clinical med nervous

  1. epidural hematomas - bleeding where?
    btwn skull and dura
  2. which artery is involved w epidural hematomas?
    which bone?
    • middle meningeal artery
    • usually temporal
  3. subdural hematomas
    bleeding where?
    due to which blood vessel?
    tricky why?
    • in dubdural space
    • bridging veins btwn brain and the large dural sinuses
    • it's not an immediate emergency, so by the time it's a problem pts often forgot about the incident
  4. subarachnoid hemorrhage is caused by...?
    usually trauma and rupture of a preexisting arterial aneurism
  5. vascular malformations are due to..?
    imcomplete and/or abnormal reslution of embryonic vasculature
  6. most common aneurism
    saccular ("berry") aneurisms - seenin 5-6% of the population
  7. saccular/berry aneurisms are usually where?
    • at bifurcation of vessels, usually in the middle cerebral artery and its branches
    • however, those in the ant. ecrebral and ant. communicating artery are more prone to ruputre
  8. cerebral (non-traumatic) hemorrage
    a collection of usually bloody fluid within brainstem or cerbral hemispheres (aka: stroke)
  9. most common cause of non-traumatic hemorrhage
    • hypertensive hemorrhage
    • occurs most frequently in basal ganglia due to ruputre of blood vessels whose walls have been previously damaged by chronic hypertension or hypertensive microaneurism
  10. diff between hemorrhages and infarcts
    hemor - not confined to an arterial distribution and tend to compress the brain parenchyma, not destroy it.
  11. infarction results from
    loss of blood supply with ensuing necrosis due to 1 - vascular thrombosis or 2 - embolism
  12. hydrocephalus
    • related to abnormal flow of cerebrospinal fluid, increased CSF vol.
    • can be due to problems with production, but more often due to problems w reabsorption
  13. noncommunicating hydrocephalus

    communicating hydrocephalus

    blockages are where??
    • noncom: blockage is within brain
    • comm: blockage is in subarachnoid space
  14. 3 causes of hydrocephalus
    • 1. overproduction of CSF
    • 2. inability of acracnoid villi to transfer CSF to venous drainage
    • 3. blockage of CSF pathways (noncom - blockage in brain, or comm - blockage in subarachnoid space)
  15. leptomeningitis
    caused by...

    what's happening

    bacterial infection caused by e. coli, h. influenza, n. meningitidis, and strep. pneumonia

    meninges fill up with purulent exudate increasing pressure, neutrophils, and protein, and decreasing glucose

    symptoms: agitation, headache, photophobia , stiff neck,
  16. cerebral absess

    caused by
    the process
    result of bacterial infection carried by bloodstream from sinus, ear, or mastoid infections

    first it's accute, with neutrophil infiltration and liquefactive necrosis w extensive cerebral edema, then fibroblasts wall of the nccrotic area and dead tissue is removed
  17. viral meningitis
    a complication of systemic viral disease and aids
  18. poliomyelitis
    any inflammation of gray matter of spinal cord, viral
  19. rabies
    encephalitis caused by rabies virus
  20. alzheimers
    what chromosome and protein are involved?
    what happens to meninges
    other changes
    death is often secondary to __
    • chrom 21, amyloid protein
    • meninges thicken
    • "gyri atrophic with dilation of ventricles due to cortical atrophy"

    to respiratory infections
  21. ALS
    • amylotrophic lateral sclerosis
    • degenerative disease, a wasting of the extremities, while sensory and mental function remain intact
    • degeneration of upper motor neurons in the CNS
    • damage to corticospinal tracts and anterior horn cells ---> denervation atrophy of muscle groups
  22. Huntington disease
    • chorea - sudden twitches and jerks
    • autosomal dominant disease
    • appears in 4th decade
    • atrophy of caudate and putamen nuc
  23. 3 CNS neoplasms w neuroglial origin
    • astrocytoma ---> siezures, motor deficits, mental changes
    • oligodendroglioma ---> siezures
    • ependymoma --->most frequently in 4th ventricle
  24. CNS neoplasm of meningial origin
    • meningioma - slow growing, benign, may or may not be symptomatic (headach, focal seizures, visual disturbances)
    • prognosis depends on accessibility to surgical removal
  25. CNS neoplasm of metastatic origin
    much worse than meningeal origin

    • primary sites in order of frequency:
    • lung, breast, melanoma, kindey, GI

    symptoms: headache, siezure
  26. Wallerian degeneration
    • PNS problem
    • degen in distal segment of a transected nerve w buildup of organelles in the proximal and distal agonal stums, and atrophy of schwann cells replaced by fibrose tissue

    a nerve is cut, stuff builds up around the stumps, the myelin turns to fibrotic tissue

    <Sam Waller -- short guy with big beautiful hair>
  27. distal axonopathy
    • a PNS problem
    • distal axonopathy (dying back) while proximal axon is intact
    • involves toxic and metabolic neruopoathies
    • regeneration is possible if the cause is removed
  28. segmental demyelination
    a PNS problem of damage in myelin sheaths
  29. diabetic neuropathy
    • a PNS problme
    • it's the most common form of symmetrical polyneruopath
    • can involve sensory and autonomic nerves w extensive segmental dmyelination secondary to axonal degneration
  30. Guillain-Barre disease
    • PNS trouble
    • an autoimmune disorder w progressive ascending motor paralysis
    • may affect spinal and cranial nerves
    • preceded by viral infections
    • char. by segmental demyelination
Card Set
clinical med nervous
clinical med nervous