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184 Cards in this Set
- Front
- Back
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agnosia
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loss of ability to recognize objects through a particular sensory system; may be visual, auditory or tactile
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ataxia
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inability to coordinate muscle movements, resulting in difficulty in walking, talking, and performing self-care activities
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autonomic nervous system
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division of the nervous sytstem that regulates the involuntary body functions
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axon
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portion of the neuron that conducts impulses away from the cell body
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Babinski reflex (sign)
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a reflex action of the toes, indicative of abnormalities in the motor control pathways leading from the cerebral cortex
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clonus
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abnormal movement marked by alternating contraction and relaxation of a muscle occurring in rapid succession
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delirium
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transient loss of intellectual function, usually due to systemic problems
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dendrite
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portion of the neuron that conducts impulses towards the cell body
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dysphagia
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difficulty swallowing
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flaccid
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displaying lack of muscle tone; limp, floppy
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parasympathetic nervous system
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division of the ANS active primariy during nonstressful conditions, controlling mostly visceral functions
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photophobia
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inability to tolerate light
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position (postural) sense aka proprioception
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awareness of position of parts of the body without looking at them
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reflex
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an automatic response to stimuli
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rigidity
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increase in muscle tone at rest characterized by increased resistance to passive stretch
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Romberg test
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test for cerebellar dysfunction requiring the patient to stand with feet together eyes closed and arms extended; inability to maintain the position, with either significant stagger or sway, is a positive test
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spasticity
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sustained increase in tension of a muscle when it is passively lengthened or stretched
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sympathetic nervous system
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division of the ANS with predominantly excitatory responses, the "fight-or-flight" system
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tone
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tension present in a muscle at rest
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vertigo
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an illusion of movement, usually rotation
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ganglia aka nuclei
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nerve cell bodies occuring in clusters
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center
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a cluster of cell bodies with the same function (eg, the respiratory center)
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neuroglial cells
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small types of nerve cells that support, protect, and nourish the neurons
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where are neurotransmitters manufactured and stored??
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synaptic vesicles
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Alcohol withdrawal seizures are caused by...
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an increase in GABA (gamma-aminobutyric acid)
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Parkinson's disease is caused by...
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an decrease in dopamine as well as sometimes an increase in acetylcholine
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Myasthenia gravis is caused by...
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a decrease in acetylcholine
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Direct (inotropic) receptors
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are linked to ion channels and allow passage of ions when opened
-excitatory or inhibitory -rapid acting |
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Indirect receptors
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affects metabolic processes in the cell
-can take seconds to hours to occur |
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PET related to neuro
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positron emission tomography
-can detected abnormal levels of dopamine, serotonin, and acetylcholine in the brain |
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SPECT as related to neuro
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single photon emission computed tomography
-similar to PET -can detect change in some neurotransmitters in the brain such as dopamine |
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acetylcholine is the major transmitter for the _________ nervous system
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parasympathetic nervous system
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source of Ach
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many areas of the brain; autonomic nervous system
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action of Ach
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usually excitatory; parasympathetic effects sometimes inhibitory (stimulation of heart by vagal nerve)
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source of serotonin
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brain stem, hypothalamus, dorsal horn of spinal cord
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action of serotonin
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inhibitory, helps control mood and sleep, inhibits pain pathways
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source of dopamine
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substantia nigra and basal ganglia
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action of dopamine
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usually inhibits, affects behavior (attention, emotions) and fine movement
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norepinephrine is the major neurotransmitter of the ____________ nervous system
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sympathetic nervous system
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source of norepinephrine
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brain stem, hypothalamus, post-ganglionic neurons of the sympathetic nervous system
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action of norepinephrine
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usually excitatory; affects mood and overall activity
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source of GABA (gamma-aminobutyric acid)
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spinal cord, cerebellum basal ganglia, some cortical areas
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action of GABA
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excitatory
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source of enkephalin and endorphin
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nerve terminals in the spine, brain stem, thalamus and hypothalamus, and pituitary gland
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action of enkephalin and endorphin
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excitatory; pleasurable sensation, inhibits pain transmission
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What is the major neurotransmitter of the sympathetic nervous system?
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norepinephrine
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What is the major neurotransmitter of the parasympathetic nervous system?
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acetylcholine
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Where are the connections for CN I and CN III?
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in the cerebrum
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Where are the connections for all CN except I and III?
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the brain stem
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great longitudinal fissure
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incompletely separates the cerbrum
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transverse and association pathways
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tracts or pathways connecting various parts of the brain with one another in the white matter
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projection fibers
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tracts that connect the cortex to lower portions of the brain and spinal cord
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frontal lobe major functions
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conscentration
abstract thought information storage memory motor function Broca's area affect judgement personality inhibitions |
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parietal lobe major functions
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mostly sensory
analyzes sensory information and relays the interpretation of this info to the thalamus and other cortical areas awareness of the body in space orientation in space other spatial relations |
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temporal lobe major functions
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auditory sensory areas
integration of somatization, visual, and auditory areas (interpretive area) most dominant role in the cortex for thinking |
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occipital lobe major functions
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visual interpretation
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Which lobe has the most dominant role of any area of the cortex for thinking?
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temporal lobe
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basal ganglia
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masses of nuclei located deep in the cerebral hemispheres that are responsible for control of fine motor movements, including those of the hands and extremities
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thalamus
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primarily a relay station for all sensation, EXCEPT FOR SMELL
all memory, sensation, and pain impulses pass through the thalamus |
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What lies on either side of the third ventricle?
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the thalamus
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hypothalamus
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contains the optic chiasm and mamillary bodies
regulates pituitary secretions appetite control (hunger center) sleep-wake cycle blood pressure agressive and sexual behavior emotional responses (blushing, rage, depression, panic, fear) controls and regulates the ANS |
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optic chiasm
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the point at which the two optic tracts cross
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mamillary bodies
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involved in olfactory reflexes and emotional response to odors
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where is the pituitary gland located?
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in the sella turcia at the base of the brain
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If a pituitary gland has a tumor it may cause...
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hormonal imbalance or visual disturbance secondary to pressure on the optic chiasm
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midbrain
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contains sensory and motor pathways
center for auditory and visual reflexes |
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What CN's originate in the midbrain?
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III and IV
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pons
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contains motor and sensory pathways
controls the heart, respiration, and blood pressure |
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What CN's originate in the pons?
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V through VIII
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medulla oblongata
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contains motor corticospinal fibers and fibers from the spinal cord to the brain
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hypothalamus
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contains the optic chiasm and mamillary bodies
regulates pituitary secretions appetite control (hunger center) sleep-wake cycle blood pressure agressive and sexual behavior emotional responses (blushing, rage, depression, panic, fear) controls and regulates the ANS |
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optic chiasm
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the point at which the two optic tracts cross
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mamillary bodies
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involved in olfactory reflexes and emotional response to odors
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where is the pituitary gland located?
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in the sella turcia at the base of the brain
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If a pituitary gland has a tumor it may cause...
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hormonal imbalance or visual disturbance secondary to pressure on the optic chiasm
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midbrain
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contains sensory and motor pathways
center for auditory and visual reflexes |
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What CN's originate in the midbrain?
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III and IV
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pons
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contains motor and sensory pathways
controls the heart, respiration, and blood pressure |
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What CN's originate in the pons?
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V through VIII
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medulla oblongata
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contains motor corticospinal fibers and fibers from the spinal cord to the brain
most fibers cross, or decussate, in the medulla oblongata |
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What CN's connect to the brain in the medulla?
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CN IX and XII
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tentorium cerebelli
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separates the cerebrum from the cerebelum
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cerebellum
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largely responsible for coordination of movement
fine movement balance proprioception integration of sensory input |
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meninges
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fibrous CT that cover the brain and spinal cord
protection, support, and nourisment to the brain and spinal cord pia mater arachnoid mater dura mater |
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falx cerebri
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extension of the dura that separates the two hemispheres longitudinally
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What is responsible for the production of CSF and how much is produced a day?
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chroroid plexus of the ventricles, 500 mL
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What absorbs CSF, and how much does it absorb a day?
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arachnoid villi, 350-375 mL
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When blood enters the CSF fluid system, as in trauma or hemorrhagic stroke, what may result?
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The villi become obstructed and hydrocephalus (increased size of ventricles) may result
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What space contains CSF?
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subarachnoid space
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specific gravity of CSF
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1.007
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Normal CSF contains
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a minimal number of WBC
No RBC |
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Why does the brain need a high blood flow of 15% of cardiac output?
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The brain does not store nutrients and has a high metabolic demand.
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What major arteries supply the brain?
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Two internal carotid arteries
Two verterbral arteries |
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What major veins carry blood back to the heart?
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the internal jugular vein
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Why are cerebral vein unique?
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Unlike other veins in the body, they do not have valves to prevent blood from flowing backward and they depend on both gravity and pressure.
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All substances entering the CSF must filter through ...
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the capillary endothelial cells and astrocytes
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where does the spinal cord begin and end?
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foramen magnum to the first lumbar vertebra
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The PNS contains what 3 types of nerves?
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cranial
spinal ANS |
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The dorsal roots of the spinal cord are....
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sensory and transmit sensory impulses from specific areas of the body known as dermatomes to the dorsal ganglia.
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The sympathetic nervous system controls predominantly...
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excitatory responses, such as the fight or flight
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The parasympathetic nervous system controls mostly...
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visceral functions
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the adrenergic system is aka
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the sympathetic system
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the cholinergic system is aka
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the parasympathetic system
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sympathetic storming
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results from hypothalamic stimulation of the sympathetic nervous system following a TBI
s/s include change in LOC altered vitals diaphoresis agitation |
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ciliary ganglia
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where fibers of both sides of the ANS join
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olfactory
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sensory - sense of smell
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optic
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sensory - visual acuity and visual fields
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oculomotor
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motor- muscles that move the eye and lid pupillary constriction, lens accomodation
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trochlear
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motor - muscles that move the eye
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trigeminal
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mixed - facial sensation, corneal reflex, mastication
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abducens
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motor - muscles that move the eye
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facial
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mixed - facial expression and muscle movement, salivation and tearing, taste, sensation in the ear
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acoustic
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sensory - hearing and equilibrium
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glossopharyngeal
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mixed - taste, sensation in pharynx and tongue, pharyngeal muscles, swallowing
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vagus
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muscles of pharynx, larynx, and soft palate; sensation in external ear, pharynx, larynx, thoracic and abdominal viscera; parasympatetic innervation of thoracic and abdominal organs
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spinal accessory
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motor - sternocleidomastoid and trapezium muscles
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hypoglossal
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motor - movement of the tongue
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What CN' move the eye?
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III oculomotor
IV trochlear VI abducens |
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What general area controls voluntary movements
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motor cortex
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Upper motor neurons begin in the .... (trace pathway)
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in the cortex of one side of the brain, descend through the internal capusule, cross to the opposite side in the brain stem, descend through the corticospinal tract, and synapse with the lower motor neurons.
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What occurs if upper motor neurons are damaged, as frequently occurs with stroke or SCI?
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paralysis (loss of voluntary movement)
but involuntary movements (reflexes) uninhibited hyperactive deep tendon reflexes diminished or absent superficial reflexes pathologic reflexes (eg, Babinski sign) severe leg spasm no muscle atrophy spastic paralysis (permanently tense) or paresis |
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what is damaged when hemiplegia has occured?
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damage to the upper motor neurons in the internal capsule
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What occurs if lower motor nuerons are damaged?
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muscle paralysis
absent reflexes flaccid muscles atrophied from disuse |
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What are the two principle signs of lower motor neuron damage
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1. flaccid paralysis
2. atrophy of the affected muscles |
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Decordicate posturing is usually the result of...
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lesions of the internal capsule or cerebral hemispheres
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Decerebrate posturing is usually the result of....
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lesions at the midbrain, is more decerebration is more ominous than decordication
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Flaccid posturing is usually the result of ....
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lower brain stem dysfunction
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what is flaccid posturing
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no motor function
limp lacks muscle tone |
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The cerebellum is responsible for...
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the coordination, balance and timing of all muscular movements that originate in the motor centers of the cerebral cortex.
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The basal ganglia plays an important role in...
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planning and coordinating motor movements and posture.
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Disorders of the basal ganglia result in...
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exaggerated, uncontrolled movement because the major effect of the basal ganglia is to inhibit unwanted muscular activity
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Impaired cerebellar function results in
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loss of muscle tone
weakness fatigue |
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Disorders of the basal ganglia include...
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Parkinson's
Huntington's spasmodic torticollis |
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athetosis
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movement of a slow, squirming, writhing, twisting type
in addition to tremons and chorea, this is another type of movement that may be seen in patients with damage to the basal ganglia |
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Decerebration followed by flaccidity in a patient with cerebral injury indicates...
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severe neurologic impairment, which may herald brain death
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What does the thalamus do?
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integrates all sensory impulses except olfaction
conscious awareness of pain recognition of variation in temperature and touch sense of movement and position ability to recognize the size, shape, and quality of objects |
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What sensory fibers cross immediately to the opposite side of the cord after entering the posterior gray column?
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pain and temperature fibers
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What sensory fibers ascend the cord for a variable distance before entering the gray matter, contacting the secondary neuron, and crossing the cord?
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Touch, light pressure, and localization
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What fibers are conveyed, uncrossed, via the posterior column to the brain stem by the axon of the primary neuron before connecting with the secondary neuron in the medulla?
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Position and vibratory sensations
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possible clinical manifestations of neurologic disease
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pain
seizures dizziness and vertigo visual disturbances weakness abnormal sensation |
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seizures are the result of ....
which then manifest as.... |
abnormal discharges in the cerebral cortex, which then manifest as an alteration in sensation, behavior, movement, perception, or consciousness
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What might be the first obvious sign of a brain lesion?
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a seizure
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dizziness is..
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an abnormal sensation of imbalance or movement
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is dizziness common in the elderly and one of the most common complaints?
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yes
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vertigo is usually a manifestation of...
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vestibular dysfunction
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severe vertigo can result in...
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spatial disorientation
light-headedness staggering nausea and vomiting |
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What abnormality of eye movement is associated with multiple sclerosis?
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nystagmus
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Is weakness a common manifestation of neurologic disease?
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yes
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What are the 5 components of a neurologic assessment?
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cerebral function
cranial nerves motor system sensory system reflexes |
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The neurologic assessment follows a logical sequence and progresses from...
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higher levels of cortical function, such as abstract thinking, to lower levels of function, such as the determination of the integrity of peripheral nerves
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Topics in the assessment of cerebral functions
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mental status
intellectual function thought content emotional status perception motor ability language ability impact on lifestyle |
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visual agnosia is caused by a lesion in the
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occipital lobe
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auditory agnosia is caused by a lesion in the
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temporal lobe
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tactile agnosia is caused by a lesion in the
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parietal lobe
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proprioception agnosia is caused by a lesion in the
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parietal lobe
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area involved with auditory-receptive aphasia
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temporal lobe
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area involved with visual-receptive aphasia
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parietal-occipital area
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area involved with expressive speaking aphasia
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inferior posterior frontal areas
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area involved with expressive writing aphasia
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posterior frontal area
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areas of examination for the motor system
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muscle strength
balance and coordination |
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5 point scale used to rate muscle strength
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5 - full power of contraction against gravity and resistance / or normal muscle strength
4 - indicates fair but not full strength against gravity and a moderate amount of resistance / or slight weakness 3 - moderate weakness - just sufficient strength to overcome the force of gravity 2 - severe weakness - indicates the ability to move but not to overcome the force of gravity 1 - very severe weakness - weak muscle contraction can be palpated but no movement is noted 0 - no movement |
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what signs suggest cerebellar dysfunction?
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lack of balance control and coordination, such as
ataxia tremors positive Romberg test |
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the Weber test is a test for
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lateralization of the acoustic CN
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The Rinne test is a test for
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air and bone conduction of the acoustic CN
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What reflex may be normally absent in older people?
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Achilles reflex - ankle jerks
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grading system of deep tendon reflexes
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4+ indicates a hyperactive reflex, often indicating pathology
3+ indicates a response that is more brisk than average, with or without clonus, but may be normal or indicate of disease 2+ normal 1+ hypoactive or diminished response 0 no response |
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the major deep tendon reflexes are...
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biceps reflex
triceps reflex brachioradialis reflex patellar reflex ankle reflex |
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the 3 major superficial reflexes are...
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corneal reflex
gag reflex plantar reflex |
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a positive Babinski sign (fanning of the toes) is indicative of
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CNS disease of the corticospinal tract
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sensory system neuropathies associated with alcoholism occur in a ...
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glove-and stocking distribution
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why do you not usually need to test for temperature?
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Because temperature and pain sensations are transmitted together (lateral part of SC)
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vibration and proprioception are transmitted together in what part of the cord?
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posterior
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stereognosis
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ability to recognize an object in your hand with eye closed
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structural change with aging
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-brain weight deceases
-number of synapses decrease -loss of neurons in select brain regions -reduced cerebral blood flow and metabolism -in the PNS, myelin is lost, resulting in a decrease in conduction velocity -overall reduction in muscle bulk -taste buds atrophy -nerve cell fibers in the olfactory bulb degenerate -nerve cells in the vestibular system of the inner ear, cerebellum, and proprioceptive pathways degenerate -deep tendon reflexes can be decreased or absent -hypothalamic function modified such that stage IV sleep is reduced -overall slowing of ANS responses -pupillary responses reduced |
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possibly normal motor alterations with aging
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-overall reduction in muscle bulk, with atrophy most easily noted in the hands
-diminished strength or agility -flexed posture, shuffling gait, rigidity of movement -decreased reaction time -decreased movement time |
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sensory isolation due to normal visual and hearing loss can cause
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confusion
anxiety disorientation misinterpretation of the environment feelings of inadequacy |
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normal temperature and pain regulation changes with aging
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-temperature regulation become less efficient
-may be more sensitive to cold -reaction to painful stimuli may decrease (so complaints of pain may need to be taken more seriously than the patient's perception might indicate) - |
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taste and smell alterations with aging
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-taste buds atrophy, leading to decreased acuity of taste buds, a decreased appetite, and weight loss
-atrophy of olfactory organs presents a safety hazard (fires, etc) |
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tactile and visual alterations with aging
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-dulling of tactile sensation due to a decrease in the number of areas of the body responding to all stimuli and in the number and sensitivity of sensory receptors
-sensitivity to glare -decreased peripheral vision -constricted visual field -may result in disorientation -night lights at night, familiar furniture setup |
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When an elderly patient has a change in mental status, what should always be suspected as a causative factor?
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drug toxicity
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delirium is seen in elderly patients who have...
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underlying CNS damage OR
are experiencing an acute condition such as infection, adverse medication rxn, dehydration, vitamin B deficiency, thyroid disease |
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how is delirium different from dementia
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delirium is an acute change in mental status attributable to a treatable medical problem, while dementia is a chronic and irreversible deterioration of cognitive status
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teaching methods for elderly include what kind of voice
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low-pitched, clear voice
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what pace should a nurse use to teach an elderly patient
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unrushed pace and use reinforcement. give the patient adequate time to receive and respond to stimuli, learn and react
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