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  1. Small unmyelinated C polymodal nociceptors responsible for transmission of
    diffuse burning or aching sensations (slow pain)
  2. _______________ carry well-localized, sharp pain; important in intitiating rapid reactions to stimuli (fast pain)
    Medium-sized A-delta fibers
  3. "gate" in the spinal cord regulates transmission of
    pain impulses that proceed cephalad for further processing and interpretation in the brain
  4. what can close pain gates?
    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)
  5. ___________ and ________ contribute to pain modulation (inhibition) in medulla and pons
    norepinephrine and serotonin
  6. edrogenous opiods
    morphine-like neurpeptides act as neurotransmitteres by binding to one or more opiod receptors
  7. ednrogenous opioids inhibit transmission of
    pain impulses in spinal cord and brain
  8. 4 types of endogenous opioids
    • enkephalins
    • endorphins
    • dynorphins
    • endomorphins
  9. Acute pain
    somatic, visceral or reffered
  10. Somatic pain
    skin or close to surface, sharp and localized
  11. visceral pain
    internal organs, abdomen, skeleton
  12. referred pain
    • 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
  13. heat production begins in
    hypothalamus with release of TSH-RH
  14. thermoregulation results in realase of
    TSH from ant. Pituitary
  15. Thyroxine causes release of _______ from adrenal medulla which causes

    vasoconstriction, glycolysis, and increased metabolic rates
  16. Steps in THermoregulation
    • 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
  17. failure of normal thermoregulatory mechanism
  18. fever begins with
    introduction of exogenous pyrogens or endotoxins
  19. Fever causes interleukin-1 (IL-1), IL-6, interferons and TNF produced and released as exogenous bacteria are
    destroyed and absorbed by phagocytic cells in host
  20. fever raises set point of
  21. heatstroke
    • 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)
  22. hypothermia
    • 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
  23. confusion
    alteration of perception of stimuli (time, then place, then person)
  24. lethargy
    oriented x3 but slow vocalization decreasd motor skills
  25. obtundation
    awakens in response to stimulation, continuous stimulation needed for arousal, eyes usually closed
  26. stupor
    arouses only to painful stimuli
  27. coma
    no arousal to any stimulus but brainstem reflexes intact
  28. Pogressioin of nonresponsiveness
    • 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)
  29. decorticate posturing response
    • flexor
    • diencephalon area involved
    • flextion of UEs, extension of LEs
  30. decerebrate posturing
    • extensor
    • midbrain and/or pons involved
    • stupor coma LOC
    • arms rigid, palms turned away from body
  31. brain death
    when irreversible brain damage allows no potential recovery and can no longer maintain respiratory and cardiovascular functions

    Destruction of brainstem and cerebellum
  32. cerebral death
    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
  33. seizures are caused by
    abnormal excessive hypersynchronous discharges of CNS neurons
  34. seizures are characterized by
    sudden transient alterations in brain function
  35. Partial seizures
    begin locally, involve neurons unilaterally
  36. Simple partial seizures
    without impairment of consciousness, with motor signs, special sensory or somatosensory symptoms (prodroma) hours to days before seizure, autonomic symptoms and psychic symptoms
  37. complex partial seizures
    with impairment of consciousness, with or without automatisms
  38. secondarily generalized complex seizure
    partial onset evolving into generalized tonic-clonic seizures
  39. generalized seizures
    bilaterally symmetric and without local onset. COnsciousness always impaired or lost
  40. types of generalized seizures
    • absence
    • clonic-alternating contraction and relaxation of muscles
    • Tonic-muscle contraction with excessive muscle tone
    • Tonic-clonic (aura precedes)
    • Atonic
  41. unclassified epileptic seizures
    • neonatal seizures
    • infantile seizures
  42. Status epilepticus
    occurrence of a second, third or multiple seizures before the person has fully regained consciousness from preceding seizure. Causes cerebral hypoxia
  43. postictal state
    follows a generalized tonic-clonic seizures. Sleeping
  44. epilepsy
    no correctable cause for seizures is found. seuzres recurrent w/o treatement
  45. Alzheimer disease
    ›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
  46. senile plaques
    accumulation of insoluble amyloid beta peptides- protein found in AD
  47. neurofibrillary triangles
    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
  48. Dyspraxias
    inability to perform coordinated acts in addition to cognitive
  49. Blunt brain injury

    Head strikes hard surface or rapidly moving object strikes head

    Dura remains intact, brain tissue not exposed to environment
  50. open brain injury

    break in dura exposes cranial contents to environment

    Results in focal brain injury
  51. Focal brain injury
    • involves specific, grossly observable brain lesions seen in cortical contusions, epidural hemorrhage, subdural hematoma, intracerebral
    • hematoma, and open-head trauma
  52. contusions
    bruises on brain from force of impact
  53. coup
    direct impact area
  54. conrecoup
    area that lies opposite of the line of force; lesions where brain strikes hard tissue on opposite side
  55. extradural hematomas
    (epidural hematomas or epidural hemorrhages)

    most often have an artery as source of bleeding
  56. subdural hematomas
    tearing of bridging veins major cause of rapid and subacute development

    subdural space fills with blood and herniation can occur
  57. intracerebral hematomas
    (intraparenchymal hemorrhages)

    small blood vessels traumatized by shearing forces
  58. difuse brain injury or diffuse axonal injury (DAI)
    results from inertial force to the head; associated with high levels of acceleration and deceleration. Memory loss, dizziness, headaches, anxiety and mood disorders
  59. Mild DAI
    decerebrate or decorticate posturing, prolonged stupor or restlessness (concussion)
  60. moderate DAI
    prolonged coma lasts days or weeks with incomplete recovery most often
  61. Severe DAI
    immediate autonomic dysfunction (brainstem signs) that resolves in a few weeks. Increased intracranial pressure (IICP) appears 4-6 days after injury
  62. Spinal cord injuries
    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
  63. Spinal shock
    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
  64. Autonomic hyperreflexia
    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
  65. Degenerative disk disease
    biochemical and biomechanical alterations of the tissue that comprise the intervertebral disk.
  66. spondylolysis
    structural defect that involves the lamina (neural arch of the vertebra)

    Most common in lumbar spine
  67. spondylolisthesis
    caused when a vertebra slides forward in relation to an inferior vertebra 

    commonly at L5-S1
  68. Image Upload 1
  69. herniation of intervertebral disk
    protrusion of part of the nucleous pulposus through a tear in the fibrous capsule that encloses the gelatinous center of the disk
  70. pain of herniation in lumbosacral area radiates along
    the sciatic nerve over the buttocks and into the calf or ankle

  71. Ischemic and hemorragic strokes
    Image Upload 2
  72. Thrombotic stroke
    caused by arteries supplying brain. Most frequently attributed to atherosclerosis and inflammatory disease processes that damage arterial walls
  73. Transeint Ischemic Attack (TIA)
    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
  74. Embolic stroke
    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
  75. hemorrhagic stroke
    most commonly caused by HTN, ruptured aneurysms, arteriovenous malformation, bleeding disorders. Causes severe headache, stiff neck, loss of consciousness, blood in CSF
  76. lacunar strokes
    very small and involve only small arteries
  77. cerebral infarction
    when an area of brain loses blood
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