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69 Cards in this Set
- Front
- Back
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Brain Tissue is made up of
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Neurons
Glial cells |
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Glial Cells
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Support structure to neurons
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Astrocytes
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Supply nutrients to neurons and other glial cells and maintains the K ion homeostasis for neurons
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Microglia
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Waste and debri removal system of the brain
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Ependymal Cells
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Produce CSF
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Oligodendrocytes
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Maintain the myelin sheath after an injury
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function of
CEREBRUM |
Performs motor and sensory functions and a variety of mental activities
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function of
CEREBELLUM |
Balance, muscle tone, posture and coordination
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function of
BRAINSTEM |
Motor control, reticular activating system (wakefulness), regulatory centers for heart rate, pulse, blood pressure and respiration
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RIGHT hemisphere controls
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Hand dominance on L side, artistic functions, music, art awareness, spatial orientation, creativity and insight
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LEFT hemisphere controls
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Hand dominance on R side, number skills, spoken language, written language, abstract reasoning and scientific functions
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Corpus Collasum
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connects R and L hemispheres of cerebrum, coord functions of the two halves
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4 lobes of the Cerebrum
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frontal, temporal, parietal, occipital
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function of
FRONTAL LOBE |
Judgment, reasoning, attention, ST memory, motor function (homunculus), motor speech (Broca's area) and personality
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function of
PARIETAL LOBE |
Sensation (homunculus), speech organization, hand skillls, grammar, perception and proprioception
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function of
TEMPORAL LOBE |
Hearing, emotion, smell, taste, understanding speech (Wernicke's area), recall of LT memory
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function of
OCCIPITAL LOBE |
Vision, sensation
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TENTORIAL NOTCH
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triangular opeining of dura that allows brainstem, blood vessels and nerves to pass through an oval opening.
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supratentorial
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above the tentorial notch; contains f, t, p and o lobes; Also corpus collosum, 2 lat ventricles, 3rd ventricle & CN I & II
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infratentorial
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area below tentorial notch; includes cerebellum and brainstem
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What is normal cerebral blood flow
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750 ml/min
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Arterial bl flow to brain is what percent of CO
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20%
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How does the brain autoregulate blo flow over a wide range of BP
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by vasoconstriction or vasodilation of the arteries
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Major arteries that supply bl flow to brain
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R and L Carotid arteries
R and L Vertebral arteries |
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Carotid arteries provide circulation to
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Anterior brain (F, T, P and O lobes). Accounts for 80% of bl flow to brain
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Vertebral arteries join to form the basilar artery and provide circulation to
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Posterior brain (cerebellum, brainstem and base of O and T lobes). Accounts for 20% of bl flow to brain
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What communication artery connects the anterior and posterior circulation
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Circle of Willis
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functions of Circle of Willis
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Connects ant & post circulation, and can act as protective mech by shunting bl from one side to the other or ant vs post port of br
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ACA
Anterior Cerebral Artery |
Supplies most medial portions of frontal lobe and superior medial parietal lobes
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AcomA
Anterior Communicating Artery |
Connects the anterior cerebral arteries at their closest juncture
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ICA
Internal Carotid Artery |
Ascends thr base of skull to give rise to ACA and MCA, and connects with post half of COW via PCA
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MCA
Middle Cerebral Artery |
Trifurcates off the ICA and supplies the lateral aspects of the T, F and P lobes
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PcomA
Posterior Communicating Artery |
Connects to anterior COW with PCA of vertebral-basilar circulation posteriorly
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PCA
Posterior Cerebral Artery |
Supplies the O lobe and the inferior portionof the T lobe. A branch supplies the choroid plexus
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BA
Basilar Artery |
Formed by junction of the two vertebral arteries, it terms as a bifurcation into post & cerebral arteries supplying brainstem
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VA
Vertebral Artery |
Vertebrals emerge from post base of skull (For Magn) and merge to form the basilar artery supplying the brainstem
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BBB
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if intact restricts mvmt of large harmful subst fr bl strm. If ischemic or infectv states, brks down and allows bad stf in
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Venous Drainage System
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cerebral veins->venous sinuses->R/L int jug veins. Vein and sinuses of br-no valves. HOB @ 30 and head in neutr pos ^ drng
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CSF
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produced in lateral ventricles by ependymal cells on the choroid plexus. Provides nutrients, removes waste prod & shk abs
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CSF statistics
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250-500cc prod q24h; 125cc in ventric syst at one time; Abs from SA space bay arachnoid villi into the venous syst
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CPP
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maintains the cerebral blood flow.
normal CPP=70-90 mm Hg hypoperfusion: CPP<60 mm Hg |
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CBF
cerebral blood flow |
affected by CPP and CVR
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CVR
cerebrovascular resistance |
the pressure across the cerebrovascular bed from the arteries to the jugular veins
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Average CBF
Ischemia CBF Tissue Death Hyperemia (CBF>tissue demand) |
50 ml/100 Gm/min
<18-20ml/100 Gm/min <8-10/100 Gm/min |
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Extrinsic factors that affect CBF
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systemic BP, CO, bl viscosity, vascular tone
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Intrinsic factors that alter CBF
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^CBF: when vessels dialate, ex: ^PaCO2(hypercarbia); vpH; vpaO2(hypoxia)
vCBF: with opposite of above |
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Other factors that affect CBF
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anesthetic and antihypertensive agents, REM sleep, arousal, pain, sz, ^T, and cerebral trauma
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Basilar Fractures Types
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Anterior Fossa
Middle Fossa Posterior Fossa |
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Anterior Fossa S&S
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rhinorrhea (d/c from nose); raccoon eyes (occurs immed); anosmia (loss of smell); oculomotor palsies
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Middle Fossa S&S
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hemotympanum; otorrhea; Battle's sign (bruising behind ear-occurs w/in 24-48 hrs); unilateral hearing loss
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Posterior Fossa S&S
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hypotension; tachycardia; alteration in respirations d/t compression of the brainstem
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Signs of CSF leak in basilar skull fx
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salty/sweet taste in mouth; post-nasal drip; coughing or clearing throat; visible drainage from ear/nose;
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Procedures to avoid if pt has basilar skull fx
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do not drink with straw; no hot liquids, no blowing of nose, don't use IS; no NG tube insertion
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Le Forte I
Le Forte II Le Forte III |
most common fx-maxilla bone
"dishpan" face free floating maxilla |
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Concussion
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alteration of consciousness following a non-penetrating TBI to brain; CT scan does not show abnormalities
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S&S of Concussion
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confusion, disorientation, headache, dizziness, fatigue, insomnia, hallmark AMNESIA; Usu resolves in 3 mos
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Cerebral Contusion
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area of bleeding and edema within the brain tissue; prim inj>swelling>bleeding>^ICP>secondary injury
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S&S Cerebral Contusion
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chg LOC, sz, disorientation, headache, vomiting, deterioration in neuro status. CT/MRI is diagnostic; repeat CT in 24hr
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Treatment for cerebral contusion
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osmotic diuretic (mannitol), barbiturates (pentobarbital, thiopenthol), hyperventilation (PaCO2 30-35), ICP monitg, sx
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SAH
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bleeding occurs below the arachnoid meninge d/t cerebral bl vessels being stretched or torn at the time of injury. Not vis on CT
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Complications of SAH
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focal ischemia, localized cerebral edema, VASOSPASM (usu4-10days s/p SAH), thrombosis of bl vess, or traumatic aneurysm
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Epidural Hematoma
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collection of bl in extradural space; Usu cased by lac of middle meningeal artery; shifts br tissue medially; immed sx req'd
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S&S Epidural Hematoma
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period of lucidity folw'd by rapid neurological deterioration; ips pupil dial; chg LOC; posturing, contrlat limb wkn, hemipar&plegia
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SDH
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collection of blood below the dura; venous in origin from the B bridging veins; diagnostic on CT
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Common causes of SDH
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falls, MVC, assault, violent shaking
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Acute SDH
Subacute SDH Chronic SDH |
24-48 hrs
2 days - 2 weeks 2 weeks - 3 months |
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ICH (intracerbral hematoma)
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results from bleeding w/in the cerebral tissue, usu from depr sk fx, penetr ing or accel-decel inj
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S&S ICH
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pt presents usu with a sudden deterioration in neuro status
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DIA
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cs by accel-decel & rotational forces during prim hd inj,wh cs stretching & shearing of neurons (white matter tracts) v neuronal tr
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