Weitere ähnliche Inhalte Ähnlich wie Week three notes (17) Mehr von Erin Yesenosky (16) Kürzlich hochgeladen (20) Week three notes1. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 11
Alterations in Cognitive Systems,
Cerebral Hemodynamics and
Motor Function
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Alterations in Cognitive Systems
Consciousness
State of awareness of oneself and the
environment
Arousal
• State of awakeness
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Alterations in Arousal
Structural
Divided by location above or below tentorial
plate
Metabolic
Psychogenic
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Alterations in Arousal (cont’d)
Coma is produced by either:
Bilateral hemisphere damage or suppression
Brain stem lesions or metabolic derangement
that damages or suppresses the reticular
activating system
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Alterations in Arousal
Clinical manifestations:
Level of consciousness changes
Pattern of breathing
• Posthyperventilation apnea (PHVA)
• Cheyne-Stokes respirations (CSR)
Pupillary changes
Oculomotor responses
Motor responses
Vomiting, yawning, hiccups
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Clinical Manifestations
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Clinical Manifestations (cont’d)
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Clinical Manifestations (cont’d)
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Clinical Manifestations (cont’d)
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Brain Death (Total Brain Death)
Body can no longer maintain internal
homeostasis
Brain death criteria:
Completion of all appropriate and therapeutic
procedures
Unresponsive coma (absence of motor and
reflex responses)
No spontaneous respirations (apnea)
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Brain Death (Brain Stem Death)
Brain death criteria:
No ocular responses
Isoelectric EEG
Persistence 6 to 12 hours after onset
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Cerebral Death
Cerebral death (irreversible coma) is death
of the cerebral hemispheres exclusive of
the brain stem and cerebellum
No behavioral or environmental responses
The brain can continue to maintain internal
homeostasis
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Cerebral Death (cont’d)
Survivors of cerebral death:
Remain in coma
Emerge into a persistent vegetative state
Progress into a minimal conscious state (MCS)
Locked-in syndrome
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Alterations in Awareness
Selective attention:
Ability to select from available, competing
environmental and internal stimuli
Sensory inattentiveness
• Extinction
• Neglect syndrome
Selective attention deficit
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Alterations in Awareness (cont’d)
Memory
Amnesia
Retrograde amnesia
Anterograde amnesia
Executive attention deficits
• ADHD
Image processing
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Seizures
Syndrome versus disease
Sudden, transient alteration of brain
function caused by an abrupt explosive,
disorderly discharge of cerebral neurons
Motor, sensory, autonomic, or psychic
signs
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Seizures (cont’d)
Convulsion
Tonic-clonic (jerky, contract-relax) movements
associated with some seizures
Epilepsy: no underlying cause can be
found
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Seizures (cont’d)
Etiologic factors:
Cerebral lesions
Biochemical disorders
Cerebral trauma
Epilepsy
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Seizures (cont’d)
Partial seizures
Simple, complex, secondary generalized
Generalized seizures
Absent, myoclonic, clonic, tonic-clonic, atonic
Unclassified epileptic seizure
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Seizures (cont’d)
Aura
Prodroma
Tonic phase
Contraction
Clonic phase
Relaxation
Postictal phase
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Data Processing Deficits
Agnosia
Tactile, visual, auditory, etc.
Dysphasia
Expressive dysphasia
Receptive dysphasia
Transcortical dysphasia
Aphasia
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Acute Confusional States (ACS)
Transient disorders of awareness that
result from cerebral dysfunction
Secondary to drug intoxication, metabolic
disorder, or nervous system disease
Delerium
• Hyperkinetic
• Hypokinetic
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Dementia
Progressive failure of cerebral functions
that is not caused by an impaired level of
consciousness
Losses:
Orientation
Memory
Language
Judgment
Decision making
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Alzheimer Disease (AD)
Familial, early and late onset
Nonhereditary (sporadic, late onset)
Theories:
Mutation for encoding amyloid precursor
protein
Alteration in apolipoprotein E
Loss of neurotransmitter stimulation of choline
acetyltransferase
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Alzheimer Disease (AD) (cont’d)
Neurofibrillary tangles
Senile plaques
Clinical manifestations:
Forgetfulness
Emotional upset
Disorientation
Confusion
Lack of concentration
Decline in abstraction, problem solving, and
judgment
Diagnosis is made by ruling out other
causes of dementia
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Cerebral Hemodynamics
CBF
CPP
CBV
Cerebral oxygenation
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Increased Intracranial Pressure
(IICP)
Normal 5 to 15 mm Hg
Caused by an increase in intracranial
content
Tumor growth, edema, excessive CSF, or
hemorrhage
Stage 1
Stage 2
Stage 3
Stage 4
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Herniation Syndromes
Supratentorial herniation
Uncal
• Uncus or hippocampal gyrus (or both) shifts from the
middle fossa through the tentorial notch into the
posterior fossa
Central
• Downward shift of the diencephalon through the
tentorial notch
Cingulate
• Cingulate gyrus shifts under the falx cerebri
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Herniation Syndromes (cont’d)
Infratentorial herniation
Cerebellar tonsil shifts through foramen
magnum
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Cerebral Edema
Increase in the fluid (intracellular or
extracellular) within the brain
Types:
Vasogenic
Cytotoxic
Interstitial
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Hydrocephalus
Excess fluid within the cranial vault,
subarachnoid space, or both
Caused by interference in CSF flow
Decreased reabsorption
Increased fluid production
Obstruction within the ventricular system
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Hydrocephalus (cont’d)
Noncommunicating hydrocephalus
Internal
Intraventricular
Communicating (extraventricular)
hydrocephalus
Acute hydrocephalus
Normal-pressure hydrocephalus
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Alterations in Neuromuscular
Function
Muscle tone
Hypotonia
Hypertonia
• Spasticity
• Gegenhalten (paratonia)
• Dystonia
• Rigidity
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Alterations in Movement
Paresis and paralysis
Upper motor neuron syndromes:
• Hemiparesis or hemiplegia
• Diplegia
• Paraparesis or paraplegia
• Quadriparesis or quadriplegia
• Pyramidal motor syndromes
• Spinal shock
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Alterations in Movement (cont’d)
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Alterations in Movement (cont’d)
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Alterations in Movement (cont’d)
Lower motor neuron syndromes:
Flaccid paresis or flaccid paralysis
Hyporeflexia or areflexia
Fibrillation
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Lower Motor Neuron Syndromes
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Lower Motor Neuron Syndromes
(cont’d)
Amyotrophies:
Paralytic poliomyelitis
Nuclear palsies
Guillain-Barré syndrome
Progressive spinal muscular atrophy
Progressive bulbar palsy
Bulbar palsy
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Alterations in Movement
Hyperkinesia
Excessive movement
Chorea, wandering, tremor at rest, postural
tremor, etc.
Paroxysmal dyskinesias
Tardive dyskinesia
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Alterations in Movement (cont’d)
Huntington disease
Also known as chorea
Autosomal dominant hereditary degenerative
disorder
Severe degeneration of the basal ganglia
(caudate nucleus) and frontal cerebral atrophy
• Depletion of gamma-aminobutyric acid (GABA)
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Alterations in Movement (cont’d)
Hypokinesia
Decreased movement
Akinesia
Bradykinesia
Loss of associated movement
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Parkinson Disease
Severe degeneration of the basal ganglia
(corpus striatum) involving the
dopaminergic nigrostriatal pathway
Parkinsonian tremor, rigidity, bradykinesia
Postural disturbances
Autonomic and neuroendocrine symptoms
Cognitive-affective symptoms
Secondary parkinsonism
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Disorders of Posture (Stance)
Dystonia
Dystonic postures and movements
Decorticate posture
Decerebrate posture
Basal ganglion posture
Senile posture
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Disorders of Posture (Stance)
(cont’d)
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Disorders of Gait
Spastic gait
Scissors gait
Cerebellar gait
Basal ganglion gait
Senile gait
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Disorders of Expression
Hypermimesis
Hypomimesis
Dyspraxias and apraxias
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Disorders of Expression (cont’d)
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Extrapyramidal Motor Syndromes
Basal ganglia motor syndromes
Cerebellar motor syndromes
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Alterations of
Neurologic Function in
Children
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Review
Remember there are many differences in
the nervous system with children:
Do you remember the following:
*Fontanels
*Sutures
*Reflexes
We Will explore one major area in children,
in this weeks notes
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Childhood Brain Tumors
Brain tumors:
Medulloblastoma
Ependymoma
Cerebellar astrocytoma
Brain stem glioma
• Craniopharyngioma
Optic glioma
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Childhood Brain Tumors