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APHASIA-loss of comprehension & language a) Expressive(motor)-difficulty speaking & writing ex. Damage Brocas area due to stroke b) Receptive(sensory)- difficulty understanding writing & speech ex. Damage Wernicke area due stroke 2. Ataxia- lack co-ordination of movement 3. Concussion-a minor traumatic brain injury 4. Dysarthria- lack control over muscles of speech 5. Transient ischemic attack (TIA)-occurs when blood flow to part of brain is stopped brieflymini stroke 6. Encephalitis- acute inflammation of brain 7. Homonymous hemianopsia- loss vision in one side visual field 8. ICP- increased intracranial pressure 9. Nuchal rigidity- neck stiffness 10. Posturing: a) Decerebrate- legs and arms extended, toes plantar flexed, arms adducted and wrist pronated with fingers flexed b) Decorticate-arms adducted & flexed, wrist & fingers flexed on chest, legs extended, internally rotated w/ plantar flexion of feet. 11. Paralysis-loss muscle fxn in part of body a) Flaccid- decreased muscle tone b) Spastic- increased muscle tone c) Paraplegia- paralysis & loss sensation in legs d) Tetraplegia- paralysis arms & legs e) Hemiplegia- paralysis one side body f) Upper motor neuron-originate in the cerebral cortex or brainstem and connect to the skeletal muscleinnervate skeletal muscles of arms, legs, trunk etc g) Lower motor neuron- connect the brain and spinal cord to skeletal muscles, bringing the impulse from the UMN to the muscles 12. Trephine-surgical instrument for cutting out circular pieces of bone or corneal tissue STRUCTURE OF NERVOUS SYSTEM A. NERVOUS SYSTEM 1. CNS- brain & spinal cord 2. PNS- 12 cranial & 33 spinal nerves a) Autonomic nervous system- regulation involuntary body fxns i. ii. Parasympathetic nervous system-maintenance of normal body fxns Sympathetic nervous system-fight or flight

3. Cells 4. Neuron- conducts & receives impulses 5. Neuroglial cell- supports, nourishes and protects neuron a) Oligodendrite- CNS, white matter- production myelin sheath (Swann cell in PNS) b) Astrocyte- PNS, grey matter- supports cell, forms blood brain barrier. when injury acts as phagocyte c) Ependemal cell- line ventricles brain- produce CSF 20-30mL/hr d) Micoglia-phagocyte C. CRANIAL NERVES I. II. III. IV. V. VI. Olfactory- smell Optic- vision Oculomotor- movement of eye and superior levator palpabre Trochlear- eve movement & superior oblique Trigeminal- sensation in face, biting, chewing, swallow Abducens-eye movement & lateral rectus NERVE GENERATION To maintain resting membrane potential (action potential), need energy (ATP) to pump Na+ out of cell (NA-K+ pump)ACTION POTENTIAL. Neurons release chemicals into synapse: Acetylcholine-activates muscle in PNS decrease seen in alzheimers, decreased receptors seen in myasthenia gravis Epinephrine & norepinephrine- fight or flight, speeds up physiologic respones Serotonin-mood, emotions, sleep, increased w/ schizophrenia Dopamine- emotions, mood, motor control, decreased w/ Parkinson's Gamma-aminobutyric acid (GABA)- regulates muscle tone Endorphins well being, analgesia (feel goods) - & enkephalins-regulate nocioception in body (noxious stimuli) Substance P- pain transmission-morphine blocks XII. XI. VII. VIII. IX. X. Facial-muscles of expression Vestibulocochlear- hearing Glossopharyngeal- tongue & taste Vagus- heart, lung, stomach, intestines Accessory- sternocleidomastoid, trapezius & other neck muscles Hypoglossal- tongue and buccinator


Cerebrum a) Frontal lobe- higher level fxn, intellectual fx, social appropriateness, creative thinking, long term memory, personality Brocas area- motor aspects speech- damage= can understand spoken word, but cant properly form words or produce speech--expressive(motor) aphasia- difficulty speaking & writing b) c) Parietal- sensory & spatial, interpretation of touch, pressure & pain as well as distinguish objects, shapes & sizespin prick test palm of hand or place object in hand w/ eyes closed Temporal-hearing, speech, behaviour & memory d) e) f) g) Wernicke's area- comprehension & recognition of written & spoken word, damage=sensory(receptive) aphasia speech & meanings not understood Occipital lobe- vision Hypothalamus- control autonomic nervous system, endocrine, motor controlmaintain homeostasis Thalamus-sensory perception & motor control, sleep-wake cycles Limbic system-primitive emotions & motivations for survivalanger, sex, eating


Brainstem- pons, midbrain, medulla respirations, vasomotor & cardiac fxns etc Cerebrum- coordination voluntary movement, posture, equilibrium & gait LUMBAR PUNCTURE- CSF analysis, med. Administration, assess spinal blocks etc. Contraindicated ICP & skin infection . For pressure readings, CSF analysis, medication

BEFORE: Informed consent Explain & reinforce HCP Note discomfort w/ injection, pain leg Void Assist into fetal position -checks for spinal blocks, decreasing mild-moderate ICP AFTER: Strict bed rest HOB flat 4-8hrs Neuro, neurovasc & VS Encourage fluids to decrease spinal headache Admin. Analgesics spinal headache

B. Before:

CEREBRAL ANGIOGRAPHY- illumination of cerebral arteries, injection dye into femoral artery, -dx aneurysm, arteriovenous malformations,

Assess allergy to iodine, shellfish, contrast media Reinforce procedure & informed consent Inform must remain still, head immobile, Burning & heat on injection NPO 8-12hrs Remove hairpins, jewellery, hearing aides etc Baseline VS, neuro, neurovasc Void Admin analgesics -occlusions, leaky blood, displacements After: Strict bed rest w/ affected leg extended until off bed rest Check for bleeding @ puncture site Check neurovasc, neuro, VS Maintain pressure dressing & ice Encourage fluids to help excrete dye C. CT SCAN- 3D imaging w/without dye Before: if using dye Check for allergies Explain procedure & informed consent Instruct remove hairpins, jewellery etc No food 4-6hrs prior (can have fluids) After: Assess delayed allergic rx. IV fluids -tumours, infarcts, hemorrhage, hydrocephalus, bone malformations D. ELECTROENCEPHALOPGRAPHY (EEG BEFORE: Explain procedure If for sleep deprived, instruct wake at 2-3a.m & stay awake for rest of night Avoid stimulants & depressants; anticonvulsants if D.O Monitor for seizures Shampoo hair before & after procedure records electrical activity of cerebral hemispheres on ambulatory basis



BEFORE: Informed consent Explain procedure Hard, cold surface, noisy, earplugs available, if claustrophobic sedative given Remove all metal clothing, jewellery etc. -enhanced when use Galladium (non-iodine), -Detects abnormalities of brain & spine, contraindicated in those with metal implants, pacemakers, pregnant, confused, agitated, tattoos, unstable VS, continuous life support F. ELECTROMYOGRAPHY BEFORE: May cause discomfort Some may need sedative AFTER: Comfort measure Inspect needle sites G. Dx neuromuscular, LMN, & peripheral nerve disorders -EMG lab/bedside electrode placed along nerve --test muscle potential, needle electrode inserted TRANSCRANIAL DOPPLER

Measures time needed for pulse travel specific depth & return to skulls surface