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Chapter 15 Notes

by: Kendall Frenkel

Chapter 15 Notes Nurs 20363

Kendall Frenkel
GPA 3.5
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Chapter 15 Notes covering Neurology
Class Notes




Popular in pathophysiology

Popular in Nursing and Health Sciences

This 9 page Class Notes was uploaded by Kendall Frenkel on Thursday March 31, 2016. The Class Notes belongs to Nurs 20363 at Texas Christian University taught by Cheek in Spring 2016. Since its upload, it has received 5 views. For similar materials see pathophysiology in Nursing and Health Sciences at Texas Christian University.


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Date Created: 03/31/16
Chapter 15 | Disorders of the CNS and PNS Focal Brain Injury  Observable brain lesion that occurs in a precise location  Results from compression of the skull at point of impact and rebound effects  Force of impact typically produces contusions (bruise)  Severity of contusion depends on the amount of energy transmitted by the skull to underlying brain tissue o The smaller the area of impact, the greater the severity of injury because the force is concentrated into a smaller area  Contusions: o Epidural hematoma: bleeding between the dura mater and the skull. The source of bleeding is an artery. The temporal fossa is the most common site of an epidural hematoma. o Subdural Hematoma: bleeding between the Dura mater and the brain. This is a venous bleed usually occurring in older adults. o Intracerebral Hematoma: bleeding within the brain. It acts as an expanding mass, increasing intracranial pressure, compressing brain tissues and causing edema. Diffuse Brain Injury  Involves widespread areas of the brain  Damage to axonal fibers and white matter tracts that project to the cerebral cortex cause concussion  Mechanical effects from shaking (high levels of acceleration and deceleration) are the primary mechanism of injury producing strains and distortions within the brain.  Severity corresponds to the amount of shearing forces applied to the brain and brainstem.  The most severe axonal injuries are located more periphery to the brainstem causing cognitive and affective impairments. o These ultimately reduce the speed of information processing and responding and disrupts the persons attention span  Categories: o Mild Concussion: Temporary axonal disturbances causing attention and memory deficits but no loss of consciousness  I: Confusion, disorientation, and momentary amnesia  II: momentary confusion and retrograde amnesia  III: confusion with retrograde and anterograde amnesia o Classic Cerebral Concussion: Grade IV  Disconnection of the cerebral systems from the brain stem and reticular activating system  Physiologic and neurologic dysfunction without substantial anatomic disruption  Loss of consciousness for less than 6 hours  Anterograde and retrograde amnesia  Postconclussive syndrome Spinal Cord Trauma  Most commonly occur because of vertebral injuries resulting from acceleration, deceleration or deformation forces applied at a distance.  Forces are classified as compressing, pulling or shearing (sliding into one another)  Vertebral injuries can be classified as: o Simple fracture: single break usually affecting transverse or spinous processes o Compressed fracture: vertebral fracture where the vertebral body is compressed anteriorly o Comminuted fracture: vertebral body shattered into several fragments o Dislocation  Most common locations of spinal cord injuries are C1, C2, C4-C7 and T1-L2 (the most mobile portions of the vertebral column and where the spinal cord occupies most of the vertebral canal)  Normal activity of the spinal cord ceases of injury at and below the level of injury because the sites lack continuous nerve discharges from the brain resulting in Spinal Shock. o Complete loss of reflex function below the level of the lesion 2 o Condition also results in disturbed thermal control because the hypothalamus cannot regulate body heat o Generally lasts 7 to 20 days and terminates with the return of reflex activity and other lost functions.  Paraplegia: weakness/paralysis of lower extremities  Quadriplegia: weakness/paralysis of all four extremities  Autonomic hyperreflexia (dysreflexia) | pg. 385 o May occur after spinal shock resolves o Associated with a massive, uncompensated cardiovascular response to stimulation of the sympathetic nervous system o Stimulation of the sensory receptors below the level of the cord lesion Degenerative Disorders of the Spine: a process of normal aging that includes genes that code the cartilage intermediate layer protein as well as environmental interactions that may increase susceptibility to lumbar disk disease by disrupting normal building and maintenance of cartilage.  Causes include biochemical and biomechanical alterations o Spondylolysis: structural defect (degeneration of developmental defect) o Spondylolisthesis: occurs when a vertebra slides forward and onto the vertebra below it potentially causing a fracture o Spinal Stenosis: narrowing of the spinal canal that causes pressure on the spinal nerves or cord and can be congenital or acquired and associated with trauma or arthritis.  Low Back Pain o Most cases are idiopathic o Most commonly encountered cause of it is lumbar disk herniation, degenerative disk disease, spondylolysis, spondylolisthesis, and spinal stenosis  Herniated Intervertebral Disk o Displacement of disk material beyond the intervertebral space o The ligament and posterior capsule of the disk are usually torn allowing the gelatinous material to extrude and compress the nerve route Cerebrovascular Accident (Stroke) 3  Leading cause of disability and the third leading cause of death in the US  Classified as: o Global hypoperfusion: shock o Ischemia (thrombic, embolic)  Thrombic:  Arise from arterial occulsions caused by thrombi formations in the arteries supplying the brain or intracranial vessels.  Occur when parts of the clot detach, travel upstream and obstruct blood flow causing acute ischemia  Transient ischemia Attack: brief episode of neurologic dysfunction caused by a focal disturbance of brain or retinal ischemia with clinical symptoms lasting no more than 1 hour.  Embolic:  Fragments that break from a thrombus formed outside a brain  An embolus may plug the lumen entirely and remain in place or shatter into fragments and become part of the vessel’s blood flow  Person usually has more than one stroke because the source of the embolus continues to exist o Hemorrhagic  Third most common cause of cerebrovascular accident Cerebrovascular Disorders  Hemorrhagic stroke  Lacunar Stroke o Caused by occlusion of a single deep perforating artery that supplies small penetrating subcortical vessels, causing ischemic lesions o Strokes may have pure motor or sensory deficits due to location and small area of infarction  Cerebral Infarction 4 o Results when an area of the brain loses its blood supply because of vascular occlusion o Ischemic or hemmorhagic  Cerebral Hemorrhage o Primary cause is hypertension o Nothing you can do to treat it  Intracranial Aneurysm (bulge in vessel) o Saccular (berry) aneurysms  Occur frequently and likely result from congenital abnormalities in the tunica media of the arterial wall and degenerative changes o Fusiform (giant) aneurysms  Occur as a result of diffuse arteriosclerotic changes  Most commonly found in the basilar arteries or terminal portions of the internal carotid arteries  Vascular Malformation o Arteriovenous Malformation: a tangled mass of dilated blood vessels creating abnormal channels between the arterial and venous systems.  They have abnormal blood vessel structure, are usually thin and have complex growth and remodeling structures  Can cause a characteristic chronic headache, seizures, and hemorrhage.  Subarachnoid Hemorrhage o Blood escapes from a defective or injured vessel in the subarachnoid space o When blood moves into the subarachnoid space the intracranial volume increases which increases the intracranial pressure o This can lead to a headache, changes in mental status or levels of consciousness, and nausea and vomiting.  Manifestations: these happen because meninges are inflammed o Kernig Sign: straitening the leg while laying down causes pain o Brudzinski Sign: laying down and trying to do a sit up causes pain 5 Infection and Inflammation of the CNS The CNS may be infected by bacteria, fungi, viruses, parasites, and mycobacterium. The invading organisms enter through the nervous system either by spreading through arterial blood vessels or by directly invading the nervous tissue. An immune process may initiate an inflammatory reaction  Meningitis: Inflammation of the brain and the spinal cord o Bacterial Meningitis: primarily an infection of the pia mater and arachnoid, the subarachnoid space, the ventricular system and the CSF. Meningococcus is the common cause. o Aseptic Meningitis: believed to be limited to the meninges. It is primarily caused by viruses. o Fungal Meningitis: a chronic, much less common condition. The infection occurs most often in people with impaired immune responses or alterations in normal body flora.  Brain or spinal cord abscess o Localized collection of pus within the parenchyma o Causes:  Open trauma and during neurosurgery  Contiguous spread of infection from the middle ear, mastoid cells, nasal cavity, nasal sinuses  Through metastatic or hematogenous spread from distant foci  Cryptogenically: without other associated areas of infection o Early manifestations include low grade fever, headache (most common symptom), neck pain and stiffness, confusion, drowsiness, sensory deficits and communication deficits o Later Manifestations are inattentiveness (distractibility), memory deficits, decreased visual acuity and narrowed visual fields, papilledema, ocular palsy, ataxia, and dementia  Encephalitis o Acute febrile illness, usually of viral origin with nervous system involvement o Most common forms are caused by arthropod-borne viruses and herpes simplex virus 6 o May occur as a complication of a system viral disease or follow vaccination with a live attenuated virus vaccine if the vaccine has the encephalitis component. o Meningeal involvement is present in all encephalitis How HIV can affect nervous system  Activated macrophages and monocytes penetrate the blood brain barrier causing neuroinflammation and neurodegeneration  It can cause impaired concentration and memory deficits as well as difficulty speaking, loss of balance, and decreased writing ability. Demyelinating Disorders  Multiple Sclerosis: relatively common acquired autoimmune inflammatory disorder involving destruction of axonal myelin in the brain and spinal cord. o Progressive, inflammatory, demyelinating disorder of the CNS o Types:  Mixed (general)  Spinal  Cerebellar Nervous System Disorders  Amyotrophic Lateral Sclerosis o Classic ALS (Lou Gehrig Disease): may begin at any time from the fourth decade of life o Worldwide neurodegenerative disorder that diffusively involves lower and upper motor neurons, resulting in progressive muscle weakness leading to respiratory failure and death o Patient has normal intellectual and sensory function until death Neuromuscular Junction Disorder  Myasthenia Gravis o Acquired chronic autoimmune disease mediated by antibodies against the acetylcholine receptor at the neuromuscular junction  An IgG antibody is produced against the AChR o Characterized by muscle weakness and fatigability 7  Weakness and fatigue of the muscles of the eyes and throat causing diplopia and difficulty chewing, swallowing, talking o Results from a defect in nerve impulse transmission at the neuromuscular junction o Myasthenic Crisis  Occurs when severe muscle weakness causes extreme quadriparesis  respiratory insufficiency with shortness of breath and extreme difficulty in swallowing o Cholinergic Crisis  Can arise from anticholinesterase drug toxicity with increased intestinal motility, episodes of diarrhea and complaints of intestinal cramping, bradycardia, pupillary constriction, etc.  These are caused by the smooth muscle hyperactivity secondary to excessive accumulation of acetylcholine  Person is in danger of respiratory arrest Central Nervous System Tumors Cranial Tumors  Primary Intracerebral tumors (gliomas): originate from brain substance including neuroglia, neurons, cells of blood vessels and connective tissue o Astrocytoma: a slow growing, invasive tumor that originates from astrocytes located anywhere in the brain or spinal cord o Oligodendroglioma: relatively avascular, mostly encapsulated tumor originated from oligodendrites most commonly found in frontal lobes in deep white matter. They also may arise from the brain stem, cerebellum and spinal cord. o Ependymoma: a tumor that is more common in children with variable growth rates that originated from ependymal cells. It is found in the intramedullary: wall of ventricles and can arise in the caudal tail of the spinal cord  Primary Extracerebral Tumors: originate outside substances of brain and include meningomas, acoustic nerve tumors, and tumors or pituitary and pineal glands. 8 o Meningioma: slow growing, circumcised, encapsulated, sharply demarcated from normal tissues and compressive in nature. They originate from arachnoid cells (sometimes fibroblasts) and are found in the frontal and parietal lobes, the olfactory groove and superior surface of cerebellum o Nerve sheath tumors: slow growing tumors found in the Schwann cells. Located in the cranial nerves and the extramedullary o Metastatic carcinoma 9


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