60 Questions
What physiologic change is most likely to lead to an increase in intracranial pressure?
Cerebral vasodilation
What is the primary cause of manifestations of acute brain ischemia (Cushing reflex)?
Sympathetic nervous system activation
What triggers vasodilation, increased capillary pressure, and increased edema in the brain?
Cerebral hypoxia
What is the effect of an extreme increase in intracranial pressure on the sympathetic nervous system?
Activation
What is the term for the intense reaction by the sympathetic nervous system to an extreme increase in intracranial pressure?
Cushing reflex
What is the result of compression of vessels in the brain due to fluid collection?
Inadequate blood and oxygen perfusion
What is the primary cause of increased edema in the brain?
Cerebral hypoxia
What is the term for the process whereby fluid collection in the brain leads to compression of vessels?
Cerebral edema
What is the effect of an extreme increase in intracranial pressure on cerebral perfusion?
Decreased perfusion
What is the term for the process initiated by fluid collection in the brain leading to compression of vessels, triggering a series of physiologic changes?
Edema cascade
What is the most frequent cause of cerebral aneurysm?
Subarachnoid hemorrhage
What is commonly associated with leakage of cerebrospinal fluid from the nose or ears?
Basilar skull fracture
What symptom is typically reported by a patient before the rupture of a cerebral aneurysm?
Sudden, severe headache
Why is volume expansion and blood pressure support necessary in managing subarachnoid hemorrhage?
Cerebral vasospasm
What is the typical focus of treatment in the acute phase of stroke?
Treatment of cerebral aneurysm
What is not a typical consideration in the acute phase of stroke?
Neurologic rehabilitation
What is the usual cause of embolic stroke?
Cardiac source
What is the most common cause of subdural hematomas?
Trauma
What is the cause of meningitis?
Microbial invasion of the CNS
What is a symptom not associated with rupture of a cerebral aneurysm?
Ringing in the ears
Which statement about Cushing reflex is correct?
It is a last attempt by the brain to restore cerebral perfusion, not indicative of loss of brainstem reflexes
What does decorticate posturing indicate?
Poor neurologic functioning
What can result from acceleration-deceleration movements of the head?
Polar injuries in two opposite poles of the brain
What is the cause of secondary injury after head trauma?
The body's response to tissue damage
What is an inappropriate treatment for head trauma?
Hypoventilation
What is a risk factor for hemorrhagic stroke?
Acute hypertension
Which type of stroke has the highest morbidity and mortality among stroke etiologies?
Intracerebral hemorrhage
What are the clinical manifestations of a stroke in the right cerebral hemisphere?
Left-sided muscle weakness and neglect
What is the most important preventive measure for hemorrhagic stroke?
Blood pressure control
What is the focus of treatment in the acute phase of stroke?
Stabilization of respiratory and cardiovascular function
Which of the following is a common complication that must be monitored and managed in patients experiencing subarachnoid hemorrhage?
Cerebral vasospasm
What combination of symptoms is most consistent with meningitis?
Headache, fever, stiff neck, and signs of confusion
How is vasospasm managed in patients experiencing subarachnoid hemorrhage?
By keeping blood volume and blood pressure at normal to high levels
Which condition is characterized by fever, headache, and confusion that evolve over several days?
Encephalitis
What is the primary cause of manifestations of acute brain ischemia (Cushing reflex)?
Hypotension
What is the usual cause of embolic stroke?
Atrial fibrillation
What is the most frequent cause of cerebral aneurysm?
Genetic predisposition
What can result from acceleration-deceleration movements of the head?
Coup-contrecoup injury
What is the term for the process initiated by fluid collection in the brain leading to compression of vessels, triggering a series of physiologic changes?
Cerebral edema
What is the effect of an extreme increase in intracranial pressure on cerebral perfusion?
Decreased cerebral perfusion
What GCS level is considered to be normal?
15
What occurs when a brainstem-impaired patient exhibits a persistent rhythmic or jerky movement in one or both eyes?
Nystagmus
Which condition is characterized by eyes not moving together in the same direction?
Dysconjugate movement
What is the primary cause of acute brain injury?
Brain trauma
Which condition is a cause of acute brain injury?
Brain hemorrhage
Which condition progresses rapidly and is an acute cause of brain injury?
Central nervous system infections
What is the doll’s-eyes test used to assess?
Brainstem integrity
Which cranial nerve dysfunction results in impaired eye muscle movements in one or more directions?
Oculomotor nerve
What is the term for the condition where the eyes turn in a direction opposite to the direction of head rotation?
Doll’s eye response
Which condition is characterized by persistent rhythmic or jerky movement in one or both eyes?
Nystagmus
What is the usual cause of encephalitis?
Viral infection in brain cells
Where is epidural bleeding located?
Between the arachnoid and the dura mater
What is the most important determinant for prescribing therapy for acute stroke?
Whether it is ischemic or hemorrhagic in cause
What is the normal range of intracranial pressure?
0 to 15 mm Hg
When does cytotoxic edema occur?
When there is a decrease in cellular energy
What is a severe complication of elevated intracranial pressure?
Brain herniation
What is the purpose of the Glasgow Coma Scale (GCS)?
To assess the level of consciousness in acutely brain-injured patients
What is the significance of a sluggish pupil response to light?
Indicates increased intracranial pressure
What does a Glasgow Coma Scale (GCS) level of 3 indicate?
Likely fatal damage
What does a GCS level of 8 indicate?
Severe damage
Study Notes
Pathophysiology of Head Trauma and Stroke
- Cushing reflex is a last attempt by the brain to restore cerebral perfusion, not indicative of loss of brainstem reflexes
- Decorticate posturing indicates poor neurologic functioning
- Acceleration-deceleration movements of the head can result in polar injuries in two opposite poles of the brain
- Secondary injury after head trauma is a result of the body's response to tissue damage
- Inappropriate treatment for head trauma includes hypoventilation
- Risk factors for hemorrhagic stroke include acute hypertension
- Intracerebral hemorrhage has the highest morbidity and mortality among stroke etiologies
- Clinical manifestations of a stroke in the right cerebral hemisphere include left-sided muscle weakness and neglect
- Blood pressure control is the most important preventive measure for hemorrhagic stroke
- In the acute phase of stroke, treatment focuses on stabilization of respiratory and cardiovascular function
- Intracerebral hemorrhage carries a 38% mortality rate, with death usually occurring within minutes to hours
- Aphasia is an integrative language disorder that occurs with brain damage to the dominant cerebral hemisphere
Neurological Disorders and Pathophysiology Key Points
- Encephalitis is usually caused by viral infection in brain cells, and it accounts for the majority of encephalitis cases.
- Death occurs in 5% to 20% of encephalitis cases.
- Epidural bleeding is located between the arachnoid and the dura mater, and it is characterized by a lucid interval immediately after injury.
- The most important determinant for prescribing therapy for acute stroke is whether it is ischemic or hemorrhagic in cause.
- Intracranial pressure normally ranges from 0 to 15 mm Hg.
- Cytotoxic edema occurs when ischemic tissue swells due to cellular energy failure.
- A severe complication of elevated intracranial pressure is brain herniation, which is associated with rapid neurologic demise unless corrected quickly.
- The Glasgow Coma Scale (GCS) is used to assess the level of consciousness in acutely brain-injured patients.
- The first indication of brain compression from increasing intracranial pressure may be a sluggish pupil response to light.
- On the Glasgow Coma Scale, the lowest total score of 3 indicates likely fatal damage.
- A GCS level of 8 indicates severe damage, and a level of 12 or higher indicates mild damage.
- A GCS level of 3 indicates likely fatal damage, especially if both pupils fail to respond to light and oculovestibular responses are absent.
Test your knowledge of the pathophysiology of head trauma and stroke with this quiz. Explore concepts such as Cushing reflex, posturing, polar injuries, secondary injury, hemorrhagic stroke risk factors, clinical manifestations, and preventive measures.
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