Neuro Test 2

What does "metastatic" mean?

Cancer has spread to distant areas of the body

What does ICP stand for?

"intercranial pressure" (normal is 5-15 mmHg)acute res

What does TNM stand for?

T= size/extent of primary tumor N= # of nodes that have cancer. M= whether cancer has metastasized or not

Primary tumor

original site of tumor

Secondary tumor

additional sites where cancer has spread, cell tissue is the same as primary tumor

Malignant tumor

cancerous tumor

Benign tumor

non-cancerous tumor

Tumor staging

used to described if and how far a tumor has spread

Glioblastoma Multiforme (GBM)

aggressive, grade IV malignant tumor. median survival is 1-2 years

Meningioma

primary extrinsic tumor of the CNS. typically benign, slow growing. grows within meningeal layer of brain/spine. 10 year survival rate

Vestibular Schwannoma (acoustic neuroma)

benign, slow growing tumor. most common in 30s/40s. hearing loss, tinnitus, dizziness, balance deficits

When can athletes progress to next activity level post-concussion?

When they are symptom-free at their current level of activity

Post concussive syndrome

When symptoms of a concussion persist for weeks to months after the injury originally occurred

Second impact syndrome

When an athlete returns to sport too soon after a concussion and takes impact that injures the brain again causing a rare but life-threatening condition

What to avoid when working with patients at risk of increased ICP?

Val-salva, trendelenburg position, and cervical flexion

What is the Glasgow Coma Scale?

It assesses the level of arousal and cognition in a patient to indicate their level of brain injury. Assesses eye opening response, verbal response, and motor response

What is a 15 on the Glasgow Coma Scale?

Normal function. Patient is fully awake, responsive, and able to normally think and remember things

What are the three layers of the meninges?

Dura mater, arachnoid mater, and pia mater

Meningitis

inflammation of the pia-arachnoid, can involve cerebrum & spinal cord. Fever, severe headache, neck stiffness (nuchal rigidity)

Causes of meningitis

bacterial, viral, fungal, or protozoan infection

Exams for meningitis

Kernig's sign and Brudzinski's sign, both test for inflamed nerve roots causing irritation, pain, or spasms when put on stretch

Epidural hematoma

arterial bleed between skull & dura due to traumatic blunt force of temporal or parietal bone. Onset of symptoms is within a few hours

Subdural hematoma

venous bleed between dural and arachnoid space with slower onset of signs/symptoms within a few hours to days

Brain herniation

brain tissue, CSF, & blood vessels are moved away from their usual position inside the skull. results from increased ICP

What is CSF?

cerebrospinal fluid is a clear, colorless fluid found in the space around the brain and the central canal of the spinal cord. functions to support neural tissue via delivering nutrients/water/etc. & cushions the brain

Hydrocephalus

imbalance of rate of CSF production/absorption causes accumulation of CSF in ventricles

Overt vs occult hydrocephalus

overt= head enlarges

occult= head size remains the same

Normal pressure hydrocephalus (NPH)

drainage of CSF is blocked gradually, excess CSF builds up slowly. Average age above 60. Symptoms look similar to PD

Papilledema

swelling of the optic nerve due to increase ICP

What is a spinal tap used for?

to aid in the diagnosis of infections, subarachnoid hemorrhages, certain cancers, and inflammatory conditions. usually performed at L3-4 or L4-5

Blood brain barrier (BBB)

specialized permeable barrier between brain & the bloodstream

What can pass through the BBB?

Small, lipid soluble molecules and gasses. Anti-anxiety medications. Keeps good in & bad out

What can cause a deterioration of the BBB?

brain tumors, MS, strokes, encephalitis

What does the basal ganglia do?

plans, sends plan to prefrontal cortex, and controls the force needed to perform tasks

Direct vs indirect pathway

direct= stimulates/creates movements

indirect= prevents unwanted movements

Types of dyskinesias

essential tremor, resting (pill rolling) tremor, & intentional tremor

Parkinson's Disease symptoms

Motor: TRAP (tremors, rigidity, a kinesia, posture)

Autonomic: orthostatic hypotension, urinary incontinence

Cognitive: depression, dementia, cognitive decline

Parkinson's "freezing"

temporary inability to move/continue moving. increases risk for falls especially when turning/changing directions

Parkinson's treatments

L-Dopa/Carbidopa, PT including LSVT "Big & Loud" or PWR!, deep brain stimulation

What does a deep brain stimulator (DBS) do?

reduces unwanted movements (tremors) in Parkinson's Disease and other dyskinesias

Parkinsonism

symptoms mimic Parkinson's Disease but is caused by toxin/drug exposure, infections to nervous system, or traumatic injury

Dura septa

divides the brain into right and left hemispheres as well as separates the cerebrum from the cerebellum

Common way to treat hydrocephalus

Shunt which redirects CSF to where it is building up to where it can drain from the body

What produces CSF?

ventricles in the brain via choroid plexus

Best course of action for PTA if ICP is 16mmHg

Elevate head to see if it brings ICP down. If it continues to be high, modify treatment to avoid things that would elevate it. If it gets too high, hold treatment until it lowers

Anti-seizure meds used for epilepsy

dilantin, tegretol, phenobarbital

General symptoms of a brain tumor

headache, nausea/vomiting, seizures, motor/sensory impairments, cognitive/behavior changes, vision/hearing loss, speech impairments

Concern/consideration for a patient who is level V on the Rancho Los Amigos scale

pt tends to be confused & overstimulated. try to treat in a less crowded/busy part of clinic so they can focus and understand directions better

Stage 4 on tumor staging system

cancer has spread to distant areas of the body (aka metastasized)

Use of decompressive craniotomy

when ICP is too high it takes the pressure off brain tissue until the swelling can be controlled

What to do if a pt with no previous history has a seizure

call for additional help, slow pt's descent to the floor, clear the area, and loosen clothing if necessary to maintain the airway

Huntington's Disesase

aka "hunting for control". progressive, hereditary disorder that causes the degeneration of the basal ganglia and cerebral cortex. affects primarily adults, ages 40 to 50s

"hyperkinetic" disorder

excessive, involuntary movement. seen with Huntingtons

Chorea vs choreoathetosis

chorea = involuntary, jerky movements almost like dance

choreoathetosis = slow, withering movements affecting hands/feet typically

treatment for Huntington's

meds, PT, deep brain stimulation of globus pallidus

dystonias

genetic movement disorder that causes involuntary sustained muscle contractions. symptoms increase with activity & decrease/resolve with sleep

treatment for dystonias

medications, bafilin pump, PT, botox, DBS, surgery

cerebellum

coordinates movement & postural control by comparing actual motor output with the intended movement & adjusting as necessary. involved in learning timing, rhythm, synchronization of movements

cerebellar leisons

DO NOT affect sensory perception or muscle strength

dysdiadochokinesia

inability to perform rapid, coordinated movements

dysmetria

over/undershooting movements

asynergia/ataxia

lack of coordination

nystagmus

rapid, uncontrolled eye movement side-to-side

dysequilibrium

feeling like being on a boat

dysarthria

difficulty speaking

Chiari malformation

displacement of cerebellar tonsils below foramen magnum into spinal canal

symptoms of chiari malformation

headache, impaired balance, gait disturbances, nystagmus, vertigo, numbness & tingling in hands/feet

Dementia

general term that includes conditions that result in changes in cognitive function. may also affect personality, behaviors, emotions, & relationships

How to diagnose dementia

no single test. pt history, physical exam, lab tests, imaging, cognitive/neuropsychological tests

causes of dementia

Alzheimer's disease, vascular dementia, lewy body dementia, depression, normal pressure hydrocephalus, Parkinson's, Huntington's, drugs, alcohol, etc

signs/symptoms of dementia

short term memory loss, disorientation, aphasia, auditory hallucinations, impaired visuospatial skills, paranoia, unpredictable behavior, psychosocial impairment

Alzheimer's Disease

6th leading cause of death in US. decrease in # of synapses & formation of amyloid plaques/tangles. 3 stages: early, intermediate, late

some early signs of Alzheimer's

memory loss disrupts daily life, challenges planning/solving problems, difficulty completing familiar tasks, withdrawal from work/social activities, changes in mood/personality

intermediate signs of Alzheimer's

longest stage, can last years. will need assistance for ADLs. increasing memory deficits, behavior/personality changes, changes in gait, sleep changes, "sundowners", wandering, weight loss

late stages of Alzheimer's

lose ability to respond to the environment, carry on conversation, control movement. likely requires 24/7 assistance for ADLs. difficulty communicating, decline in physical function, vulnerable to infection, pressure ulcers, anorexia

medications for Alzheimer's

meds to improve memory: cholinesterase inhibitors, memantime

meds to control behaviors: anti-depressants, anti-anxiety, anti-psychotics

meds for sleep: nortriptyline, benzodiazepines, sedative hypnotics

behavior tips for dementia

listen/reassure/acknowledge their feelings, reorient without arguing or demanding they understand, decrease complexity of task or change task if frustration occurs, redirect attention, maintain calm environment, don't take behaviors personally

festination of gait

short, rapid steps to avoid falling

coup injury

damage at sire of impact

contrecoup injury

damage to the brain on the opposite side of impact due to jarring of the brain in the skull

brain contusion

localized bruising on the surface of the brain sustained at the site of impact. NOT the same as a concussion

anoxic injury

complete lack of O2 to brain, death of brain cells after 4 min

hypoxic injury

restriction of O2 to brain, gradual death of brain cells

Anoxic & hypoxic injury

most common cause is cardiac arrest, causes diffuse brain damage, full recovery from severe injury is rare

common problems post-TBI

acute respiratory distress, increased ICP, seizures, impaired cerebrovascular regulation

acute respiratory distress (ARDS)

characterized by inflammation of the lungs resulting in hypoxia, leading cause of death in TBI

intraventricular catheters

gold standard for measuring ICP. placed directly in the ventricle through a burr hole in the skull. no PT with ICP monitor

levels of arousal

alert, lethargy, obtundity, stupor, coma