Content of thought it mediated by all three basic core networks: ______, ______/______, and ______.
attention, memory/language, affective
A loss of ______ function yields a vegetative state, which is a crude ______ ______.
cerebral, waking state
The crude waking state that is a vegetative state is maintained by ______ and the ______ ______.
RAS, brain stem
Structural alterations in arousal are divided by what?
they location above or below the tentorial plate (infra-tentorial vs. supra-tentorial)
The tentorial plate is a fold of the ______ ______ which separates the ______ from the ______ and often often encloses a process or plate of the skull called the ______ ______.
dura mater, cerebellum, cerebrum, bony tentorium
What sorts of things can cause metabolic alterations in arousal?
hypoxia, electrolyte imbalance, drugs, toxins, etc
Changes in arousal produced that are supratentorial can be produced by ______ dysfunction or ______ dysfunction.
Diffuse dysfunction that is supratentorial can be a disease process, such as ______, or disorders outside the brain but inside the cranial vault such as...(2)
encephalitis, neoplasms or closed head trauma with subdural bleeding
Localized dysfunction is often caused by a ______. Disorders in brain substance, such as ______ or ______, function as masses.
mass. infarcts or emboli
Localized supratentorial dysfunction can can cause impingement in what two ways?
either by impinging on deep structures directly OR impingement is secondary to herniation
Changes in arousal that are infratentorial are caused by either direct destruction of ______ and ______ or the entire ______ ______, or caused by direct ______ or indirect ______ of ______ supply.
RAS, pathways, brain stem, invasion, impairment, blood
What are the five types of clinical manifestations of altered arousal?
level of consciousness, pattern of breathing, pupillary changes, oculomotor responses, motor responses
An individual may have ______ breathing patterns or ______ ______ breathing patterns.
hemispheric, brain stem
What are the three types of hemispheric breathing patterns?
normal, post-hyperventilation apnea, Cheynes-Stokes respirations
Normal breathing is not associated with an injury to the CNS. A person with normal breathing may ______ if needed to lower ______, but otherwise their breathing is ______ with decreased ______.
hyperventilate, PaCO2, regular, depth
Post-hyperventialation apnea is associated with...
diffuse bilateral metabolic or structural cerebrum disease
In post-hyperventilation apnea, a person ______ to lower ______ to normal. Then once it's normal, respirations ______. Rhythmic breathing will resume when ______ comes back up.
hyperventilates, PaCO2, stop, PaCO2
Cheynes-Stokes respirations are associated with ______ dysfunction in ______ cerebral or ______ structures.
bilateral, deep, diencephalic
Cheynes-Stokes respirations have a ______ rate and depth which ______. This is followed by smooth ______ to the point of ______. The period of ______ lasts longer than the ______.
crescendo, peaks, decrescendo, apnea, hyperpnea, apnea
What is an example of how Cheynes-Stokes would be charted?
"Cheynes-Stokes with 20 seconds of apnea"
What are the five types of brain stem breathing patterns?
central neurogenic hyperventilation, apneusis, cluster breathing (aka Biot's breathing), ataxic breathing, agonal breathing (gasping breathing)
How does a person with central neurogenic hyperventilation breathe? What is it related to?
sustained, deep, rapid and regular hyperpnea. head trauma.
How would central neurogenic hyperventilation affect a person's labs
decrease PaCO2 and pH and increase PaO2
A person with apneustic breathing takes a ______ ______ at full ______. This is called a ______. It often alternates with a pause at the end of ______.
prolonged pause, full inspiration, cramp, expiration
Apneustic breathing is related to damage in the ______ in the brain stem, ______ (severe), ______ and ______.
pons, hypoglycemia, anoxia, meningitis
Cluster breathing is characterized by ______ breaths followed by ______ ______. It is related to dysfunction in the lower ______ and ______.
quick, irregular pauses, pons, brainstem
Ataxic breathing is completely ______ breathing which is often ______. The person will have random ______ and ______ breaths with irregular ______.
irregular, slow. shallow and deep, pauses
When is agonal breathing commonly seen?
in cardiac arrest where respirations may persist after the heart has stopped
Why does agonal breathing occur following cardiac arrest?
body's last attempt to save itself. the pulse stops, the brain initiates a couple more breathes which may be 20-30 seconds apart.
Why might pupillary changes occur with altered arousal?
brain stem areas that control arousal are near areas that control pupils
What are the three types of pupil "classifications?"
fixed vs. reactive, dilated vs. pinpoint, brisk vs. sluggish reaction to light
Dilated pupils indicate dysfunction in the ______, whereas pinpoint pupils indicate dysfunction in the ______.
Besides damage to the brain, drugs can also cause pupillary changes. What things can cause constriction? What things can cause dilation?
opioids and alcohol. atropine and amphetamines.
People with a ______-induced coma (e.g. ______ or ______) usually retain oculomotor responses, even in the presence of...
metabolically, hypoxia, hypoglycemia, other signs of brain stem damage
People with ______-______ and ______ poisoning do not retain the ocular reflexes.
barbituate-hypnotic, phenytoin (Dilantin)
The oculocephalic reflex response evaluates brain stem function in patients who are ______ or ______.
unconscious or comatose
What is a normal oculocephalic reflex response?
both eyes turn to side opposite from head turn, still able to maintain focus
What is an absent oculocephalic reflex response? What may it indicate?
eyes follow the head turn. may indicate brain damage/brain death.
Motor responses help determine the most severely damaged ______ and may indicate a loss of ______ ______.
side, cortical inhibition
What three reflexes are often referred to collectively as "frontal release" signs?
the suck, snout and palmomental reflexes
The suck, snout and palmomental reflexes are often seen in disorders that affect the ______ ______, such as...
frontal lobes. dementias, metabolic encephalopathies, CHI, hydrocephalus
In the palmomental reflex, a stimulus to the ______ area (palm, near the base of the thumb), of the hand causes a reflex ______.
The decorticate position is due to damage to ______ ______ whereas the decerebrate position is due to damage of the ______ ______ ______.
corticospinal tracts, upper brain stem
What is the decorticate position?
flexion and adduction of the UEs. external rotation, plantar flexion in the LEs.
What is the decerebrate position?
all 4 extremities in rigid extension, hyperpronation of forearms, plantar flexion in LEs
What is selective attention?
the ability to select from available, competing environmental and internal stimuli affected
What is extinction?
the ability to recognize sensory input from from dysfunctional side of the brain but ignores sensory input from the dysfunctional side when stimulated from both sides
Neglect syndrome is the name for the entire complex of denial or ______, loss of ______ of own body parts and ______.
dysfunction, recognition, extinction
What are three types of dysmnesias?
retrogade amnesia, anterograde amnesia, executive attention deficits
Retrograde amnesia results from damage to ______ areas in the ______ ______.
association areas in the cerebral cortex
Anterograde amnesia is also called ______ ______ or ______ memory.
domain independent, recent memory
Executive attention deficits involve the inability to maintain ______ ______, ______ ______ or recognize when an ______ meets a ______.
sustained attention, set goals, object, goal
People with executive attention deficits are unable to remember...
instructions and info needed to guide behavior
Executive attention deficits result from ______ and ______ or indirect destruction due to ______. They can also result from the effects of ______ and ______.
ischemia, hypoxia, compression, toxins, chemicals
Executive attention deficits involve the ______, as well as the ______ and ______ networks which are essential to cognitive function.
midbrain, memory and language
Agnosia may affect the domains of ______, ______, or ______, but it usually only affects one domain.
tactile, visual, auditory
A person with agnosia is unable to recognize/identify objects due to injury to the ______ cortex.
What is an example of tactile agnosia?
patient closes eyes, put a key in their hand, unable to recognize it
aphasia vs. dysphagia
aphasia is a LOSS of comprehension/production of language, whereas dysphagia is IMPAIRMENT
Dysphagia types are classified ______, ______ or the character of ______.
anatomically, functionally, speech
Expressive dysphagia is primarily a deficit of ______. ______ ______ deficit may also be present but usually is relatively intact.
expression, verbal comprehension deficit
Expressive dysphagia is also called ______ dysphagia or ______ dysphagia.
Broca dysphagia, motor dysphagia
A person with receptive dysphagia can produce verbal language but it is ______. This is also called ______ or ______ dysphagia.
meaningless, Wernicke or sensory dysphagia
A person with transcortical dysphagia has an inability to ______. They may range from ______ and producing little speech to ______ with impaired ability for ______.
repeat. nonfluent, fluent, naming
Acute confusional states can be secondary to ______ ______, ______ disorder, or ______ system disease.
drug intoxication, metabolic disorder, nervous system disease
The onset of an acute confusional state can be ______, or ______, but it is usually ______.
sudden, gradual, abrupt
Acute confusional states may be caused by disruption of the neural network in ______ and projections into the ______, ______ ______, ______ or ______ areas.
RAS, thalamus, basal ganglion, cortex, limbic areas
Acute confusional states may be seen as ______, because the person may have grossly altered interpretations of ______, possibly including ______. They may also be ______.
delirium, reality, hallucinations, incoherent
AMS usually functions as a ______ diagnosis when we are unsure of what's going on with a patient.
Dementia is a ______ failure of ______ functions that is not caused by an impaired level of ______.
progressive, cerebral, consciousness
Dementia is not ______. The treatment of it seeks to maximize use of remaining ______ and______.
curable, capacities and functions
The symptoms of dementia begin ______. They include a loss of both ______ and ______ memory.
insidiously. recent and remote
What are the two types of Alzheimer's? Which is most common?
late onset familial Alzheimer dementia AND non-hereditary or sporadic late-onset AD (more common)
The theories of what causes Alzheimer's include a mutation for encoding ______ ______ protein, alteration in ______ ______ and loss of neurotransmitter stimulation of ______ ______, and ultimately ______.
amyloid precursor protein, apolipoprotein E, choline acetyltransferase, Ach
A person with Alzheimer's will have "______ ______," which are area of ______ which disrupt nerve-impulse transmission.
senile plaques, degeneration
What are the symptoms of Alzheimer's?
forgetfullness, emotional upset, disorientation, confusion, lack of concentration, decline in abstraction, problem solving and judgement
What is the usual treatment of Alzheimer's?
Aricept (donepezil)--Anti-Alzheimer, cholinesterase inhibitor, doesn't prevent progression
What is CPP? What does it decrease in response to?
cerebral perfusion pressure. pressure needed to perfuse brain cells. decreases in response to IICP.
What does CBV stand for? It is the amount of blood in the _____ _____.
cerebral blood volume. intracranial vault.
Cerebral oxygenation is the _____ _____ in what vein?
oxygen saturation in the internal jugular vein
What are some examples of things that can cause IICP?
tumor growth, edema, excessive CSF, hemorrhage
The stages of IICP are differentiated by _____ status, _____, _____, _____ and widening/narrowing _____ _____, _____ (rate and quality), and _____.
mental status, pupils, breathing, BP, pulse pressure, pulse, temperature
What symptoms/signs may a person with stage I of IICP experience?
awake, alert, pupils and breathing normal, systolic BP may be somewhat elevated, pulse pressure fine, pulse may normal to elevated
What symptoms of effective compensation may a person with stage I of IICP experience? (2) What is their purpose?
vasoconstriction and external compression of venous system. to make sure that CPP remains normal.
What symptoms may a person with stage II of IICP experience?
episodes of confusin, restless, lethargy
How are the pupils of a person with stage II IICP? How is their breathing?
pupils still equal and reactive, breathing still normal
In stage III of IICP, the person begins to have an inability to _____ _____. They progress into a deeper _____.
stay awake, deeper coma
In stage III of IICP, how are the pupils? How is breathing?
small and reactive, progressing slowing of response to light. breathing is normal but may begin to slow.
In stage III of IICP, the _____ _____ begins to widen due to an increase in _____ blood pressure.
pulse pressure, systolic
What happens to the pulse of a person with stage III of IICP?
pulse begins to slow and becomes full and bounding
In stage IV IICP, how are the person's pupils?
pupil reaction to light slows and progresses to bilateral dilation and fixation
How is the breathing of a person with stage IV IICP?
slow, progresses to severely abnormal breathing patterns
In herniation syndromes, brain tissue shifts (herniates) from compartment of _____ _____ to compartment of _____ _____.
greater pressure, lesser pressure
Herniation syndromes are classified according to the _____ affected. They can be either _____ or _____. Which is more common?
structures, supratentorial, infratentorial (most common)
What may be some of the possible causes of cerebral edema?
trauma, infection, hemorrhage, tumor, ischemia, infarct or hypoxia
The harm caused by cerebral edema may result in the _____ of blood vessels, brain tissue _____ and eventual _____ of brain tissue from one compartment to the other.
distortion, displacement, herniation
What is vasogenic cerebral edema?
a change to the capillary endothelium permeability after injury to vascular structure
In vasogenic cerebral edema, the _____-_____ _____ is disrupted. What causes water to leak into extracellular spaces?
blood-brain barrier. plasma proteins leak into the extracellular spaces and water follows
In cytotoxic or metabolic cerebral edema, the cells lose _____ and gain _____. _____ follows. This affects the _____ matter. This all occurs because _____ alter active transport
potassium, sodium, water, grey, toxins
Ischemic cerebral edema includes components of both _____ and _____ cerebral edema.
vasogenic and cytotoxic
Ischemic cerebral edema results in _____ where the cells die and there is _____ _____ _____ damage.
autodigestion, blood brain barrier
Interstitial cerebral edema is seen with _____-_____ _____. It is caused by movement of _____ from the _____ into extracellular spaces of brain tissue. This is called "_____ movement."
non-communicating hydrocephalus. CSF, ventricles. transependymal movement
Hydrocephalus is caused by excess fluid in the _____ _____, _____ space, or both.
cranial vault, subarachnoid space
Hydrocephalus may be developed _____ through _____. It is caused by an interference in _____ flow.
infancy, adulthood. CSF
Communicating hydrocephalus is caused by decreased _____ of CSF and is the most common cause in _____.
Non-communicating hydrocephalus results from an _____ in the _____ system. It is more common in _____.
obstruction, ventricular system. children.
Hydrocephalus may develop slowly over time but there is also an acute form that develops from...
Hypotonia is caused by decreased _____ _____ activity and thus a decrease in the _____ of neurons.
muscle spindle, excitability
Spasticity is a gradual _____ in tone, which causes increased _____. Then tone suddenly _____.
increase, resistance, decreases
Gegenhalten hypertonia causes resistance to _____ movement which varies _____ with the force applied.
Rigidity is _____ muscle _____ to passive movement. It occurs due to...
uniform, resistance. constant, involuntary muscle contraction
Upper motor neuron syndromes result in _____, whereas lower motor neuron syndromes result in _____.
Spinal shock results in _____ paralysis, no _____ and _____/_____ function disturbances.
flaccid, reflexes, bowel/bladder
What is spinal shock related to? Under what circumstances may it not occur?
sudden destruction of efferent pathways. may not develop is the destruction is slow.
What is an isolated contraction of a single muscle? Is this always clinically visible?
Paralytic poliomyelitis is viral or bacterial? It occurs post-_____ or post-_____.
viral. infection, vaccination
Paralytic poliomyeltis affects segments of _____ _____ cells or individual _____ _____.
anterior horn cells or individual cranial nerves
Nuclear palsies are related to _____ occlusions, _____, _____, _____ or _____. They affect only the nuclei of _____.
vascular, tumor, aneurysm, TB, hemorrhage, CNs
Progressive spinal muscular atrophy affects what cells? What age group is it seen more in? What does it resemble?
anterior horn cells of spinal cord. seen more in adults. resembles progressive muscular atrophies that are inherited.
What is progressive bulbar palsy named so?
because the myencephalon used to be called "the bulb," and bulbar palsy involves cranial nerves that arise from the bulb (X, XI and XII)
Progressive bulbar palsy results in paresis or paralysis of the _____, _____, _____ and _____ muscles.
jaw, face, pharynx, tongue
What is chorea? When does it stop?
ceaseless, rapid complex body movements that look well-coordinated and purposeful but are, in fact, involuntary. when the person is asleep
Tardive dyskinesia is _____ movements of the _____, _____ and _____. It is occasional seen in people with _____. It can also occur as an adverse effect of prolonged _____ drug treatment.
involuntary, face, trunk, extremities. Parkinson's. phenothiazine.
What does Huntington disease affect?
the basal ganglia which are responsible for fine-tuning our movements
Huntington disease results from severe degeneration of the _____ _____ (_____ _____) and _____ _____ atrophy. There is also depletion of what neurotransmitter?
basal ganglia (caudate nucleus). frontal cerebral. GABA
Huntington disease causes a progressive dysfunction of _____ and _____ processes, including loss of the ability to _____, _____, as well as disinhibition and _____.
intellectual, thought, plan, organize, restlessness
The movements associated with Huntington disease typically begin in the _____ and _____ and eventually affect...
face and arms. entire body
In hypokinesia, the person is _____, has normal _____ _____ and _____ function but has decreased _____.
conscious, peripheral nerve and muscle, movement
In bradykinesia, there is a slowness of _____ movements. Movements become slow and _____.
What does loss of associated movement mean?
loss of grace, skill, and balance to voluntary movements
A person with a loss of associated movement may also have an _____ face, an absence of speech _____ or _____ gestures.
expressionless, inflection, spontaneous
What two types of hypokinesia does a person with Parkinson Disease have?
bradykinesia (can't get started when walking) and akinesia (face)
Degeneration of the dopaminergic pathway in Parkinson Disease causes _____ depletion in the _____ _____ and excess _____ activity in the feedback circuit.
dopamine, basal ganglia, cholinergic
Symptoms of Parkinson Disease include: _____ (tremor and rigidity), _____ of the face, Parkinsonian tremor at _____, Parkinsonian _____ (muscle stiffness), Parkinsonian _____ (poverty of movement) and postural disturbance (characteristically _____).
hypertonia, akinesia, rest, rigidity, bradykinesia, stooped
What autonomic and neuroendocrine symptoms may a person with Parkinson Disease experience?
What cognitive-affective symptom may a person with Parkinson Disease experience? Especially if over what age?
progressive dementia. especially if greater than 70 y.o.
Dystonic postures and movements result when muscular contractions are sustained for several _____.
Decorticate posture is also called "_____ posture," and is related to _____ inhibition.
hemiplegic posture, brainstem
Decerebrate posture is related to severe _____/_____ _____ injury where the _____ reflexes are overstimulated.
brain, brain stem, vestibular
What is the basal ganglion posture? What disease process does it occur with?
stooped, hyperflexed posture, short-stepped gait. Parkinson Disease
Senile posture is where the person is _____. It can be related to a _____ lobe dysfunction, but otherwise the cause is unknown.
What are four types of gait disorders?
spastic gait, scissors gait, cerebellar gait, basal ganglion or senile gait
What does a spastic gait look like? It is associated with a _____ injury.
shuffling with a stiff leg. unilateral.
What does a scissors gait look like? It is associated with a _____ injury.
legs swing around and in front of each other. bilateral.
A person with a cerebellar gait is _____-_____ and _____. They look _____.
wide-based, staggers, drunk
A person with a basal ganglion gait or senile gait takes _____ steps as has less _____ _____. It is related to _____ _____ dysfunction.
small, arm swing, basal ganglion
Basal ganglion gait and senile gait depend on whether the dysfunction is related to the _____ _____ or _____ _____ but they are known by the same name.
basal ganglia, frontal lobe
Hypermimesis is pathologic _____ (r/t _____-sided hemispheric injury) or _____ (r/t _____-sided hemispheric injury).
laughter, right, crying, left
Hypomimesis is a loss of _____ language. It can be receptive or expressive--explain the difference.
emotional. inability to understand emotion in speech and facial expression vs. inability to express
What are dyspraxias and apraxias?
unable to perform purposeful motor acts in the absence of paralysis, sensory lss, etc
What are dyspraxias and apraxias associated with?
vascular disorders, trauma, tumors, degenerative disorders
Extrapyramidal motor fibers carry messages for _____ motor movement to the _____ motor neurons in the _____ and _____ _____.
voluntary, lower, brain and spinal cord
Basal ganglia motor syndromes result from an imbalance between _____ and _____ activity. _____ and the _____ phenomenon will be present.
dopaminergic and cholinergic. rigidity and cogwheel