Term
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Definition
Protective layers of the brain.
Dura Mater
Arachnoid Mater
Pia Mater |
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Term
| What lies between the arachnoid & pia mater? |
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Definition
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Term
| What's inside the subarachnoid space? |
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Definition
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Term
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Definition
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Term
| Impulse travels from dendrite to the terminals via |
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Definition
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Term
| What is the "signal insulator"? |
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Definition
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Term
| Myelin is produced by which cells |
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Definition
| Schwann &/or oligodendrocytes? |
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Term
| Microglial cells are what |
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Definition
| Immune cells that turn into a macrophage when a neuron dies or an invader is present |
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Term
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Definition
Multipolar
Bipolar - retina
Pseudo-unipolar: cell body exists outside
Unipolar: direct sensory afferent input |
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Term
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Definition
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Term
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Definition
proprioception & somatic motor
FAST & THICK (myelinated) |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
| Preganglionic autonomic: myelinated |
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Term
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Definition
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Term
| C fiber function sympathetic |
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Definition
| postganglionic sympathetic |
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Term
As diameter increases what happens to..
Conduction velocity
Magnitude of electrical impulses |
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Definition
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Term
As diameter increases.. what happens to:
duration of response
refractory period
threshold of excitation |
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Definition
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Term
| Which fibers have the most --> interm ---> least susceptibility to hypoxia |
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Definition
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Term
| Which fibers have the most --> interm ---> least susceptibility to pressure |
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Definition
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Term
| Which fibers have the most --> interm ---> least susceptibility to local anes |
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Definition
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Term
| Somatic NS innervates _________ via the __________ neurons |
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Definition
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Term
| Somatic: How many neurons to how many receptors |
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Definition
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Term
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Definition
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Term
| Which part of the motor unit is the sensory side |
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Definition
| Dorsal "love is a feeling" |
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Term
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Definition
SM MUSC: blood vessels, GI tract, urinary tract, reporductive organs, airways
Cardiac: muscle & conducting tone
Glands: sweat, GI, respiration |
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Term
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Definition
Control of viscera:
Heart rate
Arterial blood pressure
GI motility and secretions
Emptying of urinary bladder
Diameter of bronchi and bronchioles
Adapt to environment |
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Term
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Definition
Thin fine diameters
Slower conduction (0.5 m/s)
Less precise control |
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Term
| ANS preganglionic neuron terminates in a |
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Definition
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Term
| ANS preganglionic neuron originates in the |
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Definition
| IML of gray matter (T1-L3) |
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Term
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Definition
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Term
| When many pregangs from same or different spinal segments come together on an individual sympathetic ganglia? |
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Definition
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Term
When pregangs innervate many post gangs in a given ganglion
The effects are? |
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Definition
Divergence --> widespread
ex: sweat glands, blood vessels |
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Term
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Definition
Thoracolumbar outflow
Short pre
Long Post
Chain of ganglion |
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Term
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Definition
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Term
| PSNS pre gangs initiate in the ? |
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Definition
| cranial nuclei & sacral segments s2-s4 |
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Term
| PSNS: where do the post gangs lie? 2 places.. |
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Definition
| In the effector itself or in a gang close to it |
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Term
| PSNS control is more __________ than SNS |
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Definition
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Term
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Definition
Cranial-sacral outflow
Long preganglionic axon
Little divergence of preganglionic axons
Short postganglionic axon
Ganglion located near or in effector |
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Term
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Definition
| Ligand gated ion channels |
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Term
| ANS has 2 neurons (pre & post) except where? |
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Definition
| Adrenal medulla ---> blood stream |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| Somatic is only excitatory while ANS can do both |
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Term
What are the adrenergic receptors?
Effects on blood flow to the... skin, sk. muscle, cardiac |
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Definition
Epi & NE
Decreased to skin, increased to sk muscle & heart |
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Term
| Effects of NE & Epi on... respiratory & GI |
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Definition
Relaxes bronchial smooth muscle
Inhibits motility & secretions (GI) |
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Term
| Effects of NE & Epi on metabolism |
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Definition
| mobilizes glucose, increases lipolysis, increases BMR, stimulates sweat glands |
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Term
| NE is released from the ___________ neuron at the _________ |
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Definition
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Term
| Epi ________ NE released from the AM |
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Definition
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Term
| What is the cholinergic NTM |
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Definition
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Term
| Ach effects on GI, GU, Glands & heart |
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Definition
| Increases all except sweat glands and heart |
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Term
| What are the two classes of receptors for ACH |
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Definition
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Term
| Where are nicotinic receptors found |
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Definition
| Motor nerve place, chromaffin cells of the AM |
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Term
| Where are muscarinic receptors found |
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Definition
| PSNS effector organs and sweat glands |
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Term
| Ach __________ smooth muscle & __________ the heart |
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Definition
excites sm. m.
inhibits the heart |
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Term
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Definition
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Term
| Atropine is what class & has what SE |
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Definition
| antimuscarinic: hot, blind, dry, red, mad |
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Term
Ach is released from
:the ____________ neurons of the PSNS & SNS
:_______________at PSNS effectors |
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Definition
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Term
| Effects of Alpha 1 agonists |
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Definition
| excitatory, smooth muscle contraction (except bronchial) |
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Term
| Effects of Alpha 2 agonists |
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Definition
| excitatory- inhibits NE release --> sedation & analgesia |
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Term
| Alpha agonists are activated most by _____ because _______ |
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Definition
| NE. Epi concentrations are too low |
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Term
| Which NTM is more effective with Beta agonists |
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Definition
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Term
| Effects of Beta 1 agonist |
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Definition
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Term
| Effects of Beta 2 agonists |
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Definition
| inhibitory- smooth muscle in the bronchioles (dilation), GI tract, Blood vessels (dilate) |
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Term
| Cholinerics mimic & stimulate the release of ? |
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Definition
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Term
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Definition
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Term
| Adrenergic mimic and stimulate the release of |
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Definition
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Term
| What is the only organ innervated by sympathetic pregang |
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Definition
| chromaffin cells of the AM |
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Term
| 4 groups of sympathetic ganglia |
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Definition
superior, middle & inferior cervical
celiac |
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Term
| How is the action of NE terminated |
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Definition
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Term
| Afferent pathways carry info from where to where? |
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Definition
| from sensory receptors to CNS |
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Term
| Which CN orginiate in the brain stem |
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Definition
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Term
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Definition
| breathing, BP, swallowing, coughing |
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Term
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Definition
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Term
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Definition
| posture, balance & breathing |
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Term
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Definition
| movement, posture, head & eye movements |
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Term
| cerebellum uses info from what for what |
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Definition
spinal cord: position
cerebral cortex: motor
inner ear: balance |
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Term
| diencephalon consists of what two parts |
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Definition
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Term
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Definition
processes sensory info to cerebral cortex
& motor info from cerebral cortex to the SC |
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Term
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Definition
| temp, food, water, hormones (pituitary gland) |
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Term
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Definition
cortex
basal ganglia
hippocampus
amygdala |
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Term
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Definition
| recieves sensory info & integrates motor movement |
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Term
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Definition
neostriatum
globus pallidus |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| emotions- interacts with ANS via hypothalamus |
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Term
| spinal cord anatomical position |
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Definition
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Term
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Definition
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Term
ascending pathways?
descending? |
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Definition
sensory from periphery to CNS
motor from CNS to periphery |
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Term
| Features of stimulus that are encoded |
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Definition
modality (touch, temp, pain, etc)
Location
intensity
duration |
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Term
| +Ions move ________ when cell is depolarized |
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Definition
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Term
| First order afferent neurons are where in relation to neuron? |
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Definition
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Term
| The higher the order of afferent neuron the _______ to CNS |
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Definition
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Term
| Hyperpolarization: positive ions move |
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Definition
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Term
| Mechanoreceptor modality, receptors & location |
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Definition
touch, auditory, visual
pacinian corpuscle --> skin
hair cell ----> organ of corti
hair cell ----> semicircular canal |
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Term
| photoreceptor modality, receptors & location |
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Definition
vision
rods & cones ----> retina |
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Term
| chemoreceptor modality, receptors & location |
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Definition
olfaction, taste, art. po2, ph of csf
olfactory receptor ---> olfactory mucosa
taste buds ----> tongue
carotid, aortic bodies, ventrolateral medulla |
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Term
| thermoreceptor modality, receptors & location |
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Definition
temp
cold & warm -----> skin |
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Term
| nociceptors modality, receptors & location |
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Definition
pain---> nociceptors ---> skin, muscle, viscera
extremes of temp ---> thermal nociceptors ---> skin |
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Term
| Dorsal column system in SC processes? |
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Definition
| touch, pressure & position (proprioception) |
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Term
| in the dorsal system, fibers enter the _________ and ascend __________ to ___________ in the ____________ |
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Definition
1. dorsal root
2. ipsilaterally
3. dorsal column nuclei
4. medulla |
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Term
| nucleus gracilis located? senses? |
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Definition
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Term
| nucleus cunatus located? senses? |
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Definition
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Term
| Fibers from the n. gracilis & cuneatus cross to the? |
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Definition
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Term
| third order fibers project from thalamus to? |
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Definition
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Term
| Pain involves which neuron fibers |
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Definition
A- delta (fast pain) - epicritic - fine
C (slow) protopathic (throbbing)- diffuse |
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Term
|
Definition
| 2nd order neurons in SC (sends info centrally via anterolateral system) |
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Term
| What is the gate keeper of pain |
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Definition
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|
Term
| What is the gate theory of pain |
|
Definition
○ Explains the idea that innocuous stimuli, such as rubbing a painful area, can reduce pain sensations. □ Their activation leads to the release of GABA and other neurotransmitters by interneurons in the substantia gelatinosa.
□ Interneurons in the substantia gelatinosa inhibit the “T” cell, thereby closing the gate |
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Term
Allodynia
Hyperalgesia
Referred pain |
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Definition
perception of pain from non painful stimuli
increased response to pain
sensation of pain from part of body with no stimulus |
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Term
|
Definition
| stretch relfex (stimulation of muscle spindle) Ia afferents enter SC and tell alpha motoneurons that there is stretching. "knee jerk" |
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Term
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Definition
| initiated by golgi tendon stimulation, senses tension --> relaxation |
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Term
|
Definition
withdrawal- initiated by group II, III, IV fibers
Excites flexor muscles in affected limb
Inhibits extensor muscles in affected limb
Onset = rapid
DOA = short |
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Term
| how does flexor reflex keep you from falling after an injury |
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Definition
○ Excites contralateral extensors muscles
○ Inhibits contralateral flexor muscles |
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Term
| volumes in the cranial vault |
|
Definition
brain 80-85%
blood 5-10%
CSF 10% |
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Term
|
Definition
| when one dept. increases, another has to decrease to maintain ICP |
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Term
| Brain consumes ______% total body oxygen |
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Definition
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Term
| ____% of cerebral O2 is used in making ATP |
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Definition
|
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Term
|
Definition
| 3-3.8 ml O2/ 100g tissue /min |
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Term
| What happens if cerebral perfusion is decreased and is not re-established in 5 mins (3-8 on pp) |
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Definition
| ATP stores become depleted and irreversible cellular injury begins to ensue |
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Term
| Primary source of energy for neuronal cells |
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Definition
|
|
Term
brain glucose consumption rate
___ % metabolized aerobically |
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Definition
|
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Term
|
Definition
CMRO2
CPP
PaCO2
PaO2
drugs
pathology |
|
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Term
|
Definition
50 ml/ 100g tissue /min
= 750 ml/min
=15% CO |
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Term
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Definition
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Term
|
Definition
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|
Term
CMRO2 increased by?
Decreased by? |
|
Definition
Increases in temp & seizures
Decreases in temp & anes |
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Term
| Normal resting body O2 consumption? |
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Definition
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|
Term
| CBF increases by ______ ml/100g/min for every 1 mmHg increase in PaCO2 |
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Definition
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Term
|
Definition
|
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Term
|
Definition
| cerebral vasoconstriction |
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Term
|
Definition
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Term
| Decreased PaO2 doesnt affect CBF until WHEN? |
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Definition
| 50 mmHg, then vasodilation & CBF increases |
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Term
| Autoregulation keeps CBF b/w |
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Definition
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Term
| If patient is chronic HTN, curve gets shifted to the |
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Definition
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Term
| Autoregulation causes arterial constriction when CPP is |
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Definition
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Term
| Autoregulation causes arterial dilation when CPP is |
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Definition
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|
Term
| Systemic Hypotension causes cerebral |
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Definition
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|
Term
| Systemic Hypertension causes cerebral |
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Definition
|
|
Term
| at 150 mmHg of CPP, cerebral blood vessels are maximally |
|
Definition
|
|
Term
|
Definition
| disrupt the BBB ---> cerebral edema & hemorrhage |
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Term
| At CPP ___-_____ ischemia s/s (nausea, dizziness, AMS) |
|
Definition
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|
Term
| Outside of autoregulation, CBF is __________ dependant |
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Definition
|
|
Term
|
Definition
| vessels surrounding ischemic area are maximally dilated |
|
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Term
|
Definition
| vasodilation of normal vessels causes reduced blood flow to diseased areas |
|
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Term
|
Definition
| Robin Hood- vasoconstriction in normal brain resulting in redistribution of BF to ischemic areas |
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Term
| Venous blood pressure has ________ effect on CPP & CBF, but _________ effect on CBV |
|
Definition
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|
Term
| CVP must be ________ ICP for venous blood to continue to leave cranial vault |
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Definition
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|
Term
| _______ has greatest effect on CBF |
|
Definition
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|
Term
| CBF is _________ to PaCO2 |
|
Definition
| proportional (tensions of 20-80) |
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Term
| CBF changes ______ ml/100g/min for every 1 mmHg change in PaCO2 *lecture |
|
Definition
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|
Term
| CBF is decreased to ____% when PaCO2 is lowered to 20 mmHg acutely |
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Definition
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|
Term
| Hyperventilation to reduce PaO2 works for how long |
|
Definition
|
|
Term
| ______ & ______ cross BBB to alter pH & CBF |
|
Definition
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|
Term
PaO2 has _________ effect on CBF.
UNLESS? |
|
Definition
minimal.
unless < 50 mmHG ---> large cerebral vasodilation and increased CBF |
|
|
Term
| Arterial hypoxemia + hypercarbia = |
|
Definition
| greater increase in CBF as a couple than alone |
|
|
Term
| CMRO2 changes ___% for every 1 deg C change in T |
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Definition
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|
Term
| Hypothermia = ________ CMRO2 & CBF |
|
Definition
|
|
Term
| Hyperthermia = ___________ CMRO2 & CBF |
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Definition
|
|
Term
| which temp may provide neuroprotection against global ischemia |
|
Definition
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|
Term
| Shivering can increase CMRO2 by |
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Definition
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Term
|
Definition
|
|
Term
Propofol, barbs and opioids are
Caveat? |
|
Definition
vasoconstrictors.
Opioids: ONLY vasoconstriction if opioid-induced ventilatory depression is controlled & no increase in PaCO2 is allowed. |
|
|
Term
| Muscle relaxants can decrease ICP how |
|
Definition
| by preventing movement & coughing |
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Term
| Succ admin in setting of increased ICP may do what |
|
Definition
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|
Term
|
Definition
|
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Term
|
Definition
○ (1) ultrafiltration and secretion by the cells of the choroid plexus (ependymal cells)
○ (2) the passage of water, electrolytes, and other substances across the blood-brain barrier. |
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Term
|
Definition
|
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Term
|
Definition
|
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Term
|
Definition
| microscopic arachnoid villi and macroscopic arachnoid granulations within the dura mater/bordering venous sinusoids and sinuses |
|
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Term
|
Definition
HA
NV
Papilledema
AMS
HTN
Bradycardia
Altered breathing pattern |
|
|
Term
|
Definition
Raise HOB - 30deg above heart- promotes venous outflow
Hyperventilate: (works for 6 hours)- maintain PaCO2 30-35
CSF drainage (lumbar drain or ventriculostomy)
Hyperosmotic drugs
Surgery to decompress
Steroids
Diuretics
Anes Agents |
|
|
Term
| Abrupt cessation of hyperventilation can result in |
|
Definition
|
|
Term
| Main complication of hyperventilation |
|
Definition
| reduction in CBF --> cerebral ischemia |
|
|
Term
|
Definition
|
|
Term
|
Definition
| increases plasma osmolarity, draws water from tissues, decreases CSF volume |
|
|
Term
| Can only administer Mannitol with intact? |
|
Definition
|
|
Term
| Administer mannitol over ____min |
|
Definition
|
|
Term
| Mannitol onset, peak & DOA |
|
Definition
10-15 min
1-2 hours
6 hours |
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|
Term
| Mannitol can remove up to _____ ml of H20 from the brain |
|
Definition
|
|
Term
| Hypertonic solution vs. mannitol |
|
Definition
Improves MAP without delayed hypotension
more favorable outcomes, may be uses in patients who cant have mannitol |
|
|
Term
| Furosemide _____ CSF production. Usually given as adjunt to |
|
Definition
|
|
Term
| Which anes agents could you use to help treat IICP |
|
Definition
|
|
Term
| Decadron given to IICP caused by |
|
Definition
| tumors & lesions, NOT BLEEDS |
|
|
Term
|
Definition
Tumors (size, obstructing CSF flow & causing edema)
Hematoma ---> Herniation syndrome
Subarachnoid hemorrhage (blood in the CSF)
Infection (meningitis, encephalitis) |
|
|
Term
| The brain can compensate for volumes up to? which phase of Intracranial pressure volume curve? |
|
Definition
|
|
Term
| How does the brain compensate for IICP |
|
Definition
• displacement of CSF from the cranial to the spinal compartment
• an increase in CSF absorption
• a decrease in CSF production
a decrease in total cerebral blood volume (primarily venous) |
|
|
Term
|
Definition
uncal,
central
cingulate (subfalcine)
transcalvarial |
|
|
Term
|
Definition
|
|
Term
| difference in focal and diffuse mass effect |
|
Definition
focal- local (bleeds, tumors, abscesses)
diffuse- generalized edema caused by within cells (cytogenic), ISF (vasogenic), CVA, meningitis |
|
|
Term
| Uncal herniation involves which structure |
|
Definition
|
|
Term
| Subfalcine (cingulate) involves which structure |
|
Definition
| cingulate gyrus under the flax cerebri |
|
|
Term
|
Definition
| brain squeezes out of hole in skull from trauma or surgery |
|
|
Term
| Central herniation involves which structure |
|
Definition
| diencephalon & temporal lobe |
|
|
Term
| Transtentorial (uncal) herniation involves _____ to ______ compression of the brain stem |
|
Definition
|
|
Term
| Which CN is compressed with Uncal herniation |
|
Definition
| 3, causes ipsilateral oculomotoral nerve dysfunction, (pupilary dilation, ptosis, down and out lateral deviation of effected eye |
|
|
Term
| Homonymous Hemianopia caused by uncal herniation is due to |
|
Definition
| compression of the post. cerebral artery |
|
|
Term
| Innermost part of the temporal lobe called |
|
Definition
|
|
Term
|
Definition
| diencephalon slips under edge of tentorium-dilated & fixed pupils, sunset eyes |
|
|
Term
| Subfalcine (cingulate) herni MOA |
|
Definition
| Herniation of cerebral hemispheric contents under the falx cerebri. Looks like a midline shift. Causes compression of the branches of the anterior cerebral artery. |
|
|
Term
| Upward herni structures involved |
|
Definition
| cerebellum moves upward from notch in tentorium cerebelli |
|
|
Term
|
Definition
| parts of cerebellum (tonsils) slip down through hole in skull called foramen magnum |
|
|
Term
| Cerebellar tonsillar herni s/s |
|
Definition
HA
Neck stiffness
Decreased LOC
Reduced muscle tone (flaccid paralysis)
Results in medullary dysfunction
Cardiac/ respiratory instability
Death |
|
|
Term
|
Definition
Increased BP
Irreg breathing
Bradycardia |
|
|
Term
| Epidural hematoma most common artery |
|
Definition
|
|
Term
| epidural hematoma CT shape |
|
Definition
|
|
Term
|
Definition
abrupt
"talk & drop" = period of lucidity
LOC
increases in ICP
decreases in CPP |
|
|
Term
| subdural hematoma CT shape |
|
Definition
|
|
Term
| Epidural hematoma bleed location |
|
Definition
|
|
Term
| subdural hematoma bleed location |
|
Definition
| b/w dura and arachnoid (under dura) |
|
|
Term
|
Definition
| gradual--> HA, confusion, changes in LOC, |
|
|
Term
| BOTH subdural & epidural s/s |
|
Definition
HA, drowsiness, obtunded, hemiparesis, hemianopsia, language probs
*** elderly: unexplained dementia |
|
|
Term
| subarachnoid bleed causes & RF |
|
Definition
-aneurysm rupture
• May be trauma related
• Bleeding disorders
• Infections, tumors, toxins
• AVM rupture
RF: HTN, smoking, fam hx |
|
|
Term
|
Definition
• “Worst headache of life”
• Vomiting, coma, death
• Neck stiffness, positive Kernigs sign
○ Lies supine, bend the hips & flex the knee - on straightening leg = pain
Vasospasm, hydrocephalus may occur
Drowsiness or coma may persist in survivors |
|
|
Term
|
Definition
| cerebral contusion, vessel injury, HTN, infection |
|
|
Term
|
Definition
|
|
Term
|
Definition
subarachnoid
epidural
subdural
intraparenchymal |
|
|
Term
|
Definition
severe TBI
severe brain injury? 50% patients die or veg |
|
|
Term
|
Definition
Spontaneous eye opening -4
Obeys with motor response -6
Oriented -5 |
|
|
Term
Permanent vegetative state if non-traumatic?
Traumatic? |
|
Definition
|
|
Term
| Apneustic breathing center located |
|
Definition
|
|
Term
| Unresponsive midsize pupils (5mm) = |
|
Definition
|
|
Term
| Fixed dilated pupil (7mm) = |
|
Definition
| oculomotor nerve compression (brain herniation) |
|
|
Term
|
Definition
|
|
Term
|
Definition
A new seizure in an adult
Gradual loss of movement or sensation in an arm or leg
Unsteadiness or imbalance, especially if it is associated with headache
Loss of vision in one or both eyes, especially if the vision loss is more peripheral
Double vision, especially if it is associated with headache
Hearing loss with or without dizziness
Speech difficulty of gradual onset '
Nausea & vomiting in the MORNING (especially in older adults) |
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|
Term
| Supratentorial tumors are where? |
|
Definition
| Above the cerebellum in the cebrum. most common kind and more common in adults |
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|
Term
| Infratentorial tumor location? |
|
Definition
| cerebellum and or brainstem- more common in children |
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Term
| Metastatic tumors originate |
|
Definition
lung
breast
kidney
colon
melanoma |
|
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Term
| Mets to the brain most likely from |
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Definition
malignant melanoma
renal cell CA
colon CA |
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Term
| Primary vs. Secondary TBI |
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Definition
• Primary injury-occurs at impact
Shearing and tearing of axons
Hematomas
• Secondary injury-
ischemia
cerebral edema
seizures
oxidative stress leading to neuronal
axonal & glial injury |
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Term
|
Definition
1. ABCs
2. C-Spine
3. Maintain brain perfusion
-minimize IICP to optimize CPP (60-70)
-treat ICP > 22
-Keep SBP >90 |
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