Chapter 7 Neurological System Disorders Flashcards
1
Q
Frontal lobe
- Precentral gyrus
- Prefrontal cortex
- Premotor cortex
A
- Precentral gyrus - primary motor cortex for voluntary muscle activiation
- Prefrontal cortex - controls emotions, judgements
- Premotor cortex - planning of movements including Broc’s area, controls motor aspects of speech
2
Q
Parietal lobe
A
Post central gyrus - primary sensory cortex for integration of sensation, recieved fibers conveying touch, proprioceptive, pain and temperature sensations from opposite side of body.
3
Q
Temporal lobe
A
- Primary auditory corex - receives/processes auditory stimuli
- Associateive auditory cortex - processes auditory stimuli
- Wernicke’s area - language comprehendsion
4
Q
Occipital lobe
A
- Primary visual cortex - recieves processes visual stimuli
- Visual association cortex - processes visual stimuli
5
Q
Hemispheric specialization
Left Hemisphere
A
- Movement of right side of body, processing of sensory information from right side of body
- Visual reception from right field
- Visual verbal processing
- Bilateral motor praxis
- Verbal memeory
- Bilateral auditory reception
- Speech
- Processing of verbal auditory information
6
Q
Hemispheric specialization
Right hemisphere
A
- Movement of left side of body processing of sensory information from left side of body
- visual reception from left field
- visual spatial processing
- left motor praxis
- nonverbal memory
- attention to incoming stimuli
- Emotion
- Processing of nonverbal auditory information
- Interpretation of abstract information
- Interpretation of tonal inflections
7
Q
Transient ischemic attack
- Duration
- Symptoms
A
- TIA - Cerebral insufficientcy due to transient distubances in blood flow
- Duration - last only a few mins, occurs when the blood supply to part of the brain is briefly interrupted
- Symptoms - occur suddenly and include
- numbness, weakness in the face, arm or leg, especially on one side of the body
- confusion, difficulty in talking or understanding speech,
- trouble seeing in one or both eyes
- difficulty with walking, dizziness, or los of balance and coordination
- TIAs are often warning signs that a person is at risk for a more serious and debilitating stroke.
8
Q
Types of strokes
- Hemorrhagic
- Ischemic
A
- Hemorrhagic - Cerebral hemorrhage caused by bleed secondary to HTN or aneurysm
- Ischemic - Cerebral infarction due to either embolism or thrombosis of the intra or extra cranial arteries
9
Q
Symptoms of CVA
A
- Abrupt onset of unilatera neurological signs, symptoms progress over several hours to 2 days
- Symptoms are determined by the site of the infarct and involved artery
10
Q
Middle Cerebral artery stroke (MCA)
A
results in contralateral hemiplegia, hemianesthesia, homonymous hemianopsia, aphasia, and or apraxia
11
Q
Internal carotid artery stroke
A
This stroke results in contralateral hemiplegia, hemianesthesia, homonymous hemianopsia, aphasia, and apraxia.
12
Q
Anterior cerebral artery stroke (ACA)
A
Results in contralateral hemiplegia, grasp reflex, incontinence, confusion, apathy, or mutism.
13
Q
Posterior Cerebral Artery (PCA)
A
Resuls in homonymous hemianopsia, thalamic pain, hemisensory loss, and alexia
14
Q
Traumatic Brain Injury (TBI)
- Causes
- Symptoms
- Assessments
A
- Causes - Damage results from penetration of the skills form rapid acceleration or deceleration of the brain. injury occurs in the tissue at point of impact (coup), at the opposite (countrecoup). Example causes: skill fractures, closed head injuries, penetration wounds of the skill and brain
- Symptoms - Hemiplegia or mono plegia, and abnormal reflexes, Decorticate or decerebrate rigidity, fixed pupils, coma, changes in vital signs
- Assessments - Glasgow coma scale and Rancho los amigos levels of cognitive functioning
15
Q
Spinal cord injury
- Etiology
- Classification using the ASIA Scale
- A
- B
- C
- D
- E
A
- Etiology - Trauma to the spinal cord as a result fo compression, sheraing, contusion secondary to motor vehicle accident, diving accident, or fall.
- A - Complete, no sensory or motor function is preserved in teh sacral segments S4-S5
- B - Incomplete, sensory but no motor funciton is preserved below the neurological level and extends throught the sacral segments
- C - Incomplete, motor funciton is preserbed below the neurological levle, and the majority of key muscle groups below the level have a muscle grade less than or equal to 3/5
- D - Incomplete, motor funciton is preserbed below the neurological levle, and the majority of key muscle groups below the level have a muscle grade greater than or equal to 3/5
- E - Normal, sensory and motor function are normal.
16
Q
SCI Symptoms
A
- Spinal shock (4-8weeks) all reflex activity is obliterated below the level of the injury presetnign as flaccid paralysis
- Sensory deficits
- loss of bowel/bladder control
- loss of temperature control below the lesion
- Sexual dysfunction
- Decreased respiratory funciton
- Changes in muscle tone
- loss of motor funciton (paraplegia/tetraplegia)
17
Q
Clinical syndromes (sci)
- Central cord syndrome
A
- central cord - resulting from hyperextension injuries and presenting as more upper extremity deficits vs lower extremities.
18
Q
Clinical Syndromes
Brown-Sequard
A
- hemi-section of the cord resulting in ipsilateral spactic paralysis, ipsilateral loss of position sense, ipsilateral loss of discriminitve touch, contralateral loss of pain, and contralateral loss of thermal sense
19
Q
SCI Complicaitons
A
- Respiratory complications, decreased vital capcity, pneumonia
- decubitus ulcer formation
- Ortostatic hypotension - excessive fall in blood pressure upon assuming the upright position
- DVT
29
Q
Spina Bifida
A
- Incomplete closing of the embryonic nerual tube, allowing a portion of the spinal cord to protrude throughthe openig in the bones.
There are 3 types: Spina bifida occulta, spina bifida with meningocele, and spina bifida with myelomeningocele.
30
Q
Spina bifida occulta
A
- Description - a boy malformation with separation of vertebral arches of one or more vertebrae, no external manifestations.
- Ocult spinal dysraphism - with external manifestations, red virht mark, patch of hair, dermal sinus, benign tumore, dimple covering site
- Symptoms - rarely has accompanying symptoms, occasional instability and neromuscular impairment. mild giat and bowel/bladder problems can occur
- Occult spinal dysraphism may cause tethered cord which may lead to neurological damage and developmental abnormality
31
Q
Spina bifida meningocele
A
- Descriptions - Protrusion of a sac through the spine, containing cerebral spinal fluid and meninges (sac does not contain the spinal cord)
- Symptoms - does not present with symptoms impacting function as teh spinal cord is not entrapped, Occasional, slight instability and neuromuscular impairments, such as mild gait invovlement and bowel or bladder problems
32
Q
Spina bifida with Myelomeningocele
A
- Description - protrusion of a sac throuht the spine, containing cerebral spianl fluid and meninges as well as the spinal cord or nerve roots
- Symptoms - resuls in sensory and motor deficits occuring below the level of the lesion, may result in lower extremity paralysis and deformities, bowel/bladder incontinence.
- lesion of S2-S4 results in bladder and bowel problems
34
Q
Muscular Dystrophy types
Duchenne’s muscular dystrophy
A
- detected between 2-6 years of age
- symptoms - enlargement of calf muscles and enlarge forearms. weakness of the proximal joints progresses to the point that the child has to crawl up his thighs with his hands to stnad from a kneeling position (Gower’s sign)
- Weakness occurs in all vonuntary muscles including the heart and diaphragm
- Individuals rarely survive beyond their early 20s due to repiratory problems, infections, and or cardiovascular complications.
35
Q
Muscular Dystrophy Types
Arthrogryposis multiplex congenita
A
- Is detected at birth and associated with loss of anterior horn cells
- Presence of weakness, deformities, and associated joint contractures.
- position of rest for the upper extremities tends to be internal rotation of the shoulders, extension of the lebows and flexion of the wrists; for the lower extremities, there is flexion and internal rotation of the hips and club feet
- Mildly progressive/stable, or can improve
- possible issues with congenital heart defects, spinal defects, torticollis and involvement of the diaphragm
36
Q
Limb-girdle muscular dystrophy
A
- notable scapular winging
- onset begins in 1-3rd decades of life,
- proximal muscles of pelvis and shoulder are intitially affected
- Typically progresses slowly
37
Q
types
A
39
Q
Strucutral Cerebellar Lesions
A
- characterized by ataxia, dysmetria, dysdiadochokinesia, hypotonia, movment decomposition tremor, dysarthria, and nystagmus.
40
Q
Amyotrophic lateral Sclerosis (ALS)
A
- ALS - motor neuron disease of unknown etiology characterized by progressive degernation of corticospinal tracts and anterior horn cells or bulbar efferent neurons
- death usually occurs in 2-5
- Symptoms - Muscle weakness and atrophy, evidence of anterior horn cell destruction, often begins distally and asymetrically, craps and fasiculations (twitching) precede weakness. Signs usuallyl begin in the hands
- Lower motor neuron signs are soon accompanied by spasticity, hyperactive deep tendon reflexes, and evidence of corticospinal tract involvement
- Sensory systems, eye movement, and urinary sphincters are often spared.
41
Q
Brachial Plexus Disorder
A
- secondary to traction during birth, invasion of metastic cancer, or traction injury
- Symptoms
- Mixed motor and sensory disorders of the corresponding limb, rostral injuries produce dysfunciton in the hand
43
Q
Brachial plexus seen in children
Klumpke’s palsy
A
- paralysis of the lower brachial plexus including the seventh and eight cervical and first throacic nerves.
- Results in paralysis of the hand and wrist , often with ipsilateral Horner’s syndrome (ptosis = drooping of the eyelid) miosis(constriciton of the pupil) facial anhidrosis (decreased facial sweating)
- Characteristic signs are that the hand is limp and the fingers do not move
44
Q
Guillain - Barre Syndrome
A
- May occur after an infections disorder, surger, or an immunizaion
- Stats:
- 50% exhibit mild neurological deficits
- 15% exhibit residual functional deficits
- 80% are ambulatory in 6 months
- Symptoms
- Acute, rapidly, progressive form of polyneuropathy characterized by symmetric muscular weakness and mild distal sensory loss/paresthesia
- Weakness is more apparent than sensory findings
- Relatively minor sensory signs and symptoms occur, possible complaints of painful extremities, subjective and objective sensory disturbances are common initially
- Deep tendon reflexes are lost and sphincters are spared
- Respiratory failure and dysphagia possible
45
Q
Myasthenia Gravis
A
- Diseased caused by an autoimmune attach on the Ach receptor of the postsynaptic neuromuscular junciton
- usually a progressive disabling process
- Diagnosis is often missed because of vagueness of symptoms
- characterized by episodic muscl weakness, especially in muscles innervated by crancial nerves
- Ptosis, diplopia, muscle fatigue after exercise, dysarthria, dysphagia, and proximal limb weakness
- sensation and deep tendon reflexes are intact
- symptom fluctuate over the course of the day
- life threatening respiratory muscle involvement may occur
