brain phantoms Flashcards
where is the primary somatosensory cortex located
Located in parietal lobe post-central gyrus
what is phantom limb pain
Perception of pain in alimb that no longer exists- from the cortex – treatment will be along neuropathic pain killers
Often associated with amputated limbs but can occur in relation to any body part
Typically more severe soon after amputation then decreases over time but can last for years
mirror therapy
Sx of phantom limb pain
Often described as shooting burning stabbing squeezing – abnormal sensations that they cannot get rid of , muscle spasm, unnautral postion – worse if from a truamtic event
what is residual limb pain
Pain originating from actual site of the amputated limb
Common in early post-amputation period
Numerous potential causes e.g. infection, ischaemia, neuropathy
nociceptable pain from the end of that limb – WHO ladder for pain instead for treatment
Morton’s Neuroma ( tumour in nerve )
A mononeuropathy of solitary nerve in the foot
Symptoms: pain in foot
acoustic neuroma
A slow-growing, benign tumour of the acoustic nerve
Symptoms: include dizziness, headache, hearing loss, tinnitus, numbness
corneal reflex loss
How do we treat PLP?
Pharmacological
Analgesics (e.g NSAIDs, opioids), Antidepressants (e.g. TCAs), anticonvulsants (e.g. gabapentin) ( antineuropathics)
Current research on efficacy of above has shown mixed findings
Non-pharmacologicoptions
Numerous methods have been tried with varied effects:
Transcutaneous electrical nerve stimulation (TENS)- different sensory input
Spinal cord stimulation (SCS)
Mirror therapy- An amputee moves his/her intact limb in front of a mirror to create a visual representation of the missing limb
Provides artificial visual feedback to the brain about the removed limb - thought to result in neuronal reorganization
Redisual limb pain orginaite from actual site , common in elderly post ampuatioon period , tends to resolve with wound healin g
Phatom limb pain originate sin missing limb, can occur soon after amputation or afte rmoths/years, can reduce in severeity over time or may persist
cotard syndrome
People with Cotard’s syndrome (also called walking corpse syndrome or Cotard’s delusion) believe that parts of their body are missing, or that they are dying, dead, or don’t exist
Alien hand syndrome (AHS)
Involves uncontrollable involuntary, yet often purposeful, movements of the affected hand
Patients often describe the feeling that their hand is not under their control
Associated with a range of neurological conditions e.g. stroke, corticobasal syndrome, neurodegenerative illness, midline tumour
3 variants of alien hand syndrome
Frontal
Callosal
Posterior
frontal AHS
grasping
Patients develop disinhibited grasping/groping at objects in visual or tactile field
Patients are often aware that the limb belongs to them but have difficulty controlling/suppressing movements
Associated with lesions in unilateral supplementary motor area, cingulate region, medial prefrontal cortex. May also involve anterior corpus callosum
callosal AHS
conflict
Intermanual conflict is often the predominant symptom i.e. limb conflicts with opposite unaffected limb
Arises from corpus callosal lesions e.g. stroke, midline tumour, demyelination
Theorized to arise from disconnection between the two cerebral hemispheres
Epileptic patient ssevere corpus callosum to stop jerkic movement – example of similar pathophysiology
posterior AHS
clumsy and not own
Manifests as involuntary, clumsy, non-complex movements and parietal sensory deficits
Patient often has subjective feeling that his/her hand does not belong to himself/herself
Associated with injury (often infarction) in the parietal lobe. Rarely, may also involve thalamus or occipital lobe
