Term
Protection of the brain
Skull |
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Definition
- Protection of the brain (with meninges, CSF and BBB)
- Sutures (baby skull is rubbery, sutures haven't formed)
- Foramina: canals for nerves and blood vessels to pass |
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Term
Protection of the brain
Meninges (three tissue membranes) |
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Definition
- Dura Matter (tough mother) - Superficial, double-layered
- Subdural space (space between dura matter)
- Arachnoid (spider web)
- Subarachnoid space (CFS, beneath arachnoid)
- Arachnoid villi: CFS absorbed in venous blood
- Pia Matter (soft mother): fine capillaries, not much protection - Deep |
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Term
Protection of the brain
Cerebral Spinal Fluid |
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Definition
- Equal production/reabsorption (for constant pressure within the skull)
- Sticky, clear liquid
- Sub arachnoid space (where it circulates)
- 1/2 cup surrounding brain and spinal cord
- cushion |
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Term
Protection of the brain
Blood-Brain Barrier |
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Definition
- BBB
- Impermeable capillaries
- Controls passage, and balance in electrolytes, glucose & proteins
- poorly developed in neonates
- Drug has to be able to get through BBB
- lipid-soluble substances pass (alcohol)
- Astrocytes regulate what goes in |
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Term
| Subdivisions of the brain |
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Definition
- Most folded brain out of all mammals
- Forebrain
- Cerebrum
- Basal nuclei
- Cerebral cortex (only in mammals)
- Diencephalon
- Hypothalamus
- Thalamus
- Cerebellum |
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Term
Functional areas
Cerebral Hemispheres |
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Definition
- each controls voluntary movement/sensory function of the opposite (contralateral) side of the body
- motorcortex (upper motorneurons) form corticospinal tracts of spinal cord
- LH: usually dominant, language, logic, math, problem solving
- RH: creativity, emotion, spatial relationships |
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Term
Functional areas
Cerebral hemispheres (cont.) |
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Definition
- basal nuclei
- located deep within the hemispheres
- part of the extrapyramidal system (controls and coordinates skeletal muscle activity, initiate involuntary actions)
- limbic system (LS)
- just superior to the brain stem
- regulates emotion, feelings
- any cognitive devision must be accompanied by LS |
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Term
Functional areas
Cerebellum |
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Definition
- coordinate movement; balance and equilibrium
- responds to input from pyramidal system, proprioceptors in joints and muscles, vision, vestibular system from inner ear |
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Term
Functional areas
Diencephalon |
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Definition
- central portion of the brain
- thalamus:
- relay station for incoming sensory impulses
- hypothalamus:
- critical for body homeostasis, autonomic and endocrine function, role in regulating body temp, food/water intake, stress response, libido (biologic behaviour) |
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Term
Functional areas
Brainstem |
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Definition
- inferior portion of brain
- connecting link to the spinal cord
- pons (afferent/efferent fibers, several cranial nerves)
- medulla oblongata (vital regulation of resp/cardiac function, as well as cough reflex, swallowing, vomiting) - life support function
- RAS throughout brainstem; arousal (sleep/wake cycle, coma) |
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Term
| Blood supply to the brain |
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Definition
- brain supplied by internal carotid arteries (branches of carotid artery) and vertebral arteries
- at base of brain, carotid artery divides to anterior and middle cerebral artery
- anterior cerebral artery supplies frontal lobe
- middle cerebral artery supplies temporal/parietal lobes
- posteriorly, vertebral arteries join to form basilar artery; supplies brainstem, cerebellum |
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Term
| Blood supply to the brain (cont.) |
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Definition
- branches at base of brain, basilar artery divides to form left/right posterior cerebral arteries; supply to occipital love
- anastamoses provided by anterior communicating artery and posterior communicating arteries (circle of Willis)
- Willis: regulates pressure, safety net (important in case of blockage), pit gland & optic chiasm @ the middle |
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Term
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Definition
- 12 pairs
- originate from the brainstem to serve structures of head and neck, some viscera (ex: vagus)
- pass through foramina
- may have motor fibres, sensory fibres or both |
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Term
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Definition
- protected by bony vertebral column, meninges, CSF
- continuous with medulla oblongata and ends at first lumbar vertebra
- consists of tracts (white matter) surrounding grey matter core (cross in medulla)
- Cauda equina (nerves) are in the lumbar part, so little damage to spinal cord by putting a needle @ L3 or L4 to get CSF sample |
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Term
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Definition
- 31 pairs, motor and sensory fibres to and from organs and tissues of body
- named according to vertebral column where they emerge (ex: C1 to C8)
- each nerve has two roots
- anterior root is efferent (motor)
- posterior root consists of afferent (sensory) fibres from dorsal root ganglia (sensory fibres from peripheral receptors that have already synapsed) |
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Term
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Definition
- area of sensory innervation of the skin by a specific spinal nerve
- can be drawn on a map |
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Term
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Definition
- au automatic, rapid, involuntary response to a stimulus
- can be simple; ex: a sensory receptor, synapse in spinal cord, efferent impulse to elicit a response (hand on stove)
- at same time, message sent to brain for further assessment
- can be acquired (learned); ex: riding a bike
- great utility in diagnosis (show location of spinal cord damage, find neuro problem) |
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Term
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Definition
- specialized, post-mitotic cells that conduct impulses throughout CNS and PNS
- have dendrites (receptor site) and axons (conducts away from cell body) toward an effector site or connecting neuron, where it releases neurotransmitters
- many fibres are myelinated, by Schwann cells (regenerate) (PNS) or ogliodendrocytes (do not regenerate) (CNS) |
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Term
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Definition
- nerve cells are generally post-mitotic
- if the cell body is damaged, it dies, no cell division
- PNS neurons can regenerate
- CNS neurons?
- debatable whether we can or can't: some success in mice, but don't wire up properly, neuron controlling big toe might control something else |
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Term
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Definition
- ionic flow creates electrical current for nerve impulses
- if depolarization sufficient, threshold reached and action potential is generated
- conduction velocity specific to fibre type (larger = faster)
- conduction velocity altered by myelination (only at nodes of Ranvier, saltatory conduction) |
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Term
| Synapses and chemical neurotransmitters |
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Definition
- generally involves the release of neurotransmitter from vesicles in presynaptic bud
- may stimulate or inhibit the conduction of an impulse
- neurotransmitter interacts with receptor on post synaptic neuron |
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Term
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Definition
- Fight or Flight reaction
- Primary subdivisions (in balance for homeostasis)
- sympathetic
- parasympathetic |
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Term
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Definition
- Autonomic pathways
- 2 autonomic nerves (two neurones) which connect in a ganglion (integrating centre)
- pre-ganglionic fiber in brain or spinal cord
- post-ganglionic fiber in organ or tissue |
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Term
| Neurotransmitters of the ANS |
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Definition
- Acetylcholine
- all preganglionics
- parasympathetic postganglionics (sweat glands and blood vessels in skeletal muscle)
- Noradrenaline (adrenaline)
- sympathetic postganglionics
- Specific drugs can affects specific organs (targets) |
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Term
| Sympathetic nervous system (SNS) |
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Definition
- increases activity of the body, including cardiovascular, respiratory and neurologic functions
- regulates the stress response, in conjunction with the adrenal medulla (increase secretions)
- fight or flight |
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Term
| Parasympathetic nervous system (PNS) |
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Definition
- dominates digestive system and recovery from sympathetic activity
- arise from (pre-ganglionic fibres) both cranial (brain stem level) and spinal nerves |
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Term
| General effects of neurologic dysfunction |
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Definition
- diverse types of injury to the same part of the CNS
- effects of increased pressure (CSF) tend to be similar regardless of the cause of the increase in pressure (tumours, bleeding, infection)
- expect the unexpected - we are a long way from understanding the brain |
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Term
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Definition
- relate to a specific area of the brain or spinal cord with lesion and the specific function of that region
- loss of vision associated with occipital love damage
- speech problems with damage to Broca's region
- additional functional loss can increase as lesion expands
- radiates as tumour grows
- somatic cortex = lose sensation
- motor cortex = lose function of that region |
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Term
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Definition
- in cerebral hemispheres, above tentorium cerebelli
- lesions lead to discrete loss of a special function |
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Term
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Definition
- located in the brain stem, below the tentorium cerebelli
- even a small lesion can result in widespread impairment, including CV and CR |
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Term
| Left and right hemispheres |
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Definition
- in addition to local effects, other functional deficits can indicate side of lesion
- most people, LHS lesion leads to a loss in logic, analytical skills, communication (ex: long division) - easier to quantify
- RHS lesion leads to loss of appreciation of music/art and behavioural problems - harder to quantify |
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Term
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Definition
- we are normally totally aware of incoming stimuli, oriented with respect to place, people, time, content
- we respond quickly and appropriately to questions, events, commands (pinch skin, you pull away)
- changes in this "LOC" and early change/warning sign associated with acute neurological damage (stroke signs)
- 15 levels (Glasgow coma scale) |
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Term
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Definition
- weakness in an arm, hand or leg (numb or lose control)
- numbness on one side of the body
- sudden dimness or loss of vision, particularly in one eye (like passing out)
- sudden difficulty speaking
- inability to understand what someone is saying (cognition loss)
- dizziness or loss of balance
- sudden, excruciating headache (blood vessel compromised) |
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Term
Motor dysfunction
damage to motor cortex |
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Definition
- interferes with voluntary movements in contralateral side
- can cause hyperreflexia as a result of intact reflexes without moderating influences of motor cortex (inhibits relaxation) - message doesn't get to brain for further assessment of the reflex signal
- affects different side of the body |
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Term
Motor dysfunction
damage to motor neurons in the anterior horn of the spinal cord |
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Definition
- leads to weakness or paralysis, ipsilateral to damage, at or below the level of the lesion
- affects same side of the body
- muscles go limb, no tone |
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Term
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Definition
- somatosensory cortex is topographically mapped; specific loss of function associated with specific sites
- loss in touch, pain or temperature sensation, as well as vision, hearing, taste and smell
- spinal/cranial nerve damage can also lead to predictable deficits |
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Term
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Definition
- unique anatomy of visual pathways means that loss of visual field is dependent on site of damage within pathway
- damage of optic nerve leads to loss of vision in one eye (right nerve = right eye damage)
- damage to optic chiasm leads to blindness
- damage to optic tract leads to visual field deficit
- right optic tract = loss of left visual field (both eyes) |
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Term
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Definition
- Aphasia
- an inability to comprehend or express language
- dysphagia: partial impairment
- Dysarthria: motor dysfunction, machinery problems |
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Term
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Definition
- expressive or motor aphasia results in a loss in ability to write, speak (broca's area damage)
- receptive or sensory aphasia results in an inability to read, understand spoken language (not due to visual/hearing loss) (wernicke's area damage)
- global aphasia - combination of the two above |
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Term
| Broca and Wernicke area damage |
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Definition
- Broca: moving lips, tongue, hard to get speech out, can understand everything.
- you know what you want to say but can't get it out
- machinery still intact
- left frontal lobe (non-fluent)
- Wernicke: understanding speech, machinery still works
- left temporal lobe (fluent) |
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Term
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Definition
- usually caused by excessive discharge of anatomical pockets of neurons. may be precipitated by:
- hypoxia
- bleeding in the brain
- inflammation
- specific sensory stimulus |
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Term
| Increased intracranial pressure (ICP) |
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Definition
- skull is a rigid, non-expandable enclosure, containing tissue, blood, CSF
- increase in the volume of any of these fluids results in increased ICP
- early signs; decreasing LOC, severe headache, vomiting, papilledema (nerves leave retina, bulge out)
- too much CFS in ventricles: (baby large head) needs to be fixed fast |
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Term
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Definition
- herniation of cingulate gyrus
- not that dangerous, under falx cerebri (fold of dura matter)
- cerebral herniation
- bad problem
- downward displacement of brainstem through tentorial notch |
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Term
| Increased ICP - vital signs |
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Definition
- cerebral ischemia (kills neurons without O2)
- cushing's reflex (attempt to maintain blood supply to the brain) - sends blood to brain so neurone don't die
- systemic vasoconstriction leads to increased BP
- baroreceptor response to increased BP is to slow heart
- as circulation to brain improves, relieves ischemia, vasoconstriction relaxed (stops the reflex)
- but then ICP starts to increase again |
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Term
| Increased ICP - visual signs |
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Definition
- in addition to vital signs, significant changes in the eyes
- pressure on oculomotor nerve (III) affects the size and response of the pupils
- generally, ipsilateral pupil becomes fixed and dilated |
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Term
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Definition
- result of uncontrolled cell division
- occupy space, create pressure on adjacent brain tissue, causing local and general dysfunction
- normally (not always) derived from glial cells (astrocytomas, most common)
- normally surrounded by area of inflammation |
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Term
Pathophysiology
Benign tumors |
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Definition
- normally well defined borders which make surgical removal easier if superficial
- can still be life-threatening |
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Term
Pathology
Malignant tumors |
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Definition
- rarely metastasize outside the brain but multiples in CNS
- borders much harder to define with projections into local tissue thus difficult to totally remove |
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Term
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Definition
- second tumors common (from breast, lung)
- contrast between effects of
- brain stem: small tumours profound effects
- cerebral hemispheres: sometimes large tumours, undetected |
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Term
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Definition
- specific site determines nature of neurological deficit
- increased ICP leads to usual symptoms (headaches, vomiting, personality/behavioral changes)
- other - (seizures, facial paralysis, visual problems) depend on site/size of tumor |
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Term
|
Definition
- surgical removal (if accessible)
- chemotherapy
- radiation
- complications of damage to important regions of CNS
- hard to find a drug that does through BBB |
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Term
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Definition
- lack of adequate CNS perfusion due to vascular malfunction
- infarction of brain tissue
- 5 minutes of ischemia causes irreversible cell damage
- necrotic core and apoptotic penumbra |
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Term
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Definition
- 80% of strokes
- blood clot stops the flow of blood to an area of the brain |
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Term
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Definition
- 20% of strokes
- blood leaks into brain tissue (rupture of cerebral artery
- intracerebral
- subarachnoid
- aneurysms |
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Term
| Transient Ischemic attacks (TIA) |
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Definition
- temporary localized reduction of blood flow in the brain
- can be a warning sign for CVA |
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Term
| Dynamic changes after stroke |
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Definition
- 20% die within first few days
- complete recovery very rare |
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Term
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Definition
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Term
|
Definition
- Avoid the occurrence
- risk factors: hypertension, genetics, obesity, diabetes, high cholesterol, age,...
- stop the bleed
- surgical (or relieve carotid artery obstruction) |
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Term
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Definition
- unblock the vessel (not if it's hemorrhage)
- early "clot busters"
- Rescue the penumbra
- glutamate antagonists - ineffective
- hypothermia
- Rehabilitation |
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Term
Brain infections
Meningitis |
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Definition
- a bacterial infection of meninges
- more common in children, elderly
- severe headache, back pain, nuchal rigidity
- vomiting, irritability
- treated by aggressive antimicrobial therapy and antiinflammatories |
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Term
Brain infections
Brain abscess |
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Definition
- localized infection of the CNS
- usually infiltration of bacteria from periphery
- surgical drainage and antimicrobial therapy
- High (10%) morality |
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Term
Brain infections
Encephalitis |
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Definition
- infection of parenchyma (connective tissue) of brain or spinal cord
- usually viral origin
- ex: western equine encephalitis, st. louis encephalitis, west nile virus, lyme disease |
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Term
Brain infections
Other infections |
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Definition
- rabies
- virus transmitted by bite from rabid animal
- travels along peripheral nerves to CNS
- causes inflammation, necrosis
- tetanus (cause by clostridium tetani)
- poliomyelitis (causes paralysis and resp failures) |
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Term
Infection-related syndromes
Reye's syndrome |
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Definition
- in young children, viral infection associated influenza treated with ASA (aspirin)
- cerebral edema leading to ICP
- affects brain and liver |
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Term
Infection-related syndromes
Guillain-Barre syndrome |
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Definition
- autoimmune response associated with a viral infection
- inflammatory condition of PNS |
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Term
Infection-related syndromes
Shingles (herpes zoster) |
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Definition
- Chicken-pox virus remains dormant in dorsal root ganglion and re-emerges to affect a dermatome (or a cranial nerve)
- affects one side of the body usually
- causes a lesion |
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Term
|
Definition
- skull fractures, hemorrhage and edema, or direct injury to brain tissue
- full range of degree of damage
- bone fragments from skull can cause severe damage
- inability of skull to expand problem for pressure releif |
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Term
Types of head injury
Concussion |
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Definition
- reversible dysfunction from blow
- usually full recovery in 24 hrs |
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Term
Types of head injury
Contusion |
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Definition
- blunt blow to head bruising of brain tissue
- possibility of residual damage to force of the blow |
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Term
Types of head injury
Fractures |
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Definition
|
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Term
| Closed vs Open head injuries |
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Definition
- closed: skull is not fractures but brain tissue is injured and blood vessels may be ruptured
- open: fractures or penetration of the brain by missiles or sharp objects |
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Term
Pathophysiology
Primary brain injury |
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Definition
- direct effect of the insult
- killing or disconnecting neurons
- damaging glial cells
- damaging blood vessels |
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Term
Pathophysiology
Secondary brain injury |
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Definition
- consequences of the primary insult
- cerebral edema
- hemorrhage
- vasospasm
- infection
- ischemia |
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Term
|
Definition
- majority of accidents in young adults
- automobile, motorcycle, diving accidents
- alcohol frequently contributing factor
- falls frequent cause (elderly)
- boxers, other contact sports
- infants (violent shaking) |
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Term
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Definition
- fracture or dislocation of vertebra which compresses, stretches, or tears the spinal cord
- most common in spinal regions that are most flexible
- C1-C7 or T12-L2 |
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Term
| Types of spinal cord injuries |
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Definition
- Hyperflexion: head forward, anterior dislocation, distortion of cord, torn posterior longitudinal ligament
- Hyperextension: head back, torn anterior longitudinal ligament, compression of cord
- Compression: falling on your bum; compression fracture of L1 |
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Term
Pathophysiology
Spinal cord injury |
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Definition
- laceration usually results in permanent damage
- complete transection/crush injury results in loss function at and below the level of injury
- C3-C5 injury often affects phrenic nerve (resp)
- spinal shock initially, recovery of reflexes over time, potentially function of intact tracts |
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Term
Etiology
Spinal cord injury |
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Definition
- young men (cars, motorcycles)
- sport injuries
- elderly |
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Term
Signs and symptoms
Spinal cord injury |
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Definition
- early spinal shock with increasing impairment
- no function at or below level of injury
- includes motor, sensory and autonomic function
- later recovery from spnall shock
- gradual recovery of reflexes (hypereflexia)
- extent of permanent damage revealed |
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Term
| Effects of spinal cord damage |
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Definition
- During spinal shock
- all functions normal above injury
- below injury: no function, no sensory or motor impulses, no reflexes
- Postspinal shock
- all functions normal above injury
- below injury: no sensation, no voluntary movement, no central control of SNS, reflexes present but no voluntary control (incontinence) |
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Term
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Definition
- serious complication
- massive sympathetic reflex response that can't be controlled from the brain
- ex: pain causes high BP, spinal cord can't communicate with brain, brain slows heart rate, dangerous, must remove cause of original stimulus!!! |
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Term
|
Definition
- none
- surgery (repair tissue and relieve pressure
- treat complications of immobility
- rehabilitation |
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Term
Congenital disorders
Hydrocephalus |
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Definition
- accumulation of CSF, compresses brain and blood vessels
- noncommunicating (obstructive)
- communicating |
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Term
Congenital disorders
Spina bifida |
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Definition
- group of neural tube deficits
- diagnosed by amniocentesis
- genetic/environmental factors (gestational diabetes, vitamin A or folate deficiencies) |
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Term
Congenital disorders
Cerebral palsy |
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Definition
- group of disorders marked by motor impairment cause by damage in perinatal period
- brain malformed by mechanical, hypoxia, hemorrhage, hypoglycemia, or some other factor
- classified as spastic paralysis, dyskinetic, ataxic |
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Term
| Seizure Disorders (epilepsy) |
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Definition
- Uncontrolled, excessive neuronal discharge in brain
- Pathophysiology
- sudden/spontaneous depolarization of neurone
- abnormal motor and sensory function
- injuries may arise from impairment
- severe/frequent seizures can lead to permanent disability |
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Term
Seizure Disorders (epilepsy)
Absence seizures |
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Definition
| - last seconds, brief loss of awareness, perhaps transient facial movements |
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Term
Seizure Disorders (epilepsy)
Tonic-clonic seizures |
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Definition
| - generalized seizures; often starts with characteristics signs, loss of consciousness, tonic period, followed by clonic stage, symptoms subside |
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Term
|
Definition
- anticonvulsants (ex: phenytoin)
- no treatment for seizures after they start
- chronic conditions must be controlled |
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Term
|
Definition
- can involve
- a specific population of neurons: parkinson's disease
- diffuse neuronal loss: alzheimer's disease
- other cell types: multiple sclerosis |
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Term
Parkinson's disease
Symptoms |
|
Definition
- movement disorder
- 4 main symptoms
- tremor (hands, arms, legs, jaw or head)
- rigidity or stiffness of limbs and trunk
- bradykinesia (slowness of movement)
- postural instability, impaired balance |
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Term
| Parkinson's disease (cont) |
|
Definition
- dysfunction of the extrapyramidal motor system, progressive degenerative changes in basal ganglia
- onset generally 60+, many causal factors suggested |
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Term
Parkinson's disease
causes |
|
Definition
- gradual loss of striatal neurons involved in controlling movement
- these neurone use dopamin as a neurotransmitter
- loss of co-ordinated dopamine release from these neurone is the cause of parkinson's
- lose some nerve terminals contrianing noradrenaline - autonomic dysfunction |
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Term
Parkinson's disease
Treatments 1 |
|
Definition
- L-dopa
- replaces missing dopamine - this does cross the BBB, unlike dopamine
- MAO-B and COMT inhibitors
- slow down the enzyme MAO-B and COMT which refulate metabolism of dopamine in the brain |
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Term
Parkinson's disease
Treatments 2 |
|
Definition
- Anticholinergics
- decrease activity of neurotransmitter acetylcholine and help to reduce tremors and muscle rigidity
- Fetal dopamine cell transplants |
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|
Term
|
Definition
- progressive demyelination of neurone of brain, spinal cord, and cranial nerves
- interferes with proper conduction of impulses
- inflammatory plaques develop, can become permanent
- characterized by period of normal function; considerable individual range of severity
- onset 20-40, autoimmune disorder |
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Term
| Amyotrophic lateral sclerosis |
|
Definition
- amyotrophic (muscle wasting) sclerosis (hardening) of lateral corticospinal tracts
- onset 20-40
- some cases genetic (10%)
- flaccid paralysis
- no specific treatment |
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Term
|
Definition
- autoimmune disorder; IgG to AChR
- onset 20-30 (women), over 50 (men)
- leads to skeletal muscle weakness; initially facial and ocular muscles, later arm and trunk muscles |
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Term
|
Definition
- inherited disorder, onset late in life
- progressive brain atrophy, degeneration of GABAergic neurons of basal ganglia and frontal cortex
- autosomal dominant (50% probability of any child having disorder)
- diagnostic test (good?, bad?) |
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Term
|
Definition
- Alzheimer's most common form
- can result from vascular disease, infections, toxins, genetics
- loss of memory, personality changes
- amyloid plaques
- progressive cortical atrophy
- genetic causes identified
- no specific treatment
- CJD, vascular dementia, AIDS dementia |
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Term
| Progression of Alzheimer's |
|
Definition
- usually starts in entorhinal cortex
- likely few symptoms
- hippocampus
mild memory loss
- cortex
- developing symptoms |
|
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Term
|
Definition
- no really effective treatment
- all aimed at slowing cognitive decay
- newer drug in clinical trials directed toward inhibition of formation of amyloid plaques |
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|
Term
Mental disorders
Schizophrenia |
|
Definition
- most common (1% pop affected)
- genetic and environmental factors
- positive (delusions, bizarre behaviors) symptoms
- negative (flat affect, decreased speech) symptoms |
|
|
Term
Mental disorders
depression |
|
Definition
- classified as mood disorder, many subgroups
- unipolar: major depression
- bipolar: alternating periods of depression and mani |
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Term
|
Definition
- Tricyclic antidepressants: block NT reuptake
- SSRIs: selective serotonin reuptake inhibitors
- MAO inhibitors: block noradrenaline metabolism
- ECT: electroconvulsive therapy |
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