neurofinalexamflashcards.txt

Olfactory, its major function is smell

Optic, its major function is vision

Oculomotor, its major function is eye movement

Trochlear, its major function is eye movement

Trigeminal, its major function is chewing, face, mouth, teeth scalp sensation

Abducens and it turns eyes outward

Facial and it controls most facial expressions and taste sensation, tears, mucus and saliva production

Vestibulocochlear (Acoustic) and its major function is hearing and equilibrium

Glossopharyngeal and its major function is the sensations of throat, taste, swallowing movements, secretion of saliva normal voice (contraction of the pharynx)

Sensory and motor to larynx, (-) HR, contraction of the eliminatory tube, (+) digestive secretions, sensory of cardiac, resp. + BP reflexes

Accessory (spinal accessory) and its major function is controlling the trapezius & sternocleidomastoid muscles

Hypoglossal and its major function is controlling tongue movement

Left Hemisphere and the Right Hemisphere

• -Math
• -Problem solving
• -Logical reasoning

• -Artistic abilities
• -Creativity
• -Spatial relations
• -Emotional/Behavioral characteristics

• -Frontal Lobe
• -Parietal Lobe
• -Temporal Lobe
• -Occipital Lobe

• -Voluntary Movements
• -Intellectual function
• -Personality
• -This is where the Broca's area is located

• -Sensation (touch and pain)
• -This is where the Wernickies area is located

• Cell Body
• Dendrites
• Axon

Smell stuff

Visual Acuity

Check pupil size, shape, reactivity to light - Cardinal Gaze

Turn eye laterally, up+down

• Sensory: Use something thats sharp/dull and put on pt�s face, cheek, chin and ask pt to distinguish
• Motor: Ask pt to clinch teeth while you palpate the temporal, massetar muscle

Cardinal Gaze

• Motor: Smile, frown, raise eye brow
• Sensory: Taste something
• Parasympathetic: Mucus membranes are pink and wet

Rombergs/Snapping hearing test

• Sensory: Taste/gag reflex
• Motor: Ask patient to swallow and listen for normal voice sounds Parasympathetic: Secretion of saliva

• Sensory: Assess patient ability to swallow and produce saliva, rub tummy
• Motor: Produce normal voice sounds
• Parasympathetic: Valsalva maneuver

Ask patient to shrug shoulders and look left and right

Ask patient to stick out their tongue and move it around

• A period of prolonged inspiratory hold
• People do this on a regular basis (A deep breath)

Eupnea

• A regular irregular breathing pattern
• Usually associated with a Neurological problem, however sow people do normally
• Pattern with periods of apnea
• Looks like torsades de pointes

Fast, Deep and regular ventilations

• This is where you ask the patient to put their arms up in front of them with there palms facing up, if one of the arms fall and turns downward then it is a positive drift pronators drift test, if the arm falls but the hands remain supinated the test is positive arm drift
• Test coordination

• 4 - Spontaneous
• 3 - Open to Voice
• 2 - Open to Pain
• 1 - No eye opening

• 5 - Oriented
• 4 - Confused speech
• 3 - Inappropriate words
• 2 - Incomprehensible words
• 1 - No Verbal response

• 6 - Obeys commands
• 5 - Localizes Pain
• 4 - Withdraws from pain
• 3 - Flexion (Decorticate)
• 2 - Extension (Decerebrate)
• 1 - No Motor response

• A-alcohol/acidosis
• E-epilepsy
• I-insulin
• O-overdose
• U-uremia
• T-trauma
• I-infection
• P-psychosis
• S-stroke

CSF reabsorption is blocked, usually at an acqueduct; generally a genetic malformation

Problem with the arachnoid villi; absorption is not occurring at the rate it is supposed to; much more common type

• Birth control
• HTN
• Smoking
• Cocaine

• Previous stroke
• A Fib
• Age
• Race
• Clotting disorders
• Diabetes
• Gender

Transient ischemic attack; all SXS resolve within 24 hours with no permanent neurological deficit

• Facial Drooping
• Aphasia/Dysphasia
• Hemiparesis
• Hemiplegia
• Ataxia
• Incontinence
• Dysarthria

• Rapid recognition and transport
• Establish timeline for fibrinolytics (3 hours from onset of symptoms)
• ABCs
• Specific assessment
• Positioning- 15% elevation of head
• IV and BGL check- start with 12.5g of dextrose if indicated
• Note HTN but DO NOT TREAT IT
• EKG monitor
• Management of temperature
• Protection of paralyzed extremities
• Manage seizures if present - very bad sign; stop immediately (benzos)

Abrupt disorientation, usually with delusions and hallucinations

Slow progressive loss with the inability to learn new things, difficulty remembering recent events, and personality and behavioral changes

• Alzheimer's - most common at 50%
• Huntington's
• Creutzfeldt-Jakob disease - 1:1 million

• Progressive congenital disease involving 4 genes (3 are inherited)
• Brain cells in cerebral cortex die and brain substance shrinks
• Abnormal clumps and tangled bundles of fibers are formed

• Coordination/motor
• Personality
• Behaviors
• Memory

• Familial disease passed from parent to child through a mutation in the normal gene
• Results from genetically programmed degeneration neurons
• Causes a severe degeneration of basal ganglia and frontal lobe
• Doesn't show up until midlife

• Uncontrolled movements
• Loss of intellectual and thought processes

• Rare, fatal neurogenerative CNS disease
• Belongs to the family Transmissible spongiform encephalopathies
• In animals is known as Mad Cow disease
• Caused by an infectious protein; characterized by rapid onset and very short life span from onset of symptoms

• Confusion and forgetfulness
• Rapidly progresses to dementia
• Myoclonus and ataxia

Idiopathetic disorder of the inner ear

• Fullness in the ears
• Tinnitus
• Hearing loss
• Vertigo

Spontaneous excessive discharge of nerons in the brain; cause brief alteration in consciousness or behavior

• Protection from injury
• Airway management with adequate ventilation
• IV and BGL- give dextrose if indicated
• EKG monitor
• Transport

Muscle contractions in the head and shoulders; usually from stress

Involves a release of histamine; will usually have edema, runny nose, watery eyes accompanying

Comes from the constriction and dilation of blood vessels

Calcium channel blockers or beta blockers

• Blurry vision
• Numbness and tingling
• Photosensitivity
• Nausea

Associated with allergies or inflammation due to infection

• obtain OPQRSTU history
• ABCs
• Position the patient for comfort
• IV access if indicated
• BGL and ECG monitor
• Consider medication (anti-emetics or analgesics)
• Reassure the patient and transport

• Inflammation of the meninges
• Bacterial type is more widespread and worse
• Viral AKA aseptic type is limited to the meninges
• Fungal type is very rare
• 10-15% of the population are carriers

• Severe HA
• N/V
• Irritability
• Photophobia
• Nuchal rigidity
• Kernig's sign
• Brudzinski's sign
• Lethary or stupor
• Seizures
• Possible petekial rash (late sign)
• Decreased mentation

• Sudden onset of ataxia, nystagmus, disturbances in speech
• Can be caused by IV glucose in a malnourished patient
• This is why we administer thiamine before glucose (thiamine is needed to process glucose)

• Found with Wernicke's encephalopathy in chronic alcoholics
• Usually considered irreversible because cell damage has occurred
• Causes apathy, poor memory, retrograde amnesia, confabulation, and dementia

Linear fracture (80%)

• Keep area clean
• C-spine precautions
• Bleeding control

• Raccoon eyes
• Battle's sign
• Hemotympanium
• CSF leakage

The bone is being pushed into the brain itself; it is often associated with scalp lacerations, could involve a hematoma or cerebral contusion

An opening between the scalp and the brain; it is associated with multi-system trauma

• Spinal immobilization
• Ventilatory support with O2
• Contamination control
• Rapid transport
• IV and ECG monitor

• Mild diffuse
• Moderate diffuse
• Diffuse axonal injury
• Focal injury

AKA concussion; defined by less than 5 mins LOC; mentation continues to improve; no structural damage

• Temporary LOC
• Rapid return to normal behavior
• Amnesia retrograde or antegrade

A bruising of the brain tissue; it is actual structural damage

• Definite LOC
• Persistent confusion, disorientation, and amnesia of event
• They have no specific timeline

Shearing, stretching or tearing of the nerve fibers or cells- axons; breaks nerve cells and tears them apart so that the cells die

• Coma
• Possible posturing
• MOre amnesia
• N/V
• Decreased LOC from pressure on RAS
• Pupillary response problems

An injury to a specific area; specific grossly observable brain lesions

• Skull fractures
• Cerebral contusions
• Edema
• Ischemia
• Hemmorhage

CPP= MAP - ICP

MAP= diastolic pressure + 1/3 pulse pressure

systolic pressure - diastolic pressure

0-15 mmHg

85-95 mmHg

70-80 mmHg

• Cushing's Triad
• First HTN (systolic)
• Second Bradycardia
• Third Irregular respirations

• Tachycardia
• Hypotension

• Epidural
• Subdural
• Subarachnoid Hematoma
• Intracerebral Hematoma

• Rapidly developing
• Linear or depressed skull fracture MOI
• Transient LOC - lucid interval

Below the skull and above the dura mater; involves arterial bleeding

• Between the dura mater and the arachnoid mater
• Often caused by blunt trauma
• Involves venous bleeding
• Can develop symptoms within 24 hours or up to a few days
• Can be acute, subacute, or chronic

Intracranial bleed into the CSF below the arachnoid mater above pia mater

• Sudden and severe HA
• Meningitis SXS (i.e. stiff neck) because it irritates CSF

A brain bleed; AKA cerebral contusion; more than 5cc somewhere within the brain- BAD

• Axial loading
• Flexion
• Hyperextension
• Hyperrotation
• Subluxation
• lateral bending
• Distraction

• Drives the weight of the body against the head; having an object fall onto the head or upward force to pts feet
• AKA vertical compression

Bending forward or backwards past normal range of motion

Jointed parts are pulled away from each other by movement outside normal range of motion

Movement about the axis of the body past the normal range of motion

Incomplete or partial dislocation of a joint; vertebra are pushed into the spinal canal

The head and neck are bent to the side past normal range of motion causing injury to the Cspine

Pulling apart of the spine; accidental or intentional hangings are examples of this

• Sprains and strains
• Fractures and dislocations
• Sacral and coccygeal fractures
• Cord injuries - primary and secondary
• Cord lesions

A posterior ligament in the spinal cord tears at least partially

Whiplash

Hyperflexion from compression forces applied to the front of the vertebrae; seen in industrial falls

• Unstable fractures caused by a combination of severe hyperflexion and compression forces; the vertebrae fracture and dislocates into the spinal column
• Often seen in MVAs

Fracture of S1 and S2; loss of perianal sensory motor function and damage to bladder and bladder sphincters

"broken tailbone"; caused by direct blow or fall; causes pt moderate pain

Injury that occurs at the time of impact

• Injury that occurs after the initial insult
• swelling
• ischemia
• movement of bone fragments

• Spinal fracture or dislocation; causes a total absence of pain, pressure, and joint sensation below the level of injury
• Can cause motor paralysis below level of injury
• May be associated with ANS dysfunction below level of injury

• Associated with three main syndromes
• Central cord syndrome
• Anterior cord syndrome
• Brown-Sequard syndrome

• Usually a cervical lesion caused by hyperextension or flexion
• Classified by a greater motor dysfunction in upper extremities than lower extremities
• Paralysis of the arms and sacral sparing are common with this syndrome

• Usually associated with flexion injuries
• Causes a variable loss of motor function, pain, and/or temperature sensation below the level of injury

• Usually associated with hemitransection of the cord; common MOIs are knife or missile injuries
• Causes weakness in upper and lower extremities on the same side as the injury with loss of pain and temperature sensation on the opposite side from the injury

Temporary loss of spinal cord function distal to the injury

Oxygen, spinal immobilization, fluids

• AKA neurogenic hypotension
• Hypotension following spinal shock
• Autonomic dysfunction; relative bradycardia, hypothermia, vasodilation of peripiheral vessels

• Control oxygenation, perfusion, and pH as best as possible
• Consider dopamine 2-10mcg/kg/min

• AKA autonomic dysreflexia
• Associated with chronic SCI in patient with injuries at T6 or above
• Its a cardiovascular response stimulated by the sympathetic nervous system
• Caused by distended bladder or rectum
• Emptying of the bladder or bowel often relieves symptoms

• Severe HTN (systolic above 300)
• HA
• Blurred vision
• Sweating above level of injury
• Flushing of skin
• Bradycardia

• Spastic paralysis
• Dyskinetic
• Ataxic
• Mixed

• most common form
• scissored legs
• hyperreflexia
• increased muscle tone
• damage is in motor cortex itself
• can be para, quad, or diplic

• 2nd most common form
• basal ganglia and extrapyramidal system are affected
• fine motor is mostly affected

• cerebellum is affected
• balance issues
• least common form

combinations of the other types

sudden temporary facial paralysis due to inflammation to CN VIII (Facial)

• mild weakness to total paralysis
• twitching
• facial drooping
• ptosis
• NO PAIN

damage to CN V causes pain limited to the face but there is no motor involvement

• compression of CN IX due to inflammation causes severe pain in the tongue, throat, ear, and tonsils
• difficulty swallowing can occur
• can be life threatening if pressure starts to compress the brain stem

a benign neoplasm compresses cranial nerve VIII and causes symptoms (can involve VII and V also)

• unilateral hearing loss (differentiating from Meniere's)
• balance disturbances
• tinnitus
• HA
• fullness in the ear
• trigeminal neuralgia

progressive neurologic disease that affects the basal ganglia (and therefore fine motor control) due to an imbalance between low dopamine and normal ACH

• Tremors that occur at rest
• Rigidity
• Bradykinesia
• Micrographia

• Levodopa
• physical therapy

• ALS or Lou Gherig's disease; caused by the neurons in the mortor cortex and spinal cord wasting and hardening and becoming non-functional
• Affects voluntary skeletal muscle
• Rapidly progressing
• Does not affect intellect
• Starts in a specific isolated area and then progresses throughout body, causing paraplegia and eventually death (paralysis of diaphragm)

refers to a group of motor neuron genetic diseases characterized by progressive weakness and degeneration of skeletal muscles

• Duchenne's; affects males primarily
• involves the deficit of dystrophin protein that starts killing muscle and replacing it w/ connective tissue; usually can't walk by age 12

• thought to be an autoimmune disease that affects the central nervous system
• involves destruction of CNS myelin (demyelination) of the white matter of the brain
• most common acquired disease of the nervous system in young adults, more women than men
• does not affect intellect

• fatigue
• vertigo
• clumsiness
• unsteady gait
• slurred speech
• blurred or double vision
• facial numbness or pain

• autoimmune inflammatory disorder of the peripheral nerves and sometimes cranial nerves
• exact cause is unknown but could be viral infections or immunizations
• causes damage to myelin sheaths

• progressive muscle weakness
• can affect ANS-swallowing and respiration

• chronic autoimmune disorder that destroys ACH receptor sites at neuromuscular junctions
• prevents nerve impulses from reaching the muscles
• weakness and rapid fatigue occurs in affected muscles

ages 20-30

ages 70-80

• drooping eyelids
• difficulty speaking
• difficulty swallowing and chewing
• weakened respiratory muscles
• difficulty with extremity movements

• Severe muscle weakness involving respiratory insufficiency
• Problem here is respiratory arrest

• associated with myasenthia gravis
• anticholinergic drug toxicity causes SLUDGE symptoms along with symptoms of myasthenic crisis
• the muscles stop responding to ACH and can lead to paralysis of respiratory muscles

2-10mg

2-4mg

1-5mg

5-10mL q 5-10

25-50g

2-20mcg/kg/min; upper level for neuro shock is 10mcg/kg/min; good starting point is 5

• 0.5-1.0mg for hypoglycemia
• 3-10mg for Beta Blocker OD

acute cerebral edema not responsive to other modalities; transport only

0.4-2.0mg titrated to respiratory effect

600mg auto-injector

12.5-25mg q 4 hrs

1 mEq/kg only with MCEP

100mg

2.0mg PRN

Serotonin Dopamine GABA Norepinephrine Epinephrine ACH

• Impulse is transmitted through the preganglionic neuron and across the synaptic junction to the postganglionic neuron
• The preganglionic neurotransmitter in both the sympathetic and parasympathetic systems is ACH
• ACH is contained in vesicles on the synaptic knob on the end of the presynaptic neuron
• These vesicles break open and release ACH so that it travels across and hits the receptor sites on the plasma membrane of the postsynaptic neuron
• The postganglionic neuron then transmits the impulse to the affected organ
• In the sympathetic nervous system the postganglionic neurotransmitter is norepinephrine
• In the parasympathetic nervous system the postganglionic neurotransmitter is ACH
• At the organ, the vesicles once again break open and release whichever neurotransmitter they are carrying
• The receptor sites are stimulated at the affected organ
• Any leftover neurotransmitter after stimulation can be reabsorbed or destroyed by enzymes specific to the neurotransmitter