Term
| Why is it important to diagnose the patient before intubating if at all possible? |
|
Definition
| b/c intubation paralyzes the patient; will make signs & sypmtoms difficult or impossible to gather |
|
|
Term
| What can you give to a patient to reverse the action of opiates? |
|
Definition
|
|
Term
| vitamin needed to prevent Wernicke’s disease when glucose given to starved alcoholic |
|
Definition
|
|
Term
| the part of the brain area located above the tentorium cerebelli |
|
Definition
|
|
Term
| the part of the brain area located below the tentorium cerebelli |
|
Definition
|
|
Term
| A hemorrhage, massive infarct, tumor, or brain abscess in the cerebrum is called a ______________ lesion |
|
Definition
supratentorial
(above the tentorium cerebelli) |
|
|
Term
| A hemorrhage, massive infarct, tumor, or brain abscess or basilar migraine in the cerebrum is called a ______________ lesion |
|
Definition
| subtentorial (or infratentorial) |
|
|
Term
| a membrane that separates the cerebellum from the cerebrum |
|
Definition
|
|
Term
| Structural lesions will cause permanent damage without prompt ____________. |
|
Definition
|
|
Term
| an acute state of confusion, presenting as excitement or hypoactivity with altered perception and thought content. |
|
Definition
|
|
Term
| a state of markedly diminished awareness and responsiveness in which arousal requires constant stimulation |
|
Definition
|
|
Term
| What medical condition is characterized by sustained unresponsiveness? |
|
Definition
|
|
Term
| Patients are alert, or easily aroused to normal and sustained alertness, but thought processes are disturbed. |
|
Definition
|
|
Term
| a reflex eye movement that stabilizes images on the retina during head movement by producing an eye movement in the direction opposite to head movement, thus preserving the image on the center of the visual field |
|
Definition
|
|
Term
|
Definition
if you spray cold water into a normal person’s ear, their eyes will involuntarily turn in the direction of the cold ear (and then they might throw up)
(if their eyes don't turn, that may suggest structural lesion of brainstem) |
|
|
Term
| A _________________ is caused by lesion within the brain (like infarction), while a ______________ is caused by a systemic problem that also affects the brain (like hypoglycemia) |
|
Definition
structural lesion
diffuse dysfunction |
|
|
Term
| Absent or abnormal oculovestibular reflexes suggest structural disease of the ____________. |
|
Definition
|
|
Term
| - with the eyelids held open, abrupt passive rotation of the neck results in contralateral conjugate deviation of the eyes, whereas abrupt flexion of the neck results in conjugate upward deviation--this is a test of the ________________ reflexes |
|
Definition
oculocephalic
(aka vestibulo-ocular) |
|
|
Term
| In the oculocephalic reflex, what will eyes do if you abruptly turn the head to the left. |
|
Definition
The eyes will turn right & then quickly turn back to midline (failure or lag in doing either of these indicates a lesion on the ipsilateral side at the brainstem level)
(this reflex is also called the vestibulo-ocular reflex) |
|
|
Term
| Absence or lag of the oculocephalic reflexindicates a lesion on the ________ side at the ______________ level |
|
Definition
ipsilateral brainstem
(The oculocephalic reflex, aka the vestibulo-ocular reflex, moves the gaze opposite to the direction of head movement to stabilize the image on the retina) |
|
|
Term
|
Definition
| normal, good, unlabored breathing |
|
|
Term
| an oscillation between apnea & hyperpnea with a cycle of 30 seconds to 2 minutes; the patient doesn’t breathe for a few seconds , then breathes deeper & deeper (and sometimes faster), hits a peak, breathes shallower & shallower (and sometimes slower), and then stops breathing for a few seconds |
|
Definition
| Cheynes-Stokes Respiration |
|
|
Term
| Cheynes-Stokes respiration |
|
Definition
| an oscillation between apnea & hyperpnea with a cycle of 30 seconds to 2 minutes; the patient doesn’t breathe for a few seconds , then breathes deeper & deeper (and sometimes faster), hits a peak, breathes shallower & shallower (and sometimes slower), and then stops breathing for a few seconds |
|
|
Term
| Where is the location of problems that cause coma or delirium with eupnea? |
|
Definition
|
|
Term
| Where is the location of problems that cause coma or delirium with Cheynes-Stokes respiration? |
|
Definition
| diencephalon (thalamus, metathalamus, hypothalamus, epithalamus, prethalamus or subthalamus and pretectum) |
|
|
Term
| What part of the brain contains the thalamus, metathalamus, hypothalamus, epithalamus, prethalamus or subthalamus and pretectum? |
|
Definition
|
|
Term
| Where is the location of problems that cause coma or delirium with sustained hyperventilation? |
|
Definition
|
|
Term
|
Definition
| an abnormal pattern of breathing characterized by complete irregularity of breathing, with irregular pauses and increasing periods of apnea. |
|
|
Term
| Where is the location of problems that cause coma or delirium with ataxic respiration? |
|
Definition
|
|
Term
| What does it mean if a coma patient’s eyes will usually actively resist opening? |
|
Definition
| it's probably psychiatric unresponsiveness (conversion, dissociation, malingering, factitious illness, or catatonia) |
|
|
Term
| What happens in a coma if you open the eyelids and then release them? |
|
Definition
| In coma, upon release of the lids they will smoothly descend and the pupils deviate upwards over 1 second. An awake patient cannot easily duplicate this |
|
|
Term
| What should you do if you find that the patient is faking a coma? |
|
Definition
| A good approach towards these pts is to demonstrate active lid closing and then turn to the nurse and say “It’s OK, he/she is awake.” Then walk off and do something else for 10 minutes. While you are gone the nursing staff will take vital signs and talk to the patient. The patient, reassured that he/she will not be abused will often let go of the “coma” and be ready to talk when you return. |
|
|
Term
| an area of the brain responsible for maintaining arousal and regulating transitions from sleep to wakefulness, partly by inhibiting the Ventrolateral Pre-Optic Nucleus (VLPO) |
|
Definition
| Reticular activating system (RAS) |
|
|
Term
| a group of neurons in the hypothalamus that maintains sleep by inhibiting the RAS |
|
Definition
| Ventrolateral Pre-Optic Nucleus (VLPO) |
|
|
Term
| The Reticular activating system (RAS), which maintains wakefulness, is close to the __________ & __________ centers, so: |
|
Definition
Cardiovascular
respiratory
We would expect to see effects in wakefulness, cardiovascular actions, & respiratory actions if there were brain stem lesions. |
|
|
Term
| If the ________________________ is too active or the ________________________is not active enough, the patient will not be able to maintain normal wakefulness |
|
Definition
Ventrolateral Pre-Optic Nucleus (VLPO)
Reticular activating system (RAS) |
|
|
Term
| How do awake patients respond differently to oculovestibular testing than patients in a coma. |
|
Definition
| Awake patients will have a fast return component (eyes involuntarily move in direction of cold water, then back to neutral position, but faster in awake patients than patients in a coma) |
|
|
Term
| An epidural hematoma occurs when blunt force trauma causes a tear in the _________________ artery |
|
Definition
|
|
Term
| Patients with a(n) ____________ hematoma are most likely to have a lucid interval of minutes to hours between a brief concussion & more serious problems |
|
Definition
|
|
Term
| On a CT or MRI the patient presents with a biconvex (lens-like) fluid collection under the skullcap (that is, the fluid bumps out from the skull rather than following skull). |
|
Definition
|
|
Term
| What vessels cause a subdural hematoma & how are they injured? |
|
Definition
The bridging veins which join the superior sagitall sinus from the superficial surface of the brain to the dura mater
they sheared when head trauma causes the brain to move within the skull (the dura mater is attached to the inside of the skull & doesn't move) |
|
|
Term
| What does a subdural hematoma look like on a CT or MRI? |
|
Definition
| like a half-moon following the inner surface of the skull |
|
|
Term
| small areas of bleeding in the midbrain or pons due to high intracranial pressure shoving the brainstem downwards, which stretches the vessels until they break |
|
Definition
|
|
Term
| What is uncal herniation & what kind of hemorrhage can it cause? |
|
Definition
Uncal herniation is herniation (shifting) of the middle temporal lobe
Uncal herniation can cause the brainstem to shift downward, which stretches & tears small blood vessels in the brainstem, causing small areas of bleeding called Duret's hemorrhages. |
|
|
Term
| When uncal herniation is pronounced, it can compress ____________, which can cause ________________ on the __________ side. |
|
Definition
the contralateral cerebral peduncle
hemiparesis
ipsilateral (to herniation) |
|
|
Term
| The Glasgow coma score ranges from __ to __; a score of __ to __ is considered comatose |
|
Definition
|
|
Term
| A Glasgow coma score is arrived at by adding 3 other scores. What are they? |
|
Definition
eyes (open; open to voice; open to pain; no response)
verbal (oriented & alert; disoriented; nonsensical speech; moans/ unintelligible; no response)
motor (follows commands; localizes pain; withdraws to pain; decorticate flexion; decerebrate extension; no response) |
|
|
Term
| Describe the decorticate posture. What causes the decorticate posture? |
|
Definition
decorticate flexion--rigidity, flexion of the arms, clenched fists, and extended legs (held out straight). The arms are bent inward toward the body with the wrists and fingers bent and held on the chest ("mummy baby")
Decorticate posture indicates damage to the corticospinal tract. May be bilateral or unilateral. In decorticate the red nucleus and rubrospinal tract is still intact. |
|
|
Term
| Describe the decerebrate posture. What causes decerebrate posture? |
|
Definition
Decerebrate extension—abnormal, rigid posture in which arms & legs are extended; arms are at sides & pronated (palms down/out)
Caused by damage to red nuclei and rubrospinal tract. |
|
|
Term
| If you walk into a room & see a patient with an abnormal, stiff posture, would your rather see their arms flexed with hands at chest & fists clenched, or extended with hands pronated? |
|
Definition
flexed (decorticate posture), not extended (decrebrate posture)
decorticate posture is usually due to a smaller lesion & usually has a better prognosis |
|
|
Term
| The most common cause of subarachnoid hemorrhage is ____________. The second most common cause is ruptured ___________ |
|
Definition
berry aneurysms
M1 branch of the Middle Cerebral Artery |
|
|
Term
| Berry aneurysms are more likely to rupture if they are: |
|
Definition
|
|
Term
| In what age group are berry aneurysms most commonly found? |
|
Definition
| young to middle-aged adults |
|
|
Term
| What can you do to prevent a berry aneurysm from bleeding? What is a side-effect of that procedure and how much of a concern is it? |
|
Definition
Neurosurgery to clip of aneurysm at its base
Produces vasospasm but not normally a mass lesion. |
|
|
Term
| What kind of hemorrhage causes "the worst headache of my life"? |
|
Definition
| subarachnoid hemorrhage (SAH) |
|
|
Term
| What kind of hemorrhage causes blood in the CSF? |
|
Definition
|
|
Term
| Subpial hemorrhages are rare, but most often occur in this age group. |
|
Definition
|
|
Term
| What 2 ways do you distinguish a subarachnoid hemorrhage from a subpial hemorrhage? |
|
Definition
1. subarachnoid causes blood in CSF while subpial does not.
2. subarachnoid fills sulci with blood while subpial is limited to the subpial space within the sulci |
|
|
Term
| Will a person with subpial hemorrhage have blood in the CSF? |
|
Definition
|
|
Term
|
Definition
The triangular opening in the tentorium cerebelli through which the brainstem extends from the posterior into the middle cranial fossa.
• Tentorium cerebella—extension of the dura mater that separates the cerebellum from the inferior portion of the occipital lobes. |
|
|
Term
| In what 2 ways can herniation of the brain affect consciousness? |
|
Definition
1. direct extension of the lesion into the diencephalon and midbrain
2. lateral and downward displacement of the subthalamic and upper brainstem structures w/ or w/o herniation of the medial part of the temporal lobe (uncus and hippocampus) into the tentorial notch; • Lateral displacement can cause upper midbrain (particularly the cerebral peduncle) to be crushed against the opposite free edge of the tentorium (on other side of brainstem). |
|
|
Term
| Why would herniation of the parts of the brain above or at the top of the midbrain cause ipsilateral Babinski's sign? |
|
Definition
Lateral displacement of the parts of the brain above the midbrain can cause upper midbrain (particularly the cerebral peduncle) to be crushed against the opposite free edge of the tentorium (on the side of the brainstem contralateral to the original herniating lesion).
Damaged fibers decussate back to ipsilateral side in pyramids |
|
|
Term
| In a case of uncal herniation, the ______________ artery may be compressed at the edge of the tentorium, leading to hemorrhagic infarction of the ________________. |
|
Definition
Posterior Cerebral Artery (PCA)
occipital lobe |
|
|
Term
| Unilateral destructive lesions of the hemispheres, such as infarcts or hemorrhages, do not cause coma unless: |
|
Definition
| they produce some degree of mass effect, usually delayed at onset, which secondarily compresses the upper brainstem. |
|
|
Term
| While most strokes don't cause changes in alertness unless there is mass effect, patients with massive strokes affecting the territory of the ______________________ artery are drowsy and inattentive from the onset, even before brain swelling occurs, but more often they are simply apathetic with a tendency to keep their eyes closed, a state that may be misinterpreted as stupor. |
|
Definition
|
|
Term
| eosinophilic, sharply defined inclusion bodies (protein aggregates) found in the cytoplasm of some nerve cells infected with rabies |
|
Definition
negri bodies
(negri bodies are diagnostic for rabies) |
|
|
Term
| negri bodies are diagnostic for ___________ |
|
Definition
|
|
Term
| How do you diagnose rabies before death? |
|
Definition
immunofluorescence or immunoperoxidase staining of one of the following
o skin of the neck at hairline
o saliva
o serum spinal fluid
o brain biopsy
o corneal epithelial impressions. |
|
|
Term
| Could you use PCR to diagnose rabies? Would you have to do anything special? |
|
Definition
| Yes, but it would have to be reverse transcriptase PCR (RT-PCR) b/c rabies is an RNA virus |
|
|
Term
| What are 3 routes of transmission for rabies? |
|
Definition
1. saliva
2. inhalation (in bat caves)
3. transplanted tissues |
|
|
Term
| Rabies is caused by the virus __________ in the family _________ |
|
Definition
|
|
Term
| Would you diagnose rabies by using ELISA to find antibodies in serum or CSF? |
|
Definition
| no b/c by the time ELISA finds antibodies, it's usually too late (antibodies don't show up until well after clinical disease is established) |
|
|
Term
| Symptoms in prodromal phase of rabies. |
|
Definition
| malaise, anorexia, headache, photophobia, nausea, vomiting sore throat and fever. |
|
|
Term
| How long does the prodromal phase last in rabies? |
|
Definition
|
|
Term
| Rabies causes ______________ to be overactive, which causes the following symptoms: |
|
Definition
sympathetic nervous system
lacrimation (tearing), pupillary dilation, increased salivation and perspiration. Hydrophobia (associated w/ painful spasms associated with swallowing) |
|
|
Term
| Nervous system dysfunction, nervousness, apprehension, hallucinations and bizarre behavior occur during the _______________ phase of rabies infection, which lasts ___________ |
|
Definition
|
|
Term
| What kind of cytopathic effects & inflammatory lesions does rabies cause? |
|
Definition
|
|
Term
| Where does the rabies virus enter the nervous system? |
|
Definition
| Nerve endings and Neuromuscular junctions |
|
|
Term
| In order to enter a nerve cell, the rabies virus binds to ___________ or _____________ |
|
Definition
Nicotinic acetyl choline receptor (AChR)
NCAM (Neural Cell Adhesion Molecule) |
|
|
Term
| How does rabies get up a nerve cell toward the brain? |
|
Definition
| Retrograde axonal transport |
|
|
Term
| How long does the rabies incubation period last? |
|
Definition
| 1 month to years (Depends on patient age, immune status, viral strain, amount of inoculum, severity of lacerations, location of the bite.) |
|
|
Term
| What role does cell-mediated immunity play in fighting rabies? |
|
Definition
|
|
Term
| Antibiotics can help someone fight off a rabies infection IF: |
|
Definition
| it's given during the incubation period (once symptoms appear and the prodromal period begins, prognosis is very bad) |
|
|
Term
| After the acute neurologic phase of rabies comes the _________ phase, with hypotension, hypoventilation, secondary infections , cardiac arrest, and death usually due to respiratory paralysis. This phase lasts ______________ |
|
Definition
|
|
Term
| Very little antibody is produced against the rabies virus. The only rabies antigen that provokes antibody response is ____________ |
|
Definition
|
|
Term
| What virus causes Progressive Multifocal Leukoencephalopathy (PML)? |
|
Definition
|
|
Term
| JC-virus lives latently in the ____________ until it is activated in a patient who is ________________ |
|
Definition
|
|
Term
| How does JC virus cross the blood-brain barrier? |
|
Definition
| by replicating in endothelial cells of capillaries |
|
|
Term
| Abortive (non-productive) viral infection |
|
Definition
| a viral infection of the cell in which viral proteins may be transcribed, but there is no new virus leaving the cell to infect other cells |
|
|
Term
| Productive viral infection |
|
Definition
a viral infection of the cell in which viral proteins are transcribed, new virus is made, and the virus leaves the cell to infect other cells
(as opposed to non-productive, where the cell may produce some viral proteins, or even make new virus, but the virus never leaves the cell) |
|
|
Term
| In the Central Nervous System (CNS), JC-virus has an abortive infection of ___________ & a productive infection of _______________ |
|
Definition
astrocytes
oligodendrocytes |
|
|
Term
| A type of neuroglia whose main function is to insulate axons in the CNS. |
|
Definition
|
|
Term
| JC-virus infects and kills ____________ cells in the CNS, which causes: |
|
Definition
oligodendrocyte
demyelination of axons |
|
|
Term
| Star-shaped glial cells in the CNS that support neurons & endothelial cells |
|
Definition
|
|
Term
| Symptoms of Progressive Multifocal Leukoencephalopathy (PML) |
|
Definition
Difficulty speaking, seeing, keeping balance
Poor coordination
Loss of mentation, communication
Progression to paralysis and death |
|
|
Term
| How do you diagnose Progressive Multifocal Leukoencephalopathy (PML)? |
|
Definition
PCR analysis of CSF
+
MRI and CT showing lesions |
|
|
Term
| What family does JC-virus belong to? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| JC-virus has a __________-shaped capsid that is __________ (enveloped/non enveloped). |
|
Definition
|
|
Term
| Is JC-virus common? What happens to most people who get it? |
|
Definition
yes; 85% of people have it by age 15
In most, it remains dormant in the kidney for the rest of their lives without causing problems. |
|
|
Term
| Does Progressive Multifocal Leukoencephalopathy typically have a good outcome? Are there treatments that can cure it? |
|
Definition
no; most people eventually die from it
No; Highly Active Anti-Retroviral Therapy (HAART)can increase survival form 4-6 months to years, but it will eventually kill you. |
|
|
Term
| ________ can increase survival of Progressive Multifocal Leukoencephalopathy (PML) from 4-6 months to years, but it's not a cure (PML will eventually kill you). |
|
Definition
| Highly Active Anti-Retroviral Therapy (HAART) |
|
|
Term
| A flagellate parasitic protist that causes African Sleeping Sickness. |
|
Definition
|
|
Term
| What is the vector of trypanosmal brucei? |
|
Definition
|
|
