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132 Cards in this Set
- Front
- Back
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What does the cerebral cortex do?
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** higher centers of the brain
1. attention, concentration, membroy 2. affect, appropriateness of facial expressions 3. Communication 4. orientation |
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What are 5 types of cortex abnormalities?
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1. aphasia
2. agnosia 3. apraxia 4. Dementia 5. confusion vs aphasia |
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what is considered expressive aphasia
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Broca's aphasia - can follow commands but cannot answer you
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What is considered fluent aphasia?
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Wernickes - cant follow commands. but can speak
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What types of agnosia?
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1. visual 2. audiotry 3. tactile
***like they cannot tell you what something is until they feel it...doesnt work if they see it |
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What is apraxia?
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The ability to will something. Think about something. can move extremities, but cannot do it at will
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What are the meanings of dementia?
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D- drugs and alcohol
E - eyes and ear M - metabolic and endocrine disordres E - emotional disorders N - Neurologic disorders T - tumors and trauma I - infection A - Arteriovascular disease |
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CN I ?
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olfactory
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CN II ?
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Optic
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CN III?
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Oculomotor
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CN IV
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Trochelear
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CN VI
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Abducens
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CN V
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trigeminal
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CN VII
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facial
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VIII
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Acoustic
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CN IX
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glossopharygeal
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CN X -
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vagus
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CN XI
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spinal accessory
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CN XII
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hypoglossal
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What would you do for cerebellar exam?
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Finger to nose. alternation of coordinated movements
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Babinski is normal in
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babies...toes flare
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Pain or resistance with Kernigs
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knee-chest = meningtitis
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What is brudzinski sign
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Stiff neck....knees move with neck
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reticular activating system
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area of the brain (including the reticular formation and its connections) responsible for regulating arousal and sleep-wake transitions
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abnormalities of reticular activating system reflect
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global injury
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What is the GCS for eye opening
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4 - opens eyes spontaneously
3 - open eyes to verbal commands 2 - opens eyes only to painful stimuli 1 - does not open eyes to painful stimuli |
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What is GCS for motor
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6 - Obeys simple verbal commands
5 - localizes to painful stimuli 4 - flexion withdrawal 3 - abnormal flexion 2 - abnormal extension 1- no response |
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What is GCS for verbal
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5 - oriented and conversant
4 - confused 3 - verbalizes 2 - vocalizes 1 - no vocalization |
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What nerves are pupil response to light?
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III
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what CN is dolls eyes
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III & VI
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What CN is cold calories
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VIII
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What CN is corneal reflex
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V, VIII
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What Is CN for gag reflex?
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XI, X
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If a patent has dolls eyes and eyes dont move then
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neither brain stem nor cerebrum intact
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What are early signs of inc intracranial pressure
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- LOC
- headache - facial palsy - pupil - vomiting |
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Late signs of inc intracrainial pressure
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- comatose
- posturing: abnormal flexion or extension of extremities - VS Cushings Triad |
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VS: cushings Triad
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hypertension with widened pulse pressure, bradycardia, abnormal respirations
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What type of respirations are a sign of late intracranial pressure
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-cheyne-stokes
-apneustic -cluster - ataxic |
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Most sensitive indicator of inc ICP is
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LOC
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How do you test CN II
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Hold up 2 or 3 fingers. Ask them to tell you how many they see
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How do you test CN III and VII
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Ask patient to close eyes tightly and you try to pull eyelids up, then ask patient to smile, wrinkle forehead, show their teeth
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How do you test CN XII, IX, and X
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Ask patient to stick out tongue and say 'ah'. watch for rise and fall of soft palate with phonation, note uvula symmetry
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How do you test CN XII
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Ask patient to push tongue through cheek on each side as you palpate the cheek to try and offer external resistance to the tongue
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How do you test CN V
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Ask the patient to close his mouth and bite down
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How do you test CN XI?
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ask he patient to turn head to the right and you try to push chin back to midline, same with turn to the left
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How else do you test CN XI?
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Ask patient to shrug shoulder while you try to press down on them
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How elsedo you test CN V and VII
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Brush eye lash with finger (lash reflex) or touch cornea with drop of NS (corneal reflex)
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What is Monroe-Kellie Hypothesis
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Relationship of brain, blood and CSF to pressure
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What is normal ICP
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0-15mm Hg
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How is intracranial pressure controlled?
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- Compensation
- Autoregulation |
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What is compensation?
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-shunt CSF into subarachnoid space
- inc CSF absorption in the venous sinus -dec in CSF production -dec of blood volume by altering CBF -Skull expansion |
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What are the 2 types of Autoregulation
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-Systemic blood flow
-Carbon Dioxide |
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Systemic blood flow increased
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cerebral arteries constrict
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Systemic blood flow decreased
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cerebral arteries dilate
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Increased CO2
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cerebral arteries dilate;
decreased CO2 cerebral arteries constrict |
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What is decompensation in intracranial pressure regulation?
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-decrease in CBF
-decrease in CPP -Brain anoxia |
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What is the Ventricular Pressure Curve?
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Compliance Test with Centriculostomy.
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ICP increasese <=5 is
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normal compliance
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ICP increases > 5 is
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decreased compliance
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4 causes of increased ICP
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- increase brain volume
- increase blood volume - increase CSF volume - space occupying lesions |
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are are signs and symptoms of increased ICP
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-change in LOC
-headache -nausea and vomiting -Cri-du-ca 'cry of the cat' |
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Late clinical manifestations of increased ICP
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-loss of motor and sensory functions
-pupillary changes -vital sign changes (widening pulse pressure, bradycardia, irregular respirations) -posturing -coma -changes and irrgular respiratory pattern |
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Flexion
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decorticate
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extension
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decerebrate
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intermittent posturing
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mixed
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moderately increased ICP
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15-25
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Severely increased ICP
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25-40
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Horrible ICP
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above 40
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How do you calculate CCP?
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CPP=MAP-ICP
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Normal CCP
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60-90
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What is CPP
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THe pressure to perfuse the brain cells (Cerebral Perfusion Pressure)
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What are the advantages to EPIDURAL ICP measurement techniques
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- easy to place. Lower infection rate
Disadvantages cant drain CSF |
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What type of ICP measurement does TUH do?
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Intraventricular
**gold standard. Provides access to the ventricles |
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Subdural ICP measurement devices
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Advantages - easily do in surgery when brain is exposed. sensitive to changes in ICP
Disadvantages - higher risk for infection. unable to drain or sample CSF |
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INtraparaenchymal
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Advantages- easy to place. Actual measurement of the pressure within the brain
Disadvantages- Higher risk for infections inc risk of intracerebral bleed unable to drain or sample CSF |
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Subarachnoid ICP monitoring
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Disadvantages - higher risk for infections. Easily dislodges and unable to drain or sample CSF
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Why use ICP monitoring
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detect inc in ICP before signs and symptoms
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ICP changes can be related to
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- positioning
- airway maintenance - elimination - environment -transient -medications |
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P1
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percussion wave
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P2
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tidal wave
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P3
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dicrotic wave
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When P2 is greater than P1
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ICP inc. compliance is decreased. decompensated.....brain is tight
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Treatments for inc ICP
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-Drain CSF
- Mannitol -maintain normal body temp -mild hyperventilation with intubation -sedation -neuromuscular blocking agent -barbiturate therapy |
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What does mannitol do?
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shrinks undamaged brain.
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What is the dosage of mannitol?
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25-50grma up to 100 grams....push fast
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Hold mannitol if
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serum os is >310.
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What do you have to do with mannitol?
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put on a filter...keep pt hydrated
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What are the 5 precautions with propofol use?
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1. pt must be intubated
2. minimize use of bolus doses 3. monitor BP carefully 4. Do not exceed doses of 83 mcg/kg/min 5. consider alternatives |
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How do you measure CBF
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-cerebral angiogram
-transcranial doppler |
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What is lumbar drain used for?
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-CSF drainage
*gives dura chance to heal |
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What is Coup contrecoup
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Head strikes the wall and then rebounds
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What are Cranial vault injuries? (4)
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-linear skull fractures
-basal fracture -comminuted fractures -compound fractures |
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What are characteristic of cranial vault injuries
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-Periorbital ecchymosis
-battle sign -otorrhea -rhinorrhea -inj to CN I, II, VII, VIII -serous sanguinous drainage from ears and nose -prone to meningitis |
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What is Mild Concussion?
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having your bell rung
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What is moderate concussion
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-brief loss of consciousness
-neuroloic deficits are brief |
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What is severe concussion?
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Prolonged loss of consciousness or neurologic deficits lasting mintues without clearing
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Contusion
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bruising of the brain
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Diffuse axonal injury
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severe shearing
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Epidural hematoma
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blood btw skull and dura...usually arterial in nature
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Subdural Hematoma
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between brain and dura....often in elderly and alcoholics due to brain shrinkage
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acute SDH
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deterioration within 24 hrs
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subacute SDH
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deterioration within 48-72 hrs
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2 types of secondary brain inj
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Edema & ischemia
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Complications
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vasospasms, inc ICP, herniation syndromes, infections, neuroendocrine disorders
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Risk factors for ICH
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HTN, cocaine, anticoagulation, aneurysm, and AVM
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arteriovenous malformations
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tangled collection of dilated blood vessels. Direct shunt arterial blood into the venous system
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What is Pinundra
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area around embolism that is compromised.
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What is lacunar stroke?
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cut off blood supply to basal ganglia, putamen, thalamus, and internal capsule
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What is Hunt and Huss
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Grading scale for Subarachnoid Hemorrhage
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What is an aneurysm
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small, thin walled ballooning of an artery associate with defect in media and elastica of artery wall
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What causes aneurysm
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congenital, trauma, HTN, atherosclerotic lesion, and inflammation of vascular wall
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BP management of Uncliped SAH
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SBP 120-140
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BP management of Clipped SAH
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140-160 or 160-180 for prevention of vasospasm
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WHat can occur post clipping?
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rebleed, vasospasm, hydrocephalus
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What does aneurysm coiling use?
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guglielmi detachable coil
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What are pharmacological agents for SAH
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calcium antagonist & osmotic diuretics. Antihypertensives, vasopressin & atropine sulfate
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What day is greatest risk for vasospasm?
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Day 7
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Hunt and Hess grading scale is used for
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whether or not they will get a clipping
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What CA channel blocker will they order
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Nimodipine. may cause vasodilation. Start with 30 mg and then give another 30 mg.
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What is Triple H therapy?
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Hypertension. hyperdynamic (neosynephrine) and hemodilution (give NS)
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What is the goal of triple H therapy?
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drive pressure up to perfuse brain distal to aneurysm
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What are 4 reasons for brain abscess?
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-surgical
-dental -sinus -ear infections |
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What are the 6 types of generalized seizures?
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abscence, myoclonic, atonic, clonic, tonic, tonic-conic
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That is the therapeutic level of dilantin
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10-20 mg/dL
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Never give dilantin
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> 50 mg/min IVP
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What do we give instead of dilantin
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fosphenotoin
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What drugs do we give of pt s/p spinal injury
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steroid drip & H2 blocker
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c4 and above inj
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respiratory depression
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What does and purpose neosynephrine?
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improve vascular tone. give up to 90-100 mcg/min
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C6s...can do what?
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use their wrists to pick up things
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Autonomic dysreflexia
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Pt has in above T6. severe HA. High BP. flushed face, distended neck veins. dec hr. inc sweating
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What is the brain death criteria?
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absence of all brain stem reflexes. No cough, gag, no cold calorics, no spontaneous respirations, no corneal reflexes, absence of drugs in system
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