what are the layers of the brain? starting with the outer most layer first.
dura mater, subdural space, arachnoid, subarachnoid space(contains cerebrospinal fluid), Pia mater
what is the name of the layer of that adheres to the surface of the brain?
pia mater
what is the main purpose of cerebrospinal fluid?
to provide cushion for the brain.
what are important properties of the blood-brain barrier?
limits the materials passing through to the brain, controls the balance of electrolytes, glucose and proteins in the brain.
define the cortex of the brain
also known as "grey matter", nerve cell bodies
Define corpus callosum
a broad band of nerve fibers joining the two hemispheres of the brain. also known and "white matter"
what are the 5 major lobes of the brain?
prefrontal, frontal, parietal, temporal, and occipital lobes
What is Broca's area?
motor and speech area
What's Wernicke's area?
comprehension of speech
What does the prefrontal cortex do?
Controls elaboration of thought, cognitive behaviour, and components for expression of personality
What does the basal nuclei do?
Allow movements to occur -> balancing motor input and postural support
What does the limbic system do?
controls emotions
Define Thalamus
the part of the brain located in the middle of the central core that acts primarily to relay information about the senses
Define hypothalamus
it is the key role in maintaining homeostasis of the body, controls the autonomic nervous system and the endocrine system, and also regulates body temp, fluid, food intake, regulates sleep cycles, stress responses, emotional responses and sex drive ;)
What are the 3 parts between the brain and the spinal cord?
midbrain, pons, medulla oblongata
what is the function of the cerebellum?
fine motor control/voluntary movement. proprioception
How many cranial nerves are there?
12
How many spinal nerves are there?
31 pairs
whats the difference between axons and dendrites?
axons- conduct impulses AWAY from the cell body Dendrites- conduct impulses TOWARD the cell body, also they are the receptor site
What are glial cells?
cells in the nervous system that support, nourish, and protect neurons
Where does the fight-or-flight response occur?
sympathetic nervous system
What happens if damage happens to the left hemisphere of the brain?
Loss of logical thinking, analytical skills and other intellectual communication skills
What happens if damage happens to the right hemisphere of the brain?
causes behavioural problems, spatial orientation and recognition of relationships may be deficient, self-care deficits are common
What is hemianopia caused by?
damage to the visual cortex/occipital lobe
What is aphasia?
loss of ability to understand or express speech, caused by brain damage.
What is dysarthria?
motor inability to speak (movement deficit)
What is global aphasia?
combination of expressive and receptive aphasia. Major brain damage to Broca area, Wernicke area and in communication fibres
What is agraphia?
inability to write
What is alexia?
loss of reading skills due to recent brain damage. writing and other language skills are intact.
What is agnoisa?
Loss of recognition or association
What are the criteria of the Glasgow Coma Scale?
Eye opening: spontaneous-4 response to speech-3 response to pain-2 none-1 Motor response: obeys commands-6 localizes pain-5 normal flexion to pain-4 abnormal flexion decorticate-3 abnormal flexion decerebrate-2 none-1 Verbal response: orientated to time and place-5 confused-4 inappropriate words-3 incomprehensible-2 none-1
Define decorticate
arms curl toward body
define decerebrate
arms extend outward, lower arms rotated palms-down/wrists flexed
Whats the difference between hemiparesis and hemiplegia?
Hemiparesis- weakness Hemiplegia- paralysis
Define syncope
Temporary loss of consciousness due to a lack of blood flow to the brain (fainting)
Describe Primary brain injuries
Direct injuries. Such as lacerations, rupture or compression of cerebral blood vessels or brain tissues, etc.
Describe Secondary brain injuries
Results from additional effects of cerebral edema, hemorrhage, hematoma, cerebral vasospasm, infection, ischemia related to systemic factors
What is a extradural/epidural hematoma?
Blood will fill space between dura and bone
What is a subdural hematoma?
blood fills space between dura and arachnoid
What is a intracerebral hematoma?
bleeding within the brain tissue
What are some signs and symptoms to look out for with a hematoma?
seizures, cranial nerve impairment, otorrhea or rhinorrhea(leaking of csf from ear or nose), and fever
What are the 3 main phases of a seizure and describe them?
Tonic phase- straightening of body and limbs, cyanosis, may wet themselves Clonic phase- Clonic jerks of body, limbs and head, salivation, cyanosis and eyes blinking Postictal phase- limbs and body will go limp, no movement occurs after a seizure has finished
What is an absence seizure?
Sudden lapse in consciousness and staring blankly into space. episodes will last usually 15 seconds or less
Define pseudoseizures
non-epileptic seizures
How do you manage a seizure?
Determine is trauma is a concern(did the patient fall?), protect from injury, maintain airway patency, and provide oxygen and ventilation assistance, start IV access, Emotional support and transport
What are the 2 types of stroke?
ischemic and hemorrhagic
Define ischemic stroke
Sudden neurologic deficits from focal cerebral ischemia associated with permanent brain infarction
Define hemorrhagic stroke
ruptured artery increased pressure focal bleeding from a blood vessel in the brain parenchyma chronic HTN weakens small artery and it ruptures, bleed increased pressure and the brain stem is compressed
T or F. Females have more strokes than men
True
What age is more likely to have a stroke?
30x for ages 60-79, 63x for ages over 80
Clinical feature to watch out for with stroke patients
weakness or numbness in the face, arm, or leg, especially on one side of the body Sudden confusion Trouble speaking or understanding Trouble seeing Dizziness or loss of balance or coordination Sudden severe headache
What percentage of strokes are hemorrhagic?
20%
What is the most common type of hemorrhagic stroke?
Intracerebral
What is a TIA (transient ischemic attack)?
stroke like symptoms, resolve in 24 hours. increases risk of stroke 10x
Describe encephalitis
infection of brain tissue and connective tissue , can cause permanent brain damage
What is an early indicator of increased intracranial pressure? A) Papilledema B) Bilateral fixed dilated pupils C) Decreasing responsiveness D) Rapid heart rate
C) Decreasing responsiveness
What is the typical change in blood pressure in a patient who has increased intracranial pressure? A) Erratic diastolic pressure B) Decreasing systolic pressure C) Systolic and diastolic pressures decreasing proportionately D) Increasing pulse pressure
D) Increasing pulse pressure
Signs and symptoms of a stroke depend upon: A) location of obstruction, size of artery, and area affected. B) duration of the blockage, distance from the heart, and type of obstruction. C) health of the victim, area affected, and collateral circulation. D) size of the obstruction, condition of the heart, and duration of blockage.
A) location of obstruction, size of artery, and area affected.
Which of the following is a TRUE statement about transient ischemic attacks (TIAs)? A) They usually cause necrosis and permanent brain damage. B) They may be caused by rupture of an aneurysm or a damaged artery. C) They usually indicate systemic hypertension. D) They can warn of potential cerebrovascular accidents.
D) They can warn of potential cerebrovascular accidents.
In the weeks following CVA, why might some neurological function return?
Presence of collateral circulation
Immediate therapy to dissolve thrombi and maintain perfusion
Reduced inflammation in the area
Development of alternative neuronal pathways A) 1 only B) 2 only C) 1, 3 D) 2, 3, 4 E) 1, 2, 3, 4
E) 1, 2, 3, 4
An epidural hematoma is located between the: A) dura mater and the arachnoid mater. B) dura mater and the skull. C) arachnoid mater and the pia mater. D) pia mater and the brain.
B) dura mater and the skull.
How does the heart rate change as intracranial pressure increases? A) Rate decreases B) Rate increases C) No change in rate D) Irregular heart rate
A) Rate decreases
Which of the following factors predispose(s) an individual to a CVA?
Hypertension
Smoking cigarettes
History of coronary artery disease
Diabetes mellitus A) 1, 3 B) 1, 2, 4 C) 2, 4 D) 1, 2, 3, 4
D) 1, 2, 3, 4
What are the significant early signs of a ruptured cerebral aneurysm? A) Impaired speech and muscle weakness B) Severe headache, nuchal rigidity, and photophobia C) Abnormal sensations and tremors D) Vomiting and visual abnormalities
B) Severe headache, nuchal rigidity, and photophobia
The stroke scale used to rapidly diagnose a stroke includes: A) capacity for speech, level of consciousness, motor skills, eye movements. B) motor skills, spatial awareness, time awareness, facial recognition. C) short-term memory, cognitive skills, speech, name recognition. D) hand-eye coordination, problem solving, ability to stand or walk, consciousness.
A)capacity for speech, level of consciousness, motor skills, eye movements
Typical signs of a TIA include: A) rapidly increasing intracranial pressure. B) loss of consciousness. C) transient muscle weakness in a hand or leg. D) headache, photophobia, and nuchal rigidity.
C) transient muscle weakness in a hand or leg.
Which of the following is characteristic of generalized seizures? A) The localization of the seizure activity B) The uncontrolled discharge of neurons in both hemispheres C) Seizures that persist for several hours D) Loss of consciousness and all motor function
B) The uncontrolled discharge of neurons in both hemispheres
From the following, choose the two events (in correct sequence) that immediately follow the aura during a tonic-clonic event: A) Prodromal signs, then the clonic stage B) Clonic stage, then the tonic stage C) Loss of consciousness, then the tonic stage D) Loss of consciousness and cessation of respiration
C) Loss of consciousness, then the tonic stage
What does the clonic stage of a seizure consist of? A) A sudden strong skeletal muscle contraction and rigidity of trunk and limbs B) A cry and contraction of abdominal and thoracic muscles C) Alternating contractions and relaxation of skeletal muscles D) Cessation of all skeletal muscle activity
C) Alternating contractions and relaxation of skeletal muscles
How would a seizure consisting of bizarre or inappropriate activity be classified? A) Absence seizure B) Psychomotor seizure C) Focal seizure D) Jacksonian seizure
B) Psychomotor seizure
Which of the following is used to confirm the diagnosis of, and classify, seizures? A) Characteristics of the aura B) Presence of precipitating factors C) Electroencephalogram D) Changes in the characteristics of cerebrospinal fluid
C) Electroencephalogram
Which statement does NOT apply to status epilepticus? A) Seizures are recurrent or continuous without full recovery between episodes. B) Severe hypoxia and acidosis develop. C) Person does not lose consciousness during seizure D) If the episode persists, there may be additional brain damage.
C) Person does not lose consciousness during seizure
Which type of seizure commonly occurs in children? A) Absence B) Tonic-clonic C) Focal D) Complex partial
A) Absence
All of the following may precipitate a seizure EXCEPT: A) hypoglycemia. B) hypoventilation. C) brain abscess. D) high fever in young child.
B) hypoventilation.
A 35-year-old athletic man experiences a stroke that completely incapacitates him, while a 55-year-old man who does not exercise and is sedentary gets a clean bill of health from his physician. The 35-year-old man MOST likely had a/an: A) neoplastic condition. B) autoimmune disorder. C) intracerebral infection. D) genetic predisposition.
D) genetic predisposition.
The MOST immediate and significant complication associated with a hemorrhagic stroke is: A) acute hypovolemic shock. B) hypertension and bradycardia. C) mean arterial pressure increase. D) increased intracranial pressure.
D) increased intracranial pressure.
As intracranial pressure rises: A) the heart rate acutely increases. B) the brain becomes hypocarbic. C) cerebral herniation may occur. D) mean arterial pressure decreases.
C) cerebral herniation may occur.
Which of the following would MOST likely cause a sustained increase in intracranial pressure? A) Bearing down B) Frequent coughing C) Projectile vomiting D) Intracranial tumor
D) Intracranial tumor
Hyperventilating a patient who has increased intracranial pressure (ICP) will: A) dilate the cerebral vasculature and cause further increases in ICP. B) constrict the cerebral vasculature and decrease cerebral perfusion. C) increase the carbon dioxide levels in the brain through vasodilation. D) decrease ICP and maintain adequate cerebral perfusion.
B) constrict the cerebral vasculature and decrease cerebral perfusion.
Management for a patient with a neurologic emergency begins by: A) ensuring that the patient's airway remains patent. B) taking deliberate actions to ensure personal safety. C) determining the degree of neurologic impairment. D) protecting the patient from further injury or harm.
B) taking deliberate actions to ensure personal safety.
Decerebrate posturing: A) is characterized by abnormal flexion of the arms and extension of the lower extremities. B) is considered less severe than decorticate posturing, because it indicates that the brain stem is intact. C) is an early clinical finding, because it occurs with minimal increases in intracranial pressure. D) is a more severe finding than decorticate posturing, as it indicates damage in or near the brain stem.
D) is a more severe finding than decorticate posturing, as it indicates damage in or near the brain stem.
An adult who opens her eyes in response to verbal stimuli, is disoriented, and localizes pain, has a Glasgow Coma Scale score of: A) 9 B) 10 C) 11 D) 12
D) 12
An acutely frustrated, angry, or aggressive patient should be assumed to be: A) hypoxic or hypoglycemic. B) under the influence of alcohol. C) intoxicated with a narcotic drug. D) experiencing a psychiatric crisis.
A) hypoxic or hypoglycemic.
A patient with a Glasgow Coma Scale (GCS) score of 8 or less: A) will most likely require intubation. B) has moderate neurologic dysfunction. C) is often able to localize his or her pain. D) is likely experiencing brain herniation.
A) will most likely require intubation.
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