Chronic Brain Disorders

Question 1

Transient neurologic event of paroxysmal abnormal or excessive cortical electrical discharges
-Manifested by disturbances of skeletal motor function, sensation, autonomic visceral function, behavior, or consciousness

Answer 1

Seizure

Question 2

Causes: cerebral injury, lesions, metabolic/nutritional disorders, idiopathic (no known cause)

Answer 2

Seizure

Question 3

Recurrent seizures

Answer 3

epilepsy

Question 4

May be triggered by specific stimuli such as flashing lights, fever, loud noises

Answer 4

Seizure

Question 5

Due to an alteration in membrane potential that makes certain neurons abnormally hyperactive and hypersensitive to changes in their environment (epileptogenic focus)

Answer 5

Seizure

Question 6

What’s the prodrome of a seizure?

Answer 6

subjective sense of impending seizure

Question 7

whole brain surface is affected during ______seizure

Answer 7

Involvement of thalamus and RAS system results in loss of consciousness

Question 8

Involvement of thalamus and RAS system results in loss of consciousness

Answer 8

Involvement of thalamus and RAS system results in loss of consciousness

Question 9

Absence (petite mal): occurs in children, staring spells that last only seconds
•Atypical absence: myoclonic jerks, automatisms with the staring spell

Answer 9

Generalized seizure

Question 10

Myoclonic: single/several jerks
•Atonic (drop attack): fall down
•Tonic-clonic (grand mal): jerking of many muscles

Answer 10

Generalized seizure

Question 11

continuing series of seizures without a period of recovery between episodes; can be life-threatening

Answer 11

Status epilepticus

Question 12

abnormal electrical activity restricted to one brain hemisphere

Answer 12

Partial seizures

Question 13

No change in level of consciousness; motor, sensory, and/or autonomic symptoms common in ________ seizures

Answer 13

Simple/Partial Seizure

Question 14

change in consciousness happens in ______ seizures

Answer 14

complex/partial

Question 15

Starts as simple but advances to generalized in _____ seizures

Answer 15

Partial with secondary generalization

Question 16

Electroencephalograms: assess electrical patterns of brain regions
Laboratory studies: identify metabolic/nutritional deficits, infections, and exposure to toxins
diagnose _______

Answer 16

Seizure

Question 17

Lumbar puncture: for CNS infections
CT, MRI: for structural causes
diagnose

Answer 17

Seizure

Question 18

Maintain airway•Protect from injury•Document course

to treat ____

Answer 18

Seizure

Question 19

Continued until no seizures for at least 2 years and then gradually withdrawn•Not a cure

Answer 19

Anticonvulsant medications

Question 20

Avoid triggers

Surgery: removal of foci or neurostimulation to treat ______

Answer 20

seizure

Question 21

Question 1
A patient has a tonic-clonic seizure. What type of seizure did the patient experience?
 A. Petite mal
B. Grand mal 
C. Myoclonic
D. Drop attack

Answer 21

B. Grand Mal

Question 22

Syndrome associated with many pathologies; characterized by progressive deterioration and continuing decline of memory and other cognitive changes

Answer 22

dementia

Question 23

Abrupt onset, may fluctuate often, becoming worse at night; disturbed consciousness, decreased awareness of the environment, incoherence, and hallucinations

Answer 23

delirium

Question 24

Characterized by degeneration of neurons in temporoparietal and frontal lobes, brain atrophy, amyloid plaques, and neurofibrillary tangles

Answer 24

Alzheimer disease

Question 25

Deficient synthesis of brain acetylcholine

Answer 25

Alzheimer disease

Question 26

Cause remains unknown, although genetic factors (family history increases 4x) and environmental triggers suspected Aging increases risk Behavioral problems progress from forgetfulness to total inability for self-care Depression and psychosis may be significant

Answer 26

Alzheimer disease

Question 27

Results from single cerebrovascular insults | Risk factors: stroke, hypertension, and diabetes

Answer 27

Vascular dementia

Question 28

Early: memory loss, especially short-term memory, long-term memory may be preserved; thinking ability declines, decreasing ability to function at work and in social settings; anxiety, agitation

Answer 28

dementia

Question 29

As the disease progresses, increasing difficulty with judgment, abstract thinking, problem solving, and communication; assistance for completing activities of daily living (ADLs); difficulty with eating and swallowing, weight loss; loss of bladder and bowel control and eventual complete loss of the ability to ambulate; personality and behavior changes

Answer 29

dementia

Question 30

Complete blood cell count, chemistry panel, thyroid function, vitamin B12 levels, and syphilis serology diagnose

Answer 30

dementia

Question 31

Chest x-ray, CT, MRILumbar punctureMental status examinations, clock drawing test, and tests of functional status diagnose

Answer 31

dementia

Question 32

Early diagnosis and intervention is key in the management of dementia Early stages may be able to stay at home; later stages may need nursing home or assisted living

Answer 32

dementia

Question 33

tacrine (Cognex), donepezil (Aricept), rivastigmine (Exelon), and galantamine (Reminyl) are _______ inhibitors. They are indicated for _______. NOT A CURE

Answer 33

Acetylcholinesterase; mild to moderate Alzheimer disease and vascular dementia

Question 34

Indicated for the treatment of moderate to severe Alzheimer-type dementia •Blocks stimulation by the neuroexcitatory transmitterglutamate •Not a cure, but slows progression of the disease

Answer 34

N-methyl-D-aspartate (NMDA) receptor antagonists: memantine (Namenda)

Question 35

May be idiopathic, acquired or drugs | Dopamine deficiency in the basal ganglia (substantia nigra) associated with motor impairment; Lewy bodies

Answer 35

Parkinson Disease

Question 36

Difficulty initiating and controlling movements results in akinesia, tremor, and rigidity Tremor occurs at rest and hand tremors exhibit pill-rolling movements Attempts to passively move the extremities are met with cogwheel rigidity

Answer 36

Parkinson Disease

Question 37

General lack of movement, loss of facial expression, drooling, propulsive (shuffling) gait, and absent arm swing

Answer 37

Parkinson Disease

Question 38

Treatment: no cure; restoring brain dopamine levels or activity by administration of dopamine precursors, dopamine agonists, monoamine oxidase inhibitors, and anticholinergics; antidepressant therapy may be NEEDED *Ablative surgical procedures may be helpful for motor symptoms

Answer 38

Parkinson Disease

Question 39

________responsible for smooth, coordinated control of muscle action, excitation and inhibition of postural reflexes, and maintenance of balance

Answer 39

Cerebellum

Question 40

Causes: abscess, hemorrhage, tumors, trauma, viral infection, chronic alcoholism Clinical manifestations: ataxia, hypotonia, intention tremors, disturbances in gait and balance Treatment: identify and eradicate cause

Answer 40

Cerebellum disorders

Question 41

Chronic demyelinating disease of the CNS that primarily affects young adults Autoimmune disorder that results in inflammation and scarring (sclerosis) of myelin sheaths covering nerves; slowly progressive

Answer 41

Multiple Sclerosis

Question 42

Cause unknown, but immunologic abnormalities, genetics, and environmental factors suspected Demyelination can occur throughout the CNS but often affects the optic and oculomotor nerves and spinal nerve tracts

Answer 42

Multiple Sclerosis

Question 43

Marked by exacerbations and remissions; exacerbated by heat, infection, trauma, stress Manifestations: double/blurred vision, weakness, poor coordination, and sensory deficits; bowel and bladder control may be lost; memory impairment common

Answer 43

Multiple Sclerosis

Question 44

Diagnosis: MRI Treatment: no cure; short-term steroid therapy may be helpful during acute exacerbations and immune-modifying drugs may slow progression of symptoms

Answer 44

Multiple Sclerosis

Question 45

Problem of the young Males 3 to 4x more likely Usually traumatic, a result of motor vehicle accidents, falls, penetrating wounds (usually gunshot), or sports injuries

Answer 45

Spinal cord injury

Question 46

Cord may be compressed, transected, or contused Mechanisms of injury Hyperflexion, hyperextension, compression

Answer 46

Spinal cord injury

Question 47

_______injury may result from hemorrhage, swelling, ischemia, inflammation

Answer 47

Secondary spinal cord

Question 48

________occurs immediately and is characterized by temporary loss of reflexes below the level of injuryMuscles flaccid; skeletal/autonomic reflexes lost

Answer 48

Spinal shock

Question 49

End of ______: reflexes return and flaccidity replaced by spasticity

Answer 49

spinal shock

Question 50

______shock may occur after SCI due to peripheral vasodilation

Answer 50

Neurogenic

Question 51

Hypotension, bradycardia, and circulatory collapse can occur (life-threatening); high spinal cord injuries can affect respiratory muscles, leading to ventilatory failure results from ________

Answer 51

neurogenic shock

Question 52

________is an acute reflexive response to sympathetic activation below the level of injury

Answer 52

Autonomic dysreflexia

Question 53

Visceral stimulation (full bladder or bowel) and activation of pain receptors below the injury are common stimuli Manifestations: hypertension, headache, bradycardia, flushing above the level of injury, and clammy skin below the level of injury occur in_______

Answer 53

Autonomic dysreflexia

Question 54

Prompt removal of the offending stimulus; aggressive blood pressure management may be needed (adrenergic receptor–blocking drug) to amend ____

Answer 54

Autonomic dysreflexia

Question 55

Appropriate stabilization of spinal vertebrae•May be accomplished surgically with internal fixation or with external fixation and bracing to treat _____

Answer 55

spinal cord injury

Question 56

intensive care to maintain oxygenation and blood pressure to treat ________ shock

Answer 56

neurogenic

Question 57

High-dose methylprednisolone may be used to decrease secondary injury Intensive rehabilitation required to maximize function

Answer 57

spinal cord injury

Question 58

Inflammatory demyelinating disease of the peripheral nervous system or a lower motor neuron disorder Segmental demyelination that is T-cell and B-cell mediated

Answer 58

Guillain-Barré Syndrome

Question 59

Also known as acute idiopathic polyneuropathy or polyradiculoneuropathy

Answer 59

Guillain-Barré Syndrome

Question 60

Cause unknown; postinfectious immunologic mechanism suspectedSpontaneous recovery usually occurs

Answer 60

Guillain-Barré Syndrome

Question 61

Muscle weakness that begins in the lower extremities and spreads to the proximal spinal neurons Progressive ascending weakness or paralysis, may affect respiratory muscles Diagnosis: patient history, physical examination, and nerve conduction studies, lumbar puncture

Answer 61

Guillain-Barré Syndrome

Question 62

Treatment: supportive; plasmapheresis; immunoglobulin

Answer 62

Guillain-Barré Syndrome

Question 63

Idiopathic neuropathy of the facial nerve; paralysis of the muscles on one side of the face Etiology: virus

Answer 63

Bell Palsy

Question 64

Clinical manifestations: develop rapidly over 24 to 48 hrs; unilateral facial weakness, facial droop and diminished eye blink, hyperacusis, and decreased lacrimation Diagnosis: physical findings, MRI, CT, EMG

Answer 64

Bell Palsy

Question 65

Often self-limiting condition within 3 wks Lubricating drops, ointments, and nighttime eye patching may be necessary to treat

Answer 65

Bell Palsy

Question 66

Corticosteroids improve the likelihood of complete recovery Antiviral medications: acyclovir or valacyclovir recommended to treat

Answer 66

Bell Palsy