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Notes: Nervous System DisordersVascular DisordersIntroduction: ________________________________ or ____________________________ in originSpecific area of ischemia = local damage & manifestationHemorrhagic = increased __________________________ pressureGlobal ischemia = impaired ______________________ of entire brain – cerebral edema – loss of functionTransient Ischemic Attack (TIA)Occur singly or in a seriesTemporary & localized reduction of _________________________________Warning sign of impending stroke – does ______________ precede all strokesRecovery within 24 hoursPathophysiologyPartial occlusion of artery due to:____________________________________________________________________________________________________________________________________________________________________________Signs & Symptoms: often difficult to diagnoseDepend on location of ____________________________Intermittent & short episodes of impaired functionExamples: Cerebrovascular Accidents (CVA) – aka. StrokeIntroduction:Infarction of brain tissue that results from lack of blood________________________________ of cerebral BV________________________________ of cerebral BVPathophysiology5 minutes of ischemia causes irreversible nerve cell damage.Central area of _____________________ develops, tissue liquefies leaving a cavityAll function lostSurrounded by an area of _________________________________. This zone will regain function following healing.Types of CVAsOcclusion of an artery by an _____________________________Often develop in large arteriesSudden obstruction by an _________________________ lodging in a cerebral arteryIntracerebral hemorrhage: most severe & destructiveCaused by rupture of a cerebral artery in patient with severe _____________________________________________Effects are evident in both plicated by _______________________ effects of bleeding 1st 48-72 hours:___________________________________ & ____________________ increase neurological deficitsTo limit permanent damage:Inflammation & pressure must be minimized rapidlyAdequate ________________________ must be regainedComplications common including:Recurrent ___________________________________________________ issues______________________________ issuesRisk factors include:Diabetes, hypertension, systemic lupus erythematosus, atherosclerosis, history of TIAs, increasing age, obstructive sleep apnea, heart disease, smoking, sedentary lifestyleCombination of oral contraceptives and cigarette smokingCongenital malformation of blood vesselsIncreasing ageSigns and symptomsDepend on the _______________________________ of obstructionSize of artery involvedPresence of _________________________________ circulation may diminish size of affected areaLack of voluntary movement or sensation on _________________________ side of the body.Initially ________________________________ paralysis__________________________________ paralysis develops weeks laterTreatmentClot-busting agentsSurgical interventionGlucocorticoidsSupportive treatmentOccupational and physical therapists; speech-language pathologistsTreat underlying problem to prevent recurrences.Rehabilitation begins immediately.AneurysmIntroductionLocalized weakness & ____________________ in an arteryFrequently multiple.Usually at the points of ______________________ (branching points) on the circle of _________________Known as __________________ aneurysmsPathophysiologyRupture can result from sudden increase in ____________ due to exertion or hypertension Bleeding into ___________________________ spaceEnlarging aneurysm increases pressure on __________________ or cranial nervesLoss of visual fieldsVisual disturbancesIncreasing __________________________ on BV wall & meningesLeads to headacheSmall, slow bleedHeadache______________________________Intermittent dysfunction, slurred speech, weakness________________ rigidity - Stiff extended neck – blood irritates spinal nerves causing muscle contractions in neckMassive tear leads to subarachnoid hemorrhageImmediate severe headacheVomitingPhotophobiaSeizures & loss of consciousnessSudden fatal increase in ___________ and deathTreatmentCT scan, MRI, Angiogram can locate aneurysmSmall unruptured asymptomatic aneurysms may be monitored with imaging scansIf diagnosed BEFORE rupture:______________________________________________________________________________________________________________________________Initial rupture = _______ mortality2nd rupture = additional _____ mortalityAnswer the Think About 14-10 questions pg 350 a-f. Use chapter 25 to help with letter f. Make charts where applicable & have ready on the due date.End of Quiz #1 InformationBrain Injuries – pages 355-359Make flashcards for the following types of head injuriesConcussion, contusion, closed head injury, open head injury, linear fracture, comminuted fracture, compound fracture, depressed fracture, basilar fracture, contrecoup injuryEtiologyContact sports injuries (incl. multiple concussions)Car/motorcycle accidentsFallsShaken baby syndromeAlcohol (along with other systemic factors) can mask signs of injury, delay onset of cerebral edema and increased ICP but create a greater onset at later time.PathophysiologyPrimaryDirect injuries: laceration, compression, rupture or compression of cerebral BV, rotational or shear forcesCell damage & bleeding inflammationincreased ICPischemiadysfunctionsCentral area is necrotic & will be replaced with scar tissue or cystSurrounding area of inflammation may recoverSecondaryAdditional injurious factors:Cerebral edema, hemorrhage, hematoma, cerebral vasospasm, infection, ischemiaHematoma: collection of blood in the tissue Types (make flashcards including location, cause, & signs of): Epidural, subdural, subarachnoid, intracerebralAcute vs. subacuteSigns & symptoms: know your termsFocal signs based on locationSigns of increased ICP (later in notes)SeizuresCranial nerve impairmentOtorrhea or rhinorrheaOtorrhagiaFeverStress ulcersImmobility complicationsTreatmentCT & MRI – determine extent of injuryGlucocorticoids – decrease edemaAntibiotics – reduce infectionSurgery – reduce ICPBlood products & oxygenComplete Case Study C by using info on pages 342-344.Spinal cord injuries: Results fromVertebral fracture or dislocation injury of spinal cord, intervertebral disc or supporting ligamentsEtiologyCar accidents & sport injuriesIncreased Intracranial PressureSkull contains: brain tissue, blood & CSF.Normal volume = normal pressure = relatively constantTemporary fluctuations occur with activitiesFluids are NOT compressible so fluid = pressure = arterial blood flow = space for brain tissue (which gets compressed & eventually dies due to ischemia)ICP monitored indirectly/externally through radiology & vital signs or directly through instruments placed into ventricles.See Table 14.7 on page 342Body & Brain respond to ischemia in opposing mechanisms eventually causing:Pulse pressure – difference between systolic & diastolic pressureBP dropAbnormal respiratory patterns: Cheyne-StokesPtosisIpsilateral pupil becomes fixed & dilated then both pupils (“blown”)NystagmusElevated CSF pressure with composition/color changeBrain herniation & deathComplete Case Study B by using info on pages 359 – 364 and chapter 25End of Quiz #2 InformationAlzheimer’s DiseaseCharacterized with:neurofibrillary tangles and beta-amyloid protein plaques# and distribution are significant factorsCortical atrophy, dilated ventricles & widening of sulciDeficit of neurotransmitter AChEtiologyUnknown: genetic, viral, metabolic, exposure to toxins4 defective genes (on chromosomes 1,4,19, 21) associated with early onset AD as an autosomal dominant trait.Signs & SymptomsOnset – insidious over 10-20 yearsEarly stage:As disease progresses:Late stage:TreatmentMedications show some temporary improvementProvide for safe environment: daily routine & secure environment is importantTreat physical/emotional symptoms as neededClinical trials continue focusing on plaque developmentMay Complete Case Study E by using info on pages 376-377 and turn in for HWEC any day before taking the Test. ................
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