted

What are the comps of skull fractures (3)?

1) Infections 2) hematoma 3) Tissue damage

What are the comps of basilar skull fractures?

1) CSF otorrhea 2) Bulging tympanic membrane 3) Battle's sign 4) Tinnitus 5) Rhinorrhea 6) Facial paralysis 7) Conjugate deviation of gaze 8) Vertigo

What type of skull fracture is a NG tube contraindicated?

Basilar

Name the vocab: Postoriccular ecchymosis (bruising behind ear)

Battle's sign

How do you perform a halo/ring test to check for CSF ororrhea?

1) Collect CSF fluid on tissue/paper towel 2) After about 2 minutes, see if RBCs have congreagted in the center

Name the type of skull fracture: 1) Exposure of brain to frontal air sinus 2) Possible air in forehead sinus 3) CSF rhinorrhea 4) Pneumocranium

Frontal

Name the type of skull fracture: 1) Periorbital bruising (racoon's eyes) 2) Optic nerve injury

Orbital

What are sx of a parietal skull fracture?

1) Deafness 2) CSF otorrhea 3) Bulging tympanic membrane 4) Facial paralysis 5) Loss of taste 6) Battle's sign

Name the type of skull fracture: 1) Oval shaped bruise behind ear (Battle's sign) 2) CSF otorrhea 3) Middle meningeal artery disruption 4) Epidural heamtoma

Temporal

What are the 2 types of head injuries?

1) Diffuse 2) Focal (localized)

Name the type of head injury: Concussion

Diffuse

Name the type of head injury: Contusion, hematoma

Focal

What would be the GCS of someone with a minor focal head injury?

13-15

What would be the GCS of someone with a moderate focal head injury?

9-12

What would be the GCS of someone with a severe focal head injury?

3-8

What are the sx of a concussion (diffuse injury)?

1) Brief disruption in LOC 2) Retrograde amnesia 3) HA 4) Short duration (few mins to weeks) 5) May result in post-concussion syndrome

What are the sx of post-concussion syndrome?

1) Persistent HA 2) Lethargy 3) Personality and behavior changes 4) Shortened attention span 5) Decreased short-term memory 6) Changes in intellectual ability

Name the type of head injury: Widespread axonal damage in white matter after mild, moderate, or severe TBI

Diffuse axonal injury

What are sx of a diffuse axonal injury?

1) Decreased LOC 2) Increased ICP 3) Decortication or decerebration 4) Cerebral edema

True or False: 70% of patients with a diffuse axonal injury live in a persistent vegetative state

False- 90%

Name the type of head trauma: 1) Bruising of brain in a focal area 2) Associated witha closed head injury (at fracture site) 3) Can cause hemorrhage, infarction, necrosis, edema 4) Coup-contrecoup injury

Contusion

What does "coup" mean in "coup-contrecoup injury"

Initial primary site of impact

What does countrecoup mean?

When the brain shifts to the back of the skill

True or False: Countrecoup can be worse than coup

True

What is the cardinal sign (trio) of a epidural hematoma?

Loss of consciousness --> brief lucidity --> decreased LOC

True or False: Epidural hematoma is a medical emergency

True

Name the vocab: Bleeding between the dura and inner surface of the skull

Epidural hematoma

Besides the cardinal signs, what are other sx of an epidural hematoma?

1) HA 2) N/V

Name the vocab: Bleeding between dura mater and arachnoid layer

Subdural hematoma

What is the most common cause of a subdural hematoma?

1) Veins that drain brain surface into saggital sinus **Can also be arterial

What are the 3 types of subdural hematoma?

1) Acute 2) Subacute 3) Chronic

What type of subdural hematoma are older adults most likely to experience?

Chronic

What is the time frame for an acute subdural hematoma?

24-48 hrs

What is the time frame for a subacute subdural hematoma?

2-14 days

What is the time frame for a chronic subdural hematoma?

> 20 days

Where are intracerebral hematomas (bleeding within brain tissues) found?

Frontal and temporal lobes?

What are the types of primary brain tumors?

1) Meningiomas 2) Gliomas 3) Hemangioblastoma 4) Metastatic tumors 5) Pituitary adenoma 6) Primary central nervous system lymphoma

What are the most common sites for metastatic tumors?

Lungs and breasts

What are the most common types of priamry brain tumors?

Gliomas

What is the most devastating type of glioma?

Glioblastoma multiforme (GBM)

What are the sx of a brain tumor?

1) HA --> worsens at night 2) Seizures 3) N/V 4) Cognitive dysfunction (memory) 5) Mood & personality changes 6) Motor & sensory loss 7) Aphasia

True or False: Mets are cancer that spread to the brain from elsewhere

True

What are the dx studies for brain tumors?

1) CT --> location 2) MRI & PET scans 3) Brain biopsy

Why is chemotherapy limited when treated brain tumors?

Chemo may have difficulty passing through blood-brain barrier

Name the type of neuro problem: 1) Acute inflammation of meningeal tissues aroun the brain and spinal cord 2) CNS entry through upper respiratory tract/bloodstream

Bacterial meningitis

What are the sx of bacterial menigitis?

1) Fever 2) Severe HA 3) N/V 4) Nuchal rigidity 5) Decreased LOC 6) Photophobia** 7) Increased ICP

What are dx studies for bacterial meningitis?

1) Blood cultures 2) LP 3) CT

What CSF level indicates bacterial meningitis?

> 500

What is the normal range for CSF?

15-45

What CSF level indicates viral meningitis?

50-500

What glucose levels are expected in a pt with bacterial meningitis?

5-40 (decreased) --> normal > 40

What antbx are given in bacterial meningitis that can penetrate the BBB?

1) Cephalosproins 2) Penicillins

What needs to be assessed for before an LP?

Increased ICP

When can you give antbx to a patient with suspected bacterial meningitis?

After a blood culture is drawn

True or False: For pts with bacterial meningitis, everyone in close contact of them needs to be treated

True

Name the neuro problem: Spread through direct contact with respiratory secretions

Viral meningitis

How do you test for viral meningitis?

Xpert EV --> rapid test of CSF

What are the 2 types of stroke?

1) Ischemic 2) Hemorrhagic

Name the type of stroke: Clot, inadequate blood flow

Ischemic

Name the type of stroke: Bleeding into the brain d/t insult to vasculature in the brain

Hemorrhagic

What are the non-modifiable RFs of stroke?

1) Age > 65 2) Gender 3) Race (AAs) 4) Hereditary

True or False: Women are more likely to develop strokes

False- men are more likely to develop, women are more likely to die from strokes

What are modifiable RFs of stroke?

1) Any disease that can be controlled w/ meds and lifestyle changes 2) Alcohol/smoking/inactivity 3) Sickle cell 4) Oral contraceptive use

How quickly does blood flow interruption alter neuro metabolism?

30 secs

How quickly does blood flow interruption alter normal metabolism?

2 minutes

How quickly after interruption in flood flow does cell death occur?

5 mins

What 3 factors affect blood flow?

1) BP 2) CO 3) Blood viscosity

How quickly does blood flow need to be restored to the penumbra to interrupt the ischemia cascade?

within 3 hours

What are the classifications of drug treatments for stroke

Thrombotic and embolic

What 2 drugs can be given for a stroke?

TPA & TNK

What is the time window for giving TPA & TNK?

4 hrs --> outside of this either monitor or send to surgery for clot removal

What stroke med can be given in just 1 dose?

TNK

Name the vocab: Temporary loss of neurologic function caused by ischemia, but no infarct/cell death

Transient ischemic attack (TIA)

What are the S&S of a TIA?

1) Tinnitus 2) Vertigo 3) Visual changes 4) Ptosis 5) Dysarthria 6) Ataxia 7) Bilateral or unilateral numbness/weakness

Name the vocab: Eye drooping

Ptosis

Name the vocab: Difficulty speaking

Dysarthria

Name the vocab: Trouble with balance

Ataxia

How long does a TIA usually last?

< 1 hr

What is the long-term tx for a TIA?

Prevent platelet aggregation (blood thinners--> ASA, Plavix, Aggrenox)

Name the type of stroke: 1) Injury to vessel and blood vlot formation 2) Vessel lumen narrowed d/t atherosclerotic plaque formation 3) Occlusion leads to infarction 4) 60% of strokes 5) HTN & Diabetes contribute to atherosclerosis

Thrombotic stroke

Name the type of stroke: 1) Embolus travels and occludes artery causing infarct 2) Occlusion at a narrowing or bifurcation 3) 24% of strokes

Embolic stroke

What are causes of an embolic stroke?

1) Heart problems 2) Long bone fractures (air & fat emboli)

What is the most common cause of a hemorrhagic stroke?

HTN

What are the sx of a hemorrhagic stroke?

1) Neuro deficits 2) Severe HA 3) N/V 4) Decreased LOC 5) HTN 6) Nuchal rigidity

True or False: Hemorrhagic strokes have a relatively good prognosis

False- they have a poor prognosis

Name the type of hemorrhage: 1) Bleeding into CSF space 2) "Silent Killer" --> no/minimal S&S until rupture

Subarachnoid hemorrhage

What are the causes of a subarachnoid hemorrhage?

1) Aneurysm ** 2) Trauma 3) Drug abuse (cocaine0

What are the sx of subarachnoid hemorrhage?

1) Severe HA 2) Neuro deficits 3) N/V 4) Seizures 5) Photophobia 6) Nuchal rigidity

What are the dx studies for a subarachnoid hemorrhage?

1) CT 2) Angio 3) LP

What is the tx for a subarachnoid hemorrhage?

1) Nimodipine (Ca+ Channel Blocker) 2) Tranexamix Acid (TXA) 3) Quiet environment 4) Keep SBP < 160 5) Surgery --> clipping/coiling

What tx may ICU do after surgical intervention for a subarachnoid hemorrhage?

HHH --> HTN meds, hypervolemia, vasoconstricting agent

Name the med: Antifibrinolytic --> helps prevent breakdown of clots that are already there to prevent hemorrhage

Tranexamic Acid (TXA)

What are the motor function CMs of a stroke?

1) Affects contralateral side 2) Loss of voluntary movements 3) Altered muscle tone & reflexes

What the the communication CMs of a stroke?

1) Receptive aphasia 2) Expressive aphasia 3) Global aphasia

What are the main alterations for CMs of Stroke?

1) Motor function 2) Communication 3) Affect --> exaggerated/unpredictable 4) Intellectual function 5) Spatial-perceptual deficits 6) Elimination issues

True or False: A CT can differentiate between an ischemic & hemorrhagic stroke & can tell if we can give TPA or TNK

True

What type of stroke can you not give TPA or TNK for?

Hemorrhagic

What different classes of meds are given for a stroke at home?

1) Antiplatelets 2) Anticoagulants 3) Statins

What does the stroke assessment BEFAST stand for?

Balance --> Eyes --> Face --> Arms --> Speech --> Time

Name the neuro problem: Sudden abnormal, excessive electrical discharge of neurons in the brain

Seizure disorder

What are the 4 phases of seizures?

1) Prodromal 2) Aural 3) Ictal 4) Postictal

Name the phase of seizure: Sensations or behavioral changes

Prodromal

Name the phase of seizure: Sensory warning

Aural

Name the phase of seizure: Full seizure

Ictal

Name the phase of seizure: Recovery (sleepy)

Postictal

What are the 2 types of seizures?

1) Generalized 2) Partial

Name the type of seizure: No warning, loss of consciousness after

Generealized

Name the type of seizure: Focal (localized) seizure in the brain affecting a particular part of the body

Partial

What are tonic-clonic seizures classified by?

Loss of consciousness and falling

What is the tonic phase classified by?

Body stiffens & cyanosis 10-20 secs

What is the clonic phase classified by?

Jerking of extremities 30-40 secs ***Protect their head

What is the postictal state of a tonic-clonic seizure characterized by?

Muscle soreness & fatigue ***No memory of seizure

Name the type of seizure: Usually children with numerous medical problems and rarely beyond adolesence

Absence (generalized)

What can absence seizures be precipitated by?

Flashing lights and hyperventilation

What can an atypical absence seizure be characterized by?

Staring spell and lip smacking *** lasts > 10 secs

True or false: Atypical absence seizures usually continue into adulthood

True

True or False: When someone has a focal-onset seizure, they will still have some level of awareness

True

True or False: Focal impaired awareness seizures means that the patient is in a "dreamlike" state

True

Name the comp of seizures: State of continuous seizure activity or condition when seizures recure in rapid succession without return to consciousness between seizures

Status Epilepticus

What is the most dangerous & fatal comp of seizures?

Convulsive status epilepticus

What can status epilepticus cause?

1) Ventilatory insufficiency 2) Hypoxemia 3) Cardiac dysrhythmias 4) Hyperthermia 5) Systemic acidosis

True or False: Pts with seizures need to have frequent BS checks because seizures use up a lot of glucose

True

What are diagnostic tests for seizures?

1) CBC 2) Urinalysis 3) Electrolytes 4) Blood glucose 5) CT/MRI 6) EEG

True or False: Serum blood levels are needed frequently in pts with seizures to monitor drug effectiveness

True

What class of drugs are used to treat seizures?

Anticonvulsants

What are some examples of anticonvulsants?

1) Dilantin 2) Depakote 3) Keppra 4) Tegretol 5) Ativan 6) Diazepam

What drug is used most frequently in the hospital to stop seizures?

Ativan

What is the typical rescue med that patients with seizure disorders have at home

Diazepam (intranasal or rectal)

What is the surgical tx for seizures?

1) Resection of focal area 2) Vagal nerve stimulation 3) Responsive neuro stimulation

What kind of diet is recommended for patients with seizures?

Ketogenic

What does a ketogenic diet do?

Reduces glutamate in brain to reduce GABA synthesis & make seizures less likely to occur

Name the disease: 1) Chronic, progressive, degenerative disorder of the CNS -- Autoimmune disease 2) Characterized by demyelination of the nerve fibers of the brain and spinal cord 3) Exact cause is unknown 4) Seen more in females 5) Onset 20-40 yrs old

Multiple Sclerosis

Where is MS most prevelant?

Temperate climates/further away from the equator

What are the motor S&S of MS?

1) Weakness 2) Paralysis 3) Spasticity 4) Diplopia (double vision)

What are the sensory S&S of MS?

1) Paresthesia 2) Blindness 3) Neuropathic pain

What are the cerebellar S&S of MS?

1) Ataxia 2) Nystagmus 3) Dysarthria (speaking) 4) Dysphagia

What are other S&S of MS besides motor, sensory, and cerebellar?

1) Emotional 2) Bowel and bladder issues 3) Sexual dysfunction

True or False: MS has a rapid onset with quick decline

False --> can be gradual with periods of exacerbation and remission

What are the dx studies of MS?

1) H&P 2) MRI 3) LP

What may the CSF show from an LP for MS?

Increased Immunoglobulin G and presence of oligoclonal banding

What may an MRI show for someone with MS?

Multiple lesions/plaques. inflammation, atrophy, tissue destruction

What are the types of disease modifying meds for MS?

1) Immunomodulators 2) Immunosuppressants 3) Monoclonal antibody 4) Sphingosine I-Phosphate Receptor Modulators

Name the MS drug class: Work on immune system directly by turning down and up certain proteins & regulates the progression of MS and inflammation

Immunomodulators

Name the MS drug class: Suppress certain parts of the immune system

Immunosuppressants

Name the MS drug class: Target the immune system, especially during early inflammatory stages

Monoclonal antibody

Name the MS drug class: 1) Provide symptomatic tx to try and give pt the best quality of life 2) Slows down progression of disease by suppressing the immune system

Spingosine I-Phosphate Receptor Modulators

What types of drugs are for sx management of MS?

1) Corticosteroids 2) Anticholinergics 3) Cholinergics 4) Muscle relaxants 5) Nerve conduction enhancers

What sx acronym is used for Parkinson's disease & what does it stand for?

TRAP --> Tremor, Rigidity, Akinesia, Postural instability

What is often the first sign of PD?

Tremor --> "pill rolling" at rest

Name the disease: 1) Dopamine deficit 2) Incident increases with age 3) Males > females 4) Exat cause unknown

Parkinson's disease

What are some potential environmental factors relating to PD?

1) Well water 2) Peticides/herbicides 3) Industrial chemicals 4) Wood pulp mills 5) Rural residence

What are comps of PD?

1) Dysphagia 2) Pneumonia 3) UTI 4) Skin breakdown 5) Lack of/impaired mobility

What 3 comps of PD contribute to fall risk?

1) Impaired mobility 2) Orthostatic hypotension 3) Shuffling gait

What is the aim of PD meds?

Correcting imbalance of CNS NTs

Name the drug class: 1) Enhance or release dopamine OR 2) Antagonize or block effects overactive cholinergic neurons in striatum

Antiparkinson drugs

What drug classes can be given for PD besides antiparkinsons?

1) Dopaminergics 2) Anticholinergics 3) Antihistamines 4) COMT inhibitors 5) MOAIs

What surgical txs can be done for PD?

1) Deep Brain Stimulation 2) Ablation

Name the autoimmune disease: 1) Fluctuating skeletal muscle weakness 2) Involves breathing, extraoccular muscles, eyelid, chewing, swallowing, speaking 3) Progressive weakness throughout day (feel best in morning)

Myasthenia Gravis

What factors can cause exacerbations of myasthenia gravis?

1) Fatigue 2) Illness 3) Trauma 4) Stress 5) Temp extremes

True or False: Myasthenia Gravis is highly variable from short term & remission to severe & progressive involvement

True

What are the 2 complications of a myasthenia crisis?

1) Aspiration 2) Respiratory insufficiency

What are the dx studies for Myasthenia Gravis?

1) H&P 2) EMG 3) Edrophonium test

What does an EMG look at for pts with MG?

Assesses muscle & nerve cells

What is the edrophonium test?

IV injection of edrophonium = rapid improvement in muscle strength (positive result for MG)

What is the surgical tx for MG?

Thymectomy

What drug classes are used to tx MG?

1) Anticholinesterase agents 2) Corticosteroids 3) Immunosuppressants

What do anticholinesterase agents do?

Enhance transmission at the neuromuscular junction (increase muscle strength)

What is the most common anticholinesterase agent used long-term to tx MG?

Mestinon

Name the disease: 1) Decline in level of function in 1 or more cognitive domains 2) Gradual onset

Dementia

What cognitive domains can be affected in dementia pts?

1) Complex attention 2) Executive function 3) Language 4) Learning and memory 5) Perceptual-motor 6) Social cognition

True or False: 60-80% of pts with dementia have Alzheimers

True

What are the most common causes of dementia?

1) Neurogenerative conditions 2) Vascular disorders

What is the most important risk factor for Alzheimers?

Age

Name the disease: Abnormal clumps (amyloid plaques) and neurofibrillary tangles in brain

Alzheimers

What are RFs for AD?

1) Age 2) 1st degree relative 3) CVD -- diabetes, obesity, smoking, high cholesterol 4) Head trauma

What are the dx tests for AD?

1) Time and change tests 2) Mini-Mental State Exam 3) CT/MRI

What is the most common cholinesterase inhibitor given to Alzheimers patients

Aricept

What drug classes are given to pts with AD?

1) Cholinesterase inhibitors 2) SSRIs 3) Antipsychotics 4) Benzodiazepines

True or False: Long-term memory goes before short-term memory in pts with AD

False --> Short-term goes before long-term

Name the type of spinal cord injury: 1) Result from direct physical trauma 2) Bone displacement, interruption of blood flow, traction/pulling on cord 3) Tearing or transection 4) Blunt or penetrating

Primary

Name the type of SCI: 1) Ongoing, progressive damage after initial injury (minutes to months later) 2) Edema, ischemia, and/or inflammation leading to cell death

Secondary

What is the acute phase after an SCI?

Spinal Shock

What are the characteristics of spinal shock?

1) Loss of DTRs and Sphincter reflexes 2) Loss of sensation 3) Flaccid paralysis below level of injury

What is the acute phase after cervical or upper thoracic (T6 & up) SCI?

Neurogenic shock

Name the vocab: Occurs from unopposed parasympathetic response d/t loss of SNS innervation

Neurogenic shock

What are CMs of neurogenic shock?

1) Vasodilation --> HypoTN (< 90 mmHg) 2) Venous pooling 3) Bradycardia 4) Temp dysregulation

What are the mechanisms of injury causing SCIs?

1) Flexion injury 2) Hyperextension injury 3) Compression fracture 4) Flexion-rotation injury

Name the level of SCI: 1) C1 to C8 injury 2) Can cause paralysis to all 4 extremities

Tetraplegia

Name the level of SCI: 1) T1 or lower injury 2) Paralysis and loss of sensation in legs

Paraplegia

True or false: The lower the level of SCI, the more function retained

True

True or False: The higher the SCI, the worse it is

True

What level of SCI would require intubation?

C1 & C2

Name the degree of SCI: Total loss of sensory and motor function below the level of injury

Complete

Name the degree of SCI: 1) Mixed loss of voluntary motor activity and sensation 2) Some tracts intact 3) 5 types

Incomplete (partial)

Name the type of incomplete SCI injury: 1) Motor paralysis, loss of pain/temp sensation below level of injury 2) Common in flexion injury 3) Sensations of touch, position, vibration, and motion remain intact

Anterior cord --> damage to anterior spinal artery

Name the type of incomplete SCI: 1) Damage to half of SC 2) Contralateral-loss of pain/temp sensation below level of injury 3) Ipsilateral-loss of motor function, light touch, pressure, position, and vibratory sensation 4) Typically seen in penetrating injury/trauma

Brown-Sequard

Name the type of incomplete SCI: 1) Motor weakness and altered sensation in upper extremities, along with burning pain 2) Lower extremities are usually not affected 3) More common in older adults 4) Hyperextension injury in degenerative disease

Central cord

Name the type of incomplete SCI: 1) Damage to lumbar & sacral nerve roots 2) Asymmetrical distal weakness, patchy sensation in lower extremities 3) May cause flaccid paralysis of lower extremities 4) Complete loss of sensation between legs and over buttocks, inner thighs, and back of legs 5) Flaccid bladder and bowel

Cauda Equina

Name the type of incomplete SCI: 1) Leg motor function may be preserved, weak, or flaccid 2) Decrease in/loss of sensation in perianal area 3) Flaccid bowel and bladder 4) Impotence (lack ability for erection or orgasm)

Conus Medullaris

What tools are used for spinal stabilization?

C-collar & backboard

What classes of meds are given to those with an SCI?

1) Glucocorticoids 2) Anticoagulants 3) Vasopressors

Name the type of SCI med: 1) Decrease inflammation 2) 24 infusion of high dose within 8 hrs of injury

Glucocorticoids

What is an example of a glucocorticoid used for SCIs?

Methylprednisolone

Name the SCI drug class: Maintain MAP for improved perfusion

Vasopressors

What are examples of vasopressors used for SCIs?

Phenylephrine & norepinephrine

Name the disease: 1) Return of reflexes after resolution of spinal shock in patients with T6 or higher injury 2) Exaggerated autonomic response to stimulus

Autonomic dysreflexia

What are causes of autonomic dysreflexia?

1) Full bladder/bowel (most common 2) Pressure sore 3) Infected toenail 4) Fold in bed sheets 5) Tight clothing 6) DVT

What are S&S of Autonomic Dysreflexia?

1) Increased BP 2) Bradycardia 3) Face flushed & diaphoresis above level of injury 4) Pounding HA 5) Increased spasticity 6) Anxiety/apprehension 7) Splotches on face and neck

Neuro Flashcards

(463 cards)