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The Middle cerebral artery supplies blood to......
Cerebral Infarction/Occlusion of this artery would cause....
supplies to frontal, parietal and temporal
causes aphasia in dominant hemisphere (usually left), contralateral paralysis and loss of sensation
Anterior Cerebral Artery Supplies Blood to....
A Cerebral Infarction or occlusion here would cause...
basal ganglia, corpus callosum, medial surface of Cerebral hemisphere, superior surface of frontal lobe and parietal lobe
contralateral paralysis and loss of sensation, more lower extremities symptoms than upper ext.
basilar artery supplies blood to....
a Cerebral Infarction or occlusion here would cause...
pons, medulla, lower midbrain, corticospinal, corticobulber, tracts and occular cranial nerve
quadriplegia, loss of voluntary facial, mouth and tounge movements. intact consciousness . locked in syndrome
the posterior Cerebral artery supplies blood to...
an infarction or occlusion here would cause...
visual changes (contralateral) r/t crossover of optic nerve
tension headaches are caused by...
stress, fatigue, menstration, environment (lights, noises)
other causes glaucoma, inflammation, scalp diseases, vasodilators (alcohol, histamine), sinus', head trauma, ICP, ear infections, brain bleeds
patho of tension headaches
traction or displacement of arteries, venous sinus/tributaries, and inflammation of direct pressure on the cranial nerves with afferent pain fibers.
biochemical abnormalities including local leakage of vasodilator polypeptide called neurokinin through the dilated arteries and a decrease in the plasma level of serotonin .
four phases of a headache
normal, vasoconstriction (aura), parenchymal artery dilation, vasodilation (headache)
what is a throbbing vascular headache?
what is the general patho of headaches and migraines?
associated with the construction and dilation of inter/extra cranial arteries
lobes of the cerebrum are...
frontal, temporal, parietal and occipital
frontal lobe regulates ...
personality, judgement, reasoning , and behaviors.
temporal lobe regulates...
hearing, language, storage, memories, comprehension.
parietal lobe regulates...
sensations, pain, temp, touch, shape, size, texture
occipital lobe regulates ...
interprets visual stimuli
what does the limbic system do
located deep within the temporal love it initiates primitive drives such as hunger, aggression, sexual and emotional arousals, sensory messages
pons, midbrain and medulla oblongata are located in what part of the brain?
the pons connect the cerebellum to cerebrum. and respiratory center
midbrain mediates auditory and visual reflexes and the medulla oblongata regulates respiratory vasomotor and cardiac function
what part of the brain regulates respiratory , vasomotor and cardiac function?
medulla oblongata and its located in the brain stem along with the pons and midbrain.
the central nervous system consist of ?
brain and spinal cord
the peripheral nervous system consist of...
monitor and sensory neurons sending messages to CNS
the autonomic nervous system regulates...
involuntary functions of internal organs and its a branch of the PNS
manifestations of alzheimers
loss memory, flat affect, personality changes, communication issues, personal hygiene issues
what Neuro disorder can be defined as a degenerative disorder, neurofibrillary tangles & plaques as well as granulovascuakr
what regulates ICP?
Cerebral construction and dilation regulate ICP based on the CO2, O2 and H+
decreased O2 causes Cerebral vasodilation which increases blood flow and O2 to brain
four types of Cerebral edema
vasogenic, cytotoxic (metabolic), ischaemic and interstitial
what is vasogenic Cerebral edema
vascular injury increases capillary permeability and disrupts blood brain barrier leading to leakage plasma protoena into extracellular space and pulls water into brain parenchymal
what is cytotoxic (metabolic) Cerebral edema?
toxins cause failure or active transport
loss intracellular K+ and increase in Na+ (and water) causes cells in brain to swell
what is ischemic Cerebral edema?
cerebral infarct in intracellular space then days later releases lysosomes from necrosed cells disrupts blood brain barrier
what is interstitial Cerebral edema?
movement of CSF from ventricles to extracellular space which increases brain volume.
what do all four types of Cerebral edema lead to...
distorted blood vessels and displaced brain tissue causing herniation!
what does the blood brain barrier have to do with ICP?
helps maintain hemostasis in ICP by regulating water Flow from blood and maintains volume in skull
When ICP rises what happens?
1. brain insult leads to slight increase in ICP
2. loss of autoregulatory mechanisms leads to dilation and more ICP
3. cellular hypoxia leads to herniation, then increased ICP and then brain death
what neuro disorder is known as a form of polyneuritis with muscle weakness and mild distal sensory loss?
guillain Barre syndrome
life threatening, three phases, usually from virus, demyelination of peripheral nerves
legs first for weakness
what is the path of guillain Barre?
1. segmental demyelination of the peripheral nerves
2. inflammation and degenerative changes posterior (sensory) and the anterior (motor) occurring simultaneously
3. autonomic nerve transmission impaired
what are signs and symptoms of guillain Barre?
symmetrical muscle weakness (legs first) then arms and facial nerves
paresthesia which vanishes quickly
diplegia, opthoplegia (occular paralysis)
hypotonia and arflexia
difference between primary and secondary spinal cord injuries?
primary is mechanical trauma like fractures , ligaments and joints
secondary is cellular injury as a result of mechanical trauma like inflammation, edema, ischemia, necrosis and apoptosis. it usually occurs within minutes of injury and can last 2wks
spinal cord injury or damage to c3 through c5 would cause
diaphragm function impairment r/t phrenic nerve. if phrenic nerve is severed then there is no nervous stimulation to diaphragm which means no respirations and therefore pt is ventilator dependent
what is a transaction spinal cord injury
complete or incomplete severing of spinal cord
what is a spinal cord concussion
a bruised cord
what is a spinal cord concussion
transient loss of cord function
what is a spinal cord compression
pressure from lesion, mass, or swelling leading to ischemia and tissue damage
what is a spinal cord hemorrhage
bleeding directly into spinal cord
what are three complications of spinal cord injuries
what is spinal shock
complete loss of below level of injury (skeletal, bowel, bladder and sexual)
hypothalamus cannot regulate temperature therefore patients temperature becomes the same as room
what is neurogenic shock
loss autonomic innervation
blood pooling in muscles
decreased BP decreased HR (low low neuro)
place patient supine or Trendelenburg
what is autonomic dysreflexia
parasympathetic and sympathetic nervous system imbalance
occurs T5-T6 or higher
bladder or bowel distention most common causes
myasthenia gravis is
an autoimmune disorder that attacks the peripheral nerves , mainly motor function
decreased acetylcholine which helps muslce contract so major muslce weakness
what neuro disorder is caused by a decreased production of acetylcholine
acetylcholine helps muslce contract, therefore without it there is severe muscle weakness
what neuro disorder is characterized by droopy eyes, chronic fatigue, double vision
myasthenia gravis r/t decreased acetylcholine which helps muslce contract
what are uncontrolled electrical charges in the brain neurons
what is status epileptious
seizure greater than 39 minutes
it's a medical emergency and can be fatal
what does tonic mean when referring to a seizure
what does clonic mean?
clicking or jerking
what is an absence seizure
common in children
what is a myoclonic seizure
medium clicking jerking seizure
myo means medium
clonic means clicking and jerking
what is a atonic seizure
a seizure without any tense tone. they are flaccid.
tonic means tension and A means without. so without tension
what is a partial complex seizure
repetitive lip smacking biting picking
what is a partial simple seizure
but no bodies home
no response to stimuli
what are seizures generally caused or associated with
it's idiopathic. we don't know why they happen but they are usually associates with brain infection, swelling, increased ICP, trauma, decreased O2, tumors, ETOH, drug withdrawal
what neuro disorder generally starts in legs and attacks myelin sheath
what is the difference between guillane Barre and MS
MS attacks the myelin sheath of the CNS
GB attacks the myelin sheath of PNS
what neuro disorder is characterized by no or low dopamine in the basal ganglia that gets progressively worse
what are treatments for Parkinson's
drugs to increase dopamine
exercise (because it increases dopamine)
antioxidants and other dietary changes
Parkinson's disease affects which system
brain and spinal cord
how does dyslipidemia contribute to CAD
because LDL is a key player in atherosclerosis and CAD development
what does hypertension have to do with CAD
causes endothelial damage
what does cigarette smoking have to do with CAD
nicotine causes release of catecholomines and those cause vasoconstriction and increase myocardial contractility and increase BP
what does diabetes have to do with CAD
endothelial damage, thickening blood vessel walls, increased inflammation, and leukocyte adhesion, increases thrombus, decreased prodctikn nitric acid (a vasodilator)
what is the function of VLDL
transports triglycerides and cholesterol out of liver to the bodies cells
and increase in VLDLs then increased triglycerides which increases risk of CAD
what is the function of LDL
left over VLDLs after dropping off triglycerides to cells
they hold a higher portion of cholesterol transport from liver to body.
increased LDLs means increased cholesterol which means increased risk heart disease
what is the function of HDLs
carries cholesterol away from the tissues to the liver, decreased blood cholesterol levels decrease risk of cardiovascular disease . HDLs increase with exercise, high estrogen levels , alcohol consumption and weight loss
what is the function of triglycerides
made by pancreas, metabolism as energy sources, and transporters of dietary fat
what is the function if cholesterol
hormone production, helps liver produce bile acid for digestion , main content cell membrane or structure (too much causes it to deposit in the wrong place)
what is monkenberg arteriosclerosis
calcification medium size arterial walls
commonly radial and arterial arteries
does NOT obstruct blood flow r/t no intima involvement
what is arteriosclerosis
accumulation of fat, WBCs, platelets in vessel walls
forms a plaque in the intima or artery
plaque rupture and then heart attack
what is the patho of atherosclerosis
arterial wall injury, endothelial cells inflamed, decreased ability to produce antithrombic or vasodilation cytokines macrophages and platelets adhere to area of injury toxic oxygen radicals releases more inflammation, causes stress, more endo damage
what is cardiogenic shock
heart contractility impaired, deceased perfusion caused by MI, blunt trauma, cardiac tamp, air embo, PE or pneumo
decreased BP and UO
pale cool altered senses JVD
an ECG with an ST elevation is characteristic of
what are common pressors used to increase BP
characteristics of a VSD
tired, loud pansystolic murmur at lower left sternal border
most common congenital heart defect
what are characteristic s of a PDA
failure to close at birth or shortly after
common to see blue lower extremities
BF from aorta to pulmonary artery
starves periphery of O2 left to right shunt
dyspnea, lower extremities clubbing
wide PP, loud S2
what are the treatment options for a PDA
first indomethacin to close PDA
then surgical closure if that doesn't work
note: except for transposition of the great vessels because the PDA is actually the only thing keeping them alive
what is first choice treatment to vasoconstriction peripheral arteries during septic shock
what are the three things that can increase ICP
increased brain volume
increased blood volume
what does LDL cause and why is it toxic?
it's toxic and causes smooth muscle proliferation (hyperplasia) leading to plaque
what increased cardiac contractility
what decreases cardiac contractility
diltiazem and verapamil they are calcium Chanel blockers (Calcium contrax)
what does digitalis increase cardiac contractility
because it blocks the sodium potassium pump
what are dilitiazam and verepamil
calcium channel blockers
they decrease cardiac contractility because they block calcium which causes contractility
blocks beta 1 and increases cardiac contractility and HR
how does systemic heart failure effect cardiac contractility
it decreases it
what does acidosis do to cardiac contractility
decreased cardiac contractility
how does hypoxia and hypercapnia effect cardiac contractility
what are the three types of cardiomyopathies
dilated, hypertrophic and restrictive (infiltrative)
what are the congenital heart defects that cause left to right shunting
what type of shunting?
-right sided volume overload
-RV hypertrophy and LV hypertrophy
left to right
along with VSD, ASD and PDA
tetralogy of Fallot causes what type of shunting
right to left
what cerebral artery supplies blood flow to the frontal, temporal and parietal lobes
middle Cerebral Artery
occlusion here would cause contralateral paralysis and loss of sensation as well as Aphasia of dominant hemisphere (usually left)
what Cerebral Artery serves the basal ganglia
anterior Cerebral Artery
what is considered a warning of an impending stroke
TIA (supposedly will occur within 1 yr)
what type of stroke is r/t atherosclerosis
thrombotic such as TIA, embolic stroke and Cerebral Infarction
what is a TIA caused by
a clot which temporarily blocks the flow of blood and then it dislodges in time to reverse cellular injury
an embolic strokes results from
fragments of a thrombus from outside the brain . the fragments get lodges in and block the arterial blood flow to the brain. this is what commonly happens when people have a stroke from atrial fibrillation
what type of stroke results in occlusion of the arterial supply to a portion of the brain which is fed by the occluded artery
what is a type of thrombotic stroke
TIA but last less than 24 hours and has no lasting neuro deficits
what are risk factors of emobolic strokes
atrial fibrillation , LV thrombus, LV anerysm, LA thrombus, recent MI, rheumatic valvular disease, mech prosth valves, endocarditis CAD
what are the risk factors of a hemmorrhagic stroke
previous Cerebral infarct
What is the most common congenital heart defect in Adults?
Arteriosclerosis affects which other organ besides the heart?
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