Neurology Flashcards

Flashcards related to neurology.

Define Cerebrovascular Accident (CVA)

Sudden loss of neurological function caused by an interruption of the blood flow to the brain

What are the two main types of stroke?

Ischemic (clot) and Hemorrhagic (rupture)

What is the previous name of stroke?

Apoplexia

What is the 4th leading cause of death in the US?

Stroke

List some risk factors associated with stroke.

Male gender, Older age, African American ethnicity, Mexican/Indian American & Alaska Natives ethnicity

Which artery is part of the Anterior Circulation and supplies the medial frontal lobe?

Anterior Cerebral Artery

Which artery supplies the lateral frontal lobe (arms and face area in motor homunculus)?

Middle Cerebral Artery

The lenticulostriate artery supplies which area of the brain?

Basal ganglia

Which artery supplies the occipital lobe, thalamus, and midbrain?

Posterior Cerebral Artery

Which artery supplies the pons and anterior inferior cerebellum (AICA)?

Basilar Artery

A MCA stroke affecting Area 4 results in?

Incoordination and poor dexterity in arms + face

A MCA stroke affecting Area 44 and 45 results in?

Broca’s Aphasia

A MCA stroke affecting Area 22 results in?

Wernicke’s Aphasia

A ACA stroke affecting Area 4 results in?

Incoordination and poor dexterity in legs

A PCA stroke affecting Area 17 and 18 result in?

Visual Agnosia

What is atherosclerosis?

Plaque formation with accumulation of lipids, complex carbohydrates & calcium deposits on arterial wall causing progressive narrowing of blood vessels

What is cerebral thrombosis?

Formation/development of blood clot within the cerebral arteries/branches

What is a cerebral embolus?

Bits of matter (blood clot/plaque) formed elsewhere & released into the bloodstream, traveling to the cerebral arteries where they lodge in a vessel, that leads to occlusion & infarctions

What is a lacunar stroke?

Small circumcised lesion, <1.5 cm in diameter

What is an intracerebral hemorrhage (ICH)?

Rupture at deep perforating cerebral arteries

What is a subarachnoid hemorrhage (SAH)?

Bleeding within dural space around the brain and fills basal cistern

Define transient ischemic attack (TIA)

Neurological signs and symptoms develop & disappear over several mins and resolve within 24hrs

List some signs and symptoms of an ACA syndrome.

Contralateral Weakness LE >> Face/UE, Contralateral Sensory Loss LE>> Face/UE, Abulia, Akinetic Mutism

List some signs and symptoms of an MCA syndrome.

Contralateral Weakness Face/UE >> LE, Contralateral Sensory Loss Face/UE >> LE, Ipsilateral Gaze Deviation, Contralateral Homonymous Hemianopia

List some signs and symptoms of an ICA syndrome.

ACA and MCA syndromes & Amaurosis Fugax (temporary monocular vision loss)

Describe 'man in a barrel' syndrome.

Proximal UE/LE Weakness & Sensory Loss in Proximal UE/LE

List some signs and symptoms of a PCA syndrome.

Contralateral Homonymous Hemianopia, Alexia w/o Agraphia, Contralateral Hemibody Pain

List some signs and symptoms of Lacunar infarcts.

Pure Motor Stroke, Pure Sensory Stroke, Mixed Sensorimotor, Ataxic Hemiparesis, Dysarthria/Clumsy Hand Syndrome

List some signs and symptoms of a Basilar Artery syndrome.

Ipsilateral CN VI Palsy, Contralateral Weakness, Contralateral Sensory Loss & Anterior Inferior Cerebellar Artery

List some signs and symptoms of a Vertebral Artery syndrome.

Ipsilateral CN XII Palsy, Contralateral Weakness, Contralateral Sensory Loss

List some signs and symptoms of an Intracranial Hemorrhage.

Headache, Increase Intracranial Pressure Signs (Nausea/Vomiting, Cranial Nerve Deficits, Cushing’s Triad)

List some signs and symptoms of a Subarachnoid Hemorrhage.

Thunderclap Headache, Meningeal Signs (Photophobia, Neck Stiffness, Brudzkinski’s Sign, Kernig’s Sign), Increase Intracranial Pressure Signs

What is a common symptom after a stroke?

Paralysis, Muscle weakness, Impaired gait, Spasticity, Incoordination

Which diagnostic tool is most commonly used for imaging a stroke?

Computed Tomography (CT) scan

Which imaging technique is more sensitive in the diagnosis of acute strokes?

Magnetic Resonance Imaging (MRI)

What is a Carotid Endarterectomy?

Surgical procedure to remove the atheromatous plaque material, or blockage, in the lining of an artery constricted by the buildup of deposits

CN VII is the?

Facial

CN XII is the?

Hypoglossal

Describe Brunnstrom’s Stages of Stroke Recovery.

Stage 1: Flaccidity, Stage 2: Spasticity Appears, Stage 3: Increased Spasticity, Stage 4: Decreased Spasticity, Stage 5: Spasticity Continues to Decrease, Stage 6: Spasticity Disappears and Coordination Reappears

What is Apraxia

Inability to plan and execute coordinated movements; lesions of premotor frontal cortex, left inferior parietal lobe and corpus callosum; more evident in left hemisphere

Physical agents and modalities help

Manage spasticity & improve motor control

Rood’s Facilitation Techniques-

Involves light stroking, brushing, icing, and joint compression are used to facilitate movement

The 5 “H” principle avoid:

Hypotension, Hypoxemia, Hypoglycemia, Hyperglycemia, Hyperthermia

Traumatic Brain Injury (TBI)

Defined as an injury to the brain caused by external forces.

Leading cause of death and disability Globablly-

Traumatic Brain Injury (TBI)

Areas of the brain frontal lobe involved in:? (4,6,8, 9-12, 44-45)

Personality characteristics, decision- making and movement

Frontal Lobe, contain which important speech area

Broca's area, is associated with speech ability.

The cerebrum function

Largest part of the brain, the cerebrum initiates and coordinates movement and regulates temperature

Brain Stem composed of 3 Sections in descending order:

Midbrain, Pons, and Medulla oblongata.

Occurs on the isolated area in the brain, ant. Temporal pole, frontal poles, lat.&inf temporal poles orbital and frontal cortex-

Focal Injury

Most widely used clinical scale that measures level of consciousness and helps define and classify the severity of injury ?

Glasgow Coma Scale

An operation in which a small hole is made in the skull or a piece of bone from the skull is removed to show part of the brain-

Craniotomy

Electrical shock TENS, precautions

Individuals with skin conditions like eczema or psoriasis should be cautious about using pool water, especially if it contains chlorine or other irritants.

Electrical shock TENS, Contraindications

Individuals with open wounds or infections should avoid hydrotherapy until the skin is healed.

Spinal Cord Injury Definition

Traumatic insult to the spinal cord that can result in alteration of normal motor, sensory & autonomic functions

SCI classifications

Tetraplegia: cervical injuries; all 4 extremities & Paraplegia: thoracic, lumbar/cauda equina injuries

The ratio of trauma related SCI

MVA – 42%, Falls – 45yr, Violence, Sports – 7.6%

Spinal Cord regions: cervical, thoracic, lumbar, sacral & coccyx-

Spinal cord regions

Descending tract which carries motor information from cortex to lower motor neurons (LMNs)-

Anterior corticospinal tract

Lateral corticospinal tract- Descends from forebrain, crossing brainstem, to reach LMNs at each spinal level-

Lateral corticospinal tract

SCI with Vasoconstriction of blood vessel (BV) is mediated to

Rapid release of vasoactive substance; supplying the cord leads to ischemia of gray matter

SCI (+) BCR is an indication that-

Spinal shock is resolving; 1st reflex coming back before an injury

SCI most common at risk

Autonomic Dysreflexia

Intervention SCI to relieve pressure on spinal cord caused by bone fragments, herniated disc or hematoma –

Spinal decompression (anterior & posterior)

A SCI patient is having a high BP problem

Autonomic dysreflexia

A SCI patient is presenting dependency for ADL, is d/t-

Dependency in ADLs (active daily living)

SCI C4 level chair prescription is -

Power chair, chin tuck, sip & puff

Traumatic Brain Injury (TBI)

Defined as an injury to the brain caused by external forces.

Electrical shock TENS, precautions-

Individuals with skin conditions like eczema or psoriasis should be cautious about using pool water, especially if it contains chlorine or other irritants.

Electrical shock TENS, Contraindications

Individuals with open wounds or infections should avoid hydrotherapy until the skin is healed.

Definition of Parkinson’s Disease (PD)

A slowly progressive central nervous system disease characterized by bradykinesia, resting tremor, rigidity, and postural instability

What is the peak onset of Parkinson’s Disease?

6th and 8th decades

Describe ‘Toxic Parkinsonism’.

Parkinsonism occurring in individuals exposed to certain environmental toxins and industrial chemicals such as Manganese

What is the role of Basal Ganglia?

Basal ganglia is to approve or reject movement signals that your brain sends filtering out unnecessary or incorrect signals.

The inhibitory component/chemical of substantia nigra pars reticulata is

GABA

In the direct pathway, what increases wanted motor activity?

Cortex -> Excitation (Glutamate) -> Striatum (Putamen and Caudate nucleus) -> Inhibitory (GABA) -> Internal Globus Pallidus and Substantia Nigra Pars Reticulata -> Inhibitory -> Thalamus -> Excitatory -> Cortex (Prefrontal, Premotor, and Supplementary Cortex)

Increase unwanted motor activity in Parkinson results from:

Cortex → Excitation (Glutamate) → Striatum (Putamen and Caudate nucleus) → Inhibitory → Globus Pallidus Externa → Inhibitory → Subthalamic Nuclei → Excitatory Projections → Internal Globus Pallidus and Substantia Nigra Pars Reticulata → Inhibitory → Thalamus → Excitation → Cortex

What is cogwheel rigidity characterized by?

A jerky, ratchet-like resistance to passive movement as muscles alternately tense and relax. It occurs when tremors coexist with rigidity

The 3rd cardinal feature of PD is.

Tremor

In PD, what contributes to bradykinesia?

Slowness of thought, bradyphrenia (slowed thinking and processing information)

What does a PET scan look for in a patient with PD?

Measure metabolic activity in the brain, Assess dopamine synthesis and metabolism in PD, Decrease dopamine synthesis in striatum

Is Huntington’s Disease a differential diagnosis in PD?

Yes with Rule In: Rigidity, Loss of coordination and Rule Out: Chorea, Aggression

What does pallidotomy do to brain activity?

Reduces tremor, rigidity, and dyskinesia

What is dyskinesia?

uncontrolled, involuntary muscle movement

Side effects when taking Carbidopa

Lethargy, Vomiting, Euphoria, OH, and delusion.“

Hoehn-Yahr Classification of Disability Scale

Measure for charting the progression of the disease using motor signs and elements of functional status. Stage 1 minimal disease involvement whereas stage V is indicative pf severe deterioration.

Name some goals a patient with PD can have.

Pt. will manifest ↑ ROM; Pt. will manifest an ↑ of grade 3 in MMT; Pt. will exhibit an improved posture; Pt. will exhibit improvements in balance and tolerance; Pt. will manifest an ↑ independence as to self care

Define multiple sclerosis (MS)

An autoimmune demyelinating disorder characterized by episodes of neurological deficits attributable to white matter lesions separated in space and time.

List two common symptoms of MS

Paresthesia & Diplopia

How does Optical Coherence Tomography (OCT) help in diagnosing MS?

Measures the thickness of the retinal nerve fiber layer, which can be affected in MS.

DTI can detect

Damage to the brain's white matter tracts, which are composed of nerve fibers

A surgical procedure that permanently implants electrodes in the thalamus describes

Deep Brain Stimulation

Glatiramer Acetate-

Increases release of neurotrophic factors from immune cells. Promotes differentiation in Th2 and T - reg cells leading to bystander suppression in CNS

The Expanded Disability Status Scale is on a

10 point Scale

List one physical therapy intervention that could help a patient with MS

TENS

Can hydrotherapy worsen MS?

Yes, excessive heat or cold is to be avoided.

Define Guillain-Barre Syndrome (GBS)

An acute polyradiculoneuropathy that is autoimmune in nature

Describe the pathophysiology of GBS caused by influenza vaccine.

Antibodies mistakenly attack the peripheral nerves and leads to demyelination and axonal damage decreasing conduction velocity and muscle action potential

List some of the signs and symptoms of GBS

Epigastric Pain, Mild Tongue Paresthesia, Upper Limb Dysaesthesia, Upper and Lower Limb Paresthesia, Hyperhydrosis of the face, hands and legs

What might a lumbar puncture in a patient with GBS show?

CSF may show a protein increase and a low white blood cell count.