Unit 3 CNS Flashcards by Honey-Marie de la Giroday

Descrive CVA (cerebrovascular accidents)/stroke.

a clinical syndrome characterized by a focal neurological deficit, due to an abnormality of the cerebral circulation

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Describe the blood supply to the brain.

Two internal carotid arteries anteriorly
- Ophthalmic, posterior communicating, anterior choroidal, anterior cerebral, and middle cerebral
Vertebral arteries posteriorly
Internal carotid and vertebral arteries communicate at the base of the brain through the circle of Willis.

http://postimg.org/image/8gfcmdt0b/

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Describe the cerebral vascular arteries.

Lateral View

http://en.wikipedia.org/wiki/File:Cerebral_vascular_territories.jpg

Medial View

http://en.wikipedia.org/wiki/File:Cerebral_vascular_territories_midline.jpg

Middle cerebral artery (upper body)

Anterior cerebral artery (lower body)

Occiptial (visual, etc.)

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What are the etiologies (risk factors) of a stroke?

Age
Gender
Race
High cholesterol levels
Cigarette smoking
Diabetes mellitus
Other risk factors
- Heart diseases
- Blood diseases
- Alcohol, cocaine and illicit drug use (Chlamydia pneumoniae)
- Sedentary life style

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What are the two types of stroke?

Ischemic strokes

Caused by an interruption of blood flow in a cerebral vessel and are the most common type of stroke, accounting for 70–80% of all strokes.

Hemorrhagic strokes

Caused by bleeding into brain tissue, usually from a blood vessel rupture caused by hypertension, aneurysms, arteriovenous malformations, head injury, or blood dyscrasias

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What is a thrombosis?

a solid mass of blood constituents (blood clot) formed within the vascular system in a living being

Predisposing Factors

Changes in the intimal surface of the blood vessel
Changes in the pattern of blood flow
Changes in the blood constituents

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What is an emobolism?

is a mass of material in the vascular system able to become dislodged within a vessel and block its lumen
- a piece of thrombus
- foreign bodies
- fat tissue
- bacterial organism

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What are the risk factors for a hemorrhagic stroke?

Hemorrhage

severe hypertension
aneurysm
congenital berry aneurysm
arteriovenous malformation
bleeding disorders

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What are signs and symptoms of a Cerebral Aneurysm?

Most small aneurysms are asymptomatic.
Large aneurysms may cause chronic headache, neurologic deficits, or both.
Other manifestations include signs of meningeal irritation, cranial nerve deficits,

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What are arterious malformations?

blood is shunted from the high-pressure arterial system to the low-pressure venous system without the buffering advantage of the capillary network.
The draining venous channels are exposed to high levels of pressure, predisposing them to rupture and hemorrhage

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What are the classes of stroke?

TIA
- presents with neurological deficit but will full recover within 24hr, warning sign of higher risk stroke in the future
- embolism most likely
Evolving stroke (stroke in evolution)
- progressing, begins with warm then moves to legs, most likely a thrombus (ischemia or small hemorrhage)
Completed stroke
- paralysis of R or L side
- R side stoke = language difficulties
- hemorrhagic or big thrmobus

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Descrive the pathophysiology of a stroke.

destruction of brain substance
edema of surrounding brain tissue
increased intracranial pressure

Ischemic

Cerebrovascular obstructions by an embolism or thrombus
central core of dead or dying cells surrounded by a penumbra (halo of cells recieving marginal bloodflow)
Cell in penumbra have marginal bloodflow and their metabolic activities are impaired. although areas undergoes an electrical failure, the structural integrity of the cells is maintained
Function of cells in penumbra depends on return of circulation, volume of toxic products produced by dying cells, degree of cerebral edema, and alterations in local blood flow.

Hemorrhagic

rupture of blood vessel
hemorrhage into brain tissue
focal hematoma
infarction
increased ICP by hematoma
edema

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What are the clinical manifestations of a stroke?

Clinical Manifestations are Determined:

by the cerebral artery that is affected
Size of the vessel – Lacunar infarct
by the area of brain tissue that is supplied by that vessel
By the adequacy of the collateral circulation
Presence or absence of cerebral edema and increased ICP
Ischemic (more focal) and hemorrhagic (more global)

See figure below for arteries (effects listed according to list below) (see page 1266 for more details), http://postimg.org/image/9mg9g3k8d/

anterior cerebral artery
middle cerebral artery
posterior cerebral artery
basilar and vertebral artery

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What is brain herniation?

There are four main types of brain herniation syndromes. These include the cingulate, central, uncal, and cerebellar tonsillar herniations described below:

Subfalcine (or cingulate) herniation:

A section of brain herniates under the falx cerebri. This can cause compression of the anterior cerebral artery.

Downward Transtentorial (or central) herniation:

The thalamic area herniates down over the tentorial notch. This can lead to decorticate posturing during which the individual’s body is in an extended position but the arms and wrists flex in response to pain.

Temporal Transtentorial (or uncal) herniation:

The medial part of the temporal lobe herniates down over the tentorial notch. This can lead to pressure on the brainstem and decerebrate posturing, often beginning unilaterally and progressing to involve both sides. Decerebrate posturing is full extension of the arms, legs, and back.
The paramedian arteries that branch off of the basilar artery may rupture due to excessive stretching. This will cause a characteristic brain bleed known as Duret hemorrhages. The result is usually fatal.
Uncal herniation can also create dilated pupils on the same side as the lesion. This is due to stretching of cranial nerve III.
Paresis (slight or partial paralysis) may also be present on the ipsilateral side (same side as the lesion). However, this is known as a false localizing sign because it is actually due to compression damage on the side opposite the lesion to an area known as the crux cerebri. This area is where the bulbar and corticospinal tracts run on their way to the spinal cord.

Cerebellar Tonsillar herniation:

Part of the cerebellum herniates through the foramen magnum. Neck stiffness, known as nuchal rigidity, is a common finding. Irregular respiration can quickly lead to cessation of breathing due to direct pressure on the medulla.

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What is conciousness and how is it measured (TQ)?

is a state of awareness of self and the environment and of being able to become oriented to new stimuli
rely on RAS (ascending fibers) for being alert
the content and cognitive aspects of consciousness are determined by a functioning cerebral cortex

Levels of Conciousness

Confusion – conscious but disorientated
Delirium - restless, delusions
Obtundation – decreased alertness with psychomotor retardation
Stupor – not unconscious, but no spontaneous activity
Coma - unarousable, unresponsive

http://www.smartdraw.com/examples/view/traumatic+brain+injury+-+glasgow+coma+scale/

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What tests can be used to investigation a brain head injury?

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General

Specific

Chest X ray
CT
?MRI
?arteriogram

Nursing interventions

Neurologic monitoring
Cerebral edema management
Seizure control
Medication administration

What are signs and symptoms of increased cranial pressure (TQ)?

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headache,
vomiting without nausea,
ocular palsies,
altered level of consciousness,
back pain and
papilledema.
pupillary dilatation,
abducens palsies,
and the Cushing’s triad.
- increased systolic blood pressure,
- a widened pulse pressure,
- bradycardia,
- and an abnormal respiratory pattern.

What are disorders of cognition?

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The term “dementia” refers to a syndrome of cognitive impairment

Caused by any disorder that damages large association areas of the cerebral cortex (cortical) or subcortical areas subserving memory and learning

What is dementia?

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Impairment of short- and long-term memory, associated with abstract thinking, impaired judgment, other higher cortical functions, or personality change

Caused by any disorder that permanently damages large association areas serving memory and learning

Progressive failure of cerebral functions that is not caused by an impaired level of consciousness

Classifications

Cortical
- Alzheimer and Pick diseases
Subcortical
- Parkinson and Huntington diseases
Cortical and subcortical
- Infectious and Creutzfeldt-Jakob diseases

Describe Alzhemier’s

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Etiology

Aging, genetic linkage – mutations in chromosome 21, 14 and 1

Pathophysiology

Cortical atrophy, loss of neurons
Particularly in the parietal and temporal lobes, hippocampus, basal forebrain
Associated ventricular enlargement

Pathological features

Senile plaques and neurofibrillary tangles
Amyloid beta derived from APP

What are the stages of alzheimer’s disease (TQ)?

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Initial change is subtle

Short-term memory loss
Mild changes in personality
Randomly forget important and unimportant details

Stage 1

Last for 2 – 4 years

Stage 2

Very mild

Stages 3 and 4 (Mild to moderate cognitive decline)

Performance issues in social or work
Decline in the ability to plan and organize
Seem subdued and withdrawn

Stage 5 – moderately severe

Assistance required for day to day activities

Stages 6 and 7 (Terminal stage)

Have to be institutionalized
the last stage of the disease.
Loss of ability to respond to the environment
Require total care
Bedridden
Death can occur as a result of complications related to chronic debilitation.

Why is weight loss an issue in Alzeimers?

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include loss of appetite secondary to deterioration of brain regions associated with feeding behavior and
functional and behavioral problems
- unable to chew
- forget to eat
- eat bad or expired food
- unable to feed themselves (skill loss)

What is Huntington’s Disease?

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Autosomal dominant inherited disorder
Progressive degeneration of the cerebral cortex and basal ganglia
Decreased neurotransmitter – GABA and GABA receptors
Occurs in younger age group (35-44)

Clinical Manifestations

progressive dysfunction of intellectual and thought process
loss of working memory
slow thinking
restlessness and irritability
Chorea – progressive rigidity
depression

Alzheimer and Huntington are diseases under the group ‘dementia” – a progressive degeneration of cognitive function due to organic causes.

What are the similarities and differences between this 2 (TQ)?

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What are other types of dementia?

Pick’s disease - frontotemporal dementia, very rare and poor prognosis [http://en.wikipedia.org/wiki/Pick's\_disease](http://en.wikipedia.org/wiki/Pick's_disease) Creutzfeldt-Jakob Disease [http://en.wikipedia.org/wiki/Creutzfeldt%E2%80%93Jakob\_disease](http://en.wikipedia.org/wiki/Creutzfeldt%E2%80%93Jakob_disease) Wernicke-Korsakoff Syndrome [https://en.wikipedia.org/wiki/Wernicke%E2%80%93Korsakoff\_syndrome](https://en.wikipedia.org/wiki/Wernicke%E2%80%93Korsakoff_syndrome)

What are the Primary functions of the: Frontal lobe Parietal lobe Temporal lobe Occipital lobe Higher order functions Supplementary areas, association cortex Limbic System Basal ganglion

What are the Primary functions of the: * Frontal lobe (motor, speech and language) * Parietal lobe (sensory) * Temporal lobe (part of limbic system) * Occipital lobe (vision Higher order functions * Supplementary areas, association cortex (motor and sensory integration) * Limbic System (emotions) * Basal ganglion (voluntary motor control)

What are the higher order functions of the frontal lobe?

* Abstract vs. concrete reasoning * Motivation/volition * Concentration * Decision making * Purposeful behavior * Memory, sequencing, making meaning of language * Speech organization and production * Aspects of emotional response

What are the higher order functions of the partiel lobe?

* Sensory integration and spatial relations * Bodily awareness * Filtration of background stimuli * Personality factors and symptom denial * Memory and nonverbal memory * Concept formation

What are the higher order functions of the temporal lobe?

* Visual-spatial recognition * Attention * Motivation * Emotional modulation and interpretation * Impulse and aggression control * Interpretation and meaning of social contact * Aspects of sexual action and meaning

What are the higher order functions of the occipital lobe?

* Meaningfulness of visual experience * Depth perception * Pattern, form and location in space

What are the functions of these areas of the brain? * Supplementary motor area * Premotor cortex * Posterior parietal cortex

Supplementary motor area – preparatory role in programming of complex sequences Premotor cortex – assists primary motor cortex Posterior parietal cortex – guides premotor cortex

Review this diagram to identify the primary and higher order functions of areas of the brain (TQ!). [http://postimg.org/image/hus496iil/](http://postimg.org/image/hus496iil/)

What are the primary functions of Werneke area and Brocca's area? If a patient's R side was paralyzed would they also have difficulties speaking?

* Werneck - understand language * Brocca's - speaking * 90% L side dominant * R side paralysis = difficulties speaking * L side paralysis = no difficulties

What types of aphasia are there?

* sensory (parietal/temporal) * can speak but it won't make sense * motor (frontal) * understand but cannot talk (prone to depression)

What parts of the brain make up the limbic system?

[http://postimg.org/image/xfdqobdq5/](http://postimg.org/image/xfdqobdq5/)

Describe how memory is acquired (TQ).

* Storage of acquired knowledge for later recall * Memory trace * Neural change responsible for retention or storage of knowledge * Short-term memory * Lasts for seconds to hours * Long-term memory * Retained for days to years * Consolidation * Process of transferring and fixing short-term memory traces into long-term memory stores * Two stages: 1) short term (consolidation), 2) long term [http://postimg.org/image/cw2mwco91/](http://postimg.org/image/cw2mwco91/)

What are the functions of the following neurotransmitters?

* acetylcholine * amines * dopamine, E, NE, and serotonin * aminoacids * GABA * Glutamate * Aspartate * Glycine [http://postimg.org/image/dewdi2iwt/](http://postimg.org/image/dewdi2iwt/)

Unit 3 CNS Flashcards

(37 cards)