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108 Cards in this Set
- Front
- Back
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An aneurysm at a bifercation is called what?
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Berry aneurysm
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WHat are the levels of the BBB?
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PAD
-pia -arachnoid -dura |
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What makes of the anatomical basis for the BBB?
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the tight junctions between capillary endothelial cells
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What is an injury to the brain caused by interruption of its blood flow or by bleeding into or around the brain?
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stroke
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What is a TIA?
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brief spell of numbness, weakness, or blindness that lasts less than 10 minutes
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Are stroke arterial or venous?
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arterial
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A TIA increases the risk of stroke by about how much?
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10 times
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What are the main two types of stroke?
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Ischemic and Hemorrhagic
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What type of stroke is more common?
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ischemic
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What is the MCC of an ischemic stroke?
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thrombosis
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WHat is the most common location for a hemorrhagic stroke?
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circle of willis
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What are some common causes of an embolic stroke?
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-A fib
-endocarditis -dilated cardio myopathy -MI |
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Why subtype of ischemic stroke is characterized by making small cavities in the brain?
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lacunar
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Lacunar strokes are common in what two diseases?
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DM and HTN
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Arteriosclerosis, hyperthyroidism, and Sickle Cell disease are all risk factors for what type of stroke?
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thrombotic
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If a pt has a hx of MI, A fib, and rheumatic heart disease, what type of stroke are they at increased risk for?
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Embolic
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Why does a person in A fib always need anti-coagulation?
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because of increased risk of stroke from emboli
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What are Lacunar strokes caused by?
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Occlusion of small, penetrating intracerebral arteries and are most commonly associated with HTN and DM
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What are some clinical features of a Lacunar stroke?
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-neurologic deficit
-H/A -loss of consciousness -speech disturbances (dysarthria and aphasia) -visual field defects -contralatera mortor or sensory function |
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Bilateral vision loss suggests ischemia of what system?
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Vertebrovasilar system
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What are the major risk factors for stroke? 11 of them
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1-age
2-male gender 3-race (AA) 4-Family hx 5-DM 6-Smoking 7-HTN 8-Prior stroke 9-TIAs 10-Cardiac disease 11-Asymptomatic bruit |
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What are the 5 minor risk factros for stroke?
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1-Hypercholesterolemia
2-Obesity 3-Physical inactivity 4-OCP use 5-Alcohol consumption |
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Why do you need to do a CT scan when a pt resents with a stroke?
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to differ from ischemic and hemorrhagic
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How do lacunar strokes typically appear on a CT scan?
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A small area of infarction in the subcortical area
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An initially ischemic area on CT that becomes hemorrhagic suggest what type of etiology?
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embolic
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Why do you get serum cholesterol level?
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Because they can suggest a stenotic artery as the origin of the thromboembolus
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What is the most common type of herniation that causes ICP?
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transtentorial herniation
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How does a transtentorial herniation present?
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dilated pupils that may not constrict in response to light
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What are some consequences of transtentorial herniation?
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-paralysis
-stupor -coma -abnormal heart rhythms -breathing trouble -cardiac arrest -death |
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What are the first 4 symptoms of ICP?
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1-worsening headache
2-imparied mentation 3-decreased level of consciousness 4-vomiting |
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What are 6 things that can develop as a result of ICP?
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1-arterial HTN
2-bradycardia 3-Wide pulse pressure 4-Cheyne-Strokes breathing 5-Kussmaul's respiration 6-coma |
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What is Cushing's Sign?
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Bradycardia and HTN
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In what two types of stroke might you get blood in a LP?
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1-embolic
2-hemorrhagic |
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What sign may be elicitied within minutes of a subaracnoid hemorrhage?
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Brudzinski's sign
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What other things are seen in a subarachnoid hemorrhage?
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Sudden onset of:
-severe headache -nuchal regidity -altered LOC -dizziness -photophobia -cranial nerve palsies -N/V -fever -positive Kergnig's sign |
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Lacunar strokes happen where?
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small arteries in the brain
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Why do Lacunar strokes happen?
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because there are blockages that build up over time in the small arteries
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The lowering of what is strongly indicated in hemorrhagic stroke?
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lowering of Bp gradually unless in HTN crisis then do it faster
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What do you want to use to lower Bp?
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IV hydralazine, labatelol, or Nitro
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What are some permanent nurologic deficits that are commonly caused by a stroke?
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-weakness or paralysis
-loss os sensation -problems with vision -difficulty in talking or understanding works -difficulty with organization or perception -clumsiness or lack of balance |
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What are the most common non-traumatic causes of SAH?
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-ruptured intracranial aneurysm
-bleed from a AVM |
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AVMs occur in person's under what age?
Sex? |
over 40 and male gender
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What are AVMs?
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congenital lesions that are composed ofa tangle of abnormal arteries and veins joined together without the rpesence of the smallest blood vesssels of the brain to slow down the blood flow
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What is the Meningism triad?
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-nuchal regidity
-photophobia -headache |
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What is a menigismus?
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term used when the triad is present without actual infection or inflammation
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How should ICP be managed?
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-elevation of head
-mannitol -intubation -hyperventilation |
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Those w/ ischemic strokes need to be tx aggressively for what?
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comorbidities
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What are some good medications post stroke?
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-ASA
-Dipyridamole + ASA -Clopedogrel -Warfarin -Bp meds -Cholesterol |
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What Bp do you want to shoot for after a stroke?
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160/90
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Dementia can be confused with what other disease?
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depression, so that is why it is a dx of exclusion
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What are the 2 things you want to ask yourself after you dx dementia?
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1-Is it really dementia?
2-Is is reversible? |
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Dementia can cause compromise in what?
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-language
-memory -visuospatial skills -cognition |
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What does SDAT stand for?
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Senile Dementia Alzheimer's Type
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What are the classic characteristics seen on the brain in Alzheimers?
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-Neurofibriallry tanges
-Amyloid plaques |
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Neurofibrillary tangles are the result of what?
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degeneration of neurons
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What is another name for multi-infarct dementia?
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Vascular Dementia
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What is vascular dementia?
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dementia that results from brain damage caused by stroke or TIA
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Vascular dementia is more common in what sex and in those with what other disease?
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Men and HTN
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What are some drugs that can cause dementia?
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-sedatives
-ranitidine -cimetidine -neuroleptics -anticholinergics -NSAIDs |
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Sudden onset of what 7 symptoms can be a sign of vascular dementia?
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1-confusion and problems with recent memory
2-wandering or getting lost in familiar places 3-moving with rapid, shuflfing steps 4-loss of bladder or bowel control 5-laughing or crying inappropriately 6-difficulty following instructions 7-problems handling money |
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What type of deterioration do those with vascular dementia have?
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step wise dementia
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Normal pressure hydrocephalus is associated with the triad of what three things?
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-dementia
-urinary incontinence -gait instability |
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What are some lab testing you can do to ID reversible causes of dementia?
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-Hypothyroidism
-Hypercalcemia -Hypoglycemia -Nutritional deficiencies -Infections |
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What are 8 reversible causes of dementia?
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Drugs/Depression
Elderly Multi Infarct/Medication Environmental Nutritional Toxins Ischemia Alcohol |
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Elevated what may be seen in those with vascular dementia?
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cholesterol level
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A CT scan can ID what type of dementia?
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vascular dementia
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Normal pressure hydrocephalus causes what with increased levels of CSF?
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dilated ventricles
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In normal pressure hydrocephalus, ventricular enlargement leads to what?
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periventricular ischemia
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What things are increased in NPH?
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-arterial HTN
-arteriosclerosis |
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How can a subdural hemoatoma mimic dementia?
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because it is slow bleed
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How long does it usually take for a subdural hemoatoma to show up on a CT/
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usually 1-2 months
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A subdural hemoatoma is usually a rupture of what veins?
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those coming of the sinuses
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WHat is a seizure?
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transient distrubance in cerebral function caused by abnormal neuronal discharge
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What is epilepsy?
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A group of disorders represented by recurrent seizures
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What disease is a disruption of the normal electrochemical activity of the brain that results in seizure?
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Epilepsy
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What are the types of seizure?
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Partial and Generalized
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What are two subtypes of partial seizures?
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simple and complex
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What are 4 subtypes of generalized seizures?
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-Tonic-clonic
-myoclonic -atonic -absence |
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In a Generalized or Grand Mal seizure, what part of the brain is affected?
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the entire brain
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In a generalized or grand mal seizure, consciousness is always what?
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impaired or lost
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What is the difference between a partial complex and a partial simple seizure?
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complex has affected consciousness while a simples has no loss of consciousness
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What are 5 common effects of a simple partial seizure?
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1-eye movements or shifting of facial features
2-shaking of hand or foot 3-sudden nausea 4-sweating, flushing or becoming pale 5-person may become very emotional |
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What are 5 common effects of complex partial seizures?
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1-dazed state
2-drooling and purposeless behavior 3-wandering 4-may run in fear or cry out 5-no control of movement, speech or actions |
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An Aura is what?
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a partial seizure that is experienced as a peculiar sensation that precedes the onset of a generalized seizure
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About 60% of those iwth epilepsy have what type of seizures?
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partial seizures
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Partial seizures can be mistaken for what/
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Anything from intoxication to daydreaming
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Can auras be seen in simple partial seizures?
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yes
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Generalized seizures are the result of what?
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Abnormal activity in the whole brain at the same time
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What are the 3 stages of a generalized seizure/
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1-Tonic phase
2-Clonic phae 3-Postictal phase |
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Do generalized seizures have auras?
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NO
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How long does the tonic phase of a generalized seizure last?
clonic phase? |
10-20 seconds
90 seconds |
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What occurs during the clonic phase?
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-brief, violent, generalized flexor contractions altering with progressively longer muscle relaxation
-cyanosis -cheeck or tongue biting, salivation -loss of bowel, bladder control |
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How long does the post ictal phase last?
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minutes to hours
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What are some characteristics of the post ictal phase?
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-headache
-mild confusion -sore muscles -may sleep and feel refreshed |
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Absence seizures always begin when and are mistaken for what?
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-childhood and mistaken for daydreaming or inattentiveness
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What are some characteristics of an absence seizure?
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-staring
-loss of facial expression -unresponsiveness -cessation of activity and eye blinking or upward eye movements -no memory of the event |
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What metabolic disorders can cause seizures?
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-hypocalcemia
-hypoglycemia -alcohol w/draw |
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What are some other things that can cause seizures?
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-trauma
-tumors -cerevralvascular disease -infection disease |
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Adult onset epilepsy most often indicated what?
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Presence of a structural lesion of the brain
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A deficinecy in what can cause infacts to have seizures?
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Folate def
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Febrile seizures typically occur between what ages?
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18month and 5 years
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Febrile seizures are a type of what kind of seizure?
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generalized tonic clonic
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Temporal lobe seizures are often preceded by what?
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-aura
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Pseudoseizures are seizures caused by what type of origin?
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psychogenic origin
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What test can you run to see if a seizure is true or not?
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Prolactin level because it will be higher in a true seizure
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What are some primary neurologic disorders that can be associated with seizures/
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-head trauma
-cancer -hemorrhage -stroke -vascular malformations -meningitis/encephalitis |
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What are some ststemic disorders that can be associated with seizures?
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-hypoglycemia
-hyponatremia -hypocalcemia -uremia -hepatic encephalogpathy -drug OD/with drawal -hyperosmolar states -hyperthermia |
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What are some things that can trigger a seizure?
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-strong emotions
-intense exercise -flashing lights -loud music -fever -menstruation -lack of sleep -stress |
