Patho Neuro-Psych

Helpfulness: 0
Set Details Share
created 2 weeks ago by Kijana_Danielle_Gantenbei
6 views
show moreless
Page to share:
Embed this setcancel
COPY
code changes based on your size selection
Size:
X
Show:
1

Primary brain injury

direct result of event

2

Secondary brain injury

Due to the body's response to event

3

Critical factor regarding brain cell death

ATP depletion

4

Which is more immediate as far as neurological dysfunction? Ischemia or Hypoxia?

Ischemia

5

Time before irreversible damage from lack of o2 to brain?

5-10 minutes

6

Mechanisms causing brain cell death

Anaerobic metabolism

Ion gradient deterioration

7

In anoxic depolarization, what leaves the cell?

K

8

In anoxic depolarization, what enters the cell?

NA, Cl, Ca

9

When membrane integrity is lost in neuronal cells, what amino acid may released in excess?

Glutamate (excitatory)

10

Under normal circumstances, what is Glutamate involved in?

Memory and learning

11

When membrane integrity is lost in neuronal cells, why isn't excess Glutamate removed?

Glutamate reuptake mechanisms are energy dependent

12

What does excessive Glutamate trigger neurons to do?

Take up large amounts of calcium

13

What does excessive calcium uptake cause in neurons?

Cytotoxic edema (calcium overload injury)

14

What do NMDA receptors do when activated?

Stimulate nitric oxide production in neurons

15

What does excess nitric oxide do in the brain?

May result in reactive nitrogen species, which act as free radicals

16

O2 free radicals?

hydroxyl radicals

superoxide

peroxide

17

Reperfusion injury

-O2 reenters cells--

Produces reactive oxygen species (O2 free radicals)

18

Reperfusion injury

What exactly happens to the cell walls?

Lipid peroxidation

19

Reperfusion injury

What does lipid peroxidation result in?

The formation of arachidonic acid

20

Reperfusion injury

Arachidonic acid--

causes a cascade resulting in more free radicals and inflammatory mediators

21

Autoregulation in the brain controls

vasoconstriction/dilation

22

Autoregulation in the brain is influenced by

pH, c02, o2 --arterial

23

Neurological hyperperfusion results in

edema

24

Normal ICP

15 or less

25

Any change to the volume of blood, CSF, or brain tissue results in compensatory changes

Monroe-Kellie hypothesis

26

What causes visual disturbances in ICP?

Edema of the optic disk

PAPILLEDEMA

27

Protrusion through an opening in the dura

Brain herniation

(Subfalcine, tonsillar, tentorial, uncal)

28

Main focus during treatment of brain injuries

Cerebral oxygenation

29

Most sensitive indicator of altered brain function

Altered LOC

30

State of alertness and attentiveness is dependent on

RAS neurons

31

(review)

GCS- Eyes

4- whatever

3-verbal

2-pain

1- nadda

32

Review

GCS--Verbal

5-normal ass

4-confused

3- weird words

2- shmambergured

1- nadda

33

Review

GCS--Movement

6- obeys commands

5- moves to pain

4- withdraws from pain

3- deCORticate

2- decerebrate

1- nadda

34

The eyes do not move in sync

deconjugate movement

35

Cranial nerves involved with pupil reflex

2 & 3

36

Cranial nerves involved with eye movement

3, 4, & 6

37

Focal TBI

Localized injury

38

Diffuse TBI

various locations of injury, caused by brain moving w/i skull

39

Polar TBI

Shaken baby

40

Coup injuries

focal

41

Contracoup injuries

polar

42

Primary brain injuries

-Concussions

- hematoma

- contusion

43

Pt suffers a brief period of disturbed consciousness, returns to normal (AKA lucid interval), then rapid deterioration.

- typically arterial- rapid onset

- CT imaging used

Epidural Hematoma

44

May be acute or subacute

typically involves bridging veins, slower onset

CT or MRI imaging

Subdural hematoma

45

bleeding above pia mater, typically rupture of aneurism/ arteriovenous malformation

typically rupture of bridging veins

blood spreads through CSN causing meningeal irritation, hydrocephalus, headache, vasospasm, ischemia

subarachnoid hemorrhage

46

TBI treatment includes maintaining--

correct glucose

temp (inducing mild hypothermia)

PaCO2

Blood volume

47

Treatment of acute ICP

mannitol

hypothermia

sedation

mild hyperventilation

48

Bruising under the ear is called

battle sign-- may indicate base skull fracture

49

Bilateral black eyes

raccoon sign-- may indicate base skull fracture

50

A sudden onset of neurological dysfunction resulting in an infarct

Stroke

51

Most common form of stroke

Ischemic

52

________ cause abnormalities in cerebral perfusion

Strokes

53

5th leading cause of death in the united states

strokes

54

Who experiences CVD and stroke more? Men or women?

Men

55

Area of hibernating cells around dead brain tissue

Penumbra

56

Stroke must be treated within _____ hours of onset of symptoms to be effective

Ischemic stroke

3

57

Hemorrhagic stroke occurs within the

brain parenchyma

58

Hemorrhagic strokes occur most commonly specifically in the

basal ganglia or thalamus

59

Imaging for stroke

CT

60

Stroke

Initial motor deficits are ________ as function recovers, it becomes _________

Flaccid

Spastic

61

homonymous hemianoptia

contralateral field blindness

62

Stroke- expressive aphasia

Broca's area

63

Stroke- receptive aphasia

Wernicke's area

64

Most common causes of subarachnoid hemorrhage

arteriovenous malformation (AVMs)

Cerebral aneurisms

65

Location of most cerebral aneurisms

Circle of Willis

66

Symptoms of cerebral aneurism

HA

photosensitivity

meningismus

N/V

stiff neck

67

Cerebral aneurism imaging

MRI

CT

LP (not imaging)

68

arterial blood is shunted directly into venous system causing enlargement over time

AVMs

69

Risk factors for CNS infection

Immunocompromise

steroid use

poor nutrition

radiation

contact with vectors

70

CNS infection- Viral

encephalitis

71

CNS infection- Bacterial

meningitis

cerebral abscess

72

Most common meningitis

streptococcus pneumoniae

73

What causes obstructive hydrocephalus in meningitis

inflammatory exudate

74

Where does meningitis invade in the brain?

leptomeninges

75

Steroid treatment is _________ in meningitis

controversial

76

Causes of encephalitis

West nile

herpes

western equine

77

Symptoms of meningitis

HA

fever

stiff neck

confusion/delirium

78

Symptoms of encephalitis- West Nile

fever

HA

malaise

muscle pain

rash

79

Symptoms of encephalitis-herpes

fever

HA

seizures

confusion

stupor

coma

80

Paroxysmal, excessive or abnormal electrical discharges in brain

seizures

81

Manifestations of seizure

Behavioral, autonomic visceral, skeletal, motor, sensory, consciousness

82

Causes of seizure

cerebral injury

idiopathic

nutritional

lesions

metabolic

83

Direct cause of electrical malfunction in seizure

Alteration in membrane potential causing hyperactive/hypersensitive neurons

(EPILEPTOGENIC FOCUS)

84

aura is also called

prodrome

85

neurons which may be recruited in seizure

near and far

86

Entire surface of brain is involved in a _______ seizure

Generalized

87

Involvement in RAS or thalamus in seizure results in

Loss of consciousness

88

When myoclonic jerks and automatisms occur w/ absence seizures..

atypical absence

89

Seizure

Single or several jerks

Myoclonic

90

Drop attack seizures

Atonic

91

Partial seizure w/o change in consciousness

Simple

92

Partial seizure w/ change in consciousness

complex

93

Partial seizure w/o change in consciousness that progresses to generalized

partial w/ secondary generalization

94

Antiseizure meds may be discontinued after

2 clear years

95

Grand mal seizures are

tonic clonic

96

Dementia- non-alzheimers

Vascular

97

Deficient synthesis of acetylcholine in brain

Alzheimers

98

Ruling out dementia

B-12

thyroid

syphilis

CBC

chem panel

99

Treating dementia

Acetylcholinesterase inhibitors, because, duh

100

N-methyl-D-aspartate inhibitors can be used to treat

(NMDAAAAAA)

Dementia

101

Dopanime deficiency in the basal ganglia (substantia nigra)

Parkinsons

102

Lewy Bodies

Lewy Body Dementia

Parkinsons

103

Difficulty initiating and controlling movements (akinesia), tremors, rigidity

Parkinson's manifestation

104

Tremors of parkinsons

occur at rest

pill rolling motions

cogwheel rigidity

105

Lack of expression

shuffling

no arm swing

drooling

Parkinsons

106

Nonprogressive damage to motor control areas of brain in childhood

Cerebral Palsy

107

Major types of cerebral palsy

spasticity

ataxia

dyskinesia

a mix

108

Causes of cerebral palsy

brain damage during birth

disease of the mother

nerve damaging poisons

prenatal diseases or infections

109

Cerebral palsy treatment

anticonvulsants

botox (for pain)

muscle relaxants

braces

110

Abnormal accumulation of CSF in cerebroventricular system

hydrocephalus

111

Neural tube deficit or obstruction of aqueduct of sylvius (premature closure before bitrh)

hydrocephalus causes

112

Hydrocephalus symptoms

gait instability

urinary incontinence

dementia

113

Abnormal absorption of CSF blocking flow in subarachnoid space or subarachnoid villi

Nonobstructive/Communicating hydrocephalus

114

Ventriculoperitoneal shunt

shunts CSF to peritoneal cavity in communicating hydrocephalus

115

ventriculostomy

3rd hole to allow free flow of CSF to basal cisterns in Nonobstructive/communicating hydrocephalus

116

Normal pressure hydrocephalus

Brain tissue lost, no increase in pressure

117

Obstruction in aqueduct or lesion in the 4th ventricle blocking flow of CSF

Noncommunicating/obstructive hydrocephalus

118

Part of brain responsible for smooth coordinated movement of muscle, postural reflexes and balance

cerebellum

119

Demyelination of MS often effects

optic/oculomotor nerve and spinal nerve tracts

120

MS affected by

Heat

infection

trauma

stress

121

Double vision

vision blur

memory loss

poor coordination

bowel/bladder

sensory deficits

MS presentation

122

Meds for MS

steroids during attacks

immune modifying drugs to slow

123

defective closure of bony encasement of spinal cord

spina bifida

124

Spina bifida occulta

not visible

125

Spina bifida cystica

Saclike structure protruding

126

Classification of spina bifida cystica

__extent of neural involvement__

meningocele

meningomyelocele

myelomeningocele

127

Spina bifida diagnostics

a-fetoprotein testing

ultrasound

128

Muscular weakness progressing from arms

Both upper and lower motor neurons

ALS

129

Highly suggestive of ALS

hyperreflexia of weak, atrophied extremity

130

ALS diagnosis

EMG

MRI

Nerve conduction

serum labs

131

Glutamate inhibitors treat

ALS

132

Types of spinal cord injuries

transection

contused

compressed

133

Secondary spinal cold injuries..

swelling

bleeding

ischemia

inflammation

134

Spinal shock

flaccid muscles become spastic muscles as shock wears off

135

Spinal shock is CHARACTERIZED by

temporary loss of reflexes below level of injury

136

Guillan-Barre is a _____________ disease of the ___________

demyelinating

Peripheral nervous system

137

acute idiopathic polyneuropathy AKA polyradiculoneuropathy

Guillan-Barre

138

Guillan Barre is ____________

ALS is ____________

Ascending

Descending

139

Guillan-Barre diagnostics

Nerve conduction tests

LP

Pt hx

physical

140

Guillan Barre treatment

Plasmaphoresis

immunoglobulin

141

Bell palsy imaging

MRI

CT

EMG

142

Bell Palsy onset

24-48 hrs

143

Bell palsy is suspected to be caused by

a virus

144

Hyperacusis

sensory intolerance for normal noise

145

Bell palsy typically resolve in __ weeks

3

146

Bell palsy treatment

Antiviral (acyclovir, valacyclovir)

Steroids

Nocturnal eye patching

ointments/eye drops

147

POSITIVE symptoms of schizophrenia

**excess or distortion of normal functions/ disorganization*

-fixed, false beliefs-- persecution, grandiosity, somatization, reference, religiosity, controlling

148

POSITIVE symptoms of schizo caused by

excessive dopamine D2 receptor activity

149

Catatonic motor behaviors are a _________ symptom of schizophrenia

positive

150

NEGATIVE symptoms of schizophrenia

represent a loss or deficit of normal functioning

-poverty of speech, blunted affect, asociality, avolition,

151

NEGATIVE symptoms of schizophrenia are caused by

Dopamine D1 receptor activity

152

Cognitive clinical manifestations of schizo

difficulty planning, abstract thinking, attention, working memory, language production/comprehension

153

Anhedonia is a symptom of

schizophrenia

154

Diagnosis of schizophrenia requires at least two of these symptoms and much have at least one of ******

Significant disruption in life (self care, work, relationships)

****Hallucinations

****Disorganized speech

grossly abnormal psychomotor behavior

negative symptoms

*****Delusions

155

___________ causes decreased neurotransmission and connectivity

dopamine excess

156

Schizophrenia involves an excess of _________ and a deficit of ___________

dopamine

glutamate transmission at NMDA receptors

157

____________ increases synaptic behavior and neurotransmitter output (schizophrenia)

brain derived neurotrophic factor (BDNF)

158

causes a decrease in neurotransmission and connectivity like dopamine

glutamate transmission at NMDA receptors

159

Risk of schizophrenia as a child of a schizophrenic

40-68%

160

prenatal infections, malnutrition, birth complications and brain injury are all risk factors for

schizophrenia

161

pyramidal cells not lines up

exposure to flu 2nd trimester

impairment of hippocampal development

gestational effects-- schizophrenia

162

Neuro structure-- schizophrenia

limbic and prefrontal cortex fuck ups

163

neuro structure-- schizophrenia-- hippocampus

--misarranged pyramidal cells --hippocampus

164

neuro structure-- schizophrenia--prefrontal cortex

- fucked up glucose metabolism

165

MDD lasts at least ___ years

2

166

MDD diagnosis

5 or more criteria in same 2 wk period, one must be depressed mood or loss of interest/pleasure

167

MDD hallmark- Adults

depressed mood or loss of interest/pleasure

168

MDD hallmark-- children

irritability

169

Neurobio of MDD

Fucked up hippocampal and prefrontal cell structure

HPA axis activation

reduced serotonin

170

Symptoms of serotonin syndrome

myoclonus, hyperreflexia, altered mental status, restlessness, agitation shivering, tremors

171

In MDD, there is a reduction in ______ which causes hippocampus cell atrophy

BDNF

172

Bipolar children

ADHD, mood cycling, irritability

173

Bipolar one involves

mania

174

Bipolar two involves

hypomania

175

hypomanic- __ days

manic-__ days

4

7

176

Probably bio mechanisms of bipolar

impaired emotion processing and regulation

177

lithium inhibits

action of epi and norepi on brain

178

Lithium toxicity first signs

nausea, fatigue, confusion