The Nervous System Review and Neurologic DysfunctionN 331

Functional Organization of the Brain and Spinal Cord•4 major brain regions

▫Cerebrum▫Diencephalon▫Cerebellum▫Brain stem

Pons Medulla Midbrain

Functions of the Diencephalon, Cerebellum, and Brainstem

•These 3 form the more primitive areas of the brain.

Meninges

Blood supply to the brain• Brain receives 20% of

cardiac output or 800 -1000ml of blood per minute

Circle of Willis – serves as collateral flow

12 Cranial Nerves

Alterations in Nervous System Functioning

Manifestations of Global Brain Injury

Consciousness Alterations in Neuro

Function

Consciousness

Alterations in neurologic function

•Level of Consciousness•Breathing Patterns•Vomiting •Pupillary Changes •Oculomotor Responses •Motor Responses

Glasgow Coma Scale Eye Opening  

Spontaneous 4

To loud voice 3

To pain 2

None 1

 

Verbal Response  

Oriented 5

Confused, Disoriented 4

Inappropriate words 3

Incomprehensible words 2

None 1

 

Motor Response  

Obeys commands 6

Localizes pain 5

Withdraws from pain 4

Abnormal flexion posturing 3

Extensor posturing 2

None 1

Breathing patterns

Cheyne-Stokes Respirations

https://www.youtube.com/watch?v=zrcXQhFK6ro

Brain stem damage

•Irregular and unpredictable breathing patterns

https://www.youtube.com/watch?v=FpKdq-_ZvsI

Vomiting

Pupillary Changes & Oculomotor Responses

Motor Responses

•Posturing ▫Decorticate

Brain stem intact, loss of cerebral cortex functioning

▫Decerebrate May indicate more

serious damage and results from disruption of higher brain centers and the brainstem.

Alteration in Intracranial Pressure

Measuring ICP

Neurologic DeathCerebral death Brain deathPersistent vegetative state

Traumatic Head & Spine Injuries

Scalp lacerations

Head Injuries

• Closed vs Open

Traumatic Brain Injury Major Head Trauma

Concussion

Contusion

Coup/Contrecoup

Protective Coverings of Brain

Epidural hematoma

Subdural hematoma

Diffuse Axonal Injury

Shaken Baby Syndrome

Spinal Cord Trauma

Complete cord involvement

Paralysis

Partial cord involvement

Spinal shock

Low Back Pain

Aneurysm & AV Malformation

Subarachnoid hemorhhage

CVA

A Stroke is an Emergency act: - Face

▫ Ask the person to smile. Does one side droop?

– Arms▫ Ask person to raise both arms. Does one drift

downward? Is one arm weak or numb?

– Speech▫ Ask person to repeat a simple sentence. Is speech

slurred.

– Tongue▫ Stick out tongue, Does it deviate from midline?

F

A

ST

Ischemic StrokeThrombolytic vs Embolytic

Visual Deficits

Intracranial Infections/Neoplasms

One of the physically demonstrable symptoms of meningitis is Brudzinski's sign. Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed.

One of the physically demonstrable symptoms of meningitis is Kernig's sign. Severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees.

Encephalitis

Abscess & Neoplasms

Seizures

Tonic Clonic Seizures

Nerve Conduction Disorders

Muscle toneHypotonia and Hypertonia

Muscle movement Hypokinesia and Hyperkinesia

Muscular Dystrophy• Normal skeletal muscle • Muscular Dystrophy

Deposition of collagenous scar tissue (RED)

Myasthenia Gravis

Multiple Sclerosis

Amotrophic Lateral Sclerosis

ALS

Cerebral Palsy