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This Concept Map, created with IHMC CmapTools, has information related to: CNS I, Central Nervous System I Cerebrovascular Dzs -O2 is limiting factor, not metabolic needs Cerebral AD Arteriopathy w/ Subcortical Infarcts and Leukoencephalopathy (CADASIL)-chrom 19q12-Notch3 gene -recurrent strokes, dementia -ABNL white matter, subarachnoid aa. -Sweden, France, Central Nervous System I Trauma Parenchymal: CONCUSSION - instant transient neuro dysfcn -lose consciousness -temp resp arrest -loss of reflexes -complete recovery but amnesia -many postconcussive syndromes -some->death, Central Nervous System I Brain Injury PERINATAL Cerebral Palsy-nonprogressive -neurologic motor deficit -spasticity, dystonia, paresis ataxia/athetosis -prenatal or perinatal -can be due to hemorr, infarct Intraparenchymal Hemorrhage -inc'd risk in PREMIES -w/in germinal matrix -thal/caudate nucleus jcn, Central Nervous System I Trauma DIFFUSE AXONAL INJURY -axonal swellings -via angular accel alon -no impact required -integrity dmged at Ranvier -w/in hrs of injury -heal much later -in 50% of those w/ coma after trauma, Central Nervous System I Malformations Developmental Dzs SYRINGOMYELIA -fluid-filled cleftlike cavity in inner portion of cord -anomalies of sp column common -90% have Chiari I malformation Syringobulbia if extends to bulb ->progressive loss of UL P/T sens -retain position sense -in 10s-20s yo, Central Nervous System I Hypertensive Cerebrovasc Dz HTN ENCEPHALOPATHY -diffuse cerebral dysfcn -HA, confusion, vomiting, convulsions, coma poss Tx-MUST REDUCE ICP Vascular Multi-Infarct Dementia -caused by: -cerebral atherosclerosis -vessel thrombosis, embolization -OR cerebral arteriolar sclerosis Multiple gray matter infarcts ->dementia, gait ABNL, pseudobulbar signs, focal deficits Binswanger Dz-if mostly white matter, Central Nervous System I Cerebrovascular Dzs -O2 is limiting factor, not metabolic needs SUBARACHNOID HEMORRHAGE -via rupture berry aneurysm -traumatic hematoma extension -HTN hemorrhage into ventricle Pathogenesis -risk of vasospastic injury (other vessels, not ruptured) ->more injury, esp basal -due to Endothelin-1->adventitia -also can->scar->obstruct CSF flow, Central Nervous System I Traumatic Vascular Injury SPAT-APOPLEXIE -delayed post-traumatic hemorrh -sudden deep intracerebral at 1-2 wks after minor trauma, Central Nervous System I Brain Injury SPINAL CORD TRAUMA -above C-4->resp compromise -cervical lesions-quadriplegia -thoracic lesions-paraplegia ->hemorrhage, necrosis, axonal swelling ->becomes cystic, gliotic ->Wallerian degeneration in tracts above and below, HYDROMYELIA -expansion or central canal of cord Mostly cervical cord -surrounded by gliosis ->compression of nn SYRINGOMYELIA -fluid-filled cleftlike cavity in inner portion of cord -anomalies of sp column common -90% have Chiari I malformation Syringobulbia if extends to bulb ->progressive loss of UL P/T sens -retain position sense -in 10s-20s yo, Central Nervous System I Brain Injury SEQUELAE OF TRAUMA -Post-traumatic hydrocephalus -obstruct CSF resorption after hemorr into SAS -Post-traumatic dementia -Punch-drunk syndrome (DEMENTIA PUGILISTICA) -after repeated trauma -hydrocephalus, thinned CC, diffuse axonal injury, plaques, tangles (like AD), -Post-traumatic epilepsy -Brain tumors (meningiomas) -Infx dzs -Psychiatric d/os, Central Nervous System I Traumatic Vascular Injury SUBARACHNOID HEMORRHAGE INTRAPARENCHYMAL HEMORRHAGE -most often w/ trauma w/ superficial contusions/lacerations, Central Nervous System I Traumatic Vascular Injury EPIDURAL HEMATOMA -middle meningeal aa. -Fx to temporal bone -FAST Tx-prompt drainage, Central Nervous System I Cerebrovascular Dzs -O2 is limiting factor, not metabolic needs INTRACEREBRAL HEMORRHAGE (INTRAPARENCHYMAL) -peak at 60yo -mostly rupture of small vessel -HTN most common underlying Chronic HTN->CHARCOT-BOUCHARD microaneurysms->rupture -small vessels, esp in basal ganglia LOBAR HEMORRHAGES -hemorrhagic diatheses, neoplasms, infx, noninfx vasculitis, amyloid (congophilic) angiopathy, Central Nervous System I Trauma SKULL FRACTURES 'diastatic'-if crossing fused suture 'displaced'-if bone into cavity Awake-fall on occiput Pass out-frontal Basal Fx-usually from occiput or side impact ->lower CN Sx ->orbital, mastoid hemorrhage ->CSF discharge from nose, ear ->infx (meningitis), Central Nervous System I ICP CEREBRAL EDEMA Vasogenic Cytotoxic MORPH-flattened gyri narrowed sulci can->herniation, Central Nervous System I Traumatic Vascular Injury SUBDURAL HEMATOMA -bridging vv. -due to brain displacement -worse in elderly-brain atrophy -longer bridging vv. -manifest w/in 48 hrs -bilateral in 10% CLINICAL-HA, confusion, slow deterioration MORPH-clotted blood at 1 wk ->fibs from dura into hematoma (2wks) ->develop hyalinized CT (1-3mos) (subdural membranes) -with retraction-CHRONIC SDH -risk of rebleeding Tx-remove gran tissue, organized blood, Central Nervous System I Malformations Developmental Dzs NEURAL TUBE DEFECTS Anencephaly-ant. neural tube -no brain or calvarium Encephalocele Spinal dysraphism=Spina bifida Spina Bifida Occulta Myelomeningocele-w/ cord Meningocele -can -> lower limb problems, bladder, bowel problems Risk fx-FOLATE DEFICIENCY, Central Nervous System I Cerebrovascular Dzs -O2 is limiting factor, not metabolic needs HYPOTN, HYPOPERFUSION, LOW-FLOW STATES ->GLOBAL CEREBRAL ISCHEMIA -diffuse hypoxic/ischemic encephalopathy -neurons most sensitive>glial -can->persistent veg state or death -can->autolysis to mush MORPH-swollen brain, wide gyri Early-12-24 hrs-red neurons, glia Subacute-1d-2wks-necrosis, macs, reactive gliosis Repair ɮwks-remove all necrosis, gliosis ->pseudolaminar necrosis -some layers spared WATERSHED INFARCTS -often after hypoTN episodes, Central Nervous System I Cerebrovascular Dzs -O2 is limiting factor, not metabolic needs INCOMPLETE INFARCTION -neuron necrosis but supporting structure still intact SPINAL CORD INFARCTION -mostly from tributaries from Ao, not ant. spinal a.