Neurology for Exam 2 Reduced Version

what protects and supports the brain (3)

1) skull (cranium)

2) epidural space

3) meningeal layers

what are the specific names of the meningeal layers

1) dura mater

2) subdural space

3) arachnoid mater (where the subarachnoid space is)

4) pia mater

how many bones make up the skull

22

what is the three purposes of the skulll

protects the brain

provides muscle and tendon attachment

contains sinuses to accommodate changes in air pressure

where is the epidural space

above the dura mater

what does the epidural space contain

arteries and veins to sustain the meningeal layers

does the epidural space always exist

no, it only exits when there is a problem (pathologically)

dura mater

thick, outermost layer of the meninges surrounding and protecting the brain and spinal cord (also called tough mother)

what two layers make up the dura mater

1. periosteal layer

2. meningeal layer

(contains some of the venous system between the layers)

subdural space

space between dura mater

exsits pathologically (only when there is a problem)

arachnoid layer

middle layers

thin, transparent membrane

what is within the arachnoid layers

the CSF (where the CSF enters the venous system)

subarachnoid space

filled with CSF; contains major arteries of the brain

exists independently of pathology (meaning we have this space even if we are healthy)

pia mater

deepest layer of the meninges, thinest layer, provides a covering for blood vessels

what are the layers and spaces of the brain

1) skull

2) epidurmal hematoma (bad, arterial blood, blood pushes on brain and BS)

3) dura mater

---periostal layer

---sinuses

---meningeal layer

4) subdurmal hematoma (not as bad, venus blood, slow bleed)

5) arachnoid layer

6) subarachnoid layer (filled with CSF and arteries)

7) reptured anaurism (happens to arteries in subarachnoid layer)

8) pia mater (close layer to the brain; hugs it)

9) brain and cortex

how does the brain get energy

glucose, however it is unable to store it, so it needs a constant supply

arteries

carry blood away from the heart

carry oxygen to the body

flow is pulses (as the heart pulses)

thick walls with muscle tissue

no valves

under high pressure

vein

A blood vessel that carries blood back to the heart.

Flows smoothly,

thin walls,

has valves to prevent backflow,

under low pressure

what are the 4 arteries that go to the brain and skull

1) right verterbral artery

2) right common carotid artery

3) left common carotid artery

4) left verterbral artery

external carotid artery

Artery that supplies blood to the anterior (front) parts of the scalp, face, dura mater

what specific branch carries blood to the scalp, face and dura mater in the external carotid artery

Middle Meningeal branch

internal carotid artery

blood to the brain cells

what are the 3 branches of the internal carotid artery

1) anterior cerebral artery

2) middle cerebral artery

3) posterior communicating artery

Anterior cerebral artery

medial surface, blood to foot and leg area of motor strip

middle cerebral artery

very common area for stroke

impacts brochas and werinkies area (depending on where stroke is)

outside of brain

posterior communicating artery

The artery that connects the basilar artery to the circle of willis. Supplies occipital lobe, branches off of posterior cerebral artery.

posterior cerebral Artery

supplies occipital lobe

veterbral regions (controlled by veterbral arteries)

spinal cord

Cervical Musculature and Cerebellum

basilar regions (basilar arteries)

pons

portion of the cerebellum

thalamus

midbrain

Anterior Cerebral Artery (ACA) infraction

foot and leg dragging

Middle Cerebral Artery (MCA) infraction

broca's/wernikies aphasia

posterior cerebral artery (PCA) infraction

loss of sight and smell

vertebrobasilar infraction

brainstem and spinal cord issue

cerebellar infraction

balance, smooth and accurate movements become a problem

Lacunar (deep subcortical) infraction

sensory and motor information and not accessable

what is the purpose of the veterbral and basilar regions

to have a redundancy of blood flow to the body

what is the accronm for a stroke

F-face drooping

A-arm weakness

S-speech difficulty

T-time

what are other signs of a stroke

numbness

confusion

trouble seeing

trouble walking

headache

Transient Ischemic Attach (TIA)

brief period of neurological change

usually less than one hour in length

not lasting changes

a short blockage. Vascular cause

what are the two types of ischemic strokes

thrombotic, embolic

thrombosis

artery closure from plaque at a specific location

arteriral dissection

a break in an artery, forms a clot

Emboli

debri from else where in the body that blocks an artery

ischemic stroke medical intervention

tissue plasminogen activator (tPA) or Tenecteplase (TKN)-breaks down blood clot and promotes blood flow

clot retrieval-pulling the blood clot out of you (thrombectimy)

tissue plasminogen activator (tPA)

promotes blood flow, cannot be used if someone has a bleed, can only be given if the stoke has occured in the past 3 hours is not given if a brain bleed is happening.

what is a hemorrhagic stroke

A stroke caused by bleeding into the brain due to a ruptured blood vessel

what are the two groups of hemorrhagic strokes

intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH)

what is a ICH stroke

bleeding in the brain

what is a SAH stroke and what is the main symtpom of them

bleeding of the subarachnoid space

thunderclap headache

what % of strokes are SAH and ICH

20% SAH

10% ICH

what is the leading cause for hemorrhagic strokes

hypertension (high blood pressure)

ruptured aneurysm and treatment

Subarachnoid hemorrhage (most common)

coiling and clipping

what is bad about arteriorvenous malformation (AVM)

the abnormal connection between the artery and veins can cause high blood pressure and puts pressure on the blood walls causing bleeding (causes hemorrhages)

what are the 3 different types of traumatic bleeding

epidural hemorrhage

subdural hematoma

subarachnoid hemmorrage

epidural hemorrhage

A hemorrhage that occurs between the dura mater and the skull, usually of traumatic origin. Wake up, talk, die syndrom

subdural hematoma

pertaining to below the dura mater, tumor of blood in the venus system that drips out slowly

where subarachnoid hemmorage could occur

in all the artires in the brain and into deep brain areas, bleeds fast

where intracerebral hemorrage could occur

deep in brain, blood in brain is toxic if not in vessel

what are the three types of brain tumors and diseases the brain can get

meningioma

gliblastoma multiforme

acoustic neuroma

meningioma

benign tumor of the coverings of the brain (the meninges). Most common CNS tumor

glioblastoma multiforme

most common primany brain tumor in adults

causes motor defecits, speech difficulties, confusion,

life expactancy is 17 months

acoustic neuroma

benign tumor on the auditory nerve (8th cranial nerve) that develop from the shealth of schwann cells. Causes vertigo, tinnitus, and hearing loss

Alzheimer's Deisease

Progressive form of Dementia (60-80% of all dementias)

Early onset strikes < 65 years old

Begins in hippocampal region

First sign in memory loss for new info, episodic and semantic memory

Disease process spreads throughout brain

Treatments, but no cure

Typically, people live 4-8 years post diagnosis

creutz-feldt jakob disease

Very rare (1 in 1,000,000)

puts holes in brain

Rapid deteration of brain and nerve tissues.

Prion, abnormal forms of proteins

First symptoms include decreased walking, balance, coordination, confusion, memory and descision making difficulties.

Later symptoms include immobility, dysphagia, coma

Sporadic, hereditary, and acquired forms

No treatments, no cures

korsakoff's syndrom and three components of it

Lack of B1; causes damage to brain

1) altered gait

2) bad memory

3) comfabulation (non-sense talk)

Acute form is called Wernicke's Encephalopathy

Amyotrophic Lateral Sclerosis

Upper and Lower Motor Neuron Disease

Presents initially with limb symptoms or cranial nerve symptoms

Severe impact on speech, swallowing, ambulation, respiration

Most commonly diagnosed between ages 55-75

Sporadic and familial forms

No cure, treatments can slow progression of diease

AAC approaches should begin early (voice banking, message banking)

Parkinson's disease

Progressive disorder impacting movements initially

Arises from depletion of dopamine produced in the substantia nigra (mid brain)

Classic PD signs are: resting tremor, rigidity, bradykinesia, postural instability

Age of onset is early to mid 60s

Treatment: drug, behavioral, deep brain stimulation

what are other neurological diseases of the brain

MS

Lyme disease

dementia with lewy bodies-starts with cognitive dementia then movement problems (starts as dementia, then moves to parkinson's) causes huliciations

Progressive supranuclear palsy

Wilson's disease