Clinical conditions - Neuro midterm

What are the visual field deficits?

1. Optic nerve lesion

2. Central optic chiasm

3. Optic tract

4. Incomplete optic tract

What is optic nerve lesion?

Ipsilateral (monocular) blindness; loss of direct pupillary light reflex; some impaired depth perception

Ex: person can see with their left eye but nothing with their right eye

What is central optic chaism?

Bitemporal hemiplegia; tunnel vision

Ex: Person can see through half of eye closest to midline

What is optic tract?

Homonymous hemianopia

Ex: Person can see through the right side of both eyes but not the left and vise versa

What is incomplete optic tract?

Partial contralateral loss

Ex: Person can only see through a quarter of each eye

What is the most common symptom of vestibular disorder?

What is pusher syndrome?

Powerful pushing away from their strong side in sitting and during transfers, standing, and walking; Thalamic lesion causes in an inability to relay nuclei can’t send sensory info or receive sensory info

Ex: patient feels like they are falling to their strong side when they are in an upright position

What happens during and after a brainstem stroke?

Damage to the brainstem may cause a mix of ipsilateral and contralateral motor, sensory, and autonomic dysfunction and paralysis

Locked in syndrome

What is locked in syndrome?

A severe stroke caused by severe partial occlusion of basilar artery which restricts blood flow to the pons

What does this look like: person is completely paralyzed except for the movement of their eyes; they cognition is completely intact but they are stuck in their body

What are the Ds of brainstem dysfunction?

Dysarthria, dysphagia, dysmetria, and diplopia

What is the pathophysiology of Alzheimers disease?

The accumulation of native proteins in the brain (something malfunctions so the protein builds up); chronic inflammation due to failure of microglia not getting away waste and debris and protein collection; and cortical atrophy (shrinking) of the frontal, temporal, and parietal lobe (including hippocampus)

What are the signs and symptoms of Alzheimers disease?

Progressive decline in memory and cognitive functions → inability to retain new information, poor word recall and production, Wernickes aphasia, disoriented/wandering/restlessness, emotional lability, etc

What is vascular dementia?

Cognitive impairments caused by cerebrovascular disease → executive functions are affected; can coexist with AD (“mixed dementia”)

What is dementia with Lewy bodies?

Abnormal deposits of alpha-synuclein protein (Lewy bodies) in limbic and cortical areas; cognitive decline, visual hallucinations, anxiety, motor (Parkinsonism), and autonomic functions (orthostatic hypotension and constipation)

What is a traumatic brain injury?

Its caused by a penetrating or non penetrating external force and it frequently damages the prefrontal cortex (anterior multimodal association area); can also be an acquired brain injury (stroke, seizure, tumor)

What are the signs and symptoms of TBI?

Poor planning, prioritization, initiation, organization, etc

Rigidity and poor problem solving

Distractibility and attentional disorders

Impulsivity, disinhibition (saying inappropriate things, no regard for safety)

Poor self awareness

Emotional lability

What does a middle cerebral artery (MCA) stroke cause?

Contralateral hemiparesis and hemisensory loss → primarily face and upper limb; lateral portions of primary motor area and primary somatosensory area

Apraxia → motor apraxia and ideational apraxia

Neglect → right side damage = left side affected

Aphasia → Brocas and Wernickes aphasia

Imparied cognition (frontal lobe)

Emotional lability or euphoria

What does an anterior cerebral artery ACA) stroke cause?

Contralateral hemiplegia and hemisensory loss → more severe in LE than UE

Apraxia (supplementary motor area) → motor apraxia

Personality and cognition changes → left hemisphere causes emotional lability, depression, and aphasia. Right hemisphere causes impulsiveness, euphoria, emotional disassociation, and confusion

What does a posterior cerebral artery (PCA) stroke cause?

Visual-perceptual deficits → homonymous hemianopia (contralateral side, optic tract), visual agnosia, and cortical blindness

Memory loss (hippocampus; temporal lobe)

What is a Ischemic stroke?

A clot that blocks blood flow to areas of the brain; the three types are thrombotic, embolic, and lacunar 

What is a hemorrhagic stroke?

Bleeding inside or around brain tissue → rupture of a weakened blood vessel

What is hydrocephalus?

An accumulation of CSF resulting I expansion of the ventricles and increased intracranial pressure

What is congenital hydrocephalus compared to acquired hydrocephalus?

Congenital: primarily in infants and young children; causes are genetic abnormalities, neural tube defects, infection during pregnancy, ventricular problems, etc

Acquired: causes are hemorrhages, infections (meningitis), brain tumors, MS plaques, and head trauma

What is meningitis?

Inflammation of membranes around the brain and/or spinal cord

What is Guillen-Barré Syndrome?

Autoimmune disease: antibodies attack Schwann cells (PNS)

Symptoms: weakness → paralysis (distal → proximal), respiratory risk, sensory issues

Treatment: plasmapheresis, IVIG

OT: ROM, energy conservation, ADLs

What is Multiple Sclerosis?

CNS

Immune mediated deconstruction of oligodendrocytes

Types: relapsing remitting, secondary progressive, primary progressive, and progressive relapsing

Symptoms: motor (weakness, ataxia, tremors), sensory (numbness, paresthesia, vision), cognition, autonomic (bladder and bowel)

Worse in heat

Treatment: corticosteroids, plasmapheresis, disease-modifying drugs

OT: stress management, energy conservation, moderate exercise, proactive skill building

What is Myasthenia Gravis?

Autoimmune disease: antibodies block ACh receptors at NMJ

Symptoms: fluctuating muscle weakness (worse with use, better with rest), diplopia, ptosis, swallowing/breathing issues

Treatment: corticosteroids, thymectomy, immunosuppresents, PE, IVIG

OT: energy conservation, ADL planning

What is Spina Bifida (neural tube defect)?

Types: meningocele (meninges only) and myelomeningocele (meninges + spinal cord, 75%)

Symptoms: LE weakness, impaired sensation, orthopedic issues, bladder control problems, and hydrocephalus (80-90%)

Treatment: prenatal or early surgery, infection prevention

OT: parent education, adaptive equipment, ROM/strengthening, bowel/bladder regimens, accessibility, intimacy support

What is Cerebral Palsy?

Risk factors: prematurity, low birth weight, multiple births, maternal conditions 

Neurological damage: motor cortex/tracts → spasticity; Basal ganglia/cerebellum → dyskinesia, ataxia

Classifications: spastic, dyskinetic, ataxic, or mixed; hemiplegia, diplegia, quadriplegia

Signs: abnormal tone/reflexes, delayed motor skills, posture issues, possible cognitive/visual/speech deficits

What is Autism Spectrum Disorder?

Neurological profile:

White matter: short-range over connectivity, long range under-connectivity

Grey matter: increased amygdala, occipital cortex, hippocampus; decreased prefrontal cortex, basal ganglia, insula

Signs: social/communication deficits, repetitive behaviors, restricted interests, abnormal sensory responses, 1/3 have intellectual diability