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Chapter 17: Alterations in Cognitive Systems, Cerebral Hemodynamics, and Motor Function
Terms in this set (60)
is an awareness of oneself and the environment and includes an ability
to respond to external stimuli with a wide variety of responses.
has two components: arousal (state of awakeness) and awareness (content of thought).
Alterations in level of arousal
may be caused by structural, metabolic, or psychogenic
Levels of consciousness
can diminish in stages from alert and oriented to confusion and
reflect changes in level of brainstem function, drug action, and response to hypoxia and ischemia.
Abnormal eye movements
, including nystagmus and divergent gaze, reflect alterations in
Loss of cortical inhibition
associated with decreased consciousness includes abnormal
flexor and extensor movements.
represents irreversible total brain damage including an inability to maintain cardiac, respiratory, and other vital functions.
Cerebral death or irreversible coma is death of the -- --exclusive of the brainstem and cerebellum.
With locked-in syndrome
(ventral pontine syndrome) content of thought and level of
arousal are intact but the efferent pathways are disrupted with complete paralysis.
is a neurobehavioral state characterized by a severe loss of motivation to
move or inability to voluntarily initiate motor responses, or both.
With a deficit in selective attention, mediated by the brainstem, the parietal lobe
structures, and the pulvinar nucleus of the thalamus, the individual cannot focus on
selective stimuli and thus neglects those stimuli, causing a
can be retrograde (loss of past memories) or anterograde (retention of old memories but an inability to form new ones).
is a combination of retrograde and antegrade.
mediate vigilance, detection, and working memory (temporary storage of information).
With a vigilance deficit
the person cannot maintain search and scanning
Data processing deficits
are problems associated with recognizing and processing sensory information and include agnosias, aphasia, and acute confusional states.
are a defect of recognition and may be tactile, visual, or auditory. They are caused by dysfunction in the primary sensory area or the interpretive areas of the cerebral
is an impairment of comprehension (sensory) or production of language
(expressive or motor).
involves loss of ability to produce spoken or written language with slow or difficult speech.
is a disturbance in understanding all language—verbal and reading
is an inability to name objects, people, or qualities
can be motor, sensory, or mixed.
involves anterior and posterior speech areas, with expressive and receptive aphasia
Acute confusional states
are characterized chiefly by defects in attention and coherence of thoughts and actions and, in the case of hyperactive delirium, an intense, autonomic
nervous system hyperactivity.
is an acquired impairment of intellectual function, memory, and language with alteration in behavior and can be caused by trauma, vascular disease, infection, and
is the most common chronic, irreversible dementia with accumulations of amyloid
and tau protein neurofibrillary tangles in the brain. Less common forms include vascular
and frontotemporal dementia.
represent abnormal, excessive hypersynchronous discharges of cerebral neurons with transient alterations in brain function. Seizures may be focal or generalized.
The categories of seizures
include genetic, structural, metabolic, immune, infectious, and unknown.
Cerebral perfusion pressure
determines cerebral blood flow.
An injured brain may experience cerebral --, normal cerebral blood flow but with
increased -- -- , or cerebral --.
Increased intracranial pressure
may result from edema, excess CSF, hemorrhage, or tumor growth. When intracranial pressure approaches arterial pressure, hypoxia and
hypercapnia produce brain damage.
is an increase in the fluid content of the brain resulting from infection,
hemorrhage, tumor, ischemia, infarct, or hypoxia.
The shifting or herniation of brain tissue from one compartment to another
disrupts the blood flow of both compartments and damages brain tissue.
involves temporal lobe and hippocampal gyrus shifting from the middle fossa to the posterior fossa; transtentorial herniation with a downward shift of the
diencephalon through the tentorial notch; and shifting of the cingulate gyrus herniation
under the falx.
The most common infratentorial herniation is a shift of the cerebellar tonsils through the
comprises a variety of disorders characterized by an excess of fluid within the cranial vault, subarachnoid space, or both. Hydrocephalus occurs because of interference with CSF flow caused by increased fluid production or obstruction within the ventricular system or by defective reabsorption of the fluid.
may be characterized as alterations of motor tone, movement, and
complex motor performance.
Hypotonia and hypertonia
are the main categories of altered muscle tone
Four types of hypertonia exist
: spasticity, paratonia (gegenhalten), dystonia, and rigidity.
(abnormal voluntary movement)
Included in the category of hyperkinesia
are chorea, athetosis, ballism, akathisia, tremor, and myoclonus.
is a rare hereditary irreversible disease involving the basal ganglia and frontal cerebral cort
ex with a depletion of neurons that secrete GABA (an inhibitory
neurotransmitter) that causes involuntary, fragmentary movements accompanied by
emotional lability and progressive dementia.
Types of hypokinesia
include akinesia, bradykinesia, and loss of associated movements
PD (Progressive dementia)
is a common degenerative disorder of the basal ganglia (corpus striatum) involving
degeneration of the dopamine
-secreting nigrostriatal pathway resulting in overactivity by
the subthalamic nucleus, causing tremor, rigidity, and
bradykinesia. Involvement of the
limbic system causes emotional lability. -- -- may be associated with an
advanced stage of the disease.
An upper motor neuron syndrome
is characterized by spastic paresis or paralysis, hypertonia, and hyperreflexia from interruption of the pyramidal system.
Interruption of the pyramidal tract below the pons
results in spinal shock with complete
flaccid paralysis, absence of reflexes, and marked disturbances of bowel and bladder
Lower motor neuron syndromes
manifest with impaired voluntary and involuntary movements and flaccid paralysis
occurs with only partial loss of
alpha motor neurons, and total paralysis is complete loss of alpha motor neurons. Loss of gamma motor neurons impairs muscle tone and decreases deep tendon reflexes.
Motor neuron diseases
result from progressive degeneration of upper or lower motor neurons in the spinal cord, brainstem, or cortex.
involve damage to the cranial nerve nuclei
involve cranial nerves IX, X, and XII.
is a motor neuron disease. The pathogenesis of -- is not fully known; however, lower and upper motor neuron degeneration occurs as well as degeneration of the nonmotor neurons in the cortices and spinal cord. Clinical manifestations of -- may
include weakness in all muscles that may begin in a single muscle group, slurring of
speech, and difficulty swallowing. Flaccid paresis progressing to paralysis is
characteristic of the lower motor neuron syndrome.
Alterations in complex motor performance
include disorders of posture (stance), disorders of gait, and disorders of expression.
Disorders of posture
include dystonic posture, decerebrate posture, basal ganglion posture, and senile posture.
Disorders of gait
include upper motor neuron gaits, cerebellar gait, basal ganglion
gait, and senile gait.
Disorders of expression
include hypermimesis, hypomimesis, and dyspraxia or apraxia
Extrapyramidal motor syndromes
include basal ganglia and cerebellar motor syndromes.
Basal ganglia disorders
manifest with alterations in muscle tone and posture, including rigidity, involuntary movements, and loss of postural reflexes.
Cerebellar motor syndromes
result in loss of muscle tone, difficulty with coordination,
and disorders of equilibrium and gait.
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