Neuro

diffuse burning or aching sensations (slow pain)

Medium-sized A-delta fibers

pain impulses that proceed cephalad for further processing and interpretation in the brain

stimulation of large, fast, heavy myelinated Alpha-beta fibers (which synapse in the dorsal horn of spinal cord along with their nociceptive Alpha-delta and C fiber counterparts)

norepinephrine and serotonin

morphine-like neurpeptides act as neurotransmitteres by binding to one or more opiod receptors

pain impulses in spinal cord and brain

• enkephalins
• endorphins
• dynorphins
• endomorphins

somatic, visceral or reffered

skin or close to surface, sharp and localized

internal organs, abdomen, skeleton

• area removed or distant form point of origin 
•  area supplied by same spinal segment as actual site of injury (i.e. upper abdomen- T8, L1, L2
• Cutaneous and visceral neurons converge on same ascending neuron and brain cannot distinguish between origin of the two

hypothalamus with release of TSH-RH

TSH from ant. Pituitary

epinipherine

vasoconstriction, glycolysis, and increased metabolic rates

• Heat production begins in hypothalamus with release of TSH-RH
• Results in release of TSH from ant. Pituitary
• TSH causes release of thyroxine from thyroid
• Thyroxine causes release of epinephrine from adrenal medulla which causes vasoconstriction, glycolysis and increased metabolic rates
• WALA!!!!! HEAT PRODUCTION OCCURS!

fever

introduction of exogenous pyrogens or endotoxins

destroyed and absorbed by phagocytic cells in host

hypothalamus

• potentially lethal consequence
• Thermoregulatory center is overstressed
• Brain cannot tolerate temperatures of more than 105° F
• Regulatory center may cease to function Sweating ceases (core temp rises rapidly), skin dry and flushed (vascular collapse), irritabilility, confusion, stuporous, comatose (cerebral edema, degeneration of CNS, renal tubular necrosis)

• slows chemical reactions, increases blood viscosity, slows blood flow, facilitates blood coagulation, stimulates profound vasoconstriction
• Body temp < 95° F
• Secondary to hypothyroidism, hypopituitarism, malnutrition, Parkinson’s Disease, rheumatoid arthritis
• Shivering, thinking becomes sluggish, decreased coordination
• Stuporous, decreased HR and RR, decreased cardiac output
• Moderate to severe acidosis

alteration of perception of stimuli (time, then place, then person)

oriented x3 but slow vocalization decreasd motor skills

awakens in response to stimulation, continuous stimulation needed for arousal, eyes usually closed

arouses only to painful stimuli

no arousal to any stimulus but brainstem reflexes intact

• 1. Diencephalon (thalamus/hypothalamus):
• - agitated, dull, lethargic, obtundation
• - pupils respond briskly, full-range eye movements only on “doll’s eyes” – none in direction of rotation on or after injection of hot or cold water in ear canal (caloric posturing)

• 2. Midbrain –
• - stupor or coma
• - neurogenic hyperventilation
• - midposition fixed pupils (MPF)

• flexor
• diencephalon area involved
• flextion of UEs, extension of LEs

• extensor
• midbrain and/or pons involved
• stupor coma LOC
• arms rigid, palms turned away from body

when irreversible brain damage allows no potential recovery and can no longer maintain respiratory and cardiovascular functions

Destruction of brainstem and cerebellum

irreversible coma

Death of cerebral hemispheres exclusive of brainstem and cerebellum

Permanently unable to respond in any way to environment

Brain may continue to maintain normal respiratory and cardiovascular functions, normal T control, and normal GI function

abnormal excessive hypersynchronous discharges of CNS neurons

sudden transient alterations in brain function

begin locally, involve neurons unilaterally

without impairment of consciousness, with motor signs, special sensory or somatosensory symptoms (prodroma) hours to days before seizure, autonomic symptoms and psychic symptoms

with impairment of consciousness, with or without automatisms

partial onset evolving into generalized tonic-clonic seizures

bilaterally symmetric and without local onset. COnsciousness always impaired or lost

• absence
• clonic-alternating contraction and relaxation of muscles
• Tonic-muscle contraction with excessive muscle tone
• Tonic-clonic (aura precedes)
• Atonic

• neonatal seizures
• infantile seizures

occurrence of a second, third or multiple seizures before the person has fully regained consciousness from preceding seizure. Causes cerebral hypoxia

follows a generalized tonic-clonic seizures. Sleeping

no correctable cause for seizures is found. seuzres recurrent w/o treatement

›Severe cognitive dysfunction in older people

›Exact cause unknown….only theories

›Loss of neurotransmitter stimulation by choline acetyltransferinase?

›Mutation for encoding amyloid precursor protein?

›Pathologic activation of receptors that allow influx of excess Ca+?

• ›Late-onset familial Alzheimers
• dementia (FAD) linked to a defect on chromosome 19 - hereditary

accumulation of insoluble amyloid beta peptides- protein found in AD

twisted and distored protein fibers int he neurons

more concentrated in the cerebral cortex and hippocampus

The greater the number, the more dysfunction and disturbances found in blood flow in the brain

inability to perform coordinated acts in addition to cognitive

closed 

Head strikes hard surface or rapidly moving object strikes head

Dura remains intact, brain tissue not exposed to environment

penetrating 

break in dura exposes cranial contents to environment

Results in focal brain injury

• involves specific, grossly observable brain lesions seen in cortical contusions, epidural hemorrhage, subdural hematoma, intracerebral
• hematoma, and open-head trauma

bruises on brain from force of impact

direct impact area

area that lies opposite of the line of force; lesions where brain strikes hard tissue on opposite side

(epidural hematomas or epidural hemorrhages)

most often have an artery as source of bleeding

tearing of bridging veins major cause of rapid and subacute development

subdural space fills with blood and herniation can occur

(intraparenchymal hemorrhages)

small blood vessels traumatized by shearing forces

results from inertial force to the head; associated with high levels of acceleration and deceleration. Memory loss, dizziness, headaches, anxiety and mood disorders

decerebrate or decorticate posturing, prolonged stupor or restlessness (concussion)

prolonged coma lasts days or weeks with incomplete recovery most often

immediate autonomic dysfunction (brainstem signs) that resolves in a few weeks. Increased intracranial pressure (IICP) appears 4-6 days after injury

Most often occur at first to second cervical vertebrae (C1-C2), fourth to seventh cerivical (C4-C7) and twelfth thoracic to second lumbar vertebrae (T12-L2)

These are most mobile portions of vertebral column

Cervical injuries that cause swelling may be lifethreatening b/c of impairment of diaphragm function

Caused by normal activity of SC cells at or below level of injury ceasing b/c of lack of continuous tonic discharges from brain or brainstem and impulses inhibited immediately after injury

Characterized by complete loss of reflex function in all segments below level of lesion

May last 7-20 days after onset….up to 3 months in more severe cases

syndrome that may occur any time after spinal shock resolves

Associated with a massive, uncompensated CV response to stimulation of the sympathetic nervous system

Most often at T6 level or above

Involves stimulation of sensory receptors below level of cord injury

Most common response to distended bladder or rectum

biochemical and biomechanical alterations of the tissue that comprise the intervertebral disk.

structural defect that involves the lamina (neural arch of the vertebra)

Most common in lumbar spine

caused when a vertebra slides forward in relation to an inferior vertebra 

commonly at L5-S1

protrusion of part of the nucleous pulposus through a tear in the fibrous capsule that encloses the gelatinous center of the disk

the sciatic nerve over the buttocks and into the calf or ankle

unilateral

caused by arteries supplying brain. Most frequently attributed to atherosclerosis and inflammatory disease processes that damage arterial walls

thrombotic particles that cause an intermittent blockage of circulation. Neuro deficits caused by focal disturbance of brain or retinal ischemic lasting less than an hour without an infarction

involves fragments that break from a thrombus that was formed outside of the brain.  Common sites include heart (MI or Atrial fibrillation, endocarditis, rheumatic heart disease, aorta, common carotid artery or

most commonly caused by HTN, ruptured aneurysms, arteriovenous malformation, bleeding disorders. Causes severe headache, stiff neck, loss of consciousness, blood in CSF

very small and involve only small arteries

when an area of brain loses blood