Aphasia Exam I

A ____ is removal of a portion of tissue so it can be sent for laboratory testing.

biopsy

Almost all AVMs are present at _____ and become larger over time.

birth

Primary intracranial tumors originate in the ___.

brain

The destruction of brain tissue by purulent by-products of a bacterial infection.

brain abscess

Visual anomalies, sensory loss, slowed onset; fever, chilled, headache, lethargy, & drowsiness

brain abscess

_____ means deprived of blood.

Ischemic

Type of lab technique is better at quickly seeing hemorrhagic stroke sand AVMs.

CT Scan

____ permits visualization of soft tissues not visible on standard x-ray images.

CT Scan

Enlarged ventricles without plugs or pressure.

Non-obstructive Hydrocephalus

____ intracranial tumors are those that originate elsewhere and migrating to intracranial locations.

Secondary

____ intracranial tumors form from cancerous cells that have migrated from the primary tumor site to the brain, where they settle and grow.

Secondary intracranial tumors

MRIs are sensitive to differences in ____ ____ instead of density like CT.

chemical composition

Images that are obtained from tests that use a contrast medium are said to be ___ ___.

contrast enhanced

____ ___ inserted into internal structures that wouldn't ordinarily be seen.

contrast media

In an angiogram, a ____ ____ is injected into an artery that goes to the brain (such as carotid and basilar).

contrast medium

Meningiomas are ___ to localize.

easy

In ____, variations in amplitude, frequency, duration, or pattern may indicate disease in anterior horn cells, disease affecting neuromuscular junctions, or disease affecting the muscles themselves. (neuropathy)

electromyography

Toxemia treatment is usually directed toward ____ of the source of toxin, and sometimes, _______ the toxin from the system.

removal; purging

Treatment for nutritional disorder involves ____ of the deficient compound by medication, together with dietary adjustment. In the case of vitamin or mineral excess, treatment is directed toward ____ the patient's intake of those compounds.

replenishment; reducing

_____ _____ may cause deterioration of cerebral function, leading to confusion, stupor, or coma.

severe hypoglycemia

Metabolic disorders include:

severe hypoglycemia and thyroid disorders

In Tonsillar Herniation, the brainstem is displaced downward with _____ and _____ of tissues. Respiration is compromised; heart rate decreases; blood pressure rapidly increases; and coma soon follows.

shearing and distortion

The MRI is superior to CT for imaging...

the temporal lobe, brain stem, cerebellum, & spinal cord.

The stretched arterial walls in aneurysms are _____, _____, and _________ ___ _________.

thin, weak, and susceptible to rupture

____ ____ may create CNS symptoms (apathy, confusion, and intellectual deterioration).

thyroid disorders

The pattern of recovery from a stroke depends on ________ of stroke. But the level of recovery depends on ________ of brain tissue destroyed and the ___________ of the damage.

type; amount; location

Sometimes the plaque in the arterial wall cracks or ______.

ulcerates

Predictions about a patient's eventual neurological recovery during the first few days after a stroke often prove ______ because the permanent effects of tissue destruction caused by the stroke are _______ by the stroke's temporary effects on brain chemistry and function.

unreliable; masked

___ are created from radiation from a cathode ray generator.

x-rays

In _____, surface electrodes are placed on the skin over the muscle of interest, or fine needle electrodes are inserted into muscles to record their electrical activity.

Electromyography

In _____ strokes, an artery abruptly is occluded by material that moves through the blood and blocks the artery.

Embolic strokes

_____ strokes are a consequence of sudden blockage of an artery, symptoms are maximally expressed within a few minutes.

Embolic strokes

________ strokes are caused by a fragment of material that travels through the circulatory system until it reaches an artery smaller than its own diameter, where it lodges, occluding the artery.

Embolic strokes (cerebral embolisms)

_____ are transient interruptions of blood supply to the brain that last more than 24 hours but completely resolve within a few days.

RINDs (Reversible Ischemic Neurological Deficits)

You can get viral encephalitis from things such as:

Rabies, West Nile Virus, Herpes, AIDs, etc.

In echo arteriography, a transducer that emits ____ ____ sound waves is placed against the neck over the carotid artery.

high frequency

On an x-ray, ___ density tissues appear as brighter images such as bone.

higher

A _____ aneurysm may be repaired.

leaking

MRI is susceptible to ____.

movement

In an EEG, electrodes are attached to the scalp and detect the tiny electrical signals generated by the brain cortex, which makes it ____.

non-invasive

In the early stages of tumor growth, when intracranial pressure is low, the patient may complain of _______ alterations in mental function such as forgetfulness, lack of initiative, drowsiness, blurred or double vision, light-headedness, or vertigo.

nonspecific

A patient remains severely impaired when the acute effects of the stroke have dissipated, the patient's limited recovery usually means that he or she has _______ destruction of brain tissue.

substantial

Most intracerebral hemorrhages are not ________ _________

surgically repairable

_____ ____ is computerized and can give you non-vascular structures deleted from the image that so that all you see the blood vessels.

Digital-subtraction angiography

If the blood in the artery is moving, the frequency of the reflected sound waves is altered in a predictable way, which is called the ___ ___.

Doppler Effect

____ yields a graphic record of the electrical activity of the cerebral cortex.

EEG (Electoencephalogram)

____ ____ is a procedure for visualizing carotid arteries that requires neither radiation nor the injection of a contrast agent.

Echo arteriography

FAST stands for?

F-Face - sudden drooping of one side of the face. A-Arm - sudden numbness, clumsiness, or weakness in one arm/leg. S-Speech - sudden difficulty speaking or understanding language; slurred speech. T-Time - call 911; get to the hospital immediately

Act FAST --what does this acronym ask you to heck when someone might be having a stroke?

Face Arms Speech Time

Gliomas - Grades 3-4; rapid growing, malignant, symptoms develop over 3 months to 1 year period. Less than one year survival is common.

Glioblastoma multiforme

Grade 3 or 4 glioma.

Glioblastoma multiforme

One of the most malignant and rapidly growing of all intracranial tumors and is likely to affect both hemispheres.

Glioblastoma multiforme

The second most common glioma is ____ ____.

Glioblastoma multiforme

Different kinds of intracranial tumors have different rates of growth and differ in malignancy. ________ are the most common.

Gliomas

_____ means caused by bleeding.

Hemorrhagic

What's next? Edema, Hydrocephalus, Intracranial Pressure...?

Herniation

____ is a condition in which the cerebral ventricles are enlarged, either as a result of increased pressure in the ventricles or as a result of brain atrophy.

Hydrocephalus

_____ usually causes patchy damage in the watershed regions (border zones) of the cortex supplied by the artery or branch, because the blood does not penetrate into the border zones where vessel diameters are small and flow resistance is high.

Hypoperfusion

______ ______ herniation usually occurs as a consequence of masses in the temporal lobe

Lateral Transtentorial Herniation

Intracranial tumors: Mesial surface of temporal lobe is pushed against the tentorium; puts pressure on CN 3 (causing ipsilateral pupillary dilation); can force brain tissue into the foramen magnum, compressing tissue and stretching blood vessels at the base of the brain and in the brain stem; brain stem ischemia is severe.

Lateral transtentorial herniation

About __% of those who experience a stroke are 65 years old or older.

75%

About ___% survive for at least 1 month after their first stroke, but only about __ are alive 10 years later.

75%; 1/3

___% of strokes are ischemic.

80%

Gliomas - Grades 1-2; most common, most benign, slow growing, symptoms develop over 5 to 6 years. Ten year post-operative survival is common.

Astrocytoma

This glioma is the most common most benign, and slow growing a good one to choose, if you must.

Astrocytoma

Grade 1 or 2 glimoa.

Astrocytomas

The most common and most benign of the gliomas is ______.

Astrocytomas

This glioma usually grow slowly and symptom development may span 5 to 6 years.

Astrocytomas

____ ____ is caused by obstruction of the interventricular passageways through which CSF circulates. The obstruction blocks the flow of CSF from the ventricles into the subarachnoid space.

Obstructive hydrocephalus

____ usually cause localized regions of dense neuron loss in brain tissue supplied by the affected artery or branch.

Occlusions

If they're using anti-coagulants, it must be one of these types of strokes.

Occlusive stroke (Ischemic)

____________ herniation is most common and least ominous

Subfalcine

Intracranial tumors: One brain hemisphere is pushed against the falx cerebri; most common & least ominous; no focal neurological symptoms unless the anterior cerebral artery is compressed (leading to contralateral numbness & weakness in the leg).

Subfalcine herniation

It occurs when one brain hemisphere is pushed against the falx cerebri, the rigid sheet of dura that projects downward into the superior longitudinal fissure

Subfalcine herniation

Lesions in this gyrus would result in disturbed language comprehension and formulation.

Superior Temporal Gyrus (left) (aka Wernicke's)

What type of drug therapy dissolves a cerebral artery occlusion for an acute ischemic stroke to re-establish blood flow and prevent cerebral infarction?

Thrombolytic thearpy, tPA

______ strokes are caused by slowly developing occlusion of an artery, they tend to develop in an irregular, step-wise manner, sometimes preceded by transient periods of ischemia (small strokes).

Thrombotic strokes

In ______ strokes, an artery slowly is occluded by a plug of material accumulating at a fixed location.

Thrombotic strokes (cerebral thrombosis)

Intracranial tumors: Swelling in the cerebellum, pons, or medulla, pushing them through the foramen magnum and putting pressure on the medulla; the downward shear force and tissue distortion can create dysfunction of respiration, heart rate, blood pressure, and ends in coma.

Tonsillar herniation

______ herniation is caused by swelling in the cerebellum, pons, or medulla

Tonsillar herniation

____ is caused by the introduction into the nervous system of substances that inflame or poison nerve tissue.

Toxemia

Temporary disruptions of cerebral circulation - a "silent stroke". Often viewed as a warning sign to an actual stroke. Multiple occurrences indicate a high stroke risk.

Transient Ischemic Attack (TIAs)

Smooth muscle contractions may underlie these temporary disturbances--dizziness, numbness, slurring, etc.

Transient Ischemic Attacks (TIAs)

True/False: A speech-language pathologist may perform a brief exam, bedside, while the patient is in the Stroke Unit, but will perform a full examination 2 to 3 weeks after onset when the patient is medically stable and in the Rehab Unit

True

True/False: One of the most important modifiable risk factors for stroke is hypertension

True

____ biopsy may be ordered to identify inflammatory or degenerative disease affecting the arteries.

arterial

Patients with ____ _____ are particularly susceptible to cerebral embolism, because the absence of strong atrial contraction promotes pooling and clotting of blood in the left atrium, which then embolizes.

atrial fibrillation

Fever, chills, lethargy, drowsiness, stiff neck; onset is quick and progress is rapid

bacterial meningitis

The major bacterial infections are ____ ___ and ___ ___.

bacterial meningitis and brain abscess

About half of all berry aneurysms develop in the arteries at the ______ of the brain

base - the vertebral arteries, basilar artery, internal carotid arteries, and the circle of Willis

Patients with very mild impairments during the first few days after an ischemic stroke do not ________ much from neurologic recovery because they have little to recover.

benefit

Aneurysms are sometimes called

berry aneurysms or saccular aneurysms

Faster-growing tumors produced more quickly than slower-growing ones, because the brain adapts to slowly developing masses _______ than quickly developing ones

better

_____ may be ordered to determine the nature of brain tumors, to identify the nature of an infection (as in brain abscess) or to diagnose degenerative disease.

biopsies

The resulting microhematomas cause _____ ________ and put _________ on adjacent vessels, which then rupture, leading to a cascade of events in which the hemorrhage slowly grows as adjacent blood vessels are affected.

brain swelling, pressure

As an AVM grows it presses on and displaces _____ ______ causing headache, blurred vision, or other signs of cerebral dysfunction

brain tissue

Intracerebral hemorrhages destory ______ ______ next to white matter tracts, but they usually do not destroy the tracts themselves.

brain tissue

____ ____ is specifically for viewing the ____ arteries.

carotid

In echo arteriography, a detector picks up the reflected sound waves, and a computer analyzes the variations in the waves to create an image of the ___ ____.

carotid arteries

The _______ tonsils are extruded through the foramen magnum, where they exert pressure on the medulla.

cerebellar tonsils

The rate of blood flow can be determined using ___ ___.

cerebral angiography

The _____ ______ is the longest and narrowest of the passageways between the ventricles and, consequently, is the most susceptible to obstruction

cerebral aqueduct

One of the most common causes of nonobstructive hydrocephalus is _____ ______.

cerebral atrophy

AVMs can develop in many locations in the brian, brain stem, and spinal cord, but most large AVMs appear deep in the ___________ _____________

cerebral hemispheres

The occurrence of TIAs, RINDs, and PRINDs are manifestations of ____ disease that often presage a full-blown stroke.

cerebrovascular

Blood platelets and fibrin (a protein found in blood) then adhere to ulceration, accelerating _______ development.

clot

Tumor patients with elevated intracranial pressure almost always have _____ _____, are lethargic, and may be stuporous.

cognitive impairments

____ ____ is when axons in brain tissue near the infarct establish new connections with neurons that have lost direct connections with the infarcted area.

collateral sprouting

Irreversible ____ or ____ are common outcomes of Central Transtentorial Herniation.

coma or death

The resulting brain stem ischemia may lead to ______, and if the brain stem hemorrhages to irreversible ______ or _____.

coma; coma or death

Intracranial tumors, Hydrocephalus, Infections and toxins, and nutritional metabolic disorders can cause impaired _______.

communication

Extracerebral hemorrhages - above the dura - between the dura mater and the skull

epidural

If the bleeding is above the dura, between the dura mater and the skull, it is called an ___________ _______________.

epidural hemorrhage

On an x-ray, ___ density tissues appear as dark areas on the x-ray plate.

low

A _____ ____ is performed if the physician suspects infection or hemorrhage in the patient's central nervous system.

lumbar puncture

In ___ ____, a hypodermic needle is inserted into the subarachnoid space in the lumbar spine, below the level of the spinal cord, and a sample of CSF is take for analysis.

lumbar puncture

_____ is the space within the artery.

lumen

Insufficient blood volume is most commonly caused by ____ ____ elsewhere in the body or by insufficient cardiac pumping capacity (usually from heart disease).

massive bleeding

Surgery usually is considered only if the bleeding is _____ ___________.

life threatening

In arteries, the debris consists mainly of ___ and ________ ____________ that accumulate on the lining of the artery and narrow its diameter.

lipids (fatty substances) and atherosclerotic plaque (fibrous material)

____ brain lesions often cause focal disturbances in the EEG record in the vicinity of the lesion. The disturbance usually takes the form of aberrations in rhythm and amplitude.

localized

_____ symptoms commonly appear in the early stages of tumor growth, with increasing and more generalized dysfunction as tumor growth and swelling of brain tissue cause intracranial pressure to rise.

localized

Severe hypoglycemia & thyroid disorders are _____ disorders.

metabolic

MRIs cannot be used on people who have ___ in their bodies.

metal

The process by which a tumor appears at a secondary site in the body is called ___, and such tumors are called ____ tumors.

metastasis; metastatic tumors

Neoplasm (tumor) is notorious of colonizing.

metastatic carcinoma

Chronic hypertension leads to degenerative changes in the small penetrating arteries deep in the brain, weakening them and creating _____________.

microaneurysms

___ ____ may be ordered to determine whether muscle weakness I caused by neuropathy or by disease of the muscle itself.

muscle biopsy

____ are used for looking at spinal cord rather than vertebrae.

myelograms

____ are useful in diagnosing spinal cord or spinal nerve compression, structural abnormalities of the spine, & tumors or deformities of the spinal cord or spinal nerve roots.

myelograms

_____ are x-ray procedures in which a contrast medium is injected into the subarachnoid space around the spinal cord, after which one or more x-ray images of the spine are obtained.

myelograms

Most biopsies of nervous system tissue are ____ ___ in which a hollow needle is inserted into the tissue of interest and a small amount of tissue is removed by applying suction to the needle.

needle biopsies (aspiration biopsies)

In ____ ____, a nerve fiber either motor or sensory is stimulated at one point and the response is measured at another point along the fiber.

nerve conduction

___ ___ is performed when peripheral neuropathy is suspected.

nerve conduction

The time between the stimulation and the response is called the ____ ____ _____.

nerve conduction velocity

Biopsy of ___ ___ occasionally may be ordered to determine the underlying nature of peripheral neurologic disease.

nerve tissue

Destruction of brain tissue in one area is followed by reductions in cerebral metabolism in other areas, primarily those that have substantial ____ connections to the damaged area.

neuronal

Thiamin deficiency (alcoholism), vitamin deficiencies (B12 or nicotinic acid), vitamin excess (vitamin A) are ___ disorders.

nutritional

Rare in the U.S., _____ _____ sometimes caused central nervous system dysfunction and may occasionally generate cognitive-communicative impairments.

nutritional disorders

_____ vessels do not fill with contrast medium and consequently do not appear on the angiogram image.

occluded

Recovery from hemorrhagic stroke is..

slow in the first few weeks followed by a period of rapid recovery, then recovery slows and stabilizes

Symptom development in brain abscess is _____ than in bacterial meningitis, and brain abscesses tend to generate localized symptoms rather than the generalized symptoms of meningitis.

slower

Insidious conditions make their presence known _____ over a period of time, sometimes with intermittent periods of _______ or _______, until the patient receives treatment, becomes incapacitated, or dies.

slowly, stablization or remission

Determining whether the cause of a stroke is thrombosis or embolus is difficult, so a diagnostician may hedge by referring to ischemic strokes as _______ strokes.

thromboembolic strokes

The most frequent sources of emboli are fragments of ______ in the heart, followed by fragments of atherosclerotic plaque from an artery.

thromboses

Ischemic strokes may be caused by _____ or ______.

thrombosis or embolus

A subcategory of ischemic strokes that accounts for more than half of all strokes. Commonly associated with the development of atherosclerosis

thrombotic stroke

Possibly a life-long project, building this plug on site can cause a brain attack.

thrombus

If an AVM is identified before it ruptures, it may be surgically excised, or the blood vessels that connect to it may be _____ _____ or ________

tied off or plugged

Drug overdoses, drug interactions, bacterial toxins, or heavy metal poisoning are ____.

toxemia

Hemorrhages involving the dura mater usually are caused by ________ _____ ________ in which dural blood vessels are torn or lacerated.

traumatic head injuries

T/F: CT Scan exposes the patient to radiation.

true

T/F: CT Scan sees hemorrhages and not occlusions.

true

T/F: CT or MRI scanning of the spine provides a simpler and less invasive procedure for obtaining the information provided by myelograms.

true

T/F: MRI does not expose the patient to radiation like CT Scan AND provides a better, detailed image.

true

A thrombosis typically begins in an area of increased ______--locations at which arteries change direction or bifurcates.

turbulence

The risk of bleeding from AVMs is about ___ to ___ % per year

1 to 2%

Large tumors generate more ________ symptoms.

extreme

The swelling is one of the major causes of _____ symptoms in patients with cerebral tumors.

observable

What is the leading cause of long term disability?

stroke

An AVM is unlikely to reach the age of ___ or ___ without a hemorrhage

60 or 70

Blocking this long, narrow "waterway" can cause hydrocephalus.

Aqueduct of Sylvius

A ____ is a generic term for brain damage caused by vascular disruptions.

Stroke (Cerebrovascular accident)

Stroke is the ____ leading cause of death in the U.S., ranking behind heart disease and cancer, but is the leading cause of long-term disability.

3rd

The primary source of infection for a brain abscess are the nasal sinuses, middle ear, or mastoid cells in about ____% of cases.

40%

Approximately ___ survivors of stroke are alive in the U.S. in any given year.

5 million

Of those people who have had strokes in the past, what percentage have a recurrence within one year?

5-15%

Of those who survive a stroke, from ___% to ___% are able to return to their pre-stroke living environment, usually with some level of persisting impairment

50% to 75%

Each year about ___ U.S. residents experience a first stroke.

500k

______________ _______________ are collections of dilated, thin-walled veins connected to a tangled mass of fragile arteries

Arteriovenous malformations (AVMs)

Most patients, neurologic recovery is essentially complete by ___ months after onset.

6 months

The 5 most common symptoms of a stroke are abrupt..

1. Abrupt weakness or numbness on one side of the body 2. Abrupt impairment of vision, especially in one eye 3. Abrupt difficulty speaking or understanding speech 4. Abrupt episodes of dizziness or falls 5. Abrupt severe headache, especially with any of the other symptoms

The 4 primary sources for metastatic carcinoma of the brain are: (most common to least)

1. breast 2. lung 3. pharynx 4. larynx

The percentage of people with permanent neurologic deficits may reduce by treatments and lifestyle changes that do what 3 things?

1. control hypertension 2. lower blood cholesterol 3. eliminate smoking

The number of symptoms and the rate at which symptoms progress is determined by what 3 things?

1. size 2. rate of growth 3. location of tumor

About __ of patients report headaches early in the course of tumor development. Such headaches can take several forms.

1/3

About ___ of patients who have TIAs or RINDs will have a stroke that leaves them with permanent neurological deficits within ___ years of the transient ischemic event.

1/3; 5 years

Postoperative survival of Astrocytomas are usually __ years or more years is common.

10

___% are sufficiently impaired to require institutional care

15%

About ___ die as a consequence of a stroke each year

150k

Disruption of blood flow through the mesial distribution of the PCA may result in damage to this Brodmann's area.

17

Most neurologic recovery takes place in the first ___ to ___ weeks after stroke

2 to 4 weeks

The average survival after diagnosis of metastatic carcinoma is ___ months.

2 to 6 months

Experienced clinicians often refrain from making predictions about a patient's eventual level of recovery until these temporary effects have diminished usually within...

2 weeks to a month

___% of strokes are hemorrhagic.

20%

About ___ experience a second or third stroke.

200k

Primary intracranial tumors are most common in adults from ____ to ____ years old

25 to 50 years old

tPA must be administered within _____ of onset of clinical stroke symptoms - an ischemic stroke

3 hours

Most recovery of language takes place during the first ____ months after stroke.

3 months

If the occlusion lasts more than ___ to ___ minutes, death (necrosis) of brain tissue is likely.

3 to 5 minutes

The sources of infection for brain abscess are the lungs or cardiovascular tissue in about ____% of cases.

30%

The average postsurgical survival for Glioblastoma multiforme is only about __ to __ months.

6 to 9 months

In viral encephalitis from ____, symptoms develop slowly and continue to worsen, often ending in death.

AIDS (Acquired Immunodeficiency Syndrome)

Convoluted mass of blood vessels--both arteries and veins.

AVMs

_________ are pouches formed in weakened arterial walls.

Aneurysms

The most frequent site of obstruction is the _____ _______, which connects the third and fourth ventricles.

Aquaduct of Sylvius (cerebral aqueduct)

The patient becomes feverish, chilled, lethargic, and complains of headache, drowsiness, and stiff neck. If the infection is severe, the patient may progress into coma.

Bacterial meningitis

___ ____ is a bacterial infection in the pia, arachnoid, and CSF become infected with bacteria, causing inflammation, swelling, and fluid exudate from the meninges.

Bacterial meningitis

______ ________ in the artery causes the weakened section of the arterial wall to stretch, much like an inflating balloon.

Blood pressure

Caused by introduction of bacteria, fungus, or parasites into brain tissues from a primary infection site elsewhere in the body. Transmission may be through the blood or by migration through tissue.

Brain abscess

The herniation creates pressure on Cranial Nerve ___, causing ipsilateral pupillary dilation.

CN 3 (Oculomotor)

In ____, the scanner moves up or down the parts of the body being scanned in regular steps so that a series of images representing consecutive slices of that part of the body are obtained.

CT Scan (Computerized Axial Tomography)

____ is a computer-based radiographic procedure where patient is placed in the center of a circular arrangement of x-ray generators and detectors, which rotate axially around the patient.

CT Scan (Computerized Axial Tomography)

_____ ______ herniation is caused by swelling near the apex of the brain or in the frontal lobes

Central Transtentorial Herniation

Intracranial tumors: Swelling at the apex of the brain, or in the frontal lobes, pushes brain tissue against the tentorium and into the foramen magnum, compressing tissue and stretching blood vessels at the base of the brain and in the brain stem; brain stem ischemia is severe.

Central transtentorial herniation

_____ is an x-ray procedure that provides an image of the veins and arteries of the brain and brain stem.

Cerebral Angiography (Angiogram)

________ ______ are caused by rupture or leakage of cerebral blood vessels.

Cerebral hemorrhages

TIAs occasionally (but rarely) are caused by ______ ______ of a nearly occluded artery, in which the muscles of the arterial wall contract, narrowing the lumen and compromising blood flow.

Cerebral vasospasm

Major insidious conditions that affect the Central Nervous System

Intracranial tumors Hydrocephalus Infections and toxins Nutritional and metabloic disorders

An ____ ____ is when a cannula (hollow needle connected to a small flexible tube) is passed through the brain into a ventricle. Excess CSF is the forced by intraventricular pressure through the shunt, lowering the pressure in the ventricles. The tube may be passed into the neck or the abdominal cavity, where the excess fluid is allowed to drip away.

Intraventricular shunt

Strokes can be ______ or ______.

Ischemic or Hemorrhagic

_____ strokes occur when an artery is blocked and part of the brain loses its blood supply.

Ischemic stroke (occlusive stroke)

___ can show similar density but different composition, such as gray and white matter in the brain, which cannot be seen with CT.

MRI

___ detects: Multiple Infarct Disease, MS, degenerative brain diseases, AVM (Arteriovenous Malformations), aneurysms, hemorrhaging.

MRI

____ is based on the principle that the nuclei of hydrogen atoms behave like small bar magnets.

MRI (Magnetic Resonance Imaging)

Detection of brain tumors is most easily seen with this type of lab technique.

MRI (with or without contrast)

The location of this neoplasm would be identified more easily than others from symptom observation alone.

Meningioma

Gliomas - slow growing, mostly benign tumor, arising from the arachnoid tissue, symptoms indicate specific place of pressure. Prolonged survival is common.

Meningiomas

Relatively common tumors, and, as the name implies, arise from the arachnoid tissue covering the brain, the meninges.

Meningiomas

____ rarely reoccur and have a long-term survival rate after removal.

Meningiomas

_____ are among the most benign of all intracranial tumors because they are slow growing, well-defined, and do not usually invade the brain substance.

Meningiomas

____ ___ are common causes of central nervous system dysfunction, but rarely cause isolated communication disorders.

Metabolic disorders

Gliomas - secondary intracranial tumors. Cancer cells migrated from primary tumor site (breast, lungs, pharynx, larynx). Two to six month survival is common.

Metastatic carcinomas

____ ____ is a generic label for several conditions that cause ventricular enlargement but do not involve obstruction of interventricular passageways.

Nonobstructive (communicating) hydrocephalus

____ ____ can be due absorption issues such as previous meningitis or bleeding into the subarachnoid space or idiosyncratic.

Nonobstructive hydrocephalus

In ___ you introduce positron-emitting isotope that attaches to glucose and after it is metabolizes.

PET (Positron-Emission Tomography)

_____ looks at metabolic activity specifically.

PET (Positron-Emission Tomography)

_____ permits visualizations of hypofunction in damaged brain regions in which blood flow is not compromised but brain metabolism is altered, even though no structural damage may be visible on standard CT scans.

PET (Positron-Emission Tomography)

___ ____ ___ ___ ___ are interruptions of blood supply to the brain that last more than 24 hours but leave minor deficits after a few days.

PRINDs (Partially Reversible Ischemic Neurologic Deficits)

_____ intracranial tumors are most often affect the cerebrum and the cerebellum.

Primary

This neoplasm would be your "last choice" if the choice was yours to make.

Primary-Glioblastoma multiforme Secondary-

Non-obstructive hydrocephalus could be caused by which of the following?

Prior infection in the meninges Bleeding into the subarachnoid space Cerebral atrophy

___ estimates blood flow in the brain.

SPECT (Single-Photon Emission Computed Tomography)

____ is sensitive to blood flow like PET permitting visualization of regions with increased or diminished blood low and by inference regions of increase or diminished neuronal activity.

SPECT (Single-Photon Emission Computed Tomography)

____ is similar to PET in that radioactive tracer is injected into the body, scanner detects photons, and computer generates images.

SPECT (Single-Photon Emission Computed Tomography)

Also called a "silent stroke", this is a warning sign to an actual ischemic stroke. Multiple occurrences indicate a high stroke risk

TIA

_____ are temporary disruptions of cerebral circulation accompanied by rapidly developing sensory disturbance, limb weakness, slurred speech, visual anomalies, dizziness, confusion, mild aphasia, or other symptoms, which resolve completely within a few minutes to 24 hours.

TIAs (Transient Ischemic Attacks)

What are the drawbacks of echo arteriography?

They cannot reliably differentiate between severe stenosis and complete occlusion and do not always show blood clots.

The primary symptoms of _____ ____ are paralysis of some of the eye muscles; clumsy, staggering gait; and mental confusion.

Wernicke's Encephalopathy

_____ _____ is caused by thiamine deficiency, and usually associated with alcoholism.

Wernicke's Encephalopathy

Nutritional disorders include:

Wernicke's encephalopathy, Vitamin deficiencies, Vitamin or mineral excess

The material in the embolus may be a blood clot that has broken loose from its original location such as...

a fragment of arterial lining, a piece of atherosclerotic plaque, tissue from a tumor, a clump of bacteria, or other solids that may move through the arteries.

The eventual level of recovery depends largely on the _____ of brain tissue destroyed and the _____ of the destruction.

amount, location

An ___ detected before it ruptures may be surgically repaired by clamping or tying off the artery that supplies it with blood.

aneursym

____ help look for occlusions, stenosis (narrowing), something in the brain that has displaced things such as a tumor, growth, etc. that is non-vascularized.

angiograms

Most of the remainder of aneurysms develop in the __________ and __________ cerebral arteries

anterior and middle

Subfalcine herniation does not generate focal neurologic symptoms unless the ________ _______ _______ is compressed, in which case the patient may complain of numbness and weakness in the contralateral leg

anterior cerebral artery

The standard treatment is ______ _____, which usually cures the infection.

antibiotic medication

A few _____ medications that are not toxic to the body may be to benefit. Otherwise, treatment of viral infections is palliative - directed toward maintaining the patient's vital functions, providing adequate nutrition, and regulating fluid balance to help the patient's _____ _____ rid the body of the virus.

antiviral; natural defenses

Hemorrhages in the basal ganglia, brain stem, or cerebellum rarely, if ever, directly cause ____.

aphasia

Anything that blocks the exit of CSF from the ventricles causes the pressure in the ventricles to rise. As the pressure rises the ventricles enlarge, the brain is _____ against the skull, and the patient becomes mentally dulled, lethargic, and hyporesponsive.

compressed

X-ray images of the spine may show?

congenital deformities, fractures, displacement of intervertebral disks, degenerative changes, or tumors involving the vertebrae and spinal cord.

Treatment of metabolic disorders usually involves ____ or ____ for the metabolic imbalance, and symptoms usually regress or resolve.

correcting or compensating

Ruptured aneurysms are ____ and carry substantial risk of _______ or _______ brain damage.

dangerous; death or irreversible

Neurons in undamaged parts of the brain that connect with destroyed neurons _______ because of the lost connections.

degenerate (transneural degeneration)

______ or _____ disruptions usually precede or accompany the communication impairment.

dementia or personality

CT Scan is sensitive to differences in ___ of tissues.

density

Biopsies are used for _____ of tumors or growths.

diagnosis

____ is a phenomenon in which brain function is disrupted in regions away from the site of injury but connected to it by neuronal pathways.

diaschisis

Within the first few hours after the stroke, neurons deprived of blood supply _____.

die

Patients with ischemic or hemorrhageic strokes recover at _______ rates.

different

Brain swelling, reduction in cerebral blood flow, neurotransmitter release, transneural degeneration, denervation hypersensitivity, and diaschisis, individually or in combination, create _____ _____ of brain functions, behavior, and mental status, which gradually resolves over time.

diffuse impairment

After a stroke, blood flow to both hemispheres ____.

diminishes

As time passes, cerebral swelling _________, cerebral blood flow to undamaged tissue is________, and neurotransmitters and neurotoxins are excreted or resorbed.

diminishes, restored

___ ____ provides an indirect measure of carotid artery abnormality by measuring the rate of blood flow through the artery.

doppler ultrasound

The brain is pushed against the tentorium and __________ into the foramen magnum

downward

The pressure also forces brain tissues _____ into the foramen magnum, compressing tissues and stretching blood vessels at the base of the brain and in the brain stem.

downward

Toxemia may be caused by:

drug overdoses, drug interactions, bacterial toxins, diphtheria, or heavy metal poisoning.

Vomiting sometimes occurs in the ____ stages of tumor growth, and seizures are common when a tumor is within the ____ itself.

early; brain

Nonobstructive hydrocephalus is not accompanied by _____ intracranial pressure.

elevated

The clot may eventually occlude the artery, or parts of the clot may break off and become ________ traveling through the vascular system, eventually occluding smaller vessels downstream from the original clot, causing a stroke.

emboli

Most TIAs are thought to be caused by small ____ that temporarily occlude an artery, but then _____.

emboli; break-up or dissolve

Caused by a clot or group of clots that break off from one area of the body and travel to the cerebral arteries via the carotid artery or Vetebrobasilar system.

embolic stroke

One of their effects is to affect brain tissue by compressing brain tissue.

extracerebral hematomas

Hemorrhages from the blood vessels in the meninges or on the surface of the brain are called ______ ______ because the bleeding is outside the brain.

extracerebral hemorrhages

____ exploits the response of blood hemoglobin to the magnetic field used in MRI studies.

fMRI (Functional Magnetic Resonance Imaging)

____ largely dominates functional brain imaging because of its low invasiveness, absence of radiation exposure, and relatively low cost.

fMRI (Functional Magnetic Resonance Imaging)

____, similar to PET and SPECT, produces images that infer neural activity in brain regions; however, unlike these it does not need a tracer.

fMRI (Functional Magnetic Resonance Imaging)

T/F: Echo arteriography requires a contrast medium.

false

T/F: Echo arteriography requires radiation.

false

There are very ____ long-term effects from a intraventricular shunt.

few

Pressuring the brain through this large opening an threaten life itself.

foramen magnum

X-ray images of the skull may show?

fractures, abnormal deposits, or calcification of structures inside the skull.

Two major sources of central nervous system viral infections are _______ infections such as mumps or measles, and viruses by _______ or ________ ______, such as equine encephalitis or rabies.

general infections; insects or animal bites

Although hypoperfusion causes cerebral ischemia, it is not a stroke, and unlike ischemic strokes, its effects have a ________ onset.

gradual onset

Recovery from occlusive stroke is..

greatest in the first 2 weeks and diminishes over time until the condition stabilizes

After the bleeding stops, patients are left with a subarachnoid, subdural, or epidural ______________

hematoma

The increased blood flow within neutrally active brain tissue increases the concentration of oxygen-rich ____ in the tissue.

hemoglobin

A burst blood vessel in the brain with bleeding into the brain, brain stem, brain tissue, meninges, or surface of the brain

hemorrhagic stroke

A burst blood vessel in the brain with bleeding into the brain; accounts for 15% of all strokes

hemorrhagic stroke

An accumulation of clotted or partially clotted blood in the space created by the hemorrhage.

hemotoma

When cerebral swelling is severe ___ may occur.

herniation

Almost all intracerebral hemorrhages (about 90%) occur in patients who have

high blood pressure (hypertension)

Surviving neurons that have lost some (but not all) of their input from neurons in the damaged region become _____ to residual input from the damaged region

hypersensitive (denervation hypersensitivity)

Almost all intracerebral hemorrhages (about 90%) occur in patients who have _____.

hypertension

The most important modifiable risk factor for stroke is ____.

hypertension

Insufficient blood supply to the brain secondary to low blood volume

hypoperfusion

Insufficient blood supply to the brain sometimes is caused by ____________.

hypoperfusion

With _____, the brain's blood supply is compromised not by occlusion of arteries but by insufficient blood volume.

hypoperfusion

____ is a medical term for death of brain tissue caused by loss of blood supply.

infarct

Intraventricular shunts are very susceptible to ____.

infection

This *dense band of fibers* is supplied by small penetrating arteries--contralateral limbs would become spastic if it was damaged.

internal capsule

Hemorrhage in the brain or brain stem

intracerebral

Aphasias caused by hemorrhagic stroke are almost always caused by ____ _____.

intracerebral hemorrhages

Hemorrhages into the brain or brain stem are called _____ ______ because the bleeding is in the brain tissues.

intracerebral hemorrhages

If the damage area is large, swelling may raise ____ ____ and cause displacement of brain tissue in regions remote from the site of the stroke.

intracranial pressure

The primary medical treatment for obstructive hydrocephalus is an ____ ____.

intraventricular shunt

Accounts for 80% of all strokes, and is the result of inadequate blood flow to the brain

ischemic stroke

Inadequate blood flow to the brain - could be thrombotic or embolic

ischemic stroke

Subarachnoid hemorrhages usually come from _______ or _________ blood vessels on the surface of the brain, brain stem, or cerebellum - often the result of aneurysm.

leaking or ruptured blood vessels

____ ____ is symptom management.

palliative care

The ______ of recovery depends largely on whether the stroke is ischemic or hemorrhagic (type).

pattern

In electromyography, spontaneous discharges in resting muscles (fibrillations, fasciculations) may predict ____ nerve disease.

peripheral

Inside or outside of this membrane is the defining difference--extracerebral or intracerebral.

pia mater

________ forms on these roughened areas and thickens over the course of years, until it may fill the lumen (space within the artery), causing a stroke.

plaque

Very few develop in the ___________ cerebral artery.

posterior

In a lumbar puncture, increased ____ may suggest blockage in the circulation of CSF, the presence of space-occupying pathology (tumor or abscess) or swelling of the brain tissue.

pressure

Some primary intracranial tumors appear to be related to ________ _________, and there is a tendency for some kinds of intracranial tumors to occur in ____.

previous injuries, families

Tumors affecting brain tissues may be either ______ or _____.

primary or secondary

Thrombotic and embolic strokes differ in their ______.

progression

Bacterial meningitis progresses _____ and can be _____ if not promptly treated.

quickly; fatal

Patients with hemorrhagic strokes often show little improvement for the first few weeks after the stroke, followed by a period of relatively ______ recovery.

rapid

Medical management usually includes

reducing blood pressure, maintaining adequate respiration, and regulating fluid intake

The CNS is generally ____ to infection.

resistant

On a CT scan, brain abscess have a ____ around it.

ring

Turbulence and increased blood velocity at the narrowing abrade and ________ the lining of the artery.

roughen

Microaneurysms may _______ and _____ blood into the brain.

rupture and leak

A ____ aneurysm often is impossible to repair.

ruptured

The general public, many physicians, and some neurologists forgo these categorizations and call any transient episode of sensory disruption, weakness, slurred speech, visual anomalies, dizziness, confusion, or aphasia caused by temporary interruption of blood supply to the brain a ___ ____.

small stroke

Myelograms provide an in-direct visualization of the spinal ___ and ____.

spinal nerves and spinal cord

_____ is when blood vessels that are narrowed but not occluded making the blood fill slowly.

stenosis

_____ is the most common cause of aphasia in adults.

stroke

Extracerebral hemorrhages - under the arachnoid - between the arachnoid and the pia mater

subarachnoid

Myelograms permit direct visualization of the ____ space surrounding the spinal cord.

subarachnoid

The most common type of extracerebral hemorrhage is

subarachnoid

If the bleeding is under the arachnoid, between the arachnoid and the pia mater, it is called a _____________ __________________ - the most common extracerebral hemorrhage.

subarachnoid hemorrhage

Ruptured arteries of the pia bleed into this space.

subarachnoid space

Extracerebral hemorrhages - under the dura mater

subdural

If the bleeding is under the dura mater, it is called a _____________ ________________.

subdural hemorrhage

In the first few hours and days after the patient's stroke, the symptoms generated by this diffuse impairment are ___________ on the more focal symptoms caused by death of tissue at the site of the stroke.

superimposed

The usual treatment for brain abscess is ____ ____ of the abscess in combination with ____ ____.

surgical drainage; antibiotic medication

Obstructive hydrocephalus are sometimes caused by material circulating in the CSF, but more often are caused by ________ of nearby brain tissue.

swelling

The tissue around the tumor ____.

swells

Within the first few hours after the stroke, damaged brain tissue ______.

swells

If the tumor is located in a "silent" area of the brain, it may grow to surprising size before generating __________

symptoms

The mesial surface of the temporal lobe is squeezed against the ______, the rigid sheet of dura that separates the space occupied by the brain from the space occupied by the cerebellum

tentorium

The most common sites for intracerebral hemorrhages are the _________ and ______ _______, but the brain stem and the cerebellum also are potential sites for these hemorrhages.

thalamus and basal ganglia

Most cerebral thromboses occur in the large arteries carrying blood to the brain such as the _____ ____, _____, and the _____ artery.

the internal carotid arteries, the vertebral arteries, and the basilar artery.

In nerve conduction, variations in _____ sometimes are helpful in diagnosing the nature and extent of peripheral nerve damage.

velocities

Rabies virus, Herpes simplex, poliovirus, measles virus, mosquito or tick-borne viruses are ____ ___.

viral encephalitis

In ____ ____, symptoms develop quickly, followed by gradual improvement

viral meningitis

Tissues and blood vessels at the base of the brain and in the midbrain are compressed, stretched, and distorted, leading to impairment of ______ __________

vital functions

In addition to Wernicke's Encephalopathy, vitamin deficiencies include:

vitamin B12 and nicotinic acid

Cerebral hemorrhages may be the result of

weakness of a vessel wall, traumatic injury to a vessel, or (rarely) extreme fluctuations in blood pressure.

______ are passed through body tissues onto a sheet of photographic film to create a negative image of internal body structures.

x-rays