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Exam 3 - Neuro cerebral cortex pathology Flashcards

1
Q

Where does Intracerebral Hemorrhage occur? Subarachnoid Hemorrhage?

A

IH=Bleeding into brain parenchyma

SH=bleeding into subarachnoid space

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2
Q

What is the primary cause of neuron destruction in Intracerebral Hemorrhage?

A

Hemorrhage directly destroys neurons

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3
Q

What are the secondary causes of neuron destruction in Intracerebral Hemorrhage?

A
  1. Potential rise in intracranial pressure

2. Hematoma expands creating pressure

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4
Q

What 4 areas does an Intracranial Hemmorhage mainly occur?

A
  1. Thalamus
  2. Putamen (part of basal ganglia)
  3. Cerebellum
  4. Brainstem
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5
Q

What are Subarachoid Hemmorhages often related to? What happens to intracranial pressure?

A

Berry Anuerysms. IC pressure rises dangerously.

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6
Q

What does elevated intracranial pressure in a SAH impair?

A

Impairs cerebral autoregulation (vasoconstriction, microvascular constriction, platelet aggregation)

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7
Q

What is the end result of SAH?

A

Loss of blood flow and cerebral ischemia.

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8
Q

What percent of stroke are ischemic?

A

85%

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9
Q

What are the two location locations/types of strokes?

A
  1. Extracranial Embolism

2. Intracranial Thrombus

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10
Q

Extracranial Embolism most often arises from where?

A

Heart (valve, MI, afib, diliated myopathy, CHF, etc)

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11
Q

Intracranial Thrombus mostly arises from what three areas?

A
  1. Circle of Willis cerebral branches
  2. Internal Carotid Artery
  3. Small vessels of posterior circulation
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12
Q

In primary site of ischemic stroke is the damage reversible or irreversible? Secondary site reversible or irreversible?

A

Primary site=irreversible

Secondary site=reversible

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13
Q

What happens to a neuron at the primary site of damage in an Ischemic Stroke?

A

Neuron depolarized causing influx of Ca++ which causes release of degradative enzymes destroying neuron cell membrane and releasing substances to harm neighboring neurons

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14
Q

Secondary site of damage in Ischemic Stroke called what? (Hint: means “shadow”)

A

Penumbra

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15
Q

Two ways to preserve neurons in secondary site of Ischemia Stroke?

A
  1. Restore blood flow ASAP

2. Meds to block inflammation

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16
Q

Time frame which TIA deficits resolve?

A

Neurological deficits resolve within 24h

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17
Q

What percent of TIA patients will experience a future stroke?

A

30%

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18
Q

How percent of TIA patients will experience a stroke within 90 days?

A

10% will have a stroke within 90 days

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19
Q

Which two arteries supply the Circle of Willis?

A

Internal Carotid Artery and Vetebral Artery

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20
Q

The Anterior Cerebral Artery supplies which lobe and areas of brain? Of body? What do the Perforating Arteries supply?

A

Brain=Prefrontal lobe. Motor and sensory areas.
Body=Lower body

Perforating Arteries supply subcortical areas.

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21
Q

What areas make up the Prefrontal Lobe?

A

9-12, 46, 47

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22
Q

Infarction/Occlution of the ACA results on what 3 types of MOTOR deficit and where on the body?

A
  1. Lower extremity contralateral hemiparesis (motor loss)
  2. Urinary incontinence
  3. Parkinson patterns from basal ganglia damage
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23
Q

Infarction/Occlution of the ACA results on what type of sensory deficit and where on the body?

A

Contralateral lower extremity hemiparaesthesia (abnormal feeling) or hemianesthesia (no sensation)

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24
Q

Infarction/Occlution of the ACA causing Prefrontal Lobe damage causes what?

A

Personality changes. Apathy, poor motivation, perseveration, social inappropriateness.

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25
Akinetic Mutism is due to infarction/occlusion of which artery?
ACA
26
Which 3 lobes does the Middle Cerebral Artery supply? Which aspect of each hemisphere? What area, lobe, and tract?
Frontal, Parietal, and Temporal lobes. Lateral aspect of each hemisphere. Association areas, Prefrontal Lobe, part of optic tract.
27
Infarct/occlusion of MCA Superior Branch and Inferior Branch will affect what?
Sup Branch=Brocha's Aphasia | Inf Branch=Wernicke's and visual hemianopsia
28
What is the most classic sign of an MCA infarct/occlusion?
Global/Brocha's Aphasia
29
What number area is Brocha and Wernicke? On which lobe?
Frontal lobe. Wernicke=22 Brocha=44,45
30
Superior branches of MCA supply which two lobe parts of brain?
Lateral Frontal lobe | Lateral Parietal lobe
31
Inferior branches of MCA supply which two lobe parts of brain?
Lateral Temporal lobe | Inferior Parietal lobe
32
Which two areas are affected in an MCA infarct/occlusion? Which part of body affected? Which part spared?
Contralateral hemiparesis or hemiplegia. Areas 4 and 6. Lower face/trunk and UE affected. Lower extremity spared.
33
Which area provides conjugate gaze toward opposite side? Which two CNs?
Area 8. | CNs 3 and 6.
34
MCA occlusion/infarct cause eyes to deviate toward or away from lesion?
Toward lesion
35
Define Apraxia? Dominant or non-dominant? Occurs from infarct/occlusion of which artery? Which area on which lobe?
Inability to preform purposeful voluntary movements. MCA infarct/occlusion on Dominant Hemisphere. Area 6, frontal lobe.
36
Define Hemianopia. Happens with infarct/occlusion of which artery?
Loss of half of visual field. MCA infarct/occlusion.
37
Brocha's Aphasia and Wernicke's Aphasia occurs when the dominant or non-dominant hemisphere is damaged?
Dominant
38
Brocha's Aphasia on which areas and which artery?
44, 45. MCA.
39
Wernicke's Aphasia from which area and which artery?
22. MCA.
40
These occur from loss of which hemisphere and which artery occlusion/infart? Agnosia, Construct Apraxia, Dressing Apraxia, Dysprosodia (motor and sensory), Confusion, Extinction
Nondominant hemisphere, MCA.
41
Define: Agnosia, Construct Apraxia, Dressing Apraxia
Anosognosia=neglect, denial of injury, won't turn head to contralateral side Construct Apraxia=can't draw a clock, etc Dressing Apraxia=Can't connect motor to purpose/meaning
42
Define: Dysprosodia (motor and sensory), Confusion, Extinction
Motor Dysprosodia=can't produce right pitch to speech Sensory Dysprosodia=can't interpret tone/pitch/meaning of speech Confusion=lack of familiarity, feeling list Extinction=Can't focus on 2 stimuli, usually on left
43
The PCA (posterior cerebral artery) supplies which lobes? (Hint: does part of one lobe and another full lobe)
Occipital Lobe | Inferior regions of Temporal Lobe
44
Infarct/Occlusion of the PCA leads to damage to which areas?
17=primary visual area | 18,19=visual association area
45
Infarct of Area 17 Primary Visual Area on the Occipital Lobe results in what special type of blindness? Lateral or contralateral to lesion?
Hemianopia=loss of vision on same side of both eyes. | Contralateral to lesion.
46
Infarct to Areas 18,19 Visual Association Area results in what three problems?
1. Visual Agnosia=can't recognize object by sight 2. Prosopagnosia=difficulty recognizing familiar faces 3. Alexia=can't read
47
``` Define 1. Visual Agnosia 2. Prosopagnosia 3. Alexia Associated with damage where? (Lobe and area) ```
1. Visual Agnosia=can't recognize object by sight 2. Prosopagnosia=difficulty recognizing familiar faces 3. Alexia=can't read Occipital Lobe; Areas 18,19 Visual Association Areas
48
Define Visual Agnosia. Which lobe and area?
Occipital Lobe, Area 17 Primary Visual Area
49
What is blood supply to Subcortical Regions? (Hint:5)
Small branches of Circle of Willis, ACA, MCA, PCA, and Basilar Arteries
50
What is the term for infarct/occlusion of Subcortical Regions?
Lacunar Stroke/Small Vessel Stroke
51
What are the two types of trauma to the Cerebral Cortex?
1. Concussion | 2. TBI
52
Concussion and TBI are the two examples of what?
Trauma to the Cerebral Cortex
53
Define concussion
Impairment of neurologic function that spontaneous resolves.
54
Describe how concussion symptoms resolve over time.
Symptoms resolve in a predictable pattern. 7-10 days in 80-90% of PTs
55
What do concussions show in standard imaging?
No abnormalities
56
Physical symptoms of concussion include
LOC, HA, blurry vision, dizzy, sensitive to light and sound, balance issues, tired or no energy, convulsions
57
Emotional symptoms of concussion include
Irritable, sad, more emotional than normal, nervous, anxious
58
Sleep issues with concussion?
Sleep more and trouble falling asleep
59
Can a PT return to play on the same day of concussion?
No!
60
What are the three Post-Same Day Return to Play criteria for someone AT REST?
1. Asymptomatic 2. Baseline neuro eval 3. IMPACT score returns to baseline
61
What is the time frame for Post-Concussion Syndrome? What does it mean for severity and risk?
If symptoms last more than 3 months. Longer recovery=more severe concussion and increased risk for other concussion complications.
62
Define Traumatic Brain Injury (TBI)
"Acute trauma-induced damage to brain." Actual structural damage to brain tissue. (Unlike concussion.)
63
TBI is major cause of death in what age? Highest mortality in which range? MVA TBI death in what range?
Major cause of death less than 45 y/o. Highest mortality in 15-24. MVA TBI death=20-24 y/o
64
How to classify TBI severity?
Use GCS within 48h. Mild=13-15 Moderate=9-12 Severe=3-8
65
In TBI is mental status change or LOC under 30 min, between 30min-6h, or more than 6h what is severity?
Mild=MS change or LOC under 30 min Moderate=MS change or LOC between 30min-6h Severe=MS change or LOC over 6h
66
All Primary Injuries of TBI can lead to what and is leading cause of death?
Hematoma
67
Three causes/classes of Primary Injury in TBI
1. Trauma/Penetrating 2. Acceleration-Deceleration 3. Coup-Countercoup injury
68
Primary Injury of TBI from Trauma/Penetrating aka? Describe.
Focal Injury. Direct damage to CNS.
69
Primary Injury of TBI from Acceleration-Deceleration Injury aka? Describe.
AKA "Diffuse Injury". Shear, tensile, and compression strains on CNS. Causes Diffuse Axonal Injury.
70
Define Diffuse Axonal Injury? In Primary or Secondary Injury of TBI?
In Primary Injury of TBI. Extensive tensile/stretch damage to white matter which damages axons so they don't function.
71
Primary Injury of TBI from Coup/Countercoup aka? Describe and define. Example?
Combo vascular and tissue damage. Coup=Injury at direct site of impact Countercoup=injury at opposite site of direct impact, from inertia Ex: Shaken Baby Syndrome
72
Four types of Intracranial Hemotoma?
1. Epidural=damage to meningeal and dural arteries/veins 2. Subdural=damage to subdural veins, 60-80% mortality 3. Subarachnoid=damage to posterior fossa, blood into CSF 4. Intracerebral=vessel damage in CNS tissue
73
4 Intracranial Hematoma locations/types: Where damage? Which has highest mortality? 1. Epidural 2. Subdural 3. Subarachnoid 4. Intracerebral
1. Epidural=damage to meningeal and dural arteries/veins 2. Subdural=damage to subdural veins, 60-80% mortality 3. Subarachnoid=damage to posterior fossa, blood into CSF 4. Intracerebral=vessel damage in CNS tissue
74
Describe Secondary Injury in TBI. What two things are promoted?
Primary damaged cells release excitatory neurotransmitters and promote inflammation cascade and increased ICP
75
Alzheimers disease gross findings?
Severe atrophy of the cortex. Widened sulci, shrunk gyri. Occipital pole often spared.
76
Alzheimers disease cellular findings? Three specific findings?
Loss and shrunk neurons. Neuritic Plaques, Neurofibrillary Tangles, Amyloid Angiopathy.
77
Define Neurofibrillary Tangles
Intracellular protein deposits which disrupt normal cytoskeletal architecture and cause cell death.
78
Define Neuritic Plaques
Sepherical accumulations of amyloid protein surrounded by degenerative or dystrophic nerve endings (neurites)
79
Define Amyloid Angiopathy
Deposit of Amyloid Fibrous Protein in small to mid cortical and leptomeningeal arteries. Causes ischemia and hemmorhage.
80
What is the main cause of demetia today?
Alzheimers disease

Pathophysiology 2 (15 decks)

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