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112 Cards in this Set

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1. The balance between info going into the spinal cord through large nerve fibers and info going into the spinal cord through small nerve fibers.
Pain Theories/Gate Control
If more info in large nerve fibers there is __________. (pain related)
No or minimal pain
If more info in small nerve fibers ___________.
The pain exists in more detail and/or strength
Types of Pain
1. acute
2. Chronic
3. Cutaneous
4. Visceral
5. Referred
6. Neuropathic
7. Neuralgia
8. Complex Regional Pain Syndrome
9. Phantom
10. Headache
- Primary peripheral nerve fibers & receptors
- Spinal cord circuitry
- Pathways
- Thalamus & cortex integrate and modulate
- Subjective reaction
Pain Mechanisms & Responses
Pain Receptors
Nociceptors - free nerve endings
Distibrution of nociceptors
Widely distributed:
- Skin
- Dental pulp
- Some internal organs
- Periosteum
- Meninges
Nociceptors release these pain-producing substances (2)
- Bradykinin
- Prostaglandin: enhances bradykinin
Chemical Mediators (7)
- Histamine
- Potassium
- Serotonin
- Leukotrienes
- Acetylcholine
- Adenosine triphosphate
- Substance P
Neurological Exam (6 parts)
1. Mental status
2. Language and speech abilities
3. Cranial Nerve Exam
4. Motor Function
5. Reflexes
6. Sensory Tests
Location of Cerebrospinal Fluid(CSF) (3 locations)
- 4 ventricles
- Subarachnoid space
- Spinal column
Spinal cord Circuitry & Pathways

What are the two types of fibers within Peripheral Branches of afferent fibers?
- C fibers
- A-delta fibers
What peripheral branch is associated with:

- unmyelinated
- slow
- poor localization
- buring & aching
C fibers
What peripheral branch is associated with:

- myelinated
- fast tract
- precise location
- sharp pain
- withdrawal occurs before pain occurs
A-delta fibers
Clinical Manifestions of _______ ?
- increased HR, RR, BS(blood sugar)
- pallor or flushing
- dilated pupils
- diaphoresis
- decreased gastric acid secretion & mobility
- occasionally nausea
Acute Pain
Clinical Manifestations of ________ pain ?

- persistent or intermittent
- caused or aggravated by decreased endorphins
- more difficult to manage than acute pain
- normal HR, RR(resp. rate), & BP
- persistent adaptation
Chronic Pain
Pain Management in _________

- Degenerative changes lead to intermittent or continuous chronic pain
- Pain medication absorption may be altered due to loss of muscle mass
- progressive slowing of neurological response
Pain Management in Elderly
Pathology of _________

- uncontrolled discharge of brain neurons
- changes in brain function
- cerebral neurons hyperexcitability state
- change in extracellular Na+ and Ca+
- may have genetic basis
- Type to be determined where occurs in brain
Seizure Disorders
- Begins throughout cerebral cortex
- Includes both sides of cortex
- Consciousness lost
Generalized seizure
Precipitants of ________

- Idiopathic
- Brain trauma
- Brain infection
- Brain tumor
- Bleeding in brain
Generalized seizure
Types of generalized seizures (5)
1. Tonic-clonic
2. Tonic
3. Clonic
4. Atonic
5. Absence
Rhythmic contractions & relaxation (GRAND MAL)
Tonic-clonic seizure
- No motor manifestations
- Seen in children
- Staring and sudden cessation of activity
Absence seizure
Clinical Manifestations of _______ ?

- unconsciousness
- uncontrolled jerking
- short period of apnea
- salivation and frothing
- tongue biting
- incontinence
- positcal stage of stupor or coma
- followed by confusion, headache or fatigue
- Prodroma
Generalized seizure
- Arises from discreet focus
- One side of brain
- Consciousness is not usually lost
- May become generalized
- Idiopathic after brain damage
Partial Seizure (Petit Mal)
Types of Partial Seizure
1) Simple: Consciousness is not impaired
2) Complex: Consciousness is impaired
3) Status Epilepticus
Repeated seizures in rapid succession
Status Epilepticus
Partial seizure: consciousness is not impaired
Simple
Partial seizure: consciousness is impaired
Complex
Clinical Manifestations of ________ ?

- Facial movements and grimaces
- Jerking that spreads
- Experiences of sight, smell or sounds
- Tingling
- Alterations in consciousness
Partial seizure
Effects of _______ ?

- O2 demand increase 200%
- Brain hypoxia & damage
- Social isolation
- Reduced employment
- Lifelong social effects (children)
Seizures
Causes of ________ ?

- Severe hypoxemia
- Hypoglycemia
- Acidemia or alkalemia
- Dehydration
- Water intoxication
- High fever
- Drug abuse or withdrawal
- Toxemia in pregnancy
Seizure Disorders
Common term for Cerebral Vascular Accident
Stroke
Types of Strokes (3)
- Acute Brain Infarct (ABI)
- Intracerebral Hemorrhage
- Subarachnoid Hemorrhage
- 75% of all strokes; risk increases with age
Acute Brain Infarct (ABI)
Pathophysiology of _______ ?

- Thrombotic: occlusion of blood flow - atherosclerosis
- Embolic: 1-2 TIAs(transient ischemic attacks) before true embolic stroke.
-> Stroke develops over 24-hour period
ABI
- 15% of all strokes
- high mortality
Intracerebral Hemorrhage
Pathophysiology of _______ ?

- Brain vessel breaks -> ischemia & hypoxia
Intracerebral Hemorrhage
Contributing Factors to ________ ?
- vascular formations or angiomas
- trauma from blood ejected into brain tissue
- mechanical compression of surrounding tissues
- increased ICP(intracerebral pressure) = decreased CBF(cerebral blood flow)
Intracerebral Hemorrhage
- 10% of all strokes
- 25% of all stroke deaths
Subarachnoid Hemorrhage
Contributing Factors to ________ ?

- Ruptured aneurysms -most common
- Extravasation of blood
- CSF outflow obstruction
- Hydrocephalus increased ICP
- Delayed vasospasm
Subarachnoid Hemorrhage
Clinical Manifestations of ________ ?

- Mentation and emotion changes
- Speech & vision affected
- Movement affected
- Most changes are irreversible
- Severe HA & loss of consciousness (Hemorrhagic)
CVA
- Temporary numbness face or limbs
- Is reversible
- May precede CVA (Brain attack)
- Slurring of words
- Confusion, dizziness
- Changes or blackouts in vision
TIA (transient ischemic attack)
ischemia is related to ________
hypoxia is related to ________
1. low blood supply produced by vasoconstriction
2. low oxygen levels in blood
- increase in blood, brain tissue, and/or CSF causing increased pressure within cranial vault
Increased Intracranical Pressure
What is the problem underlying ICP?
Adding mass/volume to a closed cavity most common cause: cerebral edema
Types of Hematoma (4)
1. Epidural
2. Subdural
3. Intracerebral
4. Concussion
Accumulation of blood between skull and dura
Epidural Hematoma
Pathogenesis of _______ ?

- lucid period
- brief unconsciousness
- rapid progression of unconsciousness
Epidural Hematoma
Clinical Manifestations of _______ ?

- H/A
- change in LOC
- N/V
- motor dysfunction
Epidural Hematoma
Accumulation of blood between inner layer of dura
Subdural Hematoma
Pathogenesis of ________ ?

- not visible like the Epidural Hematoma
Subdural Hematoma
Accumulation of blood in cranial vault
Intracerebral Hematoma
Pathogenesis of _______ ?

- small bruises throughout brain
- no ability to drain/decrease pressure
Intracerebral Hematoma
injury to the brain when strikes the skull on side of impact
coup injury
injury to the brain when strikes the skull opposite to the side of impact
contracoup injury
flexing inward
decorticate posturing
flexing outward
decerebrate posturing
Most injuries result from compressive force or bending movement or combination of the two
Spinal Cord Injuries
Variable degree of loss of function secondary to partial disruption of the spinal cord (some pathways intact, some disrupted either permanently or temporarily)
Incomplete Spinal cord injuries
- injury predominantly in the central gray or white matter of the cord
- usually results from hyperextension
- characterized by disproportional greater upper motor impairment than lower
- central hemorrhagic necrosis and swelling
Central cord syndrome
- usually results from hyperflexion
- characterized by variable loss of motor and sensory function below the level of injury
- posterior cord function is maintained
- variable symptoms from complete motor and sensory loss below level of injury or ability to perceive light touch
Anterior cord syndrome
- usually from penetrating injury which has damaged one side of the cord
- characterized by motor loss on the same side and sensory loss on the opposite side of the injury
Brown Sequard syndrome
- complete disruption of continuity of all spinal pathways at one or more levels of the spinal cord
- The result is absent motor function, sensory and touch sensation and position to all areas enervated below the level of disruption
Complete spinal cord injury
- upper motor neuron loss
- increased muscle tone
Spastic paralysis
- lower motor neuron lss
- decreased muscle tone
Flacid paralysis
- An episode of exaggerated sympathetic reflex responses that occur because of lack of control from higher brain centers
- HTN, bradycardia, HA
- injuries from T6 and above
- triggered by full bladder or rectum
- stimulation of pain receptors
Autonomic dysreflexia
- injuries T4-T6 and above
- interruption of descending control of sympathetic outflow to blood vessels
- impaired venous return to the heart
Postural hypotension
- communication between hypothalamus and sympathetic effector responses below injury disrupted
Temperature regulation
- pooling of blood (2)
- Edema
- Deep Vein Thrombosis (DVT)
Pathophysiology of ________ ?

- viral infection of brain
- mosquito vector, herpes simplex, cytomegalovirus
- Nerve cell degeneration widespread
Encephalitis
Clinical Manifestations of _______ ?

- Edema & swelling are severe
- Areas of necrosis c/s hemorrhage
- increased ICP -> herniation
- Postinfection autoimmuneresponse
- Direct invasion of CNS
Encephalitis
Pathophysiology of _______ ?

- Caused by bacteria, also fungus or virus
- Bacteria release toxin -> Destroys meningeal cells -> Immune & Inflammatory response
- Spread of infection elsewhere in body
- exudate & edema increase ICP
- Secondary encephalitis
- Fever
- Delirium
- Confusion -> unconsciousness
- Seizures
- Paresis & paralysis
- Involuntary movement
- Abnormal reflexes
Meningitis
Clinical Manifestations of _______ ?

- Throbbing headache
- Photophobia
- Diplopia
- Tinnitus
- Nuchal rigidity
- Projectile vomiting
- Confusion & decreased responsiveness
- Fever
Meningitis
Extra Pyramidal Syndromes
- Tremor
- Chorea
- Athetosis
- Dystonia
- Hemiballismus
Pathophysiology of ________ ?

- Progressive loss of pigmented dopaminergic neurons in the substantia nigra and the presence of Lewy bodys
- Progressive destruction of nigrostriatal pathway
Parkinson's Disease
Clinical Manifestations of _______ ?

- Also called EPS symptoms (extra parametal syndrome)
-> Tremor - pill rolling, finger movements, hand & face tremors
- Rigidity
- Bradykinesia - slow movements, slow shuffling gait
- Imbalance
Parkinson's Disease
Pathophysiology of _______ ?

- Widespread patches of myelin destruction
Multiple Sclerosis
Clinical Manifestations of _______ ?

- Sensory & Mood disorders
- Spastic weakness & cerebellar signs
- Bladder dysfunction
Multiple Sclerosis
Pathophysiology of _______ ?

- Autoimmune disease
- Antibodies toward the acetylcholine receptor (AChR) at the neuromuscular junction (NMJ) of skeletal muscles
- Rapid fatigue of voluntary muscles
Myasthenia Gravis
Clinical Manifestations of _______ ?

- Early: Ptosis diplopia facial weakness
- Respiratory involvement
- Generalized weakness
Myasthenia Gravis
Pathophysiology of _______ ?

- Shrinkage & sclerosis in the corticospinal tracts and degeneration of the large anterior horn neurons noted in spinal cord & brainstem
Amytrophic Lateral Sclerosis
Clinical Manifestations of _______ ?

- muscle weakness often starts in UE
- Hyperreflexia & spasticity
Amytrophic Lateral Sclerosis
Brain Tumors (3 types)
1. Glioma's 40-50% of
2. Astrocytoma - benign
3. Glioblastoma - malignant
Epidemiology of _______ ?

- 2-4 million afflicted
- Typically develops after 65
- 5-7% over 65 develop disease
- 20% over 80 develop disease
Alzheimer's Disease
Pathophysiology of ________ ?

- Exact cause unknown
- Death of brain neurons (esp. nucleus basalis which releases acetylcholine)
- decrease choline acetylesterase
- Neuronal tangles (senile plaques)
- Early onset (3 gene defects)
Alzheimer's Disease
Neuronal cell bodies of motor control neurons
Basal Ganglia
Clinical Manifestations of _______ ?

- Slowly progressive forgetfulness
- decreased judgement
- Behavioral & personality changes
- Short-term memory loss (early)
- Long-term memory loss (later)
- Problems with math concepts
- Memory loss continues to increase
- Disoriented & confused
Alzheimer's Disease
A condition in which there is a lack of absorption, blockage of flow, or overproduction of the cerebral spinal fluid (CSF) found in the ventricals of the brain.
Hydrocephalus
Causes of _______ ?

- tumor
- infection
- prematurity
- bleeding inside the head
- birth injury
- abnormal blood vessel formation inside of the head
- trauma
Hydrocephalus
Manifestations of _______ ?

- a full or bulging fontanelle (soft spot located on top of the head)
- increasing head circumference
- seizures
- bulging eyes & an inability of child to look up with head facing forward
- very noticeable scalp veins
- increased irritability
- high pitched cry
- poor feeding
- vomiting exploding projectiles
- sleepiness or less alert than usual
- developmental delays
Hydrocephalus
A condition in which there is abnormal development of the back bones, spinal cord, surrounding nerves, and the fluid-filled sac that surrounds the spinal cord. Causes portion of spinal cord and surrounding structures to develop outside the body.
Spina bifida
mild form of spina bifida where spinal cord and the surrounding structures remain inside the baby but the back bones in the lower back area fail to form normally. May be hairy patch, dimple, or birthmark over the area of defect.
Spina bifida occulta (subset of spina bifida)
a moderate form of spina bifida in which a fluid-filled sac is visible outside of the back area, does not contain spinal cord or nerves.
meningocele (subset of spina bifida)
a severe form of spina bifida in which the spinal cord and nerves develop outside of the body and are contained in a fluid filled sac that is visible outside of the back area.
myelomeningocele (subset of spina bifida)
Manifestations of _______ ?

- weakness and loss of sensation below defect
- problems with bowel and bladder function
- hydrocephalus
myelomeningocele (subset of spina bifida)
Causes of _______ ?

- If all or part of the neural tube fails to close, leaves an opening known as open neural tube defect (or ONTD) somewhere along the spine.
Spina bifida (same as anencephaly)
Minimal development of brain, often brain lacks part or all of the cerebrum. There is no bony covering over the back of the head and there may also be missing bones around the front and sides of the head.
Anencephaly
Causes of _______ ?

- If all or part of the neural tube fails to close, leaves an opening known as open neural tube defect (or ONTD) somewhere along the spine.
Anencephaly (same as spina bifida)
Manifestations of _______ ?

- absence of bony covering over back of head
- missing bones around the front and sides of the head
- folding of the ears
- cleft palate - a condition in which the roof of the child's mouth does not completely close, leaving an opening that can extend into the nasal cavity
- congenital heart defects
- basic reflexes
- without cerebrum, there can be no consciousness and the baby cannot survive
Anencephaly
It is a life-long condition that affects the communication between the brain and the muscles, causing a permanent state of uncoordinated movement and posturing. May be the result of an episode that causes a lack of oxygen to the brain.
Cerebral palsy
Causes of _________ ?

- idiopathic
- occurs when there is abnormal development or damage to areas in the brain that control motor function.
- occurs in approximately 2-4/1,000 live births
- more common in boys, multiple births, and African-Americans
Cerebral palsy
Risk factors for _________ ?

- prematurity
- very low birth weight (especially babies weighing < 2.2lbs)
- viruses
- chemical/substance abuse during pregnancy
- infection
- bleeding in brain
- trauma
- complications of labor and delivery
Cerebral palsy
Manifestations of _______ ?

- classified according to the kind of motor function the child may have.
Cerebral palsy
spastic movements of the arms or legs. also called paraplegia
spastic diplegia
spastic movement in all four limbs (arms and legs)
spastic quadriplegia
spasticity affecting one half, or side, of the body (such as right arm and right leg)
spastic hemiplegia
spasticity in both sides of the body, but the amount of shaking is different when comparing the right side to the left side.
spastic double hemiplegia
involuntary (unable to control), purposeless, and rigid movement
athetoid
Additional complications of _______ ?

- seizures
- vision, hearing, or speech problems
- learning disabilities and behavior problems
- mental retardation
- respiratory problems
- bowel and bladder problems
- bone abnormalities, including scoliosis (a lateral, or sideways curvature and rotation of the back bones, giving the appearance that the person is leaning to one side)
Cerebral palsy
What are four common pediatric neural disorders?
1. Hydrocephalus (increased CSF)
2. Spina bifida (failure of the fetus's spine to close properly during the first month of pregnancy)
3. Anencephaly (no brain)
4. Cerebral palsy (communication problem between brain & muscles/ uncoordinated movement)
What disorer is characterized by a discharge of sympathetic nervous system impulses as a result of stimulation of the bladder, large intestine, or other visceral organs. Occurs in persons with certain spinal cord injuries. Symptoms may include bradycardia, profuse sweating, headache, and severe hypertension.
Autonomic hyperreflexia