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107 Cards in this Set
- Front
- Back
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What are the names of the forebrain anomalies that deal with abnormal brain volume?
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Megalencephaly and microencephaly
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What is Holoprosencephaly?
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Incomplete separation of the cerebral hemispheres
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When do neural tube defects occur?
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In the 3rd week of gestation
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What is the name of the layer of germ cells that begins the development of the Nervous system?
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ectoderm
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What does the center of the neural tube represent in the developed person?
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Central canal and all the ventricles of the brain
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What is the worst form of NTD? Describe this kind.
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Anencephaly:
when the soft, bony components of the skull and part of the brain are missing. Fetus usually dies in-utero or a few hours after birth |
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what is an Encephalocele?
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Herniation or protrusion of brain and meninges through a defect in the skull, resulting in a saclike structure.
Often seen in the parietal, frontal or nasalpharyngeal area. can be removed surgically |
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Describe Spina bifida occulta.
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A failure of the vertebra column to fuse at some part of the lumbar vertebra. The only sign is a little tuft of hair where that defect resides.
-Sometimes has no tuft of hair and discovered only on a routine exam |
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What is meningeocele?
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Type of NTD where a herniation of meninges and spinal fluid, but the spinal cord is intact and in appropriate location.
-Fairly easily corrected with surgery |
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Which form of NTD can lead to urinary incontinence or bowel defects?
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myelomeningeocele
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Describe myelomeningocele.
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Herniation of meninges, spinal fluid and in the sac you have some or all of the spinal cord and spinal nerves.
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What is the most severe case of myelomeningeocele?
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When the spinal cord and nerves end in the sac
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Which neural disorder is considered a static encephalopathy?
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Cerebral Palsy
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What are 3 major areas of the brain that can be effected with cerebral palsy?
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PMC, basal ganglia and cerebellum
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What are the 3 types of movement that are characteristic of Cerebral palsy and the % of individuals that that form?
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1. Spastic (70-80%)
2. Dyskinetic (10-15%) 3. Ataxic (<5%) |
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What is cerebral palsy?
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Disorder that is characterized by motor or postural abnormalities that are noted during early development
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What is the most common place to have damage in the brain for a patient with cerebral palsy?
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PMC
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What has been thought to be a common cause of cerebral palsy?
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Premature labor and suffering from some degree of ischemia during or before delivery. The PMC is very vulnerable to ischemic injury
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What is the most common manifestation of cerebral palsy?
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Muscle spasticity. high muscle tone.
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WHy would some individuals believe that Cerebral palsy is a progressive disease?
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Even though it is a one time damage, the manifestation of CP will change over time as the childs CNS develops and matures.
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What can occur if the symptoms of a child with cerebral palsy is not managed well?
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Contractures can set in and can result in frozen joint and dislocations during PT.
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How many injuries occur during a traumatic head injury?
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2 always
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What is a focal injury? Exs?
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Injury that is contained to one area of the head.
Exs: contusion and lacerations |
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What is considered the second injury in a TBI?
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second traumatic brain injury is the swelling of the brain as a result of release of intracellular ions or transmitters.
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What is an example of a diffuse brain injury?
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AKA diffuse axonal injury: concussion
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What are examples of closed head injuries?
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contusion
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A laceration is considered a _____ injury?
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penetrating
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What are the types of traumatic vascular injuries?
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Hematomas
(epidural, subdural, subarachnoid and intraparenchymal) |
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When a hematoma occurs, what is a possible complication?
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Increased intracranial pressure
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What is the most common head injury caused by car accidents?
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Coup-countercoup head injury.
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What types of head injuries can occur in a coup, countercoup?
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Both focal and diffuse
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Generally Describe a mild concussion.
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Temporary axonal disturbances
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What are the characteristics of grades I and II concussions?
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Some disturbance in attention or memory but no loss of consciousness
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A patient experiences a head injury where he loses consciousness for less than 5 mins. What diagnosis and grade would this patient be given?
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Grade 3 concussion
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What is a classic cerebral concussion?
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Grade 4 where an immediate loss in consciousness that lasts more than 5 mins but less than 6 hours
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Where has damaged occurred in the brain if consciousness is lost?
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Reticular activating system
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What is the function of the RAS?
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It is a relay station for all sensory input coming from the body and relays it to higher cortical centers.
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What is the most common cause of epidural hematomas?
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Laceration in an artery called the middle meningeal artery
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What must a nurse or HCP do for a patient that has experienced a recent head injury without loss of consciousness?
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Keep them awake.
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If a patient experiences a subdural hematoma, which vessels were most likely involved?
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Bridging veins
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What are the bridging veins?
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They are veins that drain blood from the cerebral cortex to the central sinus (runs along the sagittal vein).
Bridge the gap between the central sinus and the brain. |
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Which groups of individuals are more at risk for developing a subdural hematoma?
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1. Elderly that experience any degree of brain atrophy
2. Small children: especially infants |
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Why are elderly individuals more at risk for a subdural hematoma?
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Brain atrophy actually increases the tension on the bridging veins and can be damaged easily from any acceleration or deceleration
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Why is shaken baby syndrome so important to teach about?
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The bridge veins in infants are very delicate and are easily damaged during shaking. This can cause a subdural hematoma and subsequent death
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What are the 4 types of CVA?
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1. Thrombotic
2. Embolic 3. Hemorrhagic 4. Lacunar |
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Which form of stroke is the most serious?
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Hemorrhagic
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Describe a hemorrhagic stroke.
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Intraparenchymal bleed.
Can occur with the rupture of an aneurism or with a defect of a blood vessel. Have significant bleeding and global ischemia. -Very serious. |
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What is the name of the CVA that refers to a clot traveling from the body, but gets lodged in a small vessel of the brain? Where do they often originate?
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Embolic Stroke:
Often from left side of the heart with A fib. |
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What is the most common form of stroke? Describe it.
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Thrombotic stroke: A clot forms in an artery of the brain secondary to atherosclerosis
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Which types of stroke are considered focal ischemias?
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1. Thrombotic
2. Embolic 3. Lacunar |
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What is a common manifestation of focal ischemic strokes?
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Loss of motor movement to one side of the body or abnormality in speech formation
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What are Lacunar Strokes?
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Microinfarcts, usually due to clot formations and tend to affect the tiny vessels located in the pons of the brain.
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What is the greatest risk factor for Lacunar Strokes?
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HTN
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Where do Lacunar strokes often take place?
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The vessels of the pons
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What is the term for an infectious injury to the brain that causes swelling of the meninges and the brain itself?
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Meningeoencephalitis
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What are the 3 classifications of meningitis?
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1. Acute Pyogenic
2. Aspetic 3. Meningoencephalitis |
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What is acute pyogenic?
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Bacterial meningitis usually caused by different bacteria for different age groups
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Which bacteria commonly causes meningitis in infants?
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E. coli and GBS
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Streptococus pneumoniae and Listeria monocytogenes are common bacteria that leads to ______ in the _______ population.
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Bacterial meningitis; elderly
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Which bacteria predominates the infection of adolescents who contract bacterial meningitis?
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Neisseria meningitidis
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Which form of meningitis is considered aseptic and why?
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Viral: when a spinal tap is done the fluid comes out clear, not cloudy like with bacterial.
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Which pathogen is predominantly responsible for aseptic meningitis?
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Enterovirus
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What are the symptoms of meningitis?
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1. Extreme headache
2. photophobia 3. neck stiffness 4. Pain when you flex the neck |
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What are the common causes of meningoencephalitis?
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Chronic infection that spreads to the brain.
ie: TB, syphilis or lyme disease |
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What is consciousness?
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The state of awareness of self and the environment and of being able to orient to new stimuli.
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What are the 2 components of consciousness
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1. Arousal and wakefulness (requires concurrent functioning of RAS and cerebral cortex)
2. Content and cognition (requires functioning cerebral cortex) |
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What is confusion?
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LOC described as impaired ability to think clearly, and to perceive, respond to, and remember stimuli (disorientation)
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Which LOC is characterized by motor restlessness, transient hallucinations, disorientation and sometimes delusions?
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Delirium
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What is obtundation?
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LOC described as decreased alertness with associated psychomotor retardation.
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If your patient is conscious, but with little or no spontaneous activity, you would document their LOC as______?
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Stupor
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A coma patient is often described as?
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unarousable and unresponsive to external stimuli or internal needs
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What test is used to determine a patient's LOC?
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Glasgow Coma scale
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Which part of the brain is where content and cognition originate?
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Cerebral cortex
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What are 2 bad postural signs of brain damage?
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Flexed or extended positions
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Define brain death.
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Irreversible loos of function of the brain, including the brain stem
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What is the clinical way to dx brain death?
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Absence of responsiveness, brain stem reflexes and respiratory effort.
-Repeat evaluation after 6 hours is recommended with use of EEG testing |
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If an individual experiences only damage to his or her RAS, what might that person say when they awaken?
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That they experienced a vivid event because their content and cognition center (cerebral cortex) was still intact
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What is a persistent vegetative state?
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Where all cognition is lost and unawareness of self and surroundings is gone. Reflex and vegetative functions remain
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Most individuals in prolonged comas who survive will evolve into a _____ state.
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Vegetative
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What is a minimally conscious state?
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is sometimes mistaken for being in persistent vegetative state but may have periods of moderate wakefulness and may be able to communicate in some way. May seem awake, but don’t communicate but seem to comprehend. This came from families that have pts in vegetative states and the person was able to communicate to some way with the families.
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Degenerative diseases of the cerebral cortex are often know as _____ syndromes?
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Dementia
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List the dementia syndromes.
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1.Alzheimer's
2. Vascular dementia 3. Parkinson's disease with Dementia 4. Frontotemporal dementia 5. Reversible demetias |
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What is the degenerative disease of the basal ganglia?
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Parkinson's disease
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What is the most common dementia syndrome?
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Alzheimers
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What may cause a vascular dementia? how does it differ from the other degenerative diseases of the cerebral cortex?
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Due to some vascular injury: massive stroke.
may not be degenerative. |
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What is the name of the disorder that manifests like alzheimers, but cannot be officially diagnosed until autopsy of the brain?
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Frontotemporal dementia
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What are some common causes of reversible dementias?
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Exposure to some drugs or environmental pollutants or a metabolic abnormality
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Where does degeneration begin in the brain for a pt with alzheimers?
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In the hippocampus: responsible for memory.
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What is the early onset sight of alzheimers?
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Loss of short term or recent memory.
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What are the 3 characteristics seen on autopsies of patients with alzheimers?
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1. Brain atrophy: slow reduction of brain volume and expansion of the ventricular spaces
2. Amyloid plaques within neuronal cells. impaired removal of these proteins that are constantly turned over. 3. Neurofibrolary tangles: extracellular! |
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What is the name of the neurofibrolary tangles that are often seen in alzheimer patients?
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Tau proteins
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What is the function of the basal ganglia?
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involved in the initiation of motor movement. Responsible for making motor movements smooth, especially purposeful and fine motor movements
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What are the common manifestations of parkinson's disease?
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Tremors due to lack of regulation of fine motor movement
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What are the 2 major NT of the basal ganglia?
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Ach and Dopamine
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Parkinson patients have a progressive degeneration of which cells in the basal ganglia?
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The dopaminergic cells of the substania nigra
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What are the common treatments for parkinsons?
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Dopamine replacement or cholinergic antagonists
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WHat is the name of the autoimmune demyelinating disease?
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Multiple sclerosis
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What is the most common pattern of disease for multiple sclerosis?
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Relapse and remission
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LIst the features suggestive of multiple sclerosis.
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1. Relapses and remissions
2. onset between 15-50 3. Optic neuritis 4. Lhermitte's sign 5. Internuclear ophthalmoplegia 6. Fatigue 7. Uhthoff's phenomenon |
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what are the most common manifestations of multiple sclerosis?
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Sensory: numbness or sensation of pins and needles in the legs, arms or trunk of the body
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What is internuclear ophthalmoplegia?
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Characteristic of MS that affects the ocular motor muscles. The eye gets pulled in one direction or you can get nystagmus
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What is Lhermitte's sign?
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Part of MS, where the person moves their neck and they get a shooting pain down the spine that feels like an electric shock
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What is true of each relapse of MS?
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You never go back to the previous baseline
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Describe Uhtoff's phenomenon.
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Between relapses of MS, the pt experiences a heat sensitivity. the symptoms get worse when exposed to elevated temperatures (ie exercise)
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What are some characteristics that are NOT seen in MS?
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-steady progression
-onset before age 10 or after age 50 -cortical defects such as aphasia, apraxia, alexia, neglect -rigidity, sustained dystonia -convulsions -early dementia |
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What is agenesis of the corpus callosum?
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A prenatal brain malformation where the separation between the hemispheres is complete but the crossing fibers are not developed. Fairly benign and the person can appear to have normal brain function
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Which are do encephaloceles occur most commonly?
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In the occipital portion
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