-
Contusion (immediate M's)
- loss of consciousness lasting < 5 minutes
- loss of reflexes
- transient cessation of respirations
- brief period of bradicardia
- decreased blood pressure
-
Contusions (later M's)
- vital signs stable and normal
- reflexes and consciousness normal in minutes to days
-
What type of bleeding results in an extradural hematoma?
Arterial bleeding between the skull and the dura mater
-
Epidural or extradural hematoma (M's)
- loss of consciousness
- headache
- vomiting
- drowsiness
- confusion
- seizure
- hemiparesis (unilateral paralysis)
- ipsilateral pupil dilation (same side as injury)
-
What M is characteristic of a herniation of the uncus part of the temporal lobe?
ipsilateral (same side as injury) pupil dilation
-
What is an Uncal herniation?
Where the lower part of the brain herniates down around the tentorium
-
What type of bleeding results in a subdural hematoma?
venous
-
Subdural hematoma (initial acute M's)
- headache
- drowsiness
- restless
- agitation
- slow cognition
- confusion
-
Subdural hematoma (later acute M's)
- loss of consciousness
- respiration changes
- pupillary dilation
-
Subdural hematoma (chronic M's)
- chronic headaches
- progressive dementia
-
Intracerebral hematoma (M's)
- decreased LOC
- confusion
- contralateral hemiplegia
- temporal lobe herniation
- coma
-
Concussion (C's)
- no loss of continuousness
- no evidence of damage on physical or radiologic exams
-
Concussion (M's)
- short-lived confusion
- amnesia for events preceding and immediately after trauma
-
Classic cerebral concussion (M's)
- immediate LOC lasting < 6 hrs
- transient apnea, bradycardia, and hypotension
- amnesia for events before and after trauma
- head pain
- nausea
- fatigue
- mood and affect (emotion) changes
-
Diffuse Axon Injury (DAI) (Definition)
- All axons fire at once
- prolonged traumatic coma (> 6 hrs)
- result of shaking and rotational acceleration
-
Diffuse Axon Injury (DAI) (physical M's)
- spastic paralysis
- peripheral nerve injury
- swallowing impairments
- visual and hearing impairments
-
Diffuse Axon Injury (DAI) (cognitive M's)
- disorientation/confusion
- short attention span
- memory deficits
- learning difficulties
- poor judgement
-
Diffuse Axon Injury (DAI) (behavioral M's)
- agitation
- impulsiveness
- blunted affect
- social withdrawal
- depression
-
CVA related to carotid artery (M's)
- contralateral hemiparesis/hemiplegia (first flaccid, then spastic)
- contralateral sensory impairment
- visual field cuts (homonymous hemianopsia)
- neglect syndrome (right CVA)
- aphasia (expressive or receptive)
- changes in consciousness
- changes in cognition
- dysphagia
-
Differentiating M of right-side CVA related to carotid circulation?
neglect syndrome (client ignores the side that doesn't work)
-
Expressive aphasia (def & M's)
- can receive, but not express
- poorly articulated speech
- sparse vocabulary
- simple grammar
-
Receptive aphasia (def & M's)
- cannot receive or express
- difficulty comprehending speech
- use of jargon
- work finding difficulties
-
CVA in Broca's area results in ___ aphasia
Expressive
-
CVA in Wernicke's area results in ___ aphasia
Receptive
-
CVA related to basilar and vertebral arteries (M's)
- ataxia
- dysarthia/dysphagia
- vertigo
- diplopia
- nausea/vomiting
-
Pressure on the chemoreceptor trigger zone (CTZ) causes ___
nausea or vomiting
-
Hemorrhagic stroke (M's)
- profound headache
- photophobia
- stiff neck
- profound neurologic deficit with hemorrhage rupture
- can cause communicating hydrocephalus
-
A congenital weakening of the medial layer of cerebral arteries can lead to ___
cerebral aneurysm
-
Most common place to find a cerebral aneurysm
circle of Willis
-
Cerebral aneurysm (pre-rupture M's)
severe headache
-
Cerebral aneurysm (post-rupture M's)
- Standard M's of a brain bleed:
- increased ICP -> profound neurological deficits
- vasospasm -> ischemia -> more neurogenic deterioration
- communicating hydrocephalus
-
Subarachnoid hemorrhage (slow leak M's)
- headache
- change in mental status
- nausea/vomiting
- focal neurologic deficits
-
Subarachnoid hemorrhage (ruptured vessels M's)
- sudden throbbing headache
- nausea/vomiting
- visual disturbances
- motor deficits
- loss of consciousness
- stiff neck
-
Communicating Hydrocephalus (def)
reduced ability of arachnoid villi to absorb CSF from subarachnoid space
-
Communicating Hydrocephalus (M's)
increased intracranial pressure
-
Non-communicating Hydrocephalus (def)
- also known as Obstructive Hydrocephalus
- usually a congenital defect resulting in an obstruction of CSF flow at the aqueduct of Sylvius between the 3rd and 4th ventricles
-
Non-communicating Hydrocephalus (M's)
- enlarging skull if bones are not yet fused
- if untreated:
- -- mental retardation
- -- growth retardation
- -- lack of development
-
Normal Pressure Hydrocephalus (def)
- increase in volume of CSF:
- -- to compensate for loss of brain tissue (Alzheimers)
- -- viral infections and neurotoxins
-
Normal Pressure Hydrocephalus (M's)
- declining memory
- unsteady, broad based gait causing falls
- apathy, inattentiveness, indifference
-
Meningitis (def & spread by)
- infection of the cerebrospinal fluid
- spread via respiratory secretions
-
Meningitis (M's)
- nuchal rigidity, headache
- photophobia
- decreased LOC
- fever, chills
- nausea/vomiting
- seizures
-
Meningitis (Lab indicators)
- Bacteria and protein in CSF
- low CSF glucose
-
Encephalitis (def)
inflammation of the brain
-
Encephalitis (M's)
- enlarged lymph nodes
- flu-like symptoms
- coma
- fever
- headache
- changes in mental status
-
Brain abscess (def)
a mass, lesion, or collection of pus in the brain that mimics a tumor
-
Brain abscess (early M's)
- headache
- low-grade fever
- neck pain and rigidity
- drowsiness
- confusion
-
Brain abscess (late M's)
- inattentiveness
- memory deficits
- decreased visual acuity
- narrowed field of view
- ocular palsy (tremors)
- dementia
-
-
Astrocytoma (def)
- most common glioma
- develop from astrocytes
- fast growing
-
Early M's of an Astrocytoma
-
Primary glioma (def)
intracerebral tumor that invades and destroys brain tissue causing compression -> ischemia -> edema -> increased intracranial pressure
-
Types and def of atypical seizures
- clonic - jerking movement
- tonic - stiffening of muscle groups
-
What are some seemingly unexpected causes of dementia?
- renal failure
- atherosclerosis
- HIV infection of the CNS
-
Multi-infarct dementia is caused by ___
atherosclerosis
-
Mutations on chromosomes 14, 19, & 21 are linked to ___
early onset of Alzheimer disease
-
Development of ___ and ___, and decreased ___ are a/w what?
- neurofibrillary tangles of tau proteins
- amyloid deposits forming senile plaques
- acetylcholine syntesis
- Alzheimer disease
-
Parkinson disease (patho)
lack of dopamine to balance out acetylcholine -> jerky muscle movement and poor coordination
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