NURS 5315 Module 7
2 main types of spina bifida defects - ANS-anterior midline and posterior defects
\3 categories of spinal cord lesions - ANS-anterior, central, posterior cord lesions
\3 meninges that surround the CNS - ANS-subarachnoid, arachnoid, subdural space
(epidural space)
\4 stages of CTE - ANS-(1) P-tau neurofibrillary tangles are isolated to the sulcal depths of
the cerebral cortex
(2) Perivascular p-tau neurofibrillary tangles
(3) P-tau deposition has spread to the frontal and temporal lobes
(4) The most severe form of CTE, the p-tau protein is deposited widespread and involves the
diencephalon, brain stem and cerebellum
\4 Stages of migraine - ANS-Premonitory phase, migraine aura, headache phase, recovery
phase
\4 types of MS - ANS--4 types:
1) Relapsing/remitting: Most common type (esp. women); episodes of symptom
exacerbations followed by full or partial recovery
2)Primary progressive: Least common; results in an ongoing progression w/o periods of
remission; usually affects the spinal cord and is less likely to affect cognitive function
3) Secondary progressive: Initially occurs as relapsing/remitting MS that is then followed by
a gradual worsening of sx between relapses
4) Progressive relapsing: Progressively worsening of sx from the onset of the disease w/
clear abrupt relapses but w/ more severe
\4 types of supratentorial cerebral herniations - ANS-i) 4 types:
(1) Uncal: When a portion of the gyri of the cerebrum move through the tentorial notch and
compresses the 3rd cranial nerve and the mesencephalon
(a) CM's: decreased LOC, dilated ipsilateral pupil first then the contralateral pupil,
decorticate or decerebrate posturing, and Cheyne stokes respirations
(2) Central: When the diencephalon is forced down and through the tentorial notch
(a) CM's: Loss of consciousness quickly, apnea, initially will have small reactive pupils and
later dilated pupils; decorticate and decerebrate posturing becomes evidence
(3) Cingulate Gyrus: The movement of the cingulate gyrus under the falx cerebri (instead of
moving down it moves laterally)
(4) Transcalvarial: Brain tissues moves through an opening in the skull. May be a results of a
skull fracture or a surgical opening
\5 types of spinal cord injury - ANS-transection, cord contusions, cord concussion, cord
compressions, cord hemmorhage
\Absense Seizure - ANS-Generalized
-Blank stare
-may have automatisms
\Acetylcholine - ANS-(a) Is excitatory & inhibitory.
(i) Located in skeletal muscles (excitatory), brain and spinal cord.
(ii) Inhibitory effects are on the cardiac muscle.
(iii) Deactivated by acetylcholinesterase.
,\Acute confusional state/delirium/acute organic brain syndromes marked by - ANS-a)
sudden, cerebral dysfunction that causes confusion, agitation, memory impairments,
distractibility, compulsive behavior, and obsessions
\Afferent Nerves - ANS-Sensory nerves that carry impulses from cells, tissues, and organs to
the CNS
\Alpha 1 Receptors - ANS-Vascular smooth muscle-blood vessels
Excitation or stimulation
Vasoconstriction
\Alzheimer's etiology - ANS--Unknown etiology
-Linked to autosomal dominant inheritance pattern
-Gene associated w/ late onset AD: apolipoprotein E gene allele 4 (APOE4) on chromosome
19
-Onset: Late/middle life
-Death: 5-10 yrs after dx
\Alzheimer's patho - ANS--APOE4 interferes w/ amyloid clearance from the brain
-Amyloid accumulates in the brain and is transformed into a substance that is toxic to
neurons that triggers the formation of plaques and tangles in the brain
-Leads to the disruption of nerve impulses transmission, neuron death, loss of function, and
death
\Alzheimer's Risk factors - ANS--Main: Age & family hx
-Other: diabetes, midlife HTN, hyperlipidemia, midlife obesity, smoking, depression, cognitive
inactivity, low educational attainment, females, estrogen deficiency during menopause,
physical inactivity, head trauma, neuro-inflammation, oxidative stress
\Alzheimer's s/sx - ANS--Results in impairment of memory, confusion, visual spatial
disorientation, inability to calculate, and impaired judgement
-Hallucinations can occur
-CM's gradually lead to a loss of independence, leaving the individual requiring assistance w/
bathing/eat/dressing/toileting
\Alzheimer's' Disease - ANS-Progressive, degenerative disease of the brain
*Most common form of dementia
\Amino acids - ANS-(i) Glutamate (brain & spinal cord): Excitatory effects. Drugs that block
glutamate treat ALS
(ii) Gamma Aminobutyric Acid (GABA, located in neurons of the CNS): Inhibitory at the post
synaptic membrane. Drugs that increase GABA treat seizures.
(iii) Glycine (Spinal cord): Inhibitory effects on the post synaptic membrane
\Ancencephaly - ANS-Soft, bony portion of the skull and part of the brain are missing
\Anterior Cerebral Artery (Stroke) Area of infarct and s/sx - ANS--Serves the basal ganglia,
corpus callosum, medial surface of the cerebral hemispheres, superior surface of the frontal
and parietal lobes
-Contralateral paralysis and loss of sensation
Sx more present in the lower extremities than the upper
\Anterior Cord lesion - ANS-a) Loss of pain and temperature sensation, motor weakness
i) Causes: Trauma, rupture intervertebral disk, anterior spinal artery occlusion, primary spinal
cord tumors, or metastatic cancer
\Anterior fontanel closes - ANS-around 18 months
\Anterior Midline defects in spina bifida - ANS-Tend to cause brain and face abnormalities
(like cyclopia which is the presence of a single, midline orbit and eye)
, \Arachnoid space - ANS-Middle meninge, avascular.
\Aseptic meningitis - ANS--No causative organism found or viral
-Can also be caused by fungi and TB
\Associated Neurons - ANS-Transmit impulses from neuron to neuron (only in the CNS)
\Astrocytes - ANS-Fills the spaces between neurons & surround the blood vessels. Part of
the blood brain barrier, provide the rapid transport of nutrients & have a role in scar formation
& seizures.
\Ataxic CP - ANS-Difficulty w/ gait and associated w/ cerebellar injury. Infants will have
hypotonia but a stiff trunk
\Autonomic Dysreflexia - ANS-a) A syndrome that is from an imbalance of the sympathetic
and parasympathetic nervous systems
b) Happens in people w/ spinal cord injury @ T6 or higher
c) A medical emergency: may result in seizures, retinal hemorrhage, pulmonary edema, AKI,
MI, cerebral hemorrhage, and death
d) Etiology
i) Triggered by a stimulus. Any painful or irritating stimulus might trigger it
ii) Most common cause: bladder distention or irritation
iii) Second most common: Bowel distention d/t fecal impaction
e) Normal patho
i) Sympathetic nervous system: flight or fight
(1) Diverts blood from the GI tract/skin by causing vasoconstriction and increases blood flow
to the skeletal muscles
(2) Causes bronchiolar dilation, increases heart rate and myocardial contractility
ii) Parasympathetic nervous system
(1) Counteracts the effects of the SNS through a negative feedback control
(2) Helps to conserve and restore energy, reduces the HR and BP, facilitates digestion and
nutrient absorption, as well as waste secretion
(3) Mediated by: CN X, vagus nerve, S2, S3, and S4 nerves
iii) In a person w/ an intact spinal cord a noxious stimulus triggers a sympathetic response
causing an elevation in the heart rate and BP through the spinal reflexes. This response is
then regulated/controlled by the parasympathetic nervous system that results in lower
BP/HR (this requires an intact spinal cord)
f) Patho
i) In a person w/ an injury at T6 or above, a noxious stimulus below the level of injury results
in a sympathetic response (vasoconstriction) below the level of injury resulting in HTN
ii) The baroreceptors in the aortic arch & carotid sinus send feedback about the HTN to the
CN Xàbradycardia and vasodilation above the level of injury
iii) B/c of the lack of integrity of the spinal cord, the PNS is unable to send signals below the
level of injury and the HTN rema
\Autonomic nervous system - ANS-1) Consists of motor neurons that control internal organs
(heart, smooth muscle, glands, uterus, intestine, bladder)
\Axon - ANS-(1) Conducts impulses to the next neuron
(a) Covered w/ a myelin sheath (lipid material) and are interrupted by nodes of Ranvier
(b) Nutrient exchange cannot occur through the myelin, but it can occur in the nodes of
Ranvier.
\Axonal Reaction - ANS-Process of peripheral nerve can self-repair (slow)
\Bacterial meningitis etiology & patho - ANS--Meningococcus or pneumococcus
-triggers the inflammation process in the brain
2 main types of spina bifida defects - ANS-anterior midline and posterior defects
\3 categories of spinal cord lesions - ANS-anterior, central, posterior cord lesions
\3 meninges that surround the CNS - ANS-subarachnoid, arachnoid, subdural space
(epidural space)
\4 stages of CTE - ANS-(1) P-tau neurofibrillary tangles are isolated to the sulcal depths of
the cerebral cortex
(2) Perivascular p-tau neurofibrillary tangles
(3) P-tau deposition has spread to the frontal and temporal lobes
(4) The most severe form of CTE, the p-tau protein is deposited widespread and involves the
diencephalon, brain stem and cerebellum
\4 Stages of migraine - ANS-Premonitory phase, migraine aura, headache phase, recovery
phase
\4 types of MS - ANS--4 types:
1) Relapsing/remitting: Most common type (esp. women); episodes of symptom
exacerbations followed by full or partial recovery
2)Primary progressive: Least common; results in an ongoing progression w/o periods of
remission; usually affects the spinal cord and is less likely to affect cognitive function
3) Secondary progressive: Initially occurs as relapsing/remitting MS that is then followed by
a gradual worsening of sx between relapses
4) Progressive relapsing: Progressively worsening of sx from the onset of the disease w/
clear abrupt relapses but w/ more severe
\4 types of supratentorial cerebral herniations - ANS-i) 4 types:
(1) Uncal: When a portion of the gyri of the cerebrum move through the tentorial notch and
compresses the 3rd cranial nerve and the mesencephalon
(a) CM's: decreased LOC, dilated ipsilateral pupil first then the contralateral pupil,
decorticate or decerebrate posturing, and Cheyne stokes respirations
(2) Central: When the diencephalon is forced down and through the tentorial notch
(a) CM's: Loss of consciousness quickly, apnea, initially will have small reactive pupils and
later dilated pupils; decorticate and decerebrate posturing becomes evidence
(3) Cingulate Gyrus: The movement of the cingulate gyrus under the falx cerebri (instead of
moving down it moves laterally)
(4) Transcalvarial: Brain tissues moves through an opening in the skull. May be a results of a
skull fracture or a surgical opening
\5 types of spinal cord injury - ANS-transection, cord contusions, cord concussion, cord
compressions, cord hemmorhage
\Absense Seizure - ANS-Generalized
-Blank stare
-may have automatisms
\Acetylcholine - ANS-(a) Is excitatory & inhibitory.
(i) Located in skeletal muscles (excitatory), brain and spinal cord.
(ii) Inhibitory effects are on the cardiac muscle.
(iii) Deactivated by acetylcholinesterase.
,\Acute confusional state/delirium/acute organic brain syndromes marked by - ANS-a)
sudden, cerebral dysfunction that causes confusion, agitation, memory impairments,
distractibility, compulsive behavior, and obsessions
\Afferent Nerves - ANS-Sensory nerves that carry impulses from cells, tissues, and organs to
the CNS
\Alpha 1 Receptors - ANS-Vascular smooth muscle-blood vessels
Excitation or stimulation
Vasoconstriction
\Alzheimer's etiology - ANS--Unknown etiology
-Linked to autosomal dominant inheritance pattern
-Gene associated w/ late onset AD: apolipoprotein E gene allele 4 (APOE4) on chromosome
19
-Onset: Late/middle life
-Death: 5-10 yrs after dx
\Alzheimer's patho - ANS--APOE4 interferes w/ amyloid clearance from the brain
-Amyloid accumulates in the brain and is transformed into a substance that is toxic to
neurons that triggers the formation of plaques and tangles in the brain
-Leads to the disruption of nerve impulses transmission, neuron death, loss of function, and
death
\Alzheimer's Risk factors - ANS--Main: Age & family hx
-Other: diabetes, midlife HTN, hyperlipidemia, midlife obesity, smoking, depression, cognitive
inactivity, low educational attainment, females, estrogen deficiency during menopause,
physical inactivity, head trauma, neuro-inflammation, oxidative stress
\Alzheimer's s/sx - ANS--Results in impairment of memory, confusion, visual spatial
disorientation, inability to calculate, and impaired judgement
-Hallucinations can occur
-CM's gradually lead to a loss of independence, leaving the individual requiring assistance w/
bathing/eat/dressing/toileting
\Alzheimer's' Disease - ANS-Progressive, degenerative disease of the brain
*Most common form of dementia
\Amino acids - ANS-(i) Glutamate (brain & spinal cord): Excitatory effects. Drugs that block
glutamate treat ALS
(ii) Gamma Aminobutyric Acid (GABA, located in neurons of the CNS): Inhibitory at the post
synaptic membrane. Drugs that increase GABA treat seizures.
(iii) Glycine (Spinal cord): Inhibitory effects on the post synaptic membrane
\Ancencephaly - ANS-Soft, bony portion of the skull and part of the brain are missing
\Anterior Cerebral Artery (Stroke) Area of infarct and s/sx - ANS--Serves the basal ganglia,
corpus callosum, medial surface of the cerebral hemispheres, superior surface of the frontal
and parietal lobes
-Contralateral paralysis and loss of sensation
Sx more present in the lower extremities than the upper
\Anterior Cord lesion - ANS-a) Loss of pain and temperature sensation, motor weakness
i) Causes: Trauma, rupture intervertebral disk, anterior spinal artery occlusion, primary spinal
cord tumors, or metastatic cancer
\Anterior fontanel closes - ANS-around 18 months
\Anterior Midline defects in spina bifida - ANS-Tend to cause brain and face abnormalities
(like cyclopia which is the presence of a single, midline orbit and eye)
, \Arachnoid space - ANS-Middle meninge, avascular.
\Aseptic meningitis - ANS--No causative organism found or viral
-Can also be caused by fungi and TB
\Associated Neurons - ANS-Transmit impulses from neuron to neuron (only in the CNS)
\Astrocytes - ANS-Fills the spaces between neurons & surround the blood vessels. Part of
the blood brain barrier, provide the rapid transport of nutrients & have a role in scar formation
& seizures.
\Ataxic CP - ANS-Difficulty w/ gait and associated w/ cerebellar injury. Infants will have
hypotonia but a stiff trunk
\Autonomic Dysreflexia - ANS-a) A syndrome that is from an imbalance of the sympathetic
and parasympathetic nervous systems
b) Happens in people w/ spinal cord injury @ T6 or higher
c) A medical emergency: may result in seizures, retinal hemorrhage, pulmonary edema, AKI,
MI, cerebral hemorrhage, and death
d) Etiology
i) Triggered by a stimulus. Any painful or irritating stimulus might trigger it
ii) Most common cause: bladder distention or irritation
iii) Second most common: Bowel distention d/t fecal impaction
e) Normal patho
i) Sympathetic nervous system: flight or fight
(1) Diverts blood from the GI tract/skin by causing vasoconstriction and increases blood flow
to the skeletal muscles
(2) Causes bronchiolar dilation, increases heart rate and myocardial contractility
ii) Parasympathetic nervous system
(1) Counteracts the effects of the SNS through a negative feedback control
(2) Helps to conserve and restore energy, reduces the HR and BP, facilitates digestion and
nutrient absorption, as well as waste secretion
(3) Mediated by: CN X, vagus nerve, S2, S3, and S4 nerves
iii) In a person w/ an intact spinal cord a noxious stimulus triggers a sympathetic response
causing an elevation in the heart rate and BP through the spinal reflexes. This response is
then regulated/controlled by the parasympathetic nervous system that results in lower
BP/HR (this requires an intact spinal cord)
f) Patho
i) In a person w/ an injury at T6 or above, a noxious stimulus below the level of injury results
in a sympathetic response (vasoconstriction) below the level of injury resulting in HTN
ii) The baroreceptors in the aortic arch & carotid sinus send feedback about the HTN to the
CN Xàbradycardia and vasodilation above the level of injury
iii) B/c of the lack of integrity of the spinal cord, the PNS is unable to send signals below the
level of injury and the HTN rema
\Autonomic nervous system - ANS-1) Consists of motor neurons that control internal organs
(heart, smooth muscle, glands, uterus, intestine, bladder)
\Axon - ANS-(1) Conducts impulses to the next neuron
(a) Covered w/ a myelin sheath (lipid material) and are interrupted by nodes of Ranvier
(b) Nutrient exchange cannot occur through the myelin, but it can occur in the nodes of
Ranvier.
\Axonal Reaction - ANS-Process of peripheral nerve can self-repair (slow)
\Bacterial meningitis etiology & patho - ANS--Meningococcus or pneumococcus
-triggers the inflammation process in the brain
