15. Neuro: Cognitive Systems & Cerebral Hemodynamics

Question 1

absence of voluntary movement

Answer 1

akinesia

Question 2

damage between fibers of language center – may not be able to control tone and emotions of language

Answer 2

transcortical dysphasia

Question 3

muscle resistance to passive movement of a rigid limb that is uniform in both flexion and extension throughout movement

Answer 3

rigidity

Question 4

ICP may not change in this stage due to compensatory mechanisms

Answer 4

Stage 1 IICP

Question 5

Cause of hydrocephalus

Answer 5

interference of CSF flow - decreased reabsorption - increased production - obstruction within ventricular system

Question 6

AD hereditary degenerative disorder that causes severe degeneration of basal ganglia and frontal cerebral atrophy -> depletion of basal ganglia GABA (inhibitory NT)

Answer 6

Huntington disease (HD or Chorea)

Question 7

inability to remember instructions and information needed to guide behavior

Answer 7

working memory deficit

Question 8

broad-based gait where person walks in small steps and the head and body are flexed -> due to basal ganglion dysfunction and seen in Parkinson disease

Answer 8

basal ganglion gait

Question 9

weakness/paralysis of lower extremities as a result of lower spinal cord injury

Answer 9

paraparesis/paraplegia

Question 10

Broca vs Wernicke

Answer 10

• Broca’s area: helps in producing coherent speech - Wernicke’s area: helps in speech processing and understanding language

Question 11

Explain the rhythm of Cheyne-Stokes respiration

Answer 11

• increased levels of CO2 -> tachypnea - CO2 levels decrease -> leads to apnea until CO2 accumulates again

Question 12

agnosia is commonly associated w/ what neurological problem

Answer 12

CVA

Question 13

Clinical manifestations of stage 3 IICP

Answer 13

• decreased levels of arousal - widened pulse pressure (systolic increases) - bradycardia - small, sluggish pupils

Question 14

4 criteria for brain death

Answer 14

• unresponsive coma (no motor or reflex movements) - no spontaneous respiration (apnea) - no brainstem functions (dilated, fixed pupils; no gag or corneal reflexes) - isoelectric EEG

Question 15

loss of emotional language (aprosody); inability to understand emotional in speech and facial expression or inability to express emotion

Answer 15

hypomimesis

Question 16

result due to damage of descending motor pathways

Answer 16

upper motor neuron syndromes

Question 17

associated w/ upper motor neuron syndromes; mainly the flexors of the arms and extensors of the legs are affected

Answer 17

pyramidal motor syndrome

Question 18

involves an inability to understand written or spoken language; speech is fluent but words and phrases have no meaning

Answer 18

Receptive dysphasia or Wernicke’s/sensory/fluent dysphasia

Question 19

defect of pattern recognition -> failure to recognize the form and nature of objects (can be tactile, visual, or auditory)

Answer 19

Agnosia

Question 20

more severe form of dysphasia and an inability to communicate using language; usually associated w/ CVA involving the middle cerebral A.

Answer 20

aphasia

Question 21

Indicates the presence and level of brainstem dysfunction

Answer 21

pupillary changes

Question 22

causes of increased intracranial pressure (IICP)

Answer 22

increased intracranial content - tumor growth - edema - excessive CSF - hemorrhage

Question 23

excessive, purposeless movement (broad category of abnormal movements)

Answer 23

hyperkinesia

Question 24

neurodegenerative disorder that diffusely affects upper and lower motor neurons of the cerebral cortex, brain stem, and spinal cord (corticospinal tracts and anterior roots)

Answer 24

amyotrophic lateral sclerosis (ALS or Lou Gehrig disease)

Question 25

acquired mental disorder characterized by deficits in attention and coherence of thought and action; secondary to intoxication, metabolic disorders, or nervous system disorders

Answer 25

acute confusional states (ACS); may also be called delirium

Question 26

complete unawareness of the self or surrounding environment and complete loss of cognitive function; can be seen in survivors of cerebral death

Answer 26

persistent vegetative state (VS)

Question 27

complete paralysis of voluntary muscles except for eye movements; person cannot communicate through speech or body movement but is fully conscious w/ intact cognitive function

Answer 27

locked-in syndrome

Question 28

isolated contraction of a single muscle fiber because of metabolic changes I denervated muscle -\> not clinically visible

Answer 28

fibrillation

Question 29

individuals may follow simple commands, manipulate objects, gesture or give yes/no responses, have intelligible speech, and have movements such as blinking/smiling

Answer 29

minimally conscious state (MCS)

Question 30

loss of motor function so that a muscle group is unable to overcome gravity

Answer 30

paralysis

Question 31

muscle rippling or quivering under the skin

Answer 31

fasciculations

Question 32

sustained involuntary muscle contraction that causes twisting movement

Answer 32

dystonia

Question 33

Clinical manifestation of ALS

Answer 33

progressive muscle weakness leading to respiratory failure and death; pt has normal intellectual and sensory function until death

Question 34

resistance to passive movement which varies in direct proportion to force applied

Answer 34

paratonia

Question 35

Classic manifestations of PD

Answer 35

- resting tremor - rigidity - bradykinesia/akinesia - postural disturbance (stooped) - short shuffling steps - cognitive-affective symptoms

Question 36

occurs when the brain is damaged so much that it can never recover (irreversible) and cannot maintain internal homeostasis

Answer 36

Brain death

Question 37

large motor neurons in ventral horn of spinal cord -\> bring nerve impulses from upper motor neurons to the skeletal muscle through anterior spinal roots and cranial nerves

Answer 37

lower motor neurons

Question 38

NT necessary to make muscle tone smooth

Answer 38

dopamine

Question 39

normal ICP

Answer 39

5-15 mmHg

Question 40

posture/response caused by severe injury to the brain/brainstem

Answer 40

decerebrate posture/response

Question 41

sleep-wake cycle are present, eyes open spontaneously, and BP and breathing are maintained without support; brainstem reflexes intact but cerebral function lost

Answer 41

persistent vegetative state (VS)

Question 42

stage of IICP where brain tissue herniates from compartment of greater pressure to compartment w/ less pressure -\> blood supply compromised -\> further hypoxia in herniated tissues

Answer 42

Stage 4 IICP

Question 43

paralysis of corresponding parts of both sides of the body as a result of cerebral hemisphere injuries

Answer 43

diplegia

Question 44

cerebral edema caused by increased permeability of capillary endothelium of brain after injury to vascular structure (BBB is disrupted)

Answer 44

vasogenic edema

Question 45

paresis/paralysis of the upper and lower extremities on one side

Answer 45

hemiparesis/hemiplegia

Question 46

inability to form new personal or factual memories but memories of distant past are retained

Answer 46

anterograde amnesia

Question 47

executive attention deficits are associated w/ alternations to which area of the brain?

Answer 47

frontal and prefrontal cortex

Question 48

death of the cerebral hemispheres exclusive of the brain stem and cerebellum (no behavior or environmental responses but brain can maintain homeostasis)

Answer 48

Cerebral death (irreversible coma)

Question 49

excess fluid within the cranial vault, subarachnoid space, or both -\> causes dilation of ventricles and IICP -\> severe headache

Answer 49

hydrocephalus

Question 50

posture/response characterized by increased tone in extensor muscles and trunk muscles w/ active tonic neck reflexes (head is neutral and all 4 extremities are rigidly extended)

Answer 50

decerebrate posture/response

Question 51

inability to set goals and recognize when an object meets a goal

Answer 51

sustained attention deficit

Question 52

progressive deterioration of cerebral functions due to neurofibrillary tangles and plaques -\> lead to neuronal death and brain atrophy

Answer 52

Alzheimer's disease (AD)

Question 53

decreased amplitude of movement

Answer 53

hypokinesia

Question 54

stage with continued expansion of intracranial contents and pressure may compromise neuronal oxygenation and systemic arterial vasoconstriction may occur to overcome IICP

Answer 54

Stage 2 IICP

Question 55

At what stage of IICP is surgical or medical intervention the best?

Answer 55

Stage 2 IICP

Question 56

loss of ability to perform activities that a person is physically able and willing to do -\> brain is unable to make and deliver correct movement instructions to the body

Answer 56

dyspraxia/apraxia

Question 57

follows an epileptic seizure and can last hours or 1-2 days; includes headache, confusion, dysphasia, memory loss, and fatigue/deep sleep

Answer 57

postictal state

Question 58

state of continuous seizures lasting more than 5 minutes or rapidly recurring seizure before the person has regained consciousness

Answer 58

status epilepticus

Question 59

Diagnostic hallmark of PD? What does it lead to later in disease?

Answer 59

- Lewy body formation in neurons (protein misfolding and accumulation of alpha-synuclein) - Lewy body dementia later in disease

Question 60

gait associated w/ bilateral upper motor neuron injury and spasticity -\> when walking, legs swing around the body and then cross in front of each other

Answer 60

scissors gait

Question 61

posture/response that occurs when the brainstem is not inhibited by the cerebral cortex motor area

Answer 61

decorticate posture/response

Question 62

Clinical manifestations of stage 4 IICP

Answer 62

- progression to deep coma - ipsilateral dilation and fixation of pupils -\> bilateral dilation and fixation of pupils - abnormal breathing (Cheyne-stokes, ataxic, or central neurogenic hyperventilation) - pulse pressure begins to decrease (as brain herniates and ICP decreases) - pulse slightly irregular

Question 63

Motor signs that indicate loss of cortical inhibition

Answer 63

primitive reflexes and rigidity (paratonia)

Question 64

5 patterns of neurologic function that are critical to evaluate

Answer 64

- level of consciousness - pattern of breathing - pupillary reaction - oculomotor responses - motor responses

Question 65

exaggerated emotional response; excessive crying (left hemisphere) or laughing (right hemisphere); may not be appropriate to environment

Answer 65

hypermimesis

Question 66

2 symptoms of the preictal phase of a generalized tonic-clonic seizure

Answer 66

- prodroma: hours to days before (anxiety/depression, inability to think clearly) - partial seizure: immediately precedes generalized seizure

Question 67

difficulty retrieving past personal history memories or past factual memories

Answer 67

retrograde amnesia

Question 68

gradual increase in tone causing increased resistance until tone suddenly diminishes

Answer 68

spasticity

Question 69

severe degeneration of basal ganglia involving dopaminergic nigrostriatal pathway -\> dopamine deficiency (inhibitory NT) and unopposed cholinergic activity (promotes muscle tone)

Answer 69

Parkinson disease (PD)

Question 70

posture/response characterized by upper extremities flexed (held close to body) and lower extremities that are externally rotated and extended

Answer 70

decorticate posture/response

Question 71

stage where ICP begins to reach arterial pressure and brain tissues experience hypoxia and hypercapnia -\> rapid deterioration

Answer 71

Stage 3 IICP

Question 72

increased fluid (intracellular or extracellular) within the brain

Answer 72

cerebral edema

Question 73

decreased speed of movement

Answer 73

bradykinesia

Question 74

abnormal, involuntary movements that occur in spasms

Answer 74

paroxysmal dyskenisias

Question 75

Clinical manifestations of stage 2 IICP

Answer 75

subtle and transient - confusion - restlessness - drowsiness - slight pupillary and breathing changes

Question 76

involves loss of ability to produce spoken or written language w/ slow or difficult speech

Answer 76

Expressive dysphasia or Broca's/motor/nonfluent dysphasia

Question 77

wide-based gait w/ increased body sway and falls, loss of truncation motion, and shuffling

Answer 77

frontal lobe ataxic gait

Question 78

passive movement of a muscle mass w/ little to no resistance

Answer 78

hypotonia

Question 79

temporary loss of all spinal cord functions below the lesion

Answer 79

spinal shock

Question 80

gait associated w/ unilateral upper motor neuron injury -\> manifests by a shuffling gait w/ leg extended and held stiff (scrapes floor surface)

Answer 80

spastic gait

Question 81

impairment of comprehension or production of language w/ impaired communication

Answer 81

dysphasia

Question 82

Clinical manifestations of lower motor neuron syndromes

Answer 82

- flaccid paralysis (both involuntary and voluntary movements affected) - hyporeflexia or areflexia (loss of tendon reflexes) - fibrillation

Question 83

partial paralysis w/ incomplete loss of muscle power

Answer 83

paresis

Question 84

clinical manifestations of AD

Answer 84

- forgetfulness - emotional upset - confusion - lack of concentration - decline in abstraction, problem solving, and judgement

Question 85

explain the phases of a tonic-clonic seizure

Answer 85

- neurons are hypersensitive (fire more frequently and w/ greater amplitude - when intensity reaches a threshold point -\> cortical excitation spreads - tonic phase (muscle contraction w/ increased muscle tone) - clonic phase (alternating contraction and relaxation of muscles) -\> begins when inhibitory neurons in cortex react to excitation

Question 86

gait that is wide-based w/ feet apart and often turned inward for greater stability (person staggers) -\> due to cerebellar dysfunction

Answer 86

cerebellar (ataxic) gait

Question 87

inability to maintain sustained attention and a working memory deficit

Answer 87

executive attention deficits

Question 88

involuntary movement of the face, lips, tongue, trunk, and extremities

Answer 88

tardive dyskinesias

Question 89

increased muscle resistance to passive movement

Answer 89

hypertonia

Question 90

paresis/paralysis of all 4 extremities as a result of upper spinal cord injury

Answer 90

quadriparesis/quadriplegia