1.

Cerebrum largest - Connects R & L cerebral hemisphere

- Corpus collusum
Rt cerebral hemisphere, Lt cerebral hemisphere
Function:
1 Sensory
2 Motor
3 Integrative
Lobes
1.) Frontal
a. Controls motor activity
b. Controls personality development
c. Where primitive reflexes are inhibited
d. Site of development of sense of umor
e. Broccas area speech center
Damage - expressive aphasia
2.) Temporal
a. Hearing
b. Short term memory
c. Wernickes area gen interpretative or knowing Gnostic area
Damage receptive aphasia
3.) Parietal lobe appreciation & discrimation of sensory imp
- Pain, touch, pressure, heat & cold
4.) Occipital - vision
5.) Insula/island of reil/ Central lobe- controls visceral fx
Function: - activities of internal organ
6.) Rhinencephalon/ Limbec
- Smell, libido, long-term memory

Basal Ganglia areas of gray matte located deep within a cerebral hemisphere
- Extra pyramidal tract
- Releases dopamine-
- Controls gross voluntary unit

Decrease dopamine (Parkinsons) pin rolling of extremities & Huntingtons Dse.

Decrease acetylcholine Myasthenia Gravis & Alzheimers
Increased neurotransmitter = psychiatric disorder Increase dopamine schizo
Increase acetylcholine bipolar

MID BRAIN relay station for sight & hearing

Controls size & reaction of pupil 2 3 mm
Controls hearing acuity
CN 3 4
Isocoria normal size (equal)
Anisocoria uneven size damage to mid brain
PERRLA normal reaction

DIENCEPHALON- between brain

Thalamus acts as a relay station for sensation
Hypothalamus (thermoregulating center of temp, sleep & wakefulness, thirst, appetite/ satiety center,
emotional responses, controls pituitary function.

BRAIN STEM- a. Pons or pneumotaxic center controls respiration

Cranial 5 8 CNS

MEDULLA OBLONGATA- controls heart rate, respiratory rate, swallowing, vomiting, hiccups/ singutus
Vasomotor center, spinal decuissation termination, CN 9, 10, 11, 12
CEREBELLUM lesser brain
- Controls posture, gait, balance, equilibrium

Cerebellar Tests:
a.) R Rombergs test- needs 2 RNs to assist
- Normal anatomical position 5 10 min
(+) Rombergs test (+) ataxia or unsteady gait or drunken like movement with loss of balance.
b.) Finger to nose test
(+) To FTNT dymetria inability to stop a movement at a desired point
c.) Alternate pronation & supination
Palm up & down . (+) To alternate pronation & supination or damage to cerebellum dymentrium

Composition of brain - based on Monroe Kellie Hypothesis

- Skull is a closed container. Any alteration in 1 of 3 intracranial components = increase in ICP

Normal ICP 0 15 mmHg

Foramen Magnum
C1 atlas
C2 axis

(+) Projectile vomiting = increase ICP

Observe for 24 - 48 hrs
CSF cushions the brain, shock absorber
Obstruction of flow of CSF = increase ICP
Hydrocephalus posteriorly due to closure of posterior fontanel
CVA partial/ total obstruction of blood supply

INCREASED ICP increase ICP is due to increase in 1 of the Intra Cranial components.
Predisposing factors:
1 Head injury
2 Tumor
3 Localized abscess
4 Hemorrhage (stroke)
5 Cerebral edema
6 Hydrocephalus
7 Inflammatory conditions - Meningitis, encephalitis

B. S&Sx change in VS = always late symptoms

Earliest Sx:
a.) Change or decrease LOC Restlessness to confusion Wide pulse pressure: Increased ICP
- Disorientation to lethargy Narrow pp: Cardiac disorder, shock
- Stupor to coma
Late sign change in V/S
1 BP increase (systolic increase, diastole- same)
2 Widening pulse pressure
Normal adult BP 120/80 120 80 = 40 (normal pulse pressure)
Increase ICP = BP 140/80 = 140 80= 60 PP (wide)
3 RR is decreased (Cheyne-Stokes = bet period of apnea or hyperpnea with periods of apnea)
4 Temp increase
Increased ICP: Increase BP Shock decrease BP
Decrease HR Increase HR CUSHINGS EFFECT
Decrease RR Increase RR
Increase Temp Decrease temp
b.) Headache
 Projectile vomiting
Papilledima (edema of optic disk outer surface of retina)
Decorticate (abnormal flexion) = Damage to cortico spinal tract /
Decerebrate (abnormal extension) = Damage to upper brain stem-pons/

c.) Uncal herniation unilateral dilation of pupil. (Bilateral dilation of pupil tentorial herniation.)
d.) Possible seizure.