Exam 1 Flashcards
A right-handed patient sustains a PCA infarct that results in damage to the left posterior white matter and the splenium of the corpus callosum, with relative gray matter sparing.
What following symptom cluster is most likely to occur
Alexia without agraphia (a.k.a. posterior alexia or associative alexia)
Evidence of which form of validity is most needed for a job screening test?
Predictive validity
PTA, or Post Traumatic Amnesia, refers to
A period of time following a TBI in which new memories cannot be consistently formed.
Anomic aphasia is typically caused by damage to the following area of the left hemisphere?
Angular Gyrus
An individual with which type of dementia is most likely to show retrieval rather than retention deficits:
Parkinson’s Disease
The primary visual area lies along the ______.
Calcarine fissure
The criterion validity of a test is limited by :
The test’s standard deviation
Functional neuroimaging (PET, fMRI) in patients with schizophrenia has shown
hypofrontality
Hypofrontality is a significant dysfunction in the activation of the prefrontal cortex, and is associated with deficits in working memory, attention, action planning, and sleep
When trying to teach something to a patient with severe memory impairment, you prevent the patient from guessing or making mistakes during the learning phase. This is an example of:
Errorless Learning
Frontal memory disorders are characterized by
Confabulation
Limited memory for temporal order of events
Attentional deficits interfere with encoding
they keep autobiographical memory
Broca’s aphasia is commonly accompanied by
Right hemiplegia
Dysarthria, dysphagia and hypoactive jaw and gag reflexes without associated cognitive or emotional changes is known as:
a) Pseudobulbar palsy
b) Bulbar palsy
c) Suprabulbar palsy
d) Meniere’s Disease
Bulbar palsy
differentiating depression from dementia (Alzheimer’s/AD)
Persons with depression may exert less effort on the performance of neuropsychological tests
Cognitive deficits in depression tend to be less severe and extensive than in AD. AD patients show more consistent impairment on memory tests than depressed patients. Persons with depression are less likely than those with AD to show impaired naming ability, verbal fluency, and visuospatial ability. Depressed patient are more likely to appear to exert less effort, and may complain more about their cognitive difficulties.
Which brain region is most often affected by hydrocephalus
Posterior regions
when hydrocephalus occurs, the ventricles expand in a posterior to anterior direction and white matter is damaged. Due to these factors, the posterior regions of the brain may be particularly susceptible. This may partially explain the PIQ < VIQ findings… interestingly, children who show proportionally greater thinning of the posterior brain regions relative to anterior tend to show the PIQ < VIQ pattern. When the thinning is comparable, so too are the IQ scores.
A lesion of Brodman’s area 44 in the dominant hemisphere is most closely associated with ____
Dysfluent aphasia
Broca’s area
What pattern of IQ performance is typically observed in children with early-onset hydrocephalus
VIQ > PIQ
This finding is somewhat controversial. On average, this is true, but there is substantial variability between cases with shunted hydrocephalus.
Contralateral superior quadranopia
is caused by legions on the lesions in the ___________.
Lesions of the temporal lobe
Lesions of the temporal lobe can cause contralateral superior quadranopia due to interruption of the lower portions of the optic radiations. This is sometimes referred to as the “pie in the sky” phenomenon
Gait difficulties, urinary incontinence, and cognitive decline are highly indicative of which condition
Normal pressure hydrocephalus
Which disorder has been most closely linked to degeneration of acetylcholine-synthesizing neurons in the basal forebrain
Alzheimer’s Disease
Although Alzheimer’s is more than a simple degeneration of the nucleus basalis of Meynert, this is a key site of degeneration and likely accounts for the prominent early memory decline. The other disorders may also involve the nucleus basalis of Meynert and/or cholinergic systems at one point or another, but less directly or centrally
Cerebellar pathways affect all but one of the following
a) Motor learning
b) Balance
c) Higher-order cognitive processes
d) Anosmia
e) Respiratory movements
anosmia
The cerebellum is involved in both a variety of motor and cognitive processes. Anosmia is a deficit of olfaction, where the sense of smell the is diminished or lost . It is also known as olfactory loss and can occur to single or to both nostrils.
Lateral cerebellar lesions primarily affect:
Motor planning
The lateral cerebellar hemisphere affects distal limb coordination and motor planning. Trunk control, posture and balance, and gait result from medial cerebellar lesions.
Which of the following statements is true?
a) The left hemisphere has more association cortex than the right hemisphere.
b) The left hemisphere has more gray matter/less white matter relative to the right hemisphere.
c) The two hemispheres have equal amounts of gray and white matter.
d) The right hemisphere has fewer interconnections than the left hemisphere.
The right hemisphere has more white matter, less gray matter, more association cortex, and more interconnections
what is Astereognosis?
What is Associative Agnosia?
can’t identify an item by touch
visual agnosia where you can’t recognize the meaning of a stimulus presented
Autopsy studies of dementia pugilistica (CTE) typically reveal _____
Prominent neurofibrillary tangles
Astrocyte proliferation
Neuronal loss
characteristics of normal aging
Decreased verbal fluency
Decreased working memory skills
Somewhat poorer initial learning but intact delayed recall of what they learned
Remote memory = intact
Neglect can occur with lesions in all of the following areas except
a) Right internal capsule
b) Right frontal lobe
c) Right thalamus or basal ganglia
d) Right midbrain
a) Right internal capsule
The structure involved in the “master clock” for circadian rhythms is the_____
Suprachiasmatic nucleus
each of a pair of small nuclei in the hypothalamus of the brain, above the optic chiasma, thought to be concerned with the regulation of physiological circadian rhythms.
What are the:
Arcuate nucleus
Median eminence
Dentate gyrus
The arcuate nucleus of hypothalamus (ARH) consists of neuroendocrine neurons and centrally-projecting neurons. The ARH is the center where the homeostasis of nutrition/metabolism and reproduction are maintained. As such, dysfunction of the ARH can lead to disorders of nutrition/metabolism and reproduction
The median eminence is the structure at the base of the hypothalamus where hypothalamic-releasing and –inhibiting hormones converge onto the portal capillary system that vascularizes the anterior pituitary gland.
The dentate gyrus is an integral region of the hippocampal formation. It is responsible for the formation of our episodic memory as well as the exploration of new environments. It is, therefore, part of the system that gives us autobiographical and episodic memories.
A test designed as a general screening for brain impairment should have….
a) High specificity
b) High sensitivity
c) Face validity
d) Low sensitivity but high specificity
High sensitivity
Sensitivity refers to a test’s ability to designate an individual with disease as positive. A highly sensitive test means that there are few false negative results, and thus fewer cases of disease are missed
Infarction of the inferior portion of the pons or medulla can cause:
Locked in syndrome
Eyes and Eyelids can move only.
The most common cause is a vascular complication in the form of a hemorrhagic or ischemic stroke.
Locked-in syndrome is caused by any lesion affecting the ventral pons, and midbrain; this includes vascular lesions, masses, infections, traumas, and demyelinating disorder
What is:
“Man in barrel” syndrome
“Pie in sky” visual defect
Man in a barrel syndrome is a neurological syndrome involving bilateral upper extremity weakness with preserved facial and lower extremity strength. This syndrome can result from injury to the bilateral cerebral hemispheres, the cervical spinal cord, or bilateral brachial plexuses
Superior Homonymous Quadrantanopia: This visual defect is often referred to as pie in the sky. This visual defect happens when the inferior optic radiating fibers (Meyer’s loop) are damaged in the temporal lobe of the brain. Strokes involving the middle cerebral artery (MCA) can result in this presentation. Lesions to the temporal lobe produce other neurologic manifestations including aphasia, memory deficits (if dominant hemisphere), seizures, and auditory and visual hallucinations.
________ is the neurotransmitter primarily found in neurons of the raphe nuclei.
Serotonin
Where is Dopamine produced?
Dopamine is a neurotransmitter that is produced in the substantia nigra, ventral tegmental area, and hypothalamus of the brain.
Where is ACH produced?
Acetylcholine originates from two major places in the brain:
1) basal forebrain – from basal nucleus of Meynert (works on M1 receptors in neocortex) & medial spetal nucleus.
2) the mesopontine tegmentum area.
Where is GABA produced?
GABA is synthesized in the cytoplasm of the presynaptic neuron from the precursor glutamate by the enzyme glutamate decarboxylase, an enzyme which uses vitamin B6 (pyridoxine) as a cofactor. After synthesis, it is loaded into synaptic vesicles by the vesicular inhibitory amino acid transporter
Where is glutamate produced?
Glutamate is recycled and made by glial cells in your brain. Glial cells convert “used” glutamate to glutamine, which is converted back again into glutamate when delivered back to the terminal area of nerve cells
phonological Alexia (give an example)
a) Reads “ought” for “thought”
b) Reads “think” for “thought”
c) Reads “hot” for “thought”
d) Reads “though” for “thought”
Phonological alexia and agraphia are acquired disorders characterized by an impaired ability to convert graphemes to phonemes. This is a reading disorder.
reads “though” for “thought”
reading “fling” for FLIG
This is due to an impaired non-lexical reading route, but relatively preserved lexical reading route.
Symptoms: problems sounding out words esp. unfamliar words, problems spelling based on sounds heard, labored reading aloud with hesitations/errors, trouble rhyming, impaired pseudo word reading
Analysis of motion and spatial relationships between objects and between the body and visual stimuli is most likely to occur in the ________________.
Parietal-occipital association cortex
The parietal-temporal-occipital (PTO) association area, also referred to as the temporo-parieto-occipital (TPO) junction, is an area within the cerebral cortex where the parietal, temporal and occipital lobes meet. High level of interpreting meaningful signals in the surrounding sensory area.
myelination
(motor or sensory is myelinated first?)
sensory areas of the brain are myelinated before motor areas
This myelin sheath allows electrical impulses to transmit quickly and efficiently along the nerve cells. If myelin is damaged, these impulses slow down
In humans, the motor roots begin to myelinate in the fifth fetal month, and the brain is almost completely myelinated by the end of the second year of life. It is generally true that pathways in the nervous system become myelinated before they become completely functional.
lesions of the dominant inferior parietal lobe, centering on the angular gyrus
The angular gyrus syndrome is a constellation of neuropsychological deficits in patients with damage to the dominant angular gyrus and surrounding regions.
Symptoms: transcortical sensory aphasia, alexia with agraphia, impaired visuoconstruction, hemisensory loss, contralateral homonymous visual field deficit, and components of Gerstmann’s syndrome.
Gerstmann’s syndrome includes acalculia, agraphia, difficulty in distinguishing left from right, and finger agnosia.
The pattern of “dementia with psychomotor slowing” occurs in all except which of the following disorders?
a) HIV-related dementia
b) Progressive supranuclear palsy
c) Huntington’s disease
d) Alzheimer’s dementia
Alzheimer’s dementia
The type of memory deficit most apparent in patients with alcoholic Korsakoff amnesia is a deficit in
Initial encoding of new material
Korsakoff syndrome (also known as Korsakoff’s amnesic syndrome) is a memory disorder that results from vitamin B1 deficiency and is associated with alcoholism. Korsakoff’s syndrome damages nerve cells and supporting cells in the brain and spinal cord, as well as the part of the brain involved with memory
A right MCA stroke in the distribution of the inferior division would most likely cause
Left hemineglect, decreased voluntary movements, and relatively normal left-sided strength
MCA strokes typically present with the symptoms individuals associate most commonly with strokes, such as unilateral weakness and/or numbness, facial droop, and speech deficits ranging from mild dysarthria and mild aphasia to global aphasia.
What is the most likely cause for transient global amnesia?
Basilar artery TIA
Transient global amnesia is an episode of confusion that comes on suddenly in a person who is otherwise alert. This confused state isn’t caused by a more common neurological condition, such as epilepsy or stroke.
Most commonly, patients experiencing basilar artery occlusion exhibit acute neurologic signs including motor deficits, hemiparesis or quadriparesis, and facial palsies, dizziness, headache, and speech abnormalities–especially dysarthria and difficulty articulating words.
The condition most often affects people in middle or older age. With transient global amnesia, you do remember who you are, and you recognize the people you know well. Episodes of transient global amnesia always get better slowly over a few hours. During recovery, you may begin to remember events and circumstances. Transient global amnesia isn’t serious, but it can still be frightening.
Alexia without agraphia is most likely due to damage to what region(s)?
Infarction of left posterior artery territory (occipital) and the splenium (posterior part) of the corpus callosum.
Alexia w/o agraphia is “pure word blindness” or pure alexia- inability to read.
Research has shown that right-sided brain damage can lead to subtle language deficits in…
Prosody
Articulation
Use of abstract constructs
not Grammatical rules and structure
Research has shown that individuals with mild cognitive impairment will develop dementia at a rate of….
10-15% per year, at a greater prevalence than the general population
Which of the following is true about Lewy Body Dementia?
a) It presents with Parkinsonian motor symptoms but the cognitive functioning more similarly looks like Alzheimer’s dementia.
b) It is a variant of Parkinson Dementia in which Lewy Bodies are present in the substantia nigra.
c) Patients are responsive to l-dopa like Parkinson’s dementia, but are insensitive to DA blocking agents.
d) Auditory hallucinations are frequently present
It presents with Parkinsonian motor symptoms but the cognitive functioning more similarly looks like Alzheimer’s dementia
Protein deposits called Lewy bodies develop in nerve cells in the brain. The protein deposits affect brain regions involved in thinking, memory and movement.
Which statement is false?
a) Rolandic epilepsy occurs nocturnally and is usually in remission by age 15
b) Landau-Kleffner syndrome is characterized by an acquired aphasia, and seizures are most commonly generalized motor seizures.
c) Febrile seizures occur in 2-4% of all children, and most go on to develop temporal lobe epilepsy.
d) Lennox-Gastaut is a mixed seizure disorder in which the seizures are difficult to control, and status epilepticus is common
(c)
Most kids outgrow febrile seizures by age 5 or 6.
Kids with benign rolandic epilepsy have seizures that involve twitching, numbness, or tingling of the face or tongue. They typically happen in the early morning or just before bedtime. They also can happen during sleep. Kids almost always stop having these seizures by the time they reach their teen years
Difficulty recalling events prior to amnesia onset is called ________________, while difficulty recalling previously learned information because new information interfered with it is called __________________
Retrograde amnesia; retroactive interference
Which of the following would not be expected from frontal lobe damage
a) Acute eye deviation with persistent neglect
b) Contralateral hemiplegia
c) Anosmia
d) Acalculia
Acalculia- damage particularly on the left side of the parietal lobe
Contralateral hemiplegia is the result of brain damage where the paralyzed side of the body is the opposite side from where the brain damage occurred.
Patients with anosmia presented a significant decrease of GM volume mainly in the nucleus accumbens with adjacent subcallosal gyrus, in the medial prefrontal cortex (MPC) including the middle and anterior cingulate cortices, and in the dorsolateral prefrontal cortex (dlPFC).
Which of the following is most consistent with a mild traumatic brain injury?
a) Galveston Orientation and Amnesia Test (GOAT) score of 15
b) Glascow Coma Scale (GCS) score of 8
c) Post-Traumatic Amnesia (PTA) of 12 hours
d) Loss of consciousness of 2 hour
Post-Traumatic Amnesia (PTA) of 12 hours
Ranges for the GOAT: Score of ≥ 75 for two consecutive days, no longer in the post-traumatic amnesia phase. Score between 66 and 75 for two consecutive days, borderline status. Score < 66, the patient for two consecutive days, patient still in the post-traumatic amnesia phase
The highest possible GCS score is 15, and the lowest is 3. A score of 15 means you’re fully awake, responsive and have no problems with thinking ability or memory. Generally, having a score of 8 or fewer means you’re in a coma
PTA may last for a few minutes, hours, days, weeks or even, in rare cases, months. Certain types of medication have been used to try to improve the condition, with varying degrees of success
A further category of very severe injury is defined by a period of unconsciousness of 48 hours or more, or a period of PTA of 7 days or more. The longer the length of coma and PTA, the poorer will be the outcome
Anosodiaphoria
vs
Anosognosia
Anosognosia: no insight; unaware of the condition,
Anosodiaphoria: insight about symptoms, lacks concern. The pt fails to appreciate the significance of the brain lesion deficit.
*Often from lesion in right frontal lobe; impaired emotional processing.
*May be seen in frontal stroke or FTD.
Simultangnosia
Cortical blindness
Apperceptive Visual Agnosia
Phonagnosia
Auditory affective agnosia
Verbal auditory agnosia
Environmetnal Sound Agnosia
Amusia
Simultagnosia is the lack of ability to perceive more than a single object at a time. For example, when provided with a picture of a spoon and fork in different parts of visual space, they can attend to only 1 item at a time; worse when items are at different depths
Cortical blindness (CB) is defined as loss of vision without any ophthalmological causes and with normal pupillary light reflexes due to bilateral lesions of the striate cortex in the occipital lobes.
Apperceptive visual agnosia refers to an abnormality in visual perception and discriminative process, despite the absence of elementary visual deficits. These people are unable to recognize objects, draw, or copy a figure. They cannot perceive correct forms of the object, although knowledge of the object is intact
Phonagnosia: a dissociation between familiar and unfamiliar voices.
Auditory Affective Agnosia: impaired comprehension of emotional tone in speech. Linked to right temporal-parietal lesions.
Verbal auditory agnosia, also known as “word deafness,” is when you can’t comprehend words spoken aloud. You can still read and write them, and you have no problem speaking words yourself.
Nonverbal auditory agnosia is when speech comprehension is intact, but you can’t recognize human non-speech sounds.
Environmental Sound Agnosia: Cannot comprehend non-speech non-human sounds
Amusia: Cannot comprehend music sounds
What % of pediatric tumors are in posterior fossa versus supratentorial
70% posterior fossa
30% supratentorial
Pesticide and toxic exposures typically cause what symptoms
a) mental slowing, mood
b) visual-spatial issues
c) agraphia, alexia
d) peripheral neuropathy, optic ataxia
a) mental slowing, anxiety/depression
Chemotherapies: Do they cross BBB?
Do they cause mental status changes?
Most chemos do not cross BBB and therefore do not change mental status.
Exception = methotrexate if it’s administered into spinal canal (aka intrathecally).
Toxic effects of MTX: cortical thinning, reduced neuron density; “chemo brain”
Side effects of cranial radiotherapy
Effects can be latent
Radiation necrosis
“Pie in the Sky” [homonymous superior quadrantanopsia] can be caused by what type of lesion/damage
stroke – MCA or PCA, must effect the lower branches of the optic tracts, lower branches of the myers loop.
tumor
aneurysm
demyelinating disease
temporal lobectomy/surgery
radiation necrosis
trauma
advanced degenerative disease affecting temporal lobe
