Neuro Block 3-Pt 3

ptheodore's version from 2015-07-30 12:08


Question Answer
Visceral pain sensations to the spinal cord likely interact with somatic pain systems within second order neurons in theNucleus gracilis
Immediate sensations painAcute Pain
Persists beyond the point of tissue damage.Chronic non-malignant
Type 3 – myelinated A delta neuronsFast pain
Pain Fibers receptorsFree Nerve endings
Unmyelinated Type 4 - C FibersSlow Pain
Suppression of pain stimuliEnkephalins/Endorphins
Substance P, CGRP, Bradykinins, Histamine, Prostaglandins, Serotonin, Potassium (K+), NeurokininsTransmission of pain stimuli
Neospinothalamic tract forFast pain is A fibers.
Paleospinothalamic tract forSlow pain is C fibers.
Substance P and CGRP act on ____ to release histamine, which further stimulates pain endings.Mast cells
Pain transmission is viaSpinothalamic or trigeminal systems.
Pain suppression is theEndogenous opiate system
The _____ sends axons to the raphe, raphe axons descend into the spinal cord to Presynaptically inhibit pain Transmission in the dorsal horn.Peri aquaductal grey (PAG)
C fibers keep the ‘gate’ ___, while activation of A fibers ____ it.Open, Closes
Sensation from back of head is supplied byC2/C3
Pain sensation from the tip of the ear is supplied byAuricular branch of CN X
Concerned with localization of pain.S1: Primary somatosensory
Concerned with ‘affective’ perception of pain.SII, Cingulate gyrus, insula
Osteoarthritis; joint degeneration, if Specific to cord can be calledSpondylosis
Vertebral defects born wt. i.e; gymnastSpondylolysis
Cauda Equina Syndrome starts at which levelL2 & below
Paralysis, sensory loss, parasthesia, loss of bladder control, saddle anesthesia, sexual dysfunctionCauda Equina Syndrome
Diaphragm pain is referred toC3-C4
Heart pain is referred toT1-T8
Appendix pain is referred toT10
Testes, prostate, ovaries, uterus pain is referred toT10-T12
Increased pain sensitivity (Sunburn).Hyperalgesia
Pain from stimuli that would not ordinarily be painful (Washing face, light breeze).Allodynia
Suffering, Sleeplessness, SadnessChronic Pain
Activation of pain receptorsNociceptive
Cause vaso constriction in the sinus area and this is what causes the head acheSinus headaches – brain freeze
A set of symptoms that occur prior to the migraine.Auras
Subtle symptoms occuring 1-2 days before the migraine attack; constipation, depression, drowsiness, diarrhea, food cravings, excitability or irritability.Prodrome
Coital Cephalgia A.K.ACoital migraines
Tender scalp and pain with chewing are common symptoms. Inflammation of medium/large blood vessels. Loss of vision most serious potential complication.Temporal arteritis
Known as Giant Cell Arteritis (if it also affects neck, shoulders and even upper arms).Temporal arteritis
Typically occur over one eye, in ‘groups’ of headaches. Same location usually at the same time every day, occurring for days or weeks. Drooping eyelid, running nose, red eye are common symptoms. Walking around helps more than lying downCluster headaches
Similar to cluster headaches, but much higher frequency of attacks, shorter duration, and (most important) always responds to the NSAID Indometacin.Hemicranium continua
Account for almost 90% of all headaches. Caused by stress, fatigue, dehydration, poor posture (i.e. studying positions), hunger or eyestrain. Episodic type treated with analgesics (aspirin, ibuprofen), whereas antidepressants (TCA, SSRI) are used with chronic type.Tension headaches
Abrupt and ‘exact’ onset (80% of patients can tell you the exact time/date the headache started). Never goes away. No previous headache history.New Onset Persistent Daily headache
Burning pain and hypersensitivity to temperature in affected areas, resulting from trauma or nerve damage. Also known as Reflex Sympathetic Dystrophy. At one time called causalgia.Complex regional pain syndrome
Pain affecting contralateral side of body. Occurs after the initial infarct/damage to thalamus. numbness first, then pain. Allodynia and dysaesthesia (Dysaesthesia: pain from thalamic lesion).Thalamic Pain Syndrome (Dejerine-Roussy Syndrome)
Patients may have burning pain, that often occurs in unusual locations (groin,anus, pelvis, mouth for example).Parkinson Disease

Treatment of Pain

Question Answer
Anti-inflammatory, antipyretic, anti-clotting. Blocks production of prostaglandins, leukotrienes, and thromboxanes. NSAID.Aspirin
Reye's Syndrome, GI irritation and bleeding, ulcersSide effect of Aspirin
Aspirin, acetaminophen, ibuprofen.Analgesics
Occurs in children taking aspirin with a viral condition (i.e. chickenpox). Symptoms include fatty liver disease and encephalopathy. Can be fatal.Reye's Syndrome
An NSAID. Potential GI issues, don’t take with MAO-I’s.Naproxen (Aleve)
An NSAID. Potential GI issues.Ibuprofen (Advil, Motrin)
Not an NSAID. Side effects could include hepatic toxicity.Acetaminophen (Tylenol)
COX-2 inhibitors: ‘Super-aspirins’ i.e.Celebrex
Inhibit cyclo-oxygenase enzymes (COX-1 and COX-2, which convert arachidonic acid into prostaglandins).Non-steroidal anti-inflammatory drugs (NSAIDs)
Block production of arachidonic acid. Strong anti-inflammatory. Side effects: Numerous, including osteoporosis, immunosuppression, growth retardation, etc.Corticosteroids
May be effective if analgesics are not, for neuropathic pain. Targets Cingulate Gyrus. Side effects: Fatigue, constipation, blurred visionAntidepressants
Cause sedation along with pain relief. Side effects: Tolerance and withdrawal symptoms may occur. (Not to be confused with addiction).Opiates
Tramadol, codeine phosphateMild opioids
Oxycodone, morphineStrong opioids
Injection of a current locally to reduce painTransdermal Electromechanical Nerve Stimulation (TENS)
Administration of small quantities of meds to spinal fluid (similar to the epidural given during labor). Typically done in patients who have lots of side effects to high dose oral medicationsIntrathecal pump
Uses high frequency AC current to thermally lesion a tumor, etc.Radiofrequency lesion/ablation
Using small electric currents specifically targeted to problem areas. Neuromodulation
Always responds to the NSAID Indometacin.Hemicranium Continua

Vestibular System

Question Answer
Type of balance that maintains the head position relative to gravity (acceleration /deceleration, linear)Static
Type of balance that maintains the head position in response to movements (rotation)Dynamic
Type of equilibrium that uses the semi-cricular canalsDynamic
The ampulla of the vestibular system sensesRotation
Located inside the saccule and utricle and senses static balanceMaculae
Utricle is sensitive to a change inHorizontal Movement
The saccule gives information aboutVertical acceleration
If the eyes are showing movements when they aren’t tracking anything, this is bad and indicatesBrainstem or Cerebellar damage
Eyes move equally in each direction.Pendular nystagmus
Fast movement in one direction followed by slow return movement.Jerk nystagmus
Tilt a comatose patient’s head in one direction; if eyes move in opposite direction, brainstem is ____. If the eyes move with the head movement, indicates ____ damage.Intact, brainstem
COWS Cool Opposite, Warm Same (Caloric Test)
In normal persons, cool/cold will result in nystagmus with a fast phase directed to theOpposite side
In normal persons, warm will result in nystagmus with a fast phase directed towards theSame side
The saccule, utricle, and semicircular ducts are considered theVestibular apparatus
___ cells in the ____ respond to tilting of the head as well as linear acceleration/decelerationHair, maculae
The christa and CN8 are located in theAmpulla