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Unformatted text preview: Neurological Diagnosis Chapter 5: Brain and Environs: Cranium, Ventricles, and Meninges • 3 Fossa (anterior, posterior, middle), 3 layers of meninges, 3 spaces tied to meninges (Epidural, subdural, subarachnoid) • CSF is filtered by ependymal cells out of blood. Ionically speaking CSF is close to blood plasma, plasma close to amniotic fluid which is closed to sea water • Ependymal cells filter blood and other ions out CSF • CSF functions: protection, reduces effect of gravity on brain by 20%, nutrient and waste exchange, chemical protection o Buffer for acid/base • CSF o Flow of CSF: starts in lateral ventricles then to third ventricle, then to fourth ventricle (in front of cerebellum), then drain out the sides to cover the skull and brain. At the bottom of fourth ventricle it goes through central canal and goes down to sacrum o Walking and pumping mechanism of sacrum moves it back up o Volume is 150 cc at about 20 cc per hour: takes 7 ½ hours to turn over CSF o Most are absorbed in arachnoid granulations where CSF is taken to sagittal sinus and introduced back into blood • Headaches o 784.0=ICD 9 Code o Common neurological symptom Benign: Tension headaches, not bad May be bad: Tumor o Brain has no nociceptors but all of blood vessels, meninges, periosteum do o Sensory nerves are V, IX, X, and C1-C3 o Vascular headaches Migraine (346.0): usually start in adolescent, young women and outgrown by 30, occurs unilaterally, light and sound make it worse, cure by sleeping off migraine, blood vessels get irritated • Classic: presence of an aura, jagged lines in vision as part of aura, a feeling of uneasiness or nausea that precedes the migraine, last 2-4 hours to 24 hours • Complicated: involves a transient neurological deficit in addition to the classic presentation (numbness or tingling, vision loss on side of migraine, paralysis on one side) • Atypical: pain in blood vessels, vision gets wavy because ophthalmic artery is affected Cluster: middle-aged men, brought on by alcohol and stress, pain is unilateral and deep, boring behind the eye, timeframe is in minutes usually 15-20 minutes • Headaches comes on 3-4 times per day for several days and weeks • These headaches are sporadic in nature: occur for a period of time and then disappear for a long time and then come back • Produce a lot of tearing out of the eye if the pain is behind the eye o Tension headache: cervicogenic, subluxation induced headache Hat band Timing: years Due to misalignment in cervical area and causes pulling of vertebra from muscle o Others Acute trauma Hemorrhage: result of trauma Infarct and Artery dissection: Stroke Venous thrombosis Hydrocephalus Low CSF pressure Toxic and metabolic Meningitis and Abscess: infections Tumor Disorders of the eyes, scalp: because of sensory CN 5, 9, 10, sinus o Other causes of headache Headache with neck stiffness and fever is suggestive of meningitis...
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- Winter '11
- Corticospinal tract, lower motor neuron