Exam #3 Flashcards
MS: diagnosis requires “dissemination in time and space”
- Space: evidence of scarring (plaques) in at least two separate areas of the CNS
- Time: evidence that the plaques occurred at different points in time
- Must be no other explanation
Fazekas scale
Measures white matter in brain for people with MS
Relapsing remitting
Most common, ups and downs
Secondary progressive
Develops over time, no remissions
Primary progressive
No eventual recovery, worsen
Progressive relapsing
No remission
Pathogenesis of MS (3)
- BBB: abnormally activated lymphocytes disrupt BBB
- Autoimmune: lymphocytes enter brain, activate local immune response
- Inflammation: t-cells attack on myelin and triggers inflammatory processes
Treatment of MS (5)
- Treatment of relapses
- Symptom management
- Disease modification
- Rehab
- Psychosocial support
What do disease-modifying drugs do for MS?
All reduce attack frequency and severity, reduce scarring on MRI, and probably slow disease progression
What does MS medications NOT do? (3)
- Cure the disease
- Make people feel better
- Alleviate symptoms
Where is seizure onset usually?
Left posterior medial temporal lobe
Ictal activity (during a seizure)
Stereotyped, driven behavior, not consciously controlled
Post-ictal activity (after a seizure)
Brain is “re-booting”, confusion, headache, fatigue
Inter-ictal (between seizures)
Ranges between normal and impaired, degree and type of dysfunction depends on location and severity of underlying abnormality
Treatment goal of epilepsy
Prevent start or spread of seizure activity
Treatment options for epilepsy (3)
- AED
- Neurostimulators
- Surgery
Medial temporal lobe epilepsy (MTLE)
- onset in 1st two decades
- cryptogenic etiology
- “stuttering” course
- doesn’t respond well to medical treatment
- significant psychosocial burden
- 60-90% seizure free with surgery
- memory worse in 25-40%
Functional adequacy
Ability of MLT structures ipsilateral to seizure focus to support memory-how good the tissue is that you are removing, high functional adequacy associated with higher likelihood of post-op memory deficits, “the more you have, the more you have to lose”
Functional reserve
Ability of MLT structure contralateral to seizure focus to support memory- making sure one side is good enough to function on its own, higher functional reserve associated with lower likelihood of post-op memory deficits, “the more you have left, the more you can make up for what is lost”
Mechanism of TBI (3)
- Direct blow to head
- Indirect blow
- External force/blast wave
4 mechanisms of blast injuries
- Primary blast mechanisms
- Secondary blast mechanisms
- Injury to the brain opposite side of impact (countrecoup)
- Site of impact (coup)
Behaviors to classify TBI (3)
- Eye opening response
- Best verbal response
- Best motor response
5 Parameters of TBI
- Loss of consciousness
- Altered consciousness
- Initial glasgow coma scale
- Neurological exam
- Imaging/EEG
Shearing force
Unaligned forces pushing one part of the brain in one direction and another part of the brain in opposite direction
Rotational force
The head and the brain are being rotated, which causes the axons to twist resulting in either temporary or permanent damage to the axon and neuron
Where do contusions usually occur in the brain?
Prefrontal or anterior temporal region
For moderate and severe TBIs, the primary pathophysiology includes (4)
- Diffuse axonal injury (DAI)
- Contusions
- Diffuse micro/small vessel injury
- Widespread cellular dysfunction, neurochemical disregulation, neurometabolic disruption, NT imbalances
Secondary/delayed consequences of TBI (5)
- Hematoma
- Infection
- Anoxia/hypoxia
- Seizures
- Raised intracranial pressure
Categories of cognitive rehab (2)
- Retraining (process): if circuits have been partially spared after injury, they can be retrained, takes time
- Develop compensatory skills (strategy): retained skills and functional reorganization used to learn new strategies, external tools (cognitive support tools)
Compensatory approaches (4)
- Remediation (practice, memory tasks)
- Substitution (smart phone)
- Accommodation (adjust priorities, set new goals)
- Assimilation (adjust expectations of others)
