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    Week three notes Week three notes Presentation Transcript

    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 11 Alterations in Cognitive Systems, Cerebral Hemodynamics and Motor Function
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 22 Alterations in Cognitive Systems  Consciousness  State of awareness of oneself and the environment  Arousal • State of awakeness
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 33 Alterations in Arousal  Structural  Divided by location above or below tentorial plate  Metabolic  Psychogenic
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 44 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
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 55 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
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 66 Clinical Manifestations
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 77 Clinical Manifestations (cont’d)
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 88 Clinical Manifestations (cont’d)
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 99 Clinical Manifestations (cont’d)
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1010 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)
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1111 Brain Death (Brain Stem Death)  Brain death criteria:  No ocular responses  Isoelectric EEG  Persistence 6 to 12 hours after onset
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1212 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
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1313 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
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1414 Alterations in Awareness  Selective attention:  Ability to select from available, competing environmental and internal stimuli  Sensory inattentiveness • Extinction • Neglect syndrome  Selective attention deficit
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1515 Alterations in Awareness (cont’d)  Memory  Amnesia  Retrograde amnesia  Anterograde amnesia  Executive attention deficits • ADHD  Image processing
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1616 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
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1717 Seizures (cont’d)  Convulsion  Tonic-clonic (jerky, contract-relax) movements associated with some seizures  Epilepsy: no underlying cause can be found
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1818 Seizures (cont’d)  Etiologic factors:  Cerebral lesions  Biochemical disorders  Cerebral trauma  Epilepsy
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1919 Seizures (cont’d)  Partial seizures  Simple, complex, secondary generalized  Generalized seizures  Absent, myoclonic, clonic, tonic-clonic, atonic  Unclassified epileptic seizure
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2020 Seizures (cont’d)  Aura  Prodroma  Tonic phase  Contraction  Clonic phase  Relaxation  Postictal phase
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2121 Data Processing Deficits  Agnosia  Tactile, visual, auditory, etc.  Dysphasia  Expressive dysphasia  Receptive dysphasia  Transcortical dysphasia  Aphasia
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2222 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
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2323 Dementia  Progressive failure of cerebral functions that is not caused by an impaired level of consciousness  Losses:  Orientation  Memory  Language  Judgment  Decision making
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2424 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
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2525 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
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2626 Cerebral Hemodynamics  CBF  CPP  CBV  Cerebral oxygenation
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2727 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
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2828 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
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2929 Herniation Syndromes (cont’d)  Infratentorial herniation  Cerebellar tonsil shifts through foramen magnum
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3030 Cerebral Edema  Increase in the fluid (intracellular or extracellular) within the brain  Types:  Vasogenic  Cytotoxic  Interstitial
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3131 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
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3232 Hydrocephalus (cont’d)  Noncommunicating hydrocephalus  Internal  Intraventricular  Communicating (extraventricular) hydrocephalus  Acute hydrocephalus  Normal-pressure hydrocephalus
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3333 Alterations in Neuromuscular Function  Muscle tone  Hypotonia  Hypertonia • Spasticity • Gegenhalten (paratonia) • Dystonia • Rigidity
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3434 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
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3535 Alterations in Movement (cont’d)
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3636 Alterations in Movement (cont’d)
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3737 Alterations in Movement (cont’d)  Lower motor neuron syndromes:  Flaccid paresis or flaccid paralysis  Hyporeflexia or areflexia  Fibrillation
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3838 Lower Motor Neuron Syndromes
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3939 Lower Motor Neuron Syndromes (cont’d)  Amyotrophies:  Paralytic poliomyelitis  Nuclear palsies  Guillain-Barré syndrome  Progressive spinal muscular atrophy  Progressive bulbar palsy  Bulbar palsy
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4040 Alterations in Movement  Hyperkinesia  Excessive movement  Chorea, wandering, tremor at rest, postural tremor, etc.  Paroxysmal dyskinesias  Tardive dyskinesia
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4141 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)
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4242 Alterations in Movement (cont’d)  Hypokinesia  Decreased movement  Akinesia  Bradykinesia  Loss of associated movement
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4343 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
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4444 Disorders of Posture (Stance)  Dystonia  Dystonic postures and movements  Decorticate posture  Decerebrate posture  Basal ganglion posture  Senile posture
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4545 Disorders of Posture (Stance) (cont’d)
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4646 Disorders of Gait  Spastic gait  Scissors gait  Cerebellar gait  Basal ganglion gait  Senile gait
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4747 Disorders of Expression  Hypermimesis  Hypomimesis  Dyspraxias and apraxias
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4848 Disorders of Expression (cont’d)
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4949 Extrapyramidal Motor Syndromes  Basal ganglia motor syndromes  Cerebellar motor syndromes
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 5050 Alterations of Neurologic Function in Children
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 5151 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
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 5252 Childhood Brain Tumors  Brain tumors:  Medulloblastoma  Ependymoma  Cerebellar astrocytoma  Brain stem glioma • Craniopharyngioma  Optic glioma
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 5353 Childhood Brain Tumors