The Nervous System Review and Neurologic Dysfunction N 331
Functional Organization of the Brain and Spinal Cord 4 major brain regions ▫Cerebrum ▫Diencephalon ▫Cerebellum ▫Brain stem Pons Medulla Midbrain
Functions of the Diencephalon, Cerebellum, and Brainstem These 3 form the more primitive areas of the brain.
Meninges
Blood supply to the brain Brain receives 20% of cardiac output or ml of blood per minute
Circle of Willis – serves as collateral flow
12 Cranial Nerves
Alterations in Nervous System Functioning Manifestations of Global Brain Injury Consciousness Alterations in Neuro Function
Consciousness
Alterations in neurologic function Level of Consciousness Breathing Patterns Vomiting Pupillary Changes Oculomotor Responses Motor Responses
Glasgow Coma Scale Eye Opening Spontaneous4 To loud voice3 To pain2 None1 Verbal Response Oriented5 Confused, Disoriented4 Inappropriate words3 Incomprehensible words2 None1 Motor Response Obeys commands6 Localizes pain5 Withdraws from pain4 Abnormal flexion posturing3 Extensor posturing2 None1
Breathing patterns
Cheyne-Stokes Respirations FK6ro
Brain stem damage Irregular and unpredictable breathing patterns
Vomiting
Pupillary Changes & Oculomotor Responses
Motor Responses Posturing ▫Decorticate Brain stem intact, loss of cerebral cortex functioning ▫Decerebrate May indicate more serious damage and results from disruption of higher brain centers and the brainstem.
Alteration in Intracranial Pressure
Measuring ICP
Neurologic Death Cerebral death Brain death Persistent vegetative state
Traumatic Head & Spine Injuries
Scalp lacerations
Head Injuries Closed vs Open
Traumatic Brain Injury Major Head Trauma
Concussion
Contusion
Coup/Contrecoup
Protective Coverings of Brain
Epidural hematoma
Subdural hematoma
Diffuse Axonal Injury
Shaken Baby Syndrome
Spinal Cord Trauma
Complete cord involvement
Paralysis
Partial cord involvement
Spinal shock
Low Back Pain
Aneurysm & AV Malformation
Subarachnoid hemorhhage
CVA
A Stroke is an Emergency act: - Face ▫Ask the person to smile. Does one side droop? – Arms ▫Ask person to raise both arms. Does one drift downward? Is one arm weak or numb? – Speech ▫Ask person to repeat a simple sentence. Is speech slurred. – Tongue ▫Stick out tongue, Does it deviate from midline?
Ischemic Stroke Thrombolytic vs Embolytic
Visual Deficits
Intracranial Infections/Neoplasms
One of the physically demonstrable symptoms of meningitis is Brudzinski's sign. Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed. One of the physically demonstrable symptoms of meningitis is Kernig's sign. Severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees.
Encephalitis
Abscess & Neoplasms
Seizures
Tonic Clonic Seizures
Nerve Conduction Disorders
Muscle tone Hypotonia and Hypertonia
Muscle movement Hypokinesia and Hyperkinesia
Muscular Dystrophy Normal skeletal muscle Muscular Dystrophy Deposition of collagenous scar tissue (RED)
Myasthenia Gravis
Multiple Sclerosis
Amotrophic Lateral Sclerosis
ALS
Cerebral Palsy