Glossary of Neuro 2006

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What area of the brain is responsible for temperature control?
Diencephalon (thalamus & hypothalamus)
What is the major function of the medulla oblongata?
cardiac regulation

respiratory center
What area of the brain is responsible for equilibrium?
How long can the brain go without oxygen?
5 minutes
Which brain matter is made up of neurons?
grey matter
What is the white matter made up of?
Where does the Circle of Willis originate?
carotid artery

vertebral artery
Where do the anterior and middle cerebral arteries originate?
internal carotid artery
Where do the posterior cerebral arteries originate?
vertebral arteries
Where is CSF produced?
choroid plexus
What are the three volume components of intra-cranial pressure?
brain tissue


cerebrospinal fluid
List the brain's 3 types of compensation used to maintain a stable ICP:

Metabolic regulation

CSF regulation
What is autoregulation?
The system that maintains constant cerebral perfusion despite chantes in systemic arterial pressure; blood flow to the brain remains fairly constant
What is metabolic regulation?
Changes to o2 & co2 that affect cerebral blood flow
How does co2 affect the arteries in the brain
What causes increased intracranial pressure?
Anything that causes an increase in production of CSF


Anything that causes a decrease in reabsorption of CSF
What is meant by the term "hydrocephalus?"
increased intracranial pressure
What happens if the brain's system for regulating ICP fails?
Hypoxia and brain cell death
When does IICP occur?
When the brain cannot accomodate the increase in volume of one of the components (failure to compensate)
What areas of the brain are in danger with uncal herniation?

What is the pupil response when uncal herniation is present?
fixed and dilated
True or False: the damage caused by uncal herniation is temporary if treated quickly
false; the damage is irreversible
What respiratory pattern is sometimes seen with increased ICP?
What pupillary response is an EARLY sign of increased ICP?
Unequal pupils

Sluggish response
What pupillary response is a LATE sign of increased ICP?
fixed and dilated
List the late signs and symptoms of increased ICP:
*Fixed dilated pupils
*Decorticate/decerebrate posturing
*Loss of gag reflex
*Cushings Triad
What is Cushing's triad?
*Severe HTN
*Wide pulse pressure
List interventions for IICP:
*Administer diuretics
*Administer sedation as ordered
*Establish euvolemia
*Avoid valsalva (inc. suctioning)
*Establish eucapnia
*Elevate head of bed to 45 degrees
*Maintain the patient's head in a midline position
*Maintain normal body temperature
*Decrease environmental stimuli
What is euvolemia?
balanced fluid volume
What is eucapnia?
balanced o2
Regarding traumatic brain injuries, the extent of the injury depends on what?
the amount of force
Traumatic brain injury is a major cause of death for what age group?
children younger than age 5
What event causes the most traumatic brain injuries?
Motor vehicle accidents
What is the GCS in a mild head injury?
What is the GCS in a moderate head injury?
What is the GCS in a severe head injury?
80% of all skull fractures are what type of fracture?
Linear skull fracture
What is a common nursing assessment to determine whether fluid leaking from the ear or nose is CSF?
the "Halo" test: fluid forms a yellow ring when blotted with a tissue
What severe damage can result from a basilar skull fracture?
Severe cranial nerve damage
What are the signs/symptoms of a concussion?
*Possible loss of consciousness (usually brief)
What is vasogenic edema?
abnormal permeability of the cerebral vessel wall; plasma filters to ECS causing an increase in brain tissue volume
What is cytotoxic edema?
cellular edema; a result of hypoxic insult to the brain cells
Of what is the brain depleted in cytotoxic edema?
What can cause vasogenic edema, resulting in further IICP?
cytotoxic edema
What is low when cytotoxic edema is present?
serum Na
When does interstitial brain edema occur?
in the presence of acute brain swelling
Interstitial brain edema is associated with an increase in what?
*Blood Pressure


*CSF pressure
How is Cerebral Perfusion Pressure (CPP) calculated?
Subtract CSF pressure from the mean arterial pressure
What are hematomas?
Space occupying lesions
What is involved in an epidural hematoma?
Middle meningeal artery
Where does an epidural hematoma occur?
around the temporal lobe
With an epidural hematoma, how soon do signs & symptoms occur?
Very rapidly
What is the treatment for an artery that is injured by an epidural hematoma?
suture the artery
What is the treatment for a subdural hematoma?
remove the hematoma
What causes a subdural hematoma?
ruptured veins
When do signs/symptoms occur with a subdural hematoma?
days to weeks
Is there more or less bleeding with a subdural hematoma?
True or false: clot formation is slower with subdural hematomas
What is an intracerebral hemorrhage?
Accumulation of blood within the brain tissue
Which type of brain herniation causes compression of the medulla?
What are the long-term effects of head injuries?
*Motor deficits
*Perceptual deficits
*Speech/language deficits
*Cognitive deficits
*Difficulty with bowel/bladder function
*Traumatic epilepsy
If your client has CSF drainage from the ear, what should the nurse assess?
nuchal rigidity
What does nuchal rigidity indicate in head injury patients?
infection or blood in CSF
What should the nurse rule out BEFORE assessing for nuchal rigidity
spinal cord injury
What should ALWAYS be assessed in head injury patients?
*Systemic hypotension
*Hypoxia or hypercapnea
What are some nursing measures to decrease ICP?
*Elevate HOB 15-30 degrees
*Avoid flexion of hips, waist & knees
*Logroll patient to transfer
*Avoid rotation/extreme flexion/extension of the head
*Space out nursing activities
*Avoid Valsalva type of activities: cough/vomit/strain
*Suction ONLY as necessary
*Provide O2 before & after suctioning
*O2 via mask or nasal cannula
*Possible ET tube to control pO2 & pCO2
*Prophylactic hyperventilation (only if on ventilator)
What is significant about prophylactic hyperventilation?
It has a mild vasoconstricting effect when done properly.
When is prophylactic hyperventilation contraindicated?
In the first 20 hours after injury
When is prophylactic hyperventilation indicated?
*Acute neurologic deterioration (for brief periods)
*Intracranial HTN that does not respond to standard treatment
When should ABG's be checked if using prophylactic hyperventilation?
Twice daily
What is involved in a craniotomy?
Removal of hematoma or parts of brain to reduce pressure
What is normal ICP?
10-15 mmHg
What should you remember when preparing your patient for cranial surgery?
*NO enemas
*Shampoo hair
Into what position should a craniotomy patient be placed immediately after surgery?
What is supratentorial positioning?
*HOB 30-45 degrees
*large pillow under head & shoulders
What is infratentorial positioning?
*HOB flat with small pillow
*log roll with draw sheet
*NO neck flexion
Regarding positioning, what is important to remember when a patient has had a craniectomy?
Do not place on affected side
What is the 3rd cause of death in the US?
What is significant about an ISCHEMIC stroke?
caused by a thrombus or emboli (occluding the cerebral artery)
What are the two types of ischemic stroke?
What causes a thrombotic stroke?
atherosclerosis of arteries
What is an embolic stroke?
Embolus or emboli break off from other parts of the body and enter cerebral circulation via the carotid artery
What are the warning signs of ischemic stroke?
*Reversible ischemic neurological deficit (RIND)
What is a hemorrhagic stroke?
Vessel breaks down; occurence of bleeding into brain tissue, subarachnoid space, or ventricles
What are the causes of hemorrhagic stroke?
*AV malformation
Cocaine use causes what two side effects which increase the risk of stroke?
What is dysarthria?
nerve dysfunction
What are the classic symptoms of CVA?
*Contralateral weakness
*Aphasia (expressive/receptive/global)
*Facial weakness/paralysis
*Transient loss of bowel/bladder control
*Diminished or loss of consciousness
Which cranial nerve affects the ability to chew?
Which cranial nerve affects swallowing and the gag reflex?
Which cranial nerve affects tongue movement?
Damage to which cranial nerve causes facial paresis or paralysis?
Which abnormal heart rhythm results in an increased risk for stroke?
atrial fibrillation
How often should the GCS and vital signs be checked in stroke patients?
q 4 hours
When is the risk for IICP highest in stroke patients?
first 72 hours following injury
When are anticoagulants contraindicated?
*Hepatic failure
What is very important to monitor after a patient has had a carotid endarterectomy?
swelling of the neck or complaints of dysphagia
When is embolization indicated?
arteriovenous malformation
What are the causes of aneurysm?
What are the symptoms of an aneurysm rupture?
*Sudden explosive headache
*neck rigidity (due to blood in CSF)
*loss of consciousness
*brain ischemia
*increased ICP
*respiratory distress
What is meningitis?
inflammation of teh meninges of the brain & spinal cord
What can cause meningitis?
*Chemical inflammation
Which type of meningitis is usually not life-threatening?
How is meningitis transmitted?
What type of isolation is indicated for meningitis patients?
droplet isolation
List some predisposing conditions for meningitis:
*Otitis media
*Acute sinusitis
*Fractured base of skull w/CSF leak
*Procedures like LP or surgery
*Anatomic abnormalities like spina bifida
*Foreign objects like ventricular shunts
*Can occur from a focal infection via blood
What is SIADH?
Syndrome of Inappropriate Antidiuretic Hormone (too much adh = retain fluid)
What is Kernig's sign?
Pain in hamstring when hip & knee are flexed by examiner
What is Brudzinski's sign?
examiner elevates head of patient; knees bend involuntarily
What is opisthotonus?
severe spasm of back muscles (bends backward)
What lab findings are consistent in meningitis?
*CSF changes: appearance, WBC, glucose & protein
*Culture & sensitivity of CSF
*Elevated serum WBC
*Low serum Na
What is a partial or focal seizure?
Epileptogenic focus limited to one region of one cerebral cortex; one hemisphere
What is significant of a simple partial seizure?
*Patient remains conscious
*Experiences aura
*A "deja vu" phenomenon
*Unilateral movement of extremity
*Changes in heart rate
*Skin flushing
*Psychic symptoms
What is significant of a complex partial seizure?
*black out 1-3 minutes
*automatism (lip smacking/patting/pulling on clothes, etc.)
*Amnesia may follow immediately after
What is significant of a tonic-clonic seizure?
*lasts 2-5 minutes
*tonic: rigidity of arm or leg muscles
*immediate loss of consciousness
*Clonic: rhythmic jerking of all extremities
*May bite tongue
*Incontinence of urine or feces
*Postictal fatigue, lethargy, confusion (usually lasts an hour)
What is significant of a petit mal seizure?
*More common in children
*Brief LOC
*Blank staring, like daydreaming
*Return to baseline immediately after
What is significant of a myoclonic seizure?
*brief jerking or stiffening of extremities; single or group
*lasts only a few seconds
What is significant of an atonic seizure?
*Sudden loss of muscle tone
*Patient may fall
*Postictal confusion
What is the first-hand treatment for acute seizure?
Lorazepam or Diazepam rectal gel
What is the treatment goal for acute seizure?
to stop clusters and prevent status epilepticus
What is status epilepticus?
*Continuous or recurrent generalized seizures, in rapid succession
What is significant of status epilepticus?
*Does not regain full consciousness between seizures
*Repeated seizures lasting over 30 minutes, or one seizure lasting over 10 minutes
*More intense then regular seizures
*A potential complication for all types of epilepsy
What can cause death or brain damage in status epilepticus?
*cardiac dysrhythmia
*lactic acidosis
What are teh usual causes for status epilepticus?
*Sudden withdrawal from anticonvulsants
*Head trauma
*Cerebral edema
During status epilepticus, what is important to know regarding the administration of ativan or diazepam?
No more than 50 mg/minute via IV push
List some nursing care measures during status epilepticus:
*Maintain ABC's
*O2 via nasal cannula
*Inform physician (intubation may be needed)
*Access vein/start IV NS
*Medications: ativan or diazepam followed by dilantin
*Never leave person alone
What are typical fluid restrictions for neuro patients?
1500-2500 cc/day

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