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PSYC 424: Neuropsychology > Chapter 11 > Flashcards

Chapter 11 Flashcards

1
Q

traumatic brain injury (TBI)

A

happens when a sudden, external, physical assault damages the brain
- TBI is a broad term that describes a vast array of injuries that happen to the brain. The damage can be: focal, diffuse

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2
Q

focal damage

A

confined to one area of the brain
- contusions (visible)
- concussion (non-visible)
- chronic traumatic encephalopathy (CTE) brain degeneration suffered by professional football players
- hematomas (subdural and epidural)

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3
Q

diffuse damage

A

happens in more than one area of the brain

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4
Q

two ways TBIs may happen

A

closed brain injury, penetrating brain injury

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5
Q

closed brain injury

A
  • happen when there is a non-penetrating injury to the brain with no break in the skull
  • a rapid forward or backward movement and shaking of the brain inside the bony skull (e.g., car accident or violently shaking a baby)
  • diffuse axonal injuries (DAI)
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6
Q

penetrating brain injury

A
  • open head injuries
  • happen when there is a break in the skull, such as when a bullet pieces the brain
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7
Q

diffuse axonal injury (DAI)

A

a type of TBI that occurs due to shearing of a brain’s long connecting nerve fibers (axons) that happens when the brain is injured as it shifts and rotates inside the boney skull

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8
Q

classifications of TBI based on the Glasgow coma scale (GCS)

A

mild (13-15), moderate (9-12), severe (below 8)

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9
Q

symptoms of diffuse axonal injury (DAI)

A
  • can present in a spectrum of neurological dysfunction
  • can range from clinically insignificant to a comatose state
  • most patients are identified to be severe and commonly have a GCS of less than 8
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10
Q

etiology of DAI

A
  • most common etiology involves high-speed motor vehicle accidents
  • most common mechanism involves an accelerating and decelerating motion that leads to shearing forces to the white matter tracts of the brain
  • commonly affects white matter tracts involved in the corpus callosum and brainstem
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11
Q

coup contra coup

A
  • coup injury refers to the brain damage that occurs directly under the point of impact
  • coutra coup injury occurs on the opposite side of the brain from where the head is struck
    (when a blow is taken to one side of the skull/brain and then the skull/brain rocks back and forth in reaction)
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12
Q

bad design of the skull

A

if brain slides against ethmoid ridge and/or sphenoid ridge, it can get wrecked

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13
Q

ethmoid ridge

A

bone separating the hemispheres

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14
Q

sphenoid ridge

A

bone separating frontal and temporal lobes

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15
Q

one consequence of contusions

A

orbitofrontal cortex damage
- affects executive function

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16
Q

clinical features of mild traumatic brain injury: initial presentation

A
  • initial loss of consciousness lasting seconds to minutes, but not lasting longer than 30 minutes
  • period of confusion (post-traumatic amnesia) lasting minutes to hours, but can last up to 24 hours
  • any combination of headaches, neck ache, dizziness, and nausea
  • typically no focal findings on the remainder of the neurological examination
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17
Q

clinical features of mild traumatic brain injury: follow-up presentation

A

“neural injury”
- cognitive deficits (attention, memory, and executive function)
- behavioral deficits (depression, anxiety)

“non-neural injury”
- systemic deficits (head/neck ache, dizziness, poor sleep)

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18
Q

recovery from a mild traumatic brain injury

A
  • typical patient (loss of consciousness [LOC] <1-minute, post-traumatic amnesia [PTA] <20-40 minutes) usually recovers within 3 months
  • if injury is more severe (LOC > 10 minutes, PTA > 4-6 hours) recovery can take months to years, or not at all
  • older patients (>55 years) will take longer to recover
  • 10-15% of mild TBI patients have symptoms at 1 year (called persistent post-concussive syndrome [PPCS])
19
Q

other causes of TBI

A
  • epidural hematoma
  • subdural hematoma
20
Q

treating hematoma

A

decompressive craniectomy
- remove portion of skull so brain can inflame and go out through that removed portion rather than pushing down inside the skull

21
Q

seizure

A

abnormal discharge of neurons that causes sudden and brief (seconds to minutes) abnormalities of brain function (sensory, motor, behavioral, cognitive)

22
Q

epilepsy

A

recurrent seizures of unknown etiology

23
Q

neurotransmitters in epilepsy

A

1) influx of sodium
2) influx of calcium
3) release of glutamate
4) activation of excitatory receptors
5) inhibition of GABAergic system

  • thought that glutamate is implicated
24
Q

causes of seizures

A
  • genetic
  • trauma/brain injury
  • tumors
  • vascular - stroke, hemorrhage, AVM
  • toxic - alcohol, cocaine
  • infections - encephalitis, meningitis
  • metabolic - hyponatremia, hypoglycemia, hypocalcemia
  • other - sleep deprivation, fainting, fever (children)
25
Q

epilepsy - generalized

A
  • tonic/clonic (Grand Mal)
  • absence (petit Mal)
  • complex partial (most common in adults) (unconscious)
26
Q

epilepsy - focal (partial)

A

simple partial (conscious)

27
Q

generalized tonic-clonic epilepsy

A
  • impaired consciousness
  • aura (20%) –> feel that it is coming
  • collapse to floor
  • tonic body extension followed by clonic jerking
  • loss of bowel or bladder (20%)
  • prolonged post-ictal state up to hours
28
Q

petit mal seizures

A
  • generalized (absence)
  • impaired consciousness, brief 2-3 second episodes
  • chewing movements in 20% of cases
  • NO post-ictal state; 3 per second spike-wave discharge
29
Q

complex partial seizures

A
  • a focal onset impaired awareness seizure
  • starts in temporal lobe then moves to other areas of the brain that affect symptoms
  • impaired consciousness
  • dreamy state, deja vu
  • formed auditory hallucinations - music
  • formed visual hallucinations
  • chewing movements, automatisms (picking at clothing)
  • language disturbance
30
Q

simple partial (focal) seizures

A
  • consciousness
  • somatosensory - tingling
  • motor - twitching, head turning, grimacing
  • visual - flashes of light
  • auditory - ringing, hisses, noises
  • olfactory - bad odors
  • autonomic - sweating, flushing, epigastric pain
31
Q

treatment of epilepsy

A
  • anti-epileptic medications
  • surgery
32
Q

anti-epileptic medications

A
  • decrease membrane excitability by interacting with neurotransmitter receptors or ion channels
  • act on sodium channels, gamma-aminobutyric acid (GABA) receptors, or calcium channels
33
Q

surgery to treat epilepsy

A

remove affected brain tissue

34
Q

types of brain tumors

A

primary, secondary

35
Q

primary brain tumors

A
  • intraparenchymal –> glioma (astrocytoma)
  • extraparenchymal –> meningioma
36
Q

secondary brain tumors

A

intra or extraparenchymal –> metastases

started outside the brain then traveled into the brain

37
Q

intraparenchymal

A

inside the brain

38
Q

extraparenchymal

A

outside the brain

39
Q

location of brain tumors

A
  • adults: cerebral hemispheres
  • children: brainstem and cerebellum
40
Q

symptoms of brain tumors

A
  • depends on location
  • slowly progressive
  • if cortex involved, seizures are common
41
Q

childhood brain tumors

A
  • almost always in the posterior fossae: cerebellum and brainstem
  • balance (ataxia) and cranial nerve problems (double vision) typical
  • 4 types: 2 treatable, 2 not very treatable
42
Q

watershed zones

A

areas of the brain that are fed by two main artery supplies
- the artery diameter is small and circulating tumors get stuck
- metastasis often found at first in watershed zones

43
Q

usual sources of secondary tumors

A
  • lung
  • colon
  • breast
  • melanoma
  • kidney

PSYC 424: Neuropsychology (12 decks)

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