Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 11
Alterations in Cognitive Systems,
Cerebra...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 22
Alterations in Cognitive Systems
 Consci...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 33
Alterations in Arousal
 Structural
 Div...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 44
Alterations in Arousal (cont’d)
 Coma is...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 55
Alterations in Arousal
 Clinical manifes...
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 ...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1111
Brain Death (Brain Stem Death)
 Brain ...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1212
Cerebral Death
 Cerebral death (irreve...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1313
Cerebral Death (cont’d)
 Survivors of ...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1414
Alterations in Awareness
 Selective at...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1515
Alterations in Awareness (cont’d)
 Mem...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1616
Seizures
 Syndrome versus disease
 Su...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1717
Seizures (cont’d)
 Convulsion
 Tonic-...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1818
Seizures (cont’d)
 Etiologic factors:
...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1919
Seizures (cont’d)
 Partial seizures
 ...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2020
Seizures (cont’d)
 Aura
 Prodroma
 T...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2121
Data Processing Deficits
 Agnosia
 Ta...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2222
Acute Confusional States (ACS)
 Transi...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2323
Dementia
 Progressive failure of cereb...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2424
Alzheimer Disease (AD)
 Familial, earl...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2525
Alzheimer Disease (AD) (cont’d)
 Neuro...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2626
Cerebral Hemodynamics
 CBF
 CPP
 CBV...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2727
Increased Intracranial Pressure
(IICP)
...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2828
Herniation Syndromes
 Supratentorial h...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2929
Herniation Syndromes (cont’d)
 Infrate...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3030
Cerebral Edema
 Increase in the fluid ...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3131
Hydrocephalus
 Excess fluid within the...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3232
Hydrocephalus (cont’d)
 Noncommunicati...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3333
Alterations in Neuromuscular
Function
...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3434
Alterations in Movement
 Paresis and p...
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)
 Lowe...
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)
...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4040
Alterations in Movement
 Hyperkinesia
...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4141
Alterations in Movement (cont’d)
 Hunt...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4242
Alterations in Movement (cont’d)
 Hypo...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4343
Parkinson Disease
 Severe degeneration...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4444
Disorders of Posture (Stance)
 Dystoni...
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
 Scis...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4747
Disorders of Expression
 Hypermimesis
...
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 ...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 5050
Alterations of
Neurologic Function in
C...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 5151
Review
 Remember there are many differ...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 5252
Childhood Brain Tumors
 Brain tumors:
...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 5353
Childhood Brain Tumors
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Week three notes

  1. 1. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 11 Alterations in Cognitive Systems, Cerebral Hemodynamics and Motor Function
  2. 2. 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
  3. 3. 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
  4. 4. 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
  5. 5. 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
  6. 6. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 66 Clinical Manifestations
  7. 7. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 77 Clinical Manifestations (cont’d)
  8. 8. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 88 Clinical Manifestations (cont’d)
  9. 9. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 99 Clinical Manifestations (cont’d)
  10. 10. 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)
  11. 11. 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
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. 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
  16. 16. 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
  17. 17. 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
  18. 18. 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
  19. 19. 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
  20. 20. 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
  21. 21. 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
  22. 22. 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
  23. 23. 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
  24. 24. 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
  25. 25. 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
  26. 26. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2626 Cerebral Hemodynamics  CBF  CPP  CBV  Cerebral oxygenation
  27. 27. 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
  28. 28. 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
  29. 29. 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
  30. 30. 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
  31. 31. 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
  32. 32. 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
  33. 33. 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
  34. 34. 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
  35. 35. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3535 Alterations in Movement (cont’d)
  36. 36. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3636 Alterations in Movement (cont’d)
  37. 37. 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
  38. 38. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3838 Lower Motor Neuron Syndromes
  39. 39. 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
  40. 40. 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
  41. 41. 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)
  42. 42. 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
  43. 43. 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
  44. 44. 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
  45. 45. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4545 Disorders of Posture (Stance) (cont’d)
  46. 46. 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
  47. 47. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4747 Disorders of Expression  Hypermimesis  Hypomimesis  Dyspraxias and apraxias
  48. 48. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4848 Disorders of Expression (cont’d)
  49. 49. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4949 Extrapyramidal Motor Syndromes  Basal ganglia motor syndromes  Cerebellar motor syndromes
  50. 50. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 5050 Alterations of Neurologic Function in Children
  51. 51. 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
  52. 52. 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
  53. 53. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 5353 Childhood Brain Tumors

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