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Neuropsychology > Conditions > Flashcards

Conditions Flashcards

0
Q

Acalculia

A

Disturbances in calculation

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1
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A
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2
Q

Acalculia associated with alexia and agraphia for numbers

A
  • Most often associated with left hemisphere disease, but does not rule out right hemisphere involvement
  • Alexia for arithmetic signs w/ preserved reading of numbers often associated with left parietal or temporal-occipital regions
  • Associated features:
  1. aphasia
  2. verbal alexia
  3. ideational and ideomotor apraxia
  4. constructional deficits
  5. somatognosia
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3
Q

Acute Subdural Hematoma

A

To occur immediately after injury, the impact velocity must be quite high.

Therefore, this is usually associated with other serious injuries, such as traumatic subarachnoid hemorrhage and brain contusion.

Treatment:

  1. Surgical evacuation
  2. Small to moderate-sized chronic - depending on severity of symptoms, just follow clinically b/c some will resolve spontaneously
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3
Q

Acalculia of the Spatial Type

A
  1. Misalignment of numbers
  2. Reversal of digits
  3. Inversion of digits (e.g., 6 for 9)
  4. Reversal errors (e.g., 12 for 21)
  • Actual calculation is largely preserved
  • Generally associated with more visual-constructive impairment
  • Right hemisphere (post-rolandic) is implicated; rare in pts with lesions confined to left hemisphere
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4
Q

Agnosia

A
  • From Greek word “gnosis” or knowledge, so it means the absence of knowledge
  • A disorder of recognition; inability to recognize the meaning of info conveyed w/i a sensory system from external environment to the brain
  • Crucial feature: exists only in a singular sensory modality
  • Not attributable to:
  1. Elemetary sensory deficits
  2. Mental deterioration
  3. Non-familiarity
  4. Aphasic misnaming
  5. Impaired conciousness or attention
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5
Q

Alexia

A

An acquired deficit in the ability to interpret written language (loss of the ability to read)

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6
Q

Alexia - localization

A

Disconnection between visual cortex and Wernicke’s area

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7
Q

Anarithmetria

A
  • Deficits in performing the calculation itself (aka, primary acalculia)
  • Left sided temporal or occipital lobe lesions. Does not appear to be caused by right hemisphere unless parietal lobe is involved
  • Associated with:
  1. aphasia
  2. visuoconstructive deficits
  3. general cognitive deterioration
  4. verbal alexia
  5. directional confusion
  6. visual field deficit
  7. oculomotor disturbance
  8. sensory impairment
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8
Q

Anterior Alexia (Frontal Alexia)

A

More recently discovered so also known as the “Third Alexia” Basic clinical features: - Great difficulty naming individual letters of alphabet but can recognize some written words - Severe agraphia; ability to copy written language poor - Comprehend some spelled words, but poor at spelling aloud - Recognize some semantically meaningful words but fail to comprehend the grammatically significant function words – Agrammatism of written language Accompanying neuro findings: - Right hemiplegia - Nonfluent aphasia - May include unitlateral sensory and/or visual-field neglect Pathology is typically left frontal area Other common names: literal alexia, letter blindness

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8
Q

Apperceptive Agnosia

A
  • Damage fairly early on in recognition assembly line, before perception is properly constructed
  • Pts do not perceive objects normally so cannot recognize them
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9
Q

Apraxia

A

Inability to make sequences of movements

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10
Q

Apraxia - localization

A

Disconnection between motor and sensory areas

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11
Q

Argyll Robertson Pupils

A
  1. Bilateral small pupils that reduce in size when the patient focuses on a near object (accomodate)
  2. Do not constrict when exposed to bright light
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12
Q

Arteriovenous malformation (AVM)

A
  • Congenital abnormality
  • Abnormal direct connections b/t arteries and veins
  • Often form a tangle of abnormal blood vessels, best seen on conventional angiography
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12
Q

Assessment of Acalculia

A

These should be done orally and in written format:

  1. Appreciation of number values: greater than/less than (e.g., which is greater? 23 or 31?)
  2. Appreciation of values in written format. Point to the larger number.
  3. Reading numbers aloud
  4. Pointing to written numbers read aloud by the examiner
  5. Writing numbers to dictation
  6. Copying numbers
  7. Counting aloud
  8. Estimating numbers of items in a series of continuous vs discontinuous dots
  9. Oral arithmetic
  10. Written arithmetic
  11. Arithmetic reasoning (WAIS Arithmetic)
  12. Immediate memory for calculation problems

Qualitatively, look for specific types of errors:

  1. Substitution of one operation for another (e.g., 2+3=6, substituting multiplication for addition)
  2. Counting for calculation (e.g., 4+7=8)
  3. Perseveration of last digit presented (e.g., 4x5=24)
  4. Giving a reversal of number presented as answer (e.g., 13+6=31)
  5. Impaired immediate retention of components of problems
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13
Q

Associative Agnosia

A
  • Fault in later stages of recognition
  • Perception may be okay, but access to meaning or memory is not
  • “A normal percept stripped of it’s meaning”
  • Can successfully copy, but not identify
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14
Q

Astrocytoma

A
  • brain cancer arising from glial cells, star-like neurons, aka astrocytes
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15
Q

AVM Symptoms

A
  • Seizures
  • Migraine-like headaches
  • Hemorrhage is usually intraparenchymal, but can extend to intraventricular or subarachnoid space
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16
Q

Bacterial Meningitis

A

CSF findings:

  1. High white blood cell count
  2. High protein
  3. Low glucose

Treatment:

  1. Begin as rapidly as possible
  2. Do not wait for transport or diagnostic test results

Possible complications of:

  1. Seizures
  2. Cranial neuropathies
  3. Cerebral edema
  4. Hydropcephalus
  5. Herniation
  6. Cerebral infarcts
  7. Death
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17
Q

Cavernous Malformation

A
  • Abnormally dilated vascular cavities lined by only one layer of vascular endothelium
  • Not visible on conventional angiography
  • Often presents with seizure
  • Risk of bleed 0.1-2.7% per lesion year; increases after initial bleed occurs
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17
Q

Brain Abscess

A

Presents as an expanding intracranial mass lesion, much like a brain tumor, but often with a more rapid course.

Common presenting features:

  1. Headache
  2. Lethargy
  3. Fever (absent in 40% of cases)
  4. Nuchal rigidity
  5. Nausea/vomiting
  6. Seizures
  7. Focal signs related to site of lesion
  8. Elevated white blood cell count (absent in 20% of cases)

Treatment:

  1. Abscess < 2.5 cm in diameter - antibiotics
  2. Abscess > 2.5 cm in diameter - steriotactic needle aspiration + antibiotics
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18
Q

Central Alexia (Alexia w/ Agraphia)

A

Basic clinical features: - severe (not necessarily total) disturbance of both reading and writing - preserved ability to copy written language, but in slavish and non-comprehended manner - loss of ability to name letters, to comprehend spelled words, or to read out loud Often accompanied by other neurobehavioral disorders including: - aphasia - components of Gerstmann Syndrome (finger agnosia, right-left confusion, acalculia, and agraphia) - some degree of hemisensory loss and/or right homonymous visual field defict Locus of pathology includes inferior parietal lobe of language dominant hemisphere, centering on angular gyrus; typically damage to both cortex and white matter Causes most often from occlusion of MCA or distal branches (inferior parietal lobe); may also be caused by neoplastic lesions Other common names: semantic alexia, parieto-temporal alexia, total (literal and verbal) alexia, letter and word blindness, surface alexia

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19
Q

Central Herniation

A
  • Central, downward displacement of the brainstem
  • Caused by any lesion associated with elevated intracranial pressure (including hydrocephalus & diffuse cerebral edema)
  • Mild herniation:
    1. Causes traction on abducens nerve (CN VI) - producing lateral rectus palsey (inability for outward movement of the eye)
    2. May be unilateral or bilateral
  • Large herniation:
    1. Herniation through the tnetorial opening, resulting in bilateral uncal herniation
  • Severe herniation:
    1. Can progress downward through the foramen magnum
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20
Q

Chronic Subdural Hematoma

A

Often seen in the elderly, where atrophy allows the brain to move more freely, making bridging veins more susceptible to shear injury.

May be seen with little to no history of trauma

Oozing slowly, venous blood collects over weeks to months, allowing the brain to accommodate, causing vague symptoms:

  1. Headache
  2. Cognitive impairment
  3. Unsteady gait

Focal dysfunction of the underlying cortex may result in focal neurological deficits

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21
Q

Communicating Hydrocephalus

A
  • Impaired CSF reabsorption in the arachnoid granulations, obstruction of flow in the subarachnoid space, or by excess CSF production
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23
Q

Concussion

A
  • Reversible impairment of neurologic function for minutes to hours following head injury
  • Mechanism - unknown (might be transient diffuse neuronal dysfx)
  • CT & MRI - normal
  • Clinical features:
  1. LOC
  2. “seeing stars”
  3. headache
  4. dizziness
  5. nausea
  6. vomiting
  7. occasional anterograde and retrograde amnesia for several hours around the injury
  • Recovery is usually complete
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24
Q

Epidural Abscess

A

In the spinal canal and requires prompt diagnosis and tx to prevent:

  1. Spinal cord compression
  2. Paraparesis
  3. Urinary/fecal incontinence

Common presenting features:

  1. Back pain
  2. Fever
  3. Elevated peripheral white blood cell count
  4. Headache
  5. Sign of nerve root or spinal cord compression

Treatment:

  1. Surgical drainage
  2. Antibiotics (can be used alone in early cases without progressive deterioration)
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25
Q

Epidural Hematoma

A

Location: B/t dura and skull

Usual cause: rupture of the middle meningeal artery due to fx of temporal bone by head trauma

Clincial features:

  1. Hematoma, pulls dura away from inner surface of the skull
  2. Often does not spread past cranial sutures where the dura is tightly apposed to skull
  3. No sx initially, but within few hours hematoma begins to press on brain tissue
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27
Q

External Ventricular Drain (Ventriculostomy)

A
  • when fluid from the lateral ventricles is drained into a bag outside of the head
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27
Q

General Paresis

A

Accumulation of lesions associated with meningovascular syphilis, causes:

  1. Dementia
  2. Behavioral changes
  3. Delusions of grandeur
  4. Psychosis
  5. Difffuse upper-motor neuron (originate in the motor region of the cerebral cortex or brain stem) type weakness
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28
Q

Gertsmann’s Syndrome

A
  1. Agraphia
  2. Finger agnosia
  3. Left/right disorientation
  4. Acalculia - not associated with any specific type of acalculia
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29
Q

Glioblastoma

A
  • The most common type of Stage IV brain cancer
  • a type of glioma
  • Usually leads to death within 1 year
30
Q

Herniation

A

When mass effect is severe enough to push intracranial structures from one compatment into another.

31
Q

Hydrocephalus

A
  • “water in the head”
  • Caused by excessive CSF in the intracranial cavity
32
Q

Hydrocephalus can result from?

A
  1. Excess CSF production
  2. Obstruction of flow at any point in the ventricles or subarachnoid space
  3. Decrease in reabsorption via the arachoid granulations
33
Q

Hydrocephalus Ex Vacuo

A
  • Refers to excessive CSF in a region where the brain tissue was lost as a result of stroke, surgery, atrophy, trauma, or other insult
34
Q

Inability to read or write numbers - lesion localization

A

Left parietal; but, does not rule out right hemisphere

35
Q

Infectious Meningitis

A

Infection of the CSF in subarachnoid space

Causes:

  1. Bacteria
  2. Viruses
  3. Fungi
  4. Parasites

Signs/Symptoms:

  1. Meningeal irritation
    • headache
    • lethargy
    • photophobia
    • phonophobia
    • fever
    • nuchal rigidity
36
Q

Kernohan’s Phenomenon

A

When uncal herniation pushes all the way over until it is compressed by the opposite side of the tentorial notch, compressing the contralateral corticospinal tract, leading to ipsilateral hemiplegia.

37
Q

Lyme Disease

A

Caused by bacteria from a species of deer tick

Common features:

  1. Primary infection - raised rash, which gradually shifts location and enlarges over days to weeks
  2. In some cases, neurological manifestations occur:
    • Meningeal signs
    • Emotional changes
    • Impaired memory/concentration
    • Cranial neuropathies (especially facial nerve)
    • Peripheral neuropathies
    • Spinal cord involvement (rare)
  3. Non-neurological manifestations:
    • Arthritis
    • Cardiac conduction abnormalities

Treatment: Intravenous antibiotic

38
Q

Lymphoma

A

Arises from B lymphocytes

Commonly involves regions adjacent to ventricles

Treatment: Can be controlled for several years with chemo and radiation

Median survival rate: 4 years

39
Q

Meningioma

A
  • Arise from the arachnoid villus cells
  • Grow slowly
  • In females, associated with breast cancer
40
Q

Meningovascular Syphilis

A

Causes arteritis (inflammation of the walls of arteries) - typically medium-sized vessels.

Results in diffuse white matter infarcts

41
Q

Metastatic Tumors

A
  • Arise from neoplasms originating elsewhere in the body that spread to the brain
  • 5-8x more common than all primary CNS tumors combined
42
Q

Neurosyphilis

A

Transmitted sexually

Stages:

  1. Painless skin lesions (chancres) appear at the site of infection, about 1 month after exposure
  2. More diffuse skin lesions appear, characteristically including palms and soles, within 6 months
  3. Neurologic manifestations
  • Aseptic meningitis
    • Cranial nerve palsies, especially:
      • Optic
      • Facial
      • Vestibulocochlear
  1. 4-15 years after infection, can see:
  • Meningovascular syphilis
  • Generaly paresis
  • Tabes dorsalis
44
Q

Noncommunicating Hydrocephalus

A
  • Caused by obstruction of flow within the ventricular system
45
Q

Nontraumatic (Spontaneous) Subarachnoid Hemorrhage

A

Presentation: Sudden catastrophic headache, feeling like the head is about to explode.

Usual cause: 75-80% rupture of arterial aneurysm in subarachnoid space

Less common: 4-5% bleeding of an arteriovenous malformation

46
Q

Normal-Pressure Hydrocephalus

A
  • Characterized by chronically dilated ventricles
  • Present with clinical triad:
  1. Gait difficulties
  2. Urinary incontinence
  3. Mental decline
  • Pressure measurements are usually WNL
  • Thought to be a form of communicating hydrocephalus w/ impaired CSF reabsorption at the arachnoid villi
  • Some cases improve dramatically after lumbar puncture or ventriculoperitoneal shunting
46
Q

Nuchal Rigidity

A

The neck muscles contract involuntarily, resulting in resistance to active and passive neck flexion, accompanied by neck pain.

48
Q

Obstruction of CSF flow (cause)

A
  • Obstruction of the ventricular system by:
  1. Tumors
  2. Intraparenchymal hemorrhage
  3. Other masses
  4. Congenital malformations
  • Can also occur outside the ventricles in the subarachnoid space by:
  1. Debri
  2. Adhesions from prior hemorrhage, infection, or inflammation
49
Q

Papilledema

A
  • Engorgement & elevation of the optic disc, sometime accompanied by retinal hemorrhages
  • Resulting from elevated intracranial pressure, which is transmitted through the subarachnoid space to the optic nerve sheath, obstructing axonal transport and venous return in the optic nerve.
50
Q

Petechial Hemorrhages

A

Small spots of blood in the white matter

51
Q

Pineal Region Tumors

A

Relatively uncommon -

Include:

  1. Pinealomas (pineocytoma & pineoblastoma)
  2. germinoma
  3. teratoma (rarely)
  4. glioma (rarely)

Tumors here may:

  1. obstruct the cerebral aqueduct causing hydrocephalus
  2. compress the dorsal midbrain, causing Parinaud’s syndrome
52
Q

Pituitary Adenomas

A

Can cause endocrine disturbances or compress the optic chiasm (resulting in bitemporalvisual field defect)

53
Q

Postconcussive Syndrome

A
  1. Headaches
  2. Lethargy
  3. Mental dullness
  4. Other symptoms
  • can last up to several months after injury
54
Q

Posterior Alexia (Alexia w/o Agraphia)

A

Basic clinical features: - Individual can comprehend written material - Writing is almost or totally w/in normal limits BUT can’t comprehend what write - Easily write but have more trouble copying written language With practice, can learn to read most letters out loud; words can then be spelled out loud and recognized auditorially In most cases, ass’d neuro findings include: - right homonymous hemianopia - color naming disturbance Pathology is typically infarction of left posterior artery territory, including splenium of CC (spares angular gyrus) Disconnects visual info from language cortex Other common names: verbal alexia, visual alexia, pure alexia, occipital alexia, associative alexia

55
Q

Pott’s Disease

A

Tuberculous involvement of the epidural space and vertebral bones

A kind of tuberculous arthritis of the intervertebral joints

Usually affects lower thoracic and upper lumbar vertebrae

56
Q

Prevalence and cause of excessive CSF production

A
  • Rare
  • Seen only in certain tumors, such as a choroid plexus papilloma
57
Q

Primary Acalculia

A

Disturbance in performing calculations specifically

58
Q

Primary CNS Tumors

A
  • Arise from abnormal proliferation of cells originating IN the nervous system
60
Q

Risk factors for aneurysmal rupture

A
  1. HTN
  2. Smoking
  3. ETOH
  4. Situations causing sudden elevations in BP
60
Q

Schwannomas are most common where?

A

CN VIII

61
Q

Secondary Acalculia

A

Problems with calculations due to more general disturbances in memory, language, attention, etc The more common of the two acalculia conditions

62
Q

Signs & Symptoms of Elevated Intracranial Pressure

A
  1. Headache - worse in the am b/c of increased brain edema overnight from the effects of gravity in the reclining position
  2. Altered mental status - irritability, depressed level of alertness/attention
  3. Nausea & vomiting (projectile)
  4. Papilledema
  5. Visual loss - increased blind spot or concentric visual field deficit (affecting mainly peripheral margins of the visual field)
  6. Diplopia - resulting from downward traction on CN VI, causing unilateral or bilateral abducens nerbe palsies
  7. Cushing’s triad: HTN (reflex to maintain cerebral perfusion pressure), bradycardia (reflexive response to HTN), irregular respiration (impaired brainstem fx)
63
Q

Signs & Symptoms of Hydrocephalus

A
  1. Headache
  2. Nausea
  3. Vomitting
  4. Cognitive impairment
  5. Decreased levels of consciousness
  6. Papilledema
  7. Decreased vision
  8. 6th nerve palsies
  • if descending white matter pathways from the frontal lobes get compressed:
  1. Unsteady magnetic gait (barely lifting feet)
  2. Incontinence
65
Q

Subarachnoid Hemorrhage

A

Location: in CSF-filled space b/t arachnoid and pia, which contains major blood vessels of the brain

Radiological appearance: Blood can ben seen to track down into the sulci following the contours of the pia

Usual cause:

  1. Non-traumatic (spontaneous)
  2. Traumatic
67
Q

Subdural Empyema

A

A collection of pus in the subdural space

Cause:

  1. Usually direct extension from infection of nasal sinuses or inner ear

Treatment:

  1. Urgent surgical drainage
  2. Antibiotics
68
Q

Subdural Hematoma

A

Location: in the potential space b/t dura and arachnoid

Usual cause: rupture of bridging veins, which are particularly vulnerable to shear injury as they cross from arachnoid into the dura

Clinical features:

  1. venous blood dissects relatively easily b/t the dura and arachnoid, spreading out over a large area and forming a crescent-shaped hematoma.
  2. 2 types
    1. chronic
    2. acute
70
Q

Subfalcine Herniation

A
  • herniation of the cingulate gyrus and other brain structures under the falx cerebri from one side of the cranium to the other
  • usually no clinical signs can be attributed directly to this type of herniation
71
Q

Tabes Dorsalis

A

Involvement of the spinal cord dorsal roots, especially in the lumbosacral region, resulting in degeneration of the dorsal columns, which results in:

  1. Sensory loss in lower extremities
  2. Sensory ataxia, with characteristic high-stepping tabetic gait
  3. Incontinence
  4. Argyll Robertson pupils
  5. Optic atrophy
72
Q

Tentorial Herniation

A
  • Herniation of the medial temporal lobe, especially the uncus, inferiorly through the tentorial notch
  • Clinical triad:
  1. “Blown” pupil - due to compression of the oculomotor nerve (CN III), ususally ipsilateral to lesion. In uncal herniations, dialated pupil is ipsilateral to lesion 85% of the time
  2. Hemiplegia - compression of the cerebral peduncles
  3. Coma - distortion of the midbrain reticular formation leads to decreased levels of consciousness and ultimately coma
72
Q

Tonsillar Herniation

A

When the cerebellar tonsils are herniated downward through the foramen magnum

Compresses the medulla, leading to:

  1. Respitory arrest
  2. BP instability
  3. Death
72
Q

Third Ventriculostomy

A
  • Gaining in popularity for treating hydrocephalus
  • Make a perforation in the floor of the 3rd ventricle just in front of the mamillary bodies, allowing CSF to drain into the interpeduncular cistern
73
Q

Treatment of Pituitary Adenomas

A
  1. Dopinergic agonists - will often shrink them
  2. Transsphenoidal resection
73
Q

Toxoplasmosis

A

Initial exposure: cysts in cat feces or undercooked meat - usually asymptomatic

In HIV or other immunosupressant conditions:

  • the infection becomes reactivated and spreads to the CNS
  • forms brain abscesses (ring-enhancing lesions; MRI dark in the center with a ring of enhancement

Presenting features:

  1. seizures
  2. headache
  3. fever
  4. meningitis
  5. focal signs depending upon location of lesion
75
Q

Tuberculous Meningitis

A

Cause: Tuberculosis

Common features occurring over the course of weeks:

  1. Headache
  2. Lethargy
  3. Meningeal signs

Problems:

  1. Often has an inflammatory response in the basal cisterns, which can affect the Circle of Willis vessels, resulting in infarcts.
  2. Coma
  3. Hydrocephalus
  4. Death
76
Q

Ventriculoperitoneal Shunt

A
  • Shunt tubing that passes from the lateral ventricle out of the skull and then tunneled under the skin to drain into the peritoneal cavity of the abdomen
78
Q

Viral Encephalitis

A

When viral infections involve brain parenchyma

Most common cause: Herpese Simplex Virus Type 1

Common features:

  1. Bizarre psychotic behavior
  2. Confusion
  3. Meningeal irritation
  4. Seizures

Focal signs:

  1. Anosmia
  2. Hemiparesis
  3. Memory loss
  4. Aphasia

Progression: Causes necrosis of unilateral and bilateral temporal and frontal structures

Results (untreated) within days:

  1. Coma
  2. Death
80
Q

Viral Meningitis

A

Does not develop or progress as rapidly as bacterial meningitis

Recovery usually occurs spontaneously within 1-2 weeks

Common features:

  1. Meningeal irritation

Cause: often not identified

Treatment: no specifics, except for Herpes and HIV

81
Q

What is the normal intracranial pressure in adults?

A

Neuropsychology (4 decks)

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