Nervous System Pathophysiology

Front 1

Pain Sensation

The fast pathway?

Back 1

for sharply discriminated pain, moves directly from the receptor to the spinal cord using myelinated A fibers and from the spinal cord to the thalamus using the neospinothalamic tract

Front 2

Pain Sensation

The slow pathway?

Back 2

for continuously conducted pain, is transmitted to the spinal cord using unmyelinated C fibers & from the spinal cord to the thalamus using the slower-conducting paleospinothalamic tract

Front 3

Pain Sensation

Modulation?

Back 3

Modulated in the midbrain by chemicals called endogenous opioids (endorphins, enkephalins, and ndynorphins)

Front 4

Types of Pain

Cutaneous & Deep somatic

Back 4

Cutaneous pain- arises from superficial structures like skin and subcu tissues (ex. Papercut)
Deep somatic pain- originates in deep body structures, such as the periosteum, muscles, tendons, joints, and blood vessels

Front 5

Types of Pain

Visceral & Referred

Back 5

Visceral Pain- has its origin in the organs and is one of the most common pains produced by disease
Referred Pain- pain that is perceived at a site different from its point of origin but innervated by the same spinal segment

Front 6

Types of pain

Acute?

Back 6

Acute Pain- short duration and remits when the underlying pathologic process has resolved; warning system; It can produce physical manifestations, such as tachycardia, reflective of increased sympathetic activity.

Front 7

Types of pain

Chronic?

Back 7

Chronic Pain- elicited by an injury but may be perpetuated by factors that are both pathologically and physically remote from the originating cause. It extends for long periods of time and generally represents low levels of an underlying pathologic process that does not explain the presence or extent of the pain.; It can produce loss of appetite, sleep disturbances, depression

Front 8

Pain

Headache

Back 8

a common disorder that is caused by a number of conditions (Can be primary or secondary)
Migraine- caused by changes in serotonin levels and inflammation of the cerebral vascular system
Cluster- ANS caused cerebral vascular dilation
Tension- sustained contraction of scalp muscles

Front 9

Motor Function

Back 9

Voluntary control of motor fx is directed by the motor cortex, which consists of the primary, premotor, and supplementary motor cortex

Front 10

Muscle Tone

Back 10

Muscle tone is maintained through the combined function of the stretch reflex and the extrapyramidal system that monitors and buffers UMN innervation of the LMNs.

Front 11

Disorders of Musculoskeletal Function

Hypotonia/Hypertonia

Back 11

is a condition of less-than-normal muscle tone; and Hypertonia or spacticity is a condition of excessive tone

Front 12

Disorders of Musculoskeletal Function

Back 12

Paresis refers to weakness in muscle fx, and paralysis refers to a loss of muscle movement.
UMN lesions produce spastic paralysis and LMN lesions flaccid paralysis.

Front 13

Skeletal Muscle Disorders

Muscular Dystrophy (MD)
most common form is Duchenne MD

Back 13

a term applied to a number of genetic disorders that produce progressive degen. & necrosis of skeletal muscle fibers, replaces with fat and conn. tissue which leads to (pseudohypertrphy) muscle weakness

Front 14

Disorders of the Neuromuscular Junction

Myastenia Gravis (MA)

Back 14

autoimmune; antibodies block, destroy, or weaken the neuroreceptor Ach, causing a failure in transmission of nerve impulses at the NMJ

Front 15

Myastenia Gravis (MA)

Back 15

weak eye closure, pytosis, diplopia, fatigue, late paralysis, blank facial appearance, nasal vocal tones, frequent nasal regurgitation, eyelids drooping, head bobbing, decreased resp. muscles

Front 16

Myastenia Gravis (MA)

Dx?

Back 16

Tensilon test confirms; after giving I.V. edrophonium or neostigmine muscle fx improves in 30 to 60 seconds and last for 30 minutes; nerve stimulation tests;

Front 17

Myastenia Gravis (MA)

Treatment?

Back 17

anticolinesterse drugs- neostigmine and pyridostigmine; immunosuppressant therapy; IV IG; plasmapheresis; thymectomy

Front 18

Carpal Tunnel Syndrome

Peripheral Nerve Disorder
a compression mononeuropathy

Back 18

inflammation or fibrosis of the tendon sheaths that pass through the carpal tunnel usually causes edema and compression of the median nerve. Causes: weakness, pain, burning, numbness, or tingling

Front 19

Guillain-Barre Syndrome

Peripheral Nerve Disorder
autoimmune: polyneuropathy; involves demyelination or axonal degeneration:

Back 19

causes progressive ascending muscle weakness and loss of tendon reflexes. may progress to resp. muscles.

Front 20

Herniated Disks

A herniated intervertebral disk-

Back 20

protrusion of the nucleus pulposus into the spinal canal. Usually, at (L4 or L5 to S1) or (C6 to C7 and C5 to C6). The SxS are localized to the area of the body innervated by the affected nerves w/ pain and motor/sensory deficits

Front 21

Disorders of the Basal Ganglia

Back 21

Alteration in or abnormal muscle movements that result from disorders of the cerebellum and basal ganglia. The basal ganglia organize & then release basic movements

Front 22

Parkinson Disease

Degenerative disorder of the Basal Ganglia

Back 22

involves destruction of nigrostriatal pathway, & reduction of striatal concentrations of dopamine. depleting dopamine producing neurons.

Front 23

Disorders of the Basal Ganglia

Parkinson Disease- How?

Back 23

• Onset in 40-50s, more males
• #1 neurological disorder

Front 24

Disorders of the Basal Ganglia

Parkinson Disease- Treatment?

Back 24

diet (increase calorie, decrease protein), surgery (pallidotomy), PT, meds (anticholinergics)

Front 25

Upper Motor Neuron Disorders

Amyotrophic Lateral Sclerosis
"Lou Gehrig"

Back 25

A devastating neuro disorder that selectively affects motor function

Front 26

Upper Motor Neuron Disorders

Amyotrophic Lateral Sclerosis
"Lou Gehrig" - Who?

Back 26

Affects people from 55-60 yrs of age; twice as many men than women

Front 27

Upper Motor Neuron Disorders

Amyotrophic Lateral Sclerosis
"Lou Gehrig" - SxS, Treatment?

Back 27

rapid, progressive weakness; intellect remains intact
Treatment: no cure, supportive care only

Front 28

Demyelinating Disorders

Multiple Sclerosis- What?

Back 28

Loss of myelin on the nerve fibers throughout the CNS

Front 29

Demyelinating Disorders

Multiple Sclerosis- What?

Back 29

most common nontramatic cause of neuro disability among young and middle-aged adults; women double compared to men; immune-mediated disorder that occurs in genetically susceptible individuals

Front 30

Demyelinating Disorders

Multiple Sclerosis- SxS?

Back 30

Exacerbations and remissions are usual
S & S: decrease sensation, motor impairments (spasticity), visual problems, cognitive changes, fatigue

Front 31

Demyelinating Disorders

Multiple Sclerosis- Treatment?

Back 31

PT, meds (immunosuppressors, muscle relaxers, antidepressants, bladder control agents)

Front 32

Spinal Cord Injures

Back 32

Described by the last intact spinal nerve and the vertebral level (C5, C6)
May be temporary or permanent
Causes- traumatic, non-traumatic
Typical patient is a young male

Front 33

Spinal Cord Injures

Primary and Secondary damage

Back 33

Primary – bone fracture/dislocation, nerve tissue tearing
Secondary – bleeding, edema, necrosis

Front 34

Spinal Cord Injures (SCI)

Classification of permanent SCI

Back 34

Paraplegic or quadriplegic
Initial period of spinal shock- all function is lost, end of shock indicated by positive bulbocav ernosus reflex (stimulation of genitals elicits contraction of anus)
Complete or Incomplete

Front 35

Spinal Cord Injures (SCI)

Brown-Sequard-

Back 35

damage to one side only, usually from GSW or stabbing, loss of motor & proprio/touch/vibration ipsilaterally, loss of pain/temp contralaterally

Front 36

Spinal Cord Injures (SCI)

Anterior cord syndrome

Back 36

damage to anteriolateral 2/3, usually from flexion forces, symmetrical loss of motor & pain/temp, other sensory remains

Front 37

Spinal Cord Injures (SCI

Central cord syndrome

Back 37

damage to central aspect, UEs more involved than LEs.
sensory loss is less than motor loss

Front 38

Spinal Cord Injures (SCI

Posterior cord syndrome

Back 38

damage to post columns, proprio/touch/vibration loss only, rare

Front 39

Early Medical Management of SPI

Back 39

Immobilization to stabilize the spine and prevent cord damage-
High doses of methylprednisolone

Front 40

Early Medical Management of SPI

Back 40

These patients require the best nursing care to prevent development of complications d/t immobility. Use psychotherapeutic approach. GOAL is to restore or maintain function and /or adaptation

Front 41

Increased Intracranial Pressure

Back 41

Common pathway for brain injury.
Possible causes?
^ tissue volume from tumor, edema, bleeding-
^ blood volume of cerebral vessels or obstruction-
^ production, decreased absorption, or obstructed circulation of CSF

Front 42

Increased Intracranial Pressure

How it presents?

Back 42

change in LOC is earliest sign
Late sign: widened pulse pressure, irreg. resp., bradycardia. Hydrocephalus-

Front 43

Head and Brain Injury

Back 43

from MVAs, falls, other accidents. Patient is typically young male. There is usually primary and secondary damage.

Front 44

Traumatic Brain Injury (TBI)

Coup-contrecoup injury

Back 44

when the mechanical forces inducing head injury causes bouncing of the brain in the closed skull

Front 45

Traumatic Brain Injury (TBI)

Concussion

Back 45

momentary interruption of brain function with or without loss of consciousness

Front 46

Traumatic Brain Injury (TBI)

Contusion

Back 46

is a bruise to the cortical surface of the brain caused by blunt head trauma

Front 47

Levels of Consciousness

Back 47

Consciousness depends of the reticular activating system (RAS) and both cerebral hemispheres

Front 48

Brain Death

Back 48

Defined as the irreversible loss of function of the brain, including brain stem-
Clinical exam must disclose at least the absence of responsiveness, brain stem reflexes, and respiratory effort

Front 49

CVA - Stroke

What?

Back 49

Stroke or infarct (cerebrovascular accident) – 3rd leading cause of death in US, leading cause of disability
common in men and blacks

Front 50

CVA - Stroke

2 main types. Ischemic & Hemorrhagic.

Back 50

Ischemic strokes caused by interruption of blood flow in cerebral vessels, most common type. Thrombi common cause, within atherosclerotic vessels, & @ bifurcations

Front 51

CVA - Stroke

Hemorrhagic

Back 51

Hemorrhagic strokes caused by bleeding into the brain tissue, are less common but account for higher fatality rate.

Front 52

CVA - Stroke

Back 52

TIA- usually no lasting deficits, clear within 24 h-

Front 53

Risk Factors for CVA

Primary-

Back 53

Primary- HTN, Heart disease, Diabetes, Smoking, TIA’s, Age, Race

Front 54

Risk Factors for CVA

Secondary-

Back 54

Secondary- Physical inactivity, Obesity, High cholesterol, Alcohol/drug abuse, Polycyhemia, Sickle cell disease, hx of CVA

Front 55

CVA - Stroke

Treatments?

Back 55

Tx has changed since 1990s
extra emphasis on salvaging brain tissue and preventing long-term damage during ischemic strokes. use proper position & effective ROM.

Front 56

CVA - Stroke

Deficits.

Back 56

Motor deficits most common
then language, sensation, & cognition.

Front 57

Common Primary Deficits of CVA

Back 57

Sensory loss contralaterally
Motor- contralateral hemiparesis, UE % face more involved then LE
Cognitive impairment- more often with Anterior Cerebral Artery CVAs
Perceptual problems- neglect, apraxia if on right
Speech- aphasia if on left
Hemianopsia- loss of ½ of visual field
Depression

Front 58

CVA - Stroke

Treats?

Back 58

Preservation of Brain Tissue- Time is tissue
IV thrombolytic therapy: with CT confirmation of no bleed- tPA, Redavase within 3 hours of onset of symptoms
Oral anticoagulants- aspirin
Prevent complications and recurrence
Manage BP
Rehabilitation

Front 59

Infectious Disorders

Meningitis

Back 59

infection of the pia mater, arachnoid, and subarachnoid space. can be bacterial, viral, or fungal. Most common: bacteria- Neisseria, Strep

Front 60

Infectious Disorders

Meningitis

Back 60

* Most common in college age group
* Symptoms- fever, HA, N & V, neck rigidity, fatigue

Front 61

Infectious Disorders

Encephalitis

Back 61

generalized infection of the brain or spinal cord. caused by a virus, toxins, or vaccine.
common in US is herpes simplex

Front 62

Infectious Disorders

Encephalitis

Back 62

Edema, necrosis, hemorrhage
*Symptoms- fever, HA, neck rigidity, confusion, seizures

Front 63

Infectious Disorders

Treatment?

Back 63

Symptomatic, IV antibiotics, antifungal, antivirals, supportive care, prevention of complications

Front 64

Brain Tumors

Back 64

2% of all aggressive neoplasms- 2nd common type of CA in children.
(astrocytomas)- in adults

Front 65

Brain Tumors

SxS

Back 65

headache, nausea, vomiting, mental changes, papilledema, visual disturbances, alterations in motor and sensory functions and seizures

Front 66

Brain Tumors

Treat?

Back 66

Physical exam, visual field testing, CT, MRI, skull x-ray, brain scans, EEG, cerebral angiography: surgery, irradiation, chemotherapy

Front 67

Seizures

Back 67

A sudden uncoordinated neuron discharge from a known or unknown cause

Front 68

Unprovoked Seizure
aka primary or idiopathic

Back 68

no known cause, thought to be genetic. Epilepsy-

Front 69

Provoked Seizure
aka secondary or symptomatic

Back 69

include febrile, those precipitated by systemic metabolic conditions, and after primary CNS insult occurrence

Front 70

Partial Seizures
Simple partial seizures

Back 70

One hemisphere, no loss of consciousness, generalized symptoms (lights flashing, sweating, dream states). May have an aura

Front 71

Partial Seizures
Complex partial seizures

Back 71

often temporal lobe with loss of consciousness & responsiveness. Usually starts w/ 1 hemisphere and progresses to involve both psychomotor seizures. Repetitive, non-purpose activities

Front 72

Generalized Seizures
Typical Absence seizures

Back 72

generalized disturbance in consciousness, nonconvulsive. Usually, only in children and stop at adulthood

Front 73

Generalized Seizures
Atypical absence seizure

Back 73

greater alteration in muscle tone and less abrupt onset & cessation. Need EEG to determine. Typical anti-seizure meds may increase frequency of atypical absence type

Front 74

Generalized Seizures
Atonic/akinetic

Back 74

sudden loss of muscle tone that leads to falling. “Drop attacks”

Front 75

Generalized Seizure
Myoclonic

Back 75

brief involuntary muscle contractions d/t cerebral stimulus. Bilateral jerking of muscles of face, trunk, or extremities.

Front 76

Generalized Seizures
Tonic-Clonic: (Grand mal)

Back 76

most common of the generalized. Aura, LOC, incontinence, post-ictal phase

Front 77

Seizure-
Treatment

Back 77

Protect from injury, protect airway, Pharmacological agents (more than 20- mainly suppress the repetitive firing of neurons, or inhibit electrical impulse, surgical intervention (may be an option)

Front 78

Status Epilepticus
Seizures that do not stop spontaneously or occur without a recovery period

Back 78

if not treated can cause resp failure and death. Higher morbidity in young and old.
Treatment: Airway- intubation, IV, admin of muscle relaxants and/or generalized paralyzing agents

Front 79

Dementia
Alzheimer’s Disease- the most common

Back 79

Unknown cause
*More women than men
*Microscopic “tangles” and plaques w/ slow gradual onset, usually 50-65
* Usually not with other medical problems

Front 80

Dementia
Alzheimer’s Disease

Back 80

STM loss, short attention span, decreased reasoning, behavioral changes, decrease language skills