Module 6: Neurological and Neurovascular

Question 1

What does the somatic nervous system control?

Answer 1

associated with voluntary control of body movements

Question 2

What does the autonomic nervous system control? What are the 2 divisions and what are they responsible for?

Answer 2

• Autonomic nervous system (ANS) controls visceral functions which occur below the level of consciousness.

• sympathetic nervous system (SNS).
• prepares the body for intense physical activity (fight-or-flight)
• parasympathetic nervous system (PSNS)
• has the exact opposite effect and relaxes the body and inhibits or slows many high energy functions

Question 3

what are the components of the GCS

Answer 3

Eye response
Verbal response
Motor response

The lowest possible GCS (the sum) is 3 (deep coma or death), while the highest is 15 (fully awake person).

Question 4

what are the components of the AVPU assessment

Answer 4

A: alert
V: voice
P: pain
U: unresponsive

Question 5

What 3 responses are the pupils measured for?

Answer 5

1) Size
2) reaction to light
3) Symmetry (consistency in both eyes)

Question 6

In limb responses, what is decorticate posturing and what does it look like?

Answer 6

• Decorticate (flexor) posturing is seen when there is involvement of a cerebral hemisphere and the brain stem.
* stiff with bent arms to hold the hands on the chest, clenched fists, and legs held out straight

Question 7

In limb responses, what is decerebrate posturing and what does it look like?

Answer 7

• Decerebrate (extensor) is seen in severe metabolic disturbance or upper brainstem lesions.
* arms and legs held straight out, toes pointed downward, and the head and neck being arched backward.

Question 8

Outline 3 types of altered cognition

Answer 8

• Coma - unresponsiveness in which the patient cannot be roused by verbal and physical stimuli
• Stupor - unconsciousness from which the patient can be awakened to produce inadequate responses to verbal and physical stimuli
• Somnolence - unconsciousness from which the patient can be fully wakened

Question 9

what are the 5 radiological studies that can be conducted on the brain?

Answer 9

• Computer tomography (CT)
• Magnetic resonance imaging (MRI)
• Cerebral angiography
• Central perfusion imaging
• Intracranial pressure (ICP) monitoring

Question 10

What is the definition of post-traumatic amnesia scale?

what are the timeframes and outcomes of this scale?

Answer 10

• PTA is defined as the “time elapsed from injury until recovery or full consciousness, and return of ongoing memory”

• 1 – 4 hours = mild brain injury
• < day = moderate brain injury
• 2 – 7 days = severe brain injury
• 1 – 4 weeks = very severe brain injury
• 1 – 6 months = extremely severe brain injury

Question 11

what is the definition of a seizure?

Answer 11

• Uninhibited abrupt discharge of ions from a group of neurons, resulting in epileptic activity

> Due to: 
• Vascular 
• Infectious 
• Neoplastic 
• Traumatic 
• Degenerative 
• Metabolic 
• Toxic 
• idiopathic causes

Question 12

Name the 2 types of cerebral oedema

Answer 12

Cerebral oedema is caused by an increase in brain water content
– Intracellular (cytotoxic) = cellular swelling in grey matter, usually after cardiac arrest or minor head injury – Extracellular (vasogenic) = capillary permeability is increased (BBB breakdown).

Question 13

What is hydrocephalus?

Answer 13

• Imbalance between formation and drainage of cerebrospinal fluid
• Blockage of ventricular drainage passages
• May be cause by congenital brain defects, haemorrhage, CNS infection and tumours
• Symptoms of dementia, gait abnormalities and incontinence

Question 14

What is intracranial hypertension?

Answer 14

• Pressure exerted by the contents of the brain within the confines of the skull and BBB
• Measured by ICP measurements

Question 15

What is the Monroe-Kelly hypothesis?

Answer 15

• Monroe-Kelly hypothesis – Blood, brain matter and CSF – If there is an increase in one, there must be an auto-regulated decrease in one or both of the others

Question 16

what is the management of cerebral oedema?

Answer 16

• Identification of cause 
• Hyperventilation 
• Osmotherapy 
• Normothermia •
 Corticosteroids 
• Barbiturates and sedatives
* Surgery

Question 17

What is a stroke and explain the 2 different types

Answer 17

Stroke is defined as an interruption of the blood supply to any part of the brain, resulting in damaged brain tissue
– Ischaemic (clot)
– Haemorrhagic (burst blood vessel)

Question 18

What is the difference between meningitis and encephalitis?

Answer 18

Infections which affect the meninges (meningitis) and those which affect the brain parenchyma (encephalitis) may be viral or bacterial in aetiology

Question 19

What is Guillian-Barre Syndrome?

Answer 19

Immune mediated disorder:
results from generation of autoimmune antibodies and/or inflammatory cells which cross reacts with epitopes on peripheral nerves, leading to demyelination or axonal damage or both.