support systems

Order of meninges layers

epidural space, dura mater (TOUGH), arachnoid mater, (delicate, webish), subarachnoid space, (pia mater (thin/delicate)

denticulate ligaments

extensions of pia mater that secure cord to dura mater

filum terminale

extension of pia mater that anchors spinal cord

definition of meningitis

Inflammation of the pia arachnoid of brain, spinal cord or both

clinical signs of meningitis

fever, headache, nuchal rigidity, kernig's sign

how do you test for meningitis?

test of CSF look at glucose, proteins, lymphocytes

what levels are increased with bacterial meningitis?

lymphocyte levels

what is viral/aseptic meningitis caused by?

herpes/epstein bar, newborn e coli., influenza

kernigs' sign what is it and what is it used to test?

meningitis, knee and hip 90° in supine lying position, extension of knee is painful or limited in extension (neck pain will worsen with knee extension)

brudzinski sign what is it and what is it used to test?

meningitis, supine position, bending neck/passive flexion of neck causes knee and hip flexion

epidural hematoma is shaped like what on an x-ray?

LEMON

What is epidural hematoma?

Bleeding in epidural space (between skull and dura mater)

what is epidural hematoma caused by?

skull fracture

Symptoms of epidural hematoma

Headache - intracranial pressure, altered mental state, confusion, nausea, lucid interval - seem normal for a little bit then go back

subdural hematoma is shaped like what on an x-ray?

banana

what is subdural hematoma caused by?

bleeding between Dura mater and arachnoid mater

What causes acute subdural hematoma?

Sudden impact or tearing of vessel - traumatic brain injury

What causes chronic subdural hematoma?

Slow onset, overtime - leakage of blood vessel, shrinkage due to aging - also could be anticoagulants, long-term alcoholics, common cause of dementia

*lose function very slowly overtime

describe how cerebral spinal fluid flows through the brain

Lateral ventricles, third ventricle, cerebral aqueduct, fourth ventricle, connecting foramina

What is CSF?

Ultra filtered blood, cushions and protects CNS from trauma, nourishes CNS

Where is CSF produced?

choroid plexus

What is lumbar puncture/spinal tap usually done?

L3 vertebrae, after spinal cord has ended

Why is a lumbar puncture/spinal tap done?

Withdraw of CSF to test if meningitis is bacterial or viral

What is hydrocephalus?

Too much water pressure on the brain, too much CSF pressing on CNS tissue due to overproduction or decreased reabsorption

what are some symptoms of hydrocephalus?

enlarged ventricles, known in newborn before birth - eyes look downward, loss of bladder/bowel control - immediate medical condition sudden means problem with CNS

Obstructive hydrocephalus

tumor formation

non-Obstructive hydrocephalus

Faulty reabsorption, removal of part of choroid plexus in lateral ventricle

where does blood supply to the brain come from?

internal carotid (85%) and vertebral arteries (15%)

Vessels drain water from the brain?

Internal jugular vein, external jugular vein

anterior cerebral artery supplies

frontal and parietal lobes (superior and medial)

Middle cerebral artery supplies

frontal, temporal, and parietal lobes (lateral)

Posterior cerebral artery supplies

temporal and occipital lobes

vertebral arteries come together to form

basilar artery

cerebellar arteries supply the

cerebellum

Functional significance of circle of Willis

Allows multiple choice selection for blood flow to the brain

What feeds into dural sinuses?

venous, also where CSF goes

dural sinuses join to eventually form the internal jugular vein

anoxia

Decrease oxygen but blood still circulates

ischemia

Loss of blood flow due to cardiac/vascular causing decreased oxygen

TIA

small stroke that last a few moments and symptoms go away

what is a stroke?

Sudden onset of neurological deficits due to disruption of blood supply to the brain - cause permanent damage to brain tissue

FAST- describe symptoms of a stroke

face, arms, speech, time

Numbness/weakness of face, arm, leg

Trouble speaking/walking

Trouble seeing, dizziness, loss of balance/coordination, severe headache with no known cause

severe headache is more common in which type of stroke

hemorrhagic (rupture/increased pressure)

Stroke symptoms in women

Face, arm, leg pain, hiccups, nausea, chest pain/palpitations

thrombus

stationary blood clot

embolus

moving blood clot

what is the most common stroke?

ischemic stroke

What does recovery look like for ischemic stroke?

Recovery is dependent on damage/how long the blockage was allowed to occur - weeks to years

When do signs come on for ischemic stroke?

One by one or all at once

Treatment for ischemic stroke

Thrombolytics, anticoagulants or surgery for treatment

Where do most ischemic strokes occur?

Middle cerebral artery

Which stroke has highest rate of death but is the least common?

intracerebral hemorrhagic stroke

What is the cause of intracerebral hemorrhagic stroke?

Chronic high blood pressure

What is a common symptom of intracerebral hemorrhagic stroke?

First symptom severe headache - 50% - often during activity

What does recovery look like for intracerebral hemorrhagic stroke?

If survive usually never recover

What is treatment like for intracerebral hemorrhagic stroke?

Don't want person to have anticoagulant, given very large infusions of vitamin K which is essential for blood clotting

subarachnoid hemorrhagic stroke is how common?

3%

What is the most common cause of subarachnoid hemorrhagic stroke?

Ruptured aneurysm

Symptoms of subarachnoid hemorrhagic stroke?

Sudden severe headache - thunder clap peaks within seconds, followed by brief loss of consciousness, face pain and vision issues - think about where optic nerve is located

Treatment for subarachnoid hemorrhagic stroke?

Surgery

subarachnoid hemorrhagic stroke is more common in...

women

not a stroke if its from

head injury

survival rate of subarachnoid hemorrhagic stroke?

Half day before reaching the hospital, severe impairments become permanent