• Neuro Lecture  Stretching, inflammatory process of

• Exam - GI-->Renal the viscera, peritonitus, pleuritis.

• Pain ○ referred pain:
○ Pathway for fast pain transmission: moves • pain perceived at a site different from
from pain receptor to spinal cord over where it originates.
myelinated fibers and up the  Angina, kidney stones.
neospinothalamic tract to the thalamus
○ Pathway for slow continuous pain (achy,
chronic) travel over unmyelinated fibers to
the spinal cord and up the slower-
conducting paleospinothalamic tract.
• Processing pain (from thalamus to:)
○ sematosensory cortex: pain is perceived
and interpreted
○ limbic system: emotional part of pain
experienced
• Learned response (what perceive the
pain should be).
○ brain stem: ANS response
• BP up, R up, P up, etc.
• Types of Pain
○ cutaneous pain:
• sharp, burning pain from the skin or ○ Acute pain
subcutaneous tissues • Symptomatic ANS signs lasting
• Injections (GO FAST! Less painful) throughout, under 6 months. Anxiety
○ deep pain: ○ Chronic pain
• more diffuse and throbbing pain that • Initially VS change, but overtime ANS
comes from the bones, muscles, response lessens.
tendons and radiates to the tissues • More psychological effects. Decreased
○ visceral pain: sleep, sex drive, etc.
• diffuse, poorly defined, results from • Injury doesn't heal well.
stretching, distention or ischemia -- • Lower back pain
>develops to referred pain. • Sleep Stages
 ○ Non-Rapid Eye Movement: relatively ○ Related to release of Melatonin (effected by
inactive brain but fully movable body. 4 exposure to sunlight):
stages: (Can dream a little, not as vividly) • hormone produced by the pineal gland.
• Stage 1: onset of sleep, easily aroused, Receptors in hypothalamus-->helps
brief transitional stage (1-7 minutes) regulate sleep-wake cycle.
• Stage 2: deeper sleep (10 to 25 • Night shift, better to stay awake a few
minutes) hours after going home then sleep.
• Stage 3: deep sleep, lasts a few • Case Study
minutes, transitional
• Stage 4: deep sleep, lasts 20 to 40
minutes. muscles relax and posture
adjusted intermittently, HR and B.P.
lower, GI activity slowed. Harder to
arouse.
• After stage 4, work way back up 4-->3--
>2-->REM
○ Rapid Eye Movement: loss of muscle
movements, vivid dreaming, and rapid eye
movements
• brain can replay previous memories
 Reasons - Reorganize info? Work
through info while sleeping?
• B.P., HR, & Respirations increase and
fluctuate. Temp. regulation is lost.
• Cerebral blood flow and metabolic rate
decreases ○ Mr. Glass is at risk for what type of sleep
• deprivation of REM assoc. with anxiety, disorder? Apnea
irritability, inability to concentrate. ○ Why? Neck circumference is large extra
• REM cycles get longer as night pressure on structures that communicate
progresses. air into lungs.
• Sleep Wake Cycle ○ What symptoms would he have? Snoring,
○ Circadian Rhythm: fatigue, more accidents during day,
• 24 hour diurnal rhythm, cycle of sleep irritability.
and wakefulness • Sleep Apnea
 ○ 2 types:
• Central Sleep Apnea:
 Not as common, caused by
disorders affecting the respiratory
center of brain. slowed ventilatory
effort and oxygen desaturation.
• Obstructive Sleep Apnea:
 Common, caused by upper airway
obstruction. Airflow ceases but
respiratory muscles still function.
Snoring, disrupted sleep, daytime
sleepiness.
 Cease breathing, enter
hypercapnia, take big breath where
awaken, less REM cycle
• Obstructive Sleep Apnea
○ Apneic periods last for 15 to 120 seconds;
many episodes a night
○ Decreases tidal volume and consequently
○ Treatment (not on test): remove the
arterial oxygen saturation
adenoids/back portion f the tongue, put on
○ Sleep related collapse of the upper airway.
a Cpap (continuous pressure on nose which
○ Characterized by loud snoring and periods
pushes air into nasal cavity).
of silence. ○ Risk factors
○ Sleep related arrhythmias and htn (usually
• Male
bradyarhythmias, severe-->tachycardia,
systemic and pulmonary HTN) • increasing age (relaxation of
structures)
• Awaken with high BP, raging headache.
• Obesity (adipose tissue around
• Years of pulmonary HTN backs up on
respiratory structures)
heart-->changes on right side of heart.
• ETOH and drug that depress CNS
• Large neck girth
○ Signs and Symptoms
• noisy snoring
• insomnia
 • abnormal movement during sleep
• morning HA’s
• excessive daytime sleepiness (no REM
sleep)
• cognitive and personality disorders
• sexual impotence
• systemic htn
• pulmonary htn, cor pulmonale (b/c of
lung disease, develop Heart disease)
• Polycythemia (excess RBCs)
• Other Sleep Disorders
○ Insomnia:
• difficulty initiating sleep, staying
asleep, waking up too early, or having
nonrestorative sleep.
• Frequent in hospital, can cause several
psychological complications.
○ Somnambulism: sleep walking, repeated
episodes of complex motor movements
that involve leaving the bed. Episodes last
a few minutes to a half hour.
• Usually seen with children 7-young
teenage yrs, sometimes with adults
(particularly with stress in lives)
• Complex motor mvmts, get up, get
dressed, can get hurt.
• Can wake up indv, may be jarring, but
won't damage physically/neurologically.
○ Night Terrors: repeated waking from sleep
in first half of sleep in the first part of non-
REM sleep. Not a nightmare.
• Usually in young children. Usually
within first 90 minutes of sleep.
• Sleep Hygiene (not on test)
○ Good routine for sleep
○ Go to sleep at same time, same ritual b4
sleep, TV/comp off for awhile b4 hand,
bedroom only as a sleeping space--> get
better sleep
• Temperature
○ Regulated by heat production,
conservation, and heat loss
○ Body temp maintained around 37 degrees
C
○ Internal temp varies by:
• Response to activity (higher for people
with more activity)
• Environmental temperature
• Daily fluctuations (circadian rhythms,
minor flux, lower at 6am, highest 6pm)
○ Regulated by the hypothalamus
○ Peripheral thermoreceptors in skin (relay to
hypothalamus) & Central thermoreceptors
in the hypothalamus, spinal cord,
abdominal organs provide temp information
○ Heat Production
• Shivering muscles
○ Heat Conservation
○ Heat Loss
• Sweating, respirations
• Fever
○ Usually from Exogenous Pyrogens (ie
bacteria)
○ Release TNF-alpha, interleukin-6, &
interferon
○ Signals hypothalamus to increase heat
production, increases heat until no longer
receives message.
 ○ Fever breaks
○ Heat Reduction mechanisms increased
(sweating)
• Benefits of Fever
○ Kills many microorganisms and affects their
growth and replication
○ Decreased levels of zinc, iron, and copper
needed for bacterial replication
○ Lysosomal breakdown and autosomal
destruction of cells, prevents viral
replication
○ Facilitates immune response by increasing
motility of PMN’s
○ Phagocytosis is enhanced
○ Stopgap usually 105F, 40.5C
• Children can tolerate higher febrile
temperatures
• Case Study
○ Ms. Lily is 35 year old student with no
significant pmh that c/o frequent HA’s.
○ What questions would you ask her about
her HA’s?
• Where? One spot, band? How long last
for? How often?
○ What type of HA is she at risk for having?
• Tension headache, migraines (estrogen
and pathway for migraine
development)
• Migraine Headache
○ run in families
○ migraines without aura (most common):
• pulsatile, throbbing, unilateral HA. lasts
1-2 days and aggravated by routine
physical activity. accompanied by n/v
(often incapacitating), sensitivity to
light and sound, visual hallucinations
(flashes of light, floating dots).
○ migraines with aura:
• similar symptoms, n/v, aggravation
with phys activity, etc, but reversible
visual and sensory symptoms. Aura
(precursor feeling, see color, notice
smell, area of fuzzy sight grows [try
drinking a liter of water when aura
occurs])develops in 5 to 20 minutes
and can last an hour.
• Migraines
○ patho poorly understood.
○ trigeminal nerve becomes activated,
neuropeptides are released, painful
neurogenic inflammation of the meningeal
vasculature. (vasoconstriction then
vasodilation)
 ○ Triggers for this mechanism are estrogen;
chemicals in MSG, aged cheese, and
chocolate.
• Cluster HA
○ relatively uncommon, affect men>women
○ HA’s occur in clusters over weeks (same
time of day) for months then HA free
remission period
○ severe, unrelenting, unilateral pain.
○ Rapid onset of pain peaks in 10-15 minutes
and lasts 15 to 180 minutes
○ patho not completely understood
○ tend to run in family.
• Tension HA
○ More common.
○ dull, aching, diffuse, nondescript HA, occurs
in a hatband distribution (wraps around
head), not assoc. with n/v
○ might be related to the muscles of the
scalp and neck (beware study positioning!)
○ may be caused with oromandibular
dysfunction (problems with jaw TMJ),
psychogenic stress, anxiety, depression,
and muscular stress, caffeine withdrawal.
○ Treatment
• Hydration.