Porth's Essentials of Pathophysiology Chapter 37

The most frequently fatal stroke is a spontaneous ? into the brain

hemorrhage

Because ? indicates decreased oxygen levels in all brain tissue, it produces a generalized depressant effect on the brain

hypoxia

Signs of altered consiousness

inattention mild confusion disorientation blunted responsiveness

What is a pneumbra?

a central core of dead or dying cells, surrounded by an ischemic band or area of minimally perfused cells

What can cause a seizure?

Neurotransmitter imbalances

Occurs when integrity of the blood-brain barrier is disrupted

Vasogenic edema

For seizure disorders that do not respond to anticonvulsant medications, the option for surgical treatment exists. What is removed in the most common surgery for seizure disorder? A. Temporal neocortex B. Hippocampus C. Entorhinal cortex D. Amygdala

D. Amygdala

Although the brain makes up only 2% of the body weight, it receives 15% of the resting cardiac output and accounts for ?% of the oxygen consumption

20

Results from lesions of the cerebral hemisphere

Decorticate posturing

There are several types of brain injuries that can occur. What are the primary brain injuries? (select all) A. Focal lesions of lacerations B. Contusion C. Hypoxic D. Diffuse axonal E. Hemorrhage

A, B, D, E

Much like brain death, there are criteria for the diagnosis of a persistent vegetative state, and the criteria have to have lasted more than 1 month. What are criteria for the diagnosis of persistent vegetative state? (select all) A. Bowel and bladder incontinence B. Ability to open the eyes C. Lack of language comprehension D. Lack of enough hypothalamic function to maintain life E. Variable preserved cranial nerve reflexes

A, C, E

Inability to comprehend, integrate, and express language is called?

Aphasia

What are the two components of consciousness?

Arousal and wakefulness and content and cognition

? malformations are a complex tangle of abnormal arteries and veins linked by one or more fistulas

Arteriovenous

When the suspected diagnosis is bacterial meningitis, what assessment techniques can assist in determining if meningeal irritation is present? A. Kernig sign and Chadwick sign B. Brudzinski sign and Kernig sign C. Brudzinski sign and Chadwick sign D. Chvostek sign and Guedel sign

B. Brudzinski sign and Kernig sign

Manifestations of brain tumors are focal disturbances in brain function and increase ICP. What causes the focal disturbances manifested by brain tumors? A. Tumor infiltration and increased blood pressure B. Brain compression and decreased ICP C. Brain edema and disturbances in blood flow D. Tumor infiltration and decreased ICP

C. Brain edema and disturbances in blood flow

Brain death is the term that is used when the loss of function of the entire brain is irreversible. A clinical examination must be done and repeated at least 6 hours later with the same findings for brain death to be declared. What is not assessed in the clinical examination for brain death? A. Blink reflex B. Responsiveness C. Electrocardiogram D. Respiratory effort

C. Electrocardiogram

Excessive activity of the excitatory neurotransmitters and their receptor-mediated effects is the cause of which type of brain injury? A. Hypoxic B. Ischemic C. Excitotoxic D. Increased intercranial volume and pressure

C. Excitotoxic

? seizures involve impairment of consciousness and often arise from the temporal lobe

Complex partial

? is the state of awareness of self and the environment and of being able to become oriented to new stimuli

Consciousness

What are watershed infarcts?

During severe hypotension the distal territories undergo a profound lowering of blood flow, predisposing to focal ischemia and infarction of brain tissues

? represents a generalized infection of the parenchyma of the brain or spinal cord

Encephalitis

? usually are caused by head injury in which the skill is fractured

Epidural hematomas

What is post-concussion syndrome?

Headache, irritability, insomnia, and poor concentration and memory loss

A failure to attend to and react to stimuli coming from the contralateral side is called?

Hemineglect

Increased ? pressure is a common pathway for brain injury from different types of insults and agents

Intracranial

Reduced or interrupted blood flow is called?

Ischemia

Inflammation of the pia mater, the arachnoid, and the CSF-filled subarachnoid space is called?

Meningitis

? seizures usually involve only one hemisphere and are not accompanied by loss of consciousness or responsiveness

Simple partial

Divides the cranial cavity into anterior and posterior fossae is called?

Tentorium cerebelli

? are the most common cause of ischemic strokes, usually occurring in atherosclerotic blood vessels

Thrombi

? seizures usually present with a person having a vague warning and experiencing a sharp tonic contraction of the muscles with extension of the extremities and immediate loss of consciousness

Tonic-clonic

What is global ischemia?

When blood flow is inadequate to meet the metabolic needs of the entire brain

Manifestations of global brain injury

alterations in sensory, motor, and cognitive function and changes in LOC

In many neurologic disorders, various mediators including excitatory ? catecholamines, nitric oxide, free radicals, inflammatory cells, apoptosis, and intracellular ? may cause injury to neurons

amino acids, proteases

Bulge at a localized weakness in musculature of artery is called?

aneurysm

Brain death is defined as the irreversible loss of function of the ? , including the brain stem.

brain

The use of ? for brain tumors is somewhat limited by the blood-brain barrier

chemotherapy

Where are watershed infarcts?

concentrated in anatomically vulnerable border zones between the overlapping territories supplied by the major cerebral arteries, notably the middle, anterior, and posterior cerebral arteries

Cerebral ? is an increase in tissue volume secondary to abnormal fluid accumulation

edema

A(n) ? stroke is caused by a moving blood clot that travels from its origin to the brain

embolic

Manifestation of focal brain injury

focal neurologic deficits without altered consciousness

Cerebral ischemia can be ?, as in stroke, or ?, as in cardiac arrest

focal, global

? strokes are caused by an interruption of blood flow in a cerebral vessel, and ? strokes are caused by bleeding into the brain tissue

ischemic, hemorrhagic

What does unilateral loss of the pupillary light response mean?

lesion of the optic or oculomotor pathways

TIA or " ? " is equivalent to "brain angina" and reflects a temporary disturbance in focal cerebral blood flow, which reverses before infarction occurs, analogous to ? in relation to heart attack

ministroke, angina

Myoclonic seizures involve brief involuntary ? induced by stimuli of cerebral origin

muscle contractions

The effects of traumatic head injuries can be divided into two categories: ? injuries, in which damage is caused by impact, and secondary injuries, in which damage results from the subsequent brain swelling, infection, or ?

primary, cerebral hypoxia

A ? represents the abnormal behavior caused by an electrical discharge from neurons in the cerebral cortex

seizure

Excessive influx of ? during neural ischemia results in neuronal and interstitial edema

sodium

Seizures that do not stop spontaneously or occur in succession without recovery are called ?

status-epilepticus

? is the syndrome of acute focal neurologic deficit from a vascular disorder that injuries brain tissue

stroke

A subdural hematoma develops in the area between the dura and the arachnoid and usually is the result of a(n) ? in the small bridging veins that connect veins on the surface of the cortex to dural sinuses

tear (or rupture)

The functional manifestations of ? edema include focal neurologic deficits, disturbances in consciousness, and severe intracranial hypertension

vasogenic

The ? state is characterized by loss of all cognitive functions and the unawareness of self and surroundings

vegetative

? occurs with or without nausea, may be projectile, and is a common symptom of increased intracranial pressure (ICP) and brain stem compression

vomitting

Intracranial aneurysms that rupture cause subarachnoid hemorrhage in the client. How is the diagnosis of intracranial aneurysms and subarachnoid hemorrhage made? A. CT scan B. MRI C. Loss of cranial nerve reflexes D. Venography

A. CT scan

Which type of seizure begins in a localized area of the brain by may progress rapidly to involve both hemispheres? A. Complex partial B. Tonic C. Myoclonic D. Tonic-clonic

A. Complex partial

Global and focal brain injuries manifest differently. What is almost always a manifestation of a global brain injury? A. Altered level of consciousness B. Change in behavior C. Respiratory instabilityu D. Loss of eye movement reflexes

A. Altered level of consciousness

Generalized convulsive status epilepticus is a medical emergency caused by a tonic-clonic seizure that does not spontaneously end, or recurs in succession without recovery. What is the first-line drug of choice to treat status epilepticus? A. IV lorazepam B. IM diazepam C. IV cyclobenzaprine D. IM cyproheptadine

A. IV lorazepam

? edema involves an increase in intracellular fluid

Cytotoxic

The nurse is caring for a 31-year-old trauma victim admitted to the neurologic intensive care unit. While doing the initial assessment, the nurse finds that the client is flexing the arms, wrists, and fingers. There is adduction of the upper extremities with internal rotation and plantar flexion of the lower extremities. How would the nurse describe this in the notes? A. Decerebrate posturing B. Decorticate posturing C. Extensor posturing D. Diencephalon posturing

B. Decorticate posturing

Hypoxic injury will result in which of the following effects on the brain? A. Can be focal or global with only one part of the brain being underperfused or all of the brain being compromised B. Neuronal cell injury and death C. Clouding of consciousness, bilaterally small pupils with a full range of constriction, and motor responses to pain that are purposeful or semi-purposeful and often asymmetric D. Depends on the brain's compensatory mechanisms and the extent of the swelling

B. Neuronal cell injury and death

The regulation of cerebral blood flow is accomplished through both auto-regulation and local regulation. This allows for the brain to meet its metabolic needs. What is the low parameter for arterial blood pressure before cerebral blood flow become severely compromised? A. 30 mmHg B. 40 mmHg C. 50 mmHg D. 60 mmHg

D. 60 mmHg

Put the pathologic process of bacterial meningitis in order: A. Release endotoxins B. Development of a cloudy, purulent exudate in CSF C. Endotoxins initiate inflammatory response D. Meninges thicken and adhesions form E. Bacteria replicate and undergo lysis in CSF F. Vascular congestion and infarction in the surrounding tissues G. Pathogens, neutrophils, and albumin move across the capillary wall into the CSF H. Adhesions may impinge on the cranial nerves or may impair the outflow of CSF

E (bacteria replicate and undergo lysis in CSF) A (release endotoxins) C (Endotoxins initiate inflammatory response) G (Pathogens, neutrophils, and albumin move across the capillary wall into the CSF B (Development of a cloudy, purulent exudate in CSF) F (Vascular congestion and infarction in the surrounding tissues D (Meninges thicken and adhesions form) H (Adhesions may impinge on the cranial nerves or may impair the outflow of CSF)

Abnormal increase in CSF volume in any part or all of the ventricular system is called?

Hydrocephalus

Deprivation of oxygen with maintained blood flow is called?

Hypoxia

? infarcts result from occlusion of the smaller penetrating branches of large cerebral arteries, commonly the middle cerebral and posterior cerebral arteries

Lacunar

? refers to short serpiginous segments of necrosis that occur within and parallel to the cerebral cortex, in areas supplied by the penetrating arteries during an ischemic event

Laminar necrosis

Cerebral ? has been classically defined as the ability of the brain to maintain constant cerebral blood flow despite changes in systemic arterial pressure

autoregulation

A number of regulatory mechanisms, including the blood-brain barrier and auto-regulatory mechanisms that ensure its blood supply, maintain the ? electrically active cells

brain's

At least three metabolic factors affect cerebral blood flow: ?, ?, and ? concentration

carbon dioxide, hydrogen ion, oxygen

Aneurysmal subarachnoid hemorrhage represents bleeding into the subarachnoid space caused by a ruptured ?

cerebral aneurysm

The specific manifestations of stroke or TIA are determined by the ? that is affected, by the area of the brain tissue that is supplied by the vessel, and by the adequacy of the collateral circulation

cerebral artery

Brain ? represents a displacement of brain tissue under the falx cerebri or through the tentorial notch or incisura of the tentorium cerebelli

herniation

What does bilateral loss of pupillary light response mean?

indicates lesions of the brain stem