Exam 3 -TBI, concussion, basal ganglia, parkinson Flashcards
Frontal lobe function and deficits
Function - emotional expression, thinking, problem solving, memory, language, personality
Deficits - ability to think, communicate, personality
Pre motor function and deficits
function - planning, spatial guidance
deficits - poor motor execution due to decreased planning
Prefrontal function and deficits
function - personality, decision making, social behavior
deficits - personality changes, poor decision making
Occipital lobe injury function and deficits
function - visual perception system, visuospatial processing, discrimination of movement and color
deficits - visual field deficits, scotomas (partial loss of vision), visual hallucinations/illusions
Thalamus function and deficits
function - relay center
deficits - sensory perception distortions
reticular formation function and deficits
function - maintain behavioral arousal and consciousness
deficits - irreversible coma
Temporal lobe function and deficits
function - sensory output into meanings for appropriate retention of visual memories, language comprehension, emotion association, auditory perception
deficits - speech, recalling visual stimuli, poor attention span, unable to recognize
Amygdala function and deficits
function - response and memory of emotions, especially fear, survival instinct
deficits - difficult with memory that is linked with emotion
hippocampus function and deficits
function - processing long term memory and emotional responses, behavioral inhibition
deficits - behavior, long term memory, emotional disturbances
What is the purpose of the CSF?
- to surround and protect the brain
What are the 4 functions of the CSF?
- protection: acts as cushion
- buoyancy: reduces pressure at the base of the brain
- excretion of waste products: one way flow from CSF to blood
- endocrine medium for brain: transports hormones throughout brain
most TBIs that occur each year are what?
-75% concussions or other mild forms
TBI by age
- kids 0-4 years
- teens 15-19
- adults 65+
= most likely to sustain one. over 75 y/o is highest rate of TBI related death.
TBI by gender
higher in males.
males aged 0-4 years have highest rates
What the the meninges?
- a covering/protective layer of brain and spinal cord
Dura mater (superficial) "tough" arachnoid - prevents permeability of toxins into brain. pia mater (deep) - super thin
What layer of meninges prevents permeability of toxins into brain?
-arachnoid mater
gray matter vs white matter
gray = cell bodies white = axons
TBI - diffuse vs focal
diffuse = axonal injury focal = local injury
TBI - open vs closed
- whether or not skull is fractured
- open = more risk of infection
TBI - high vs low velocity
high = MVA low = blow from blunt object or fall less than 6 feet
Glascow coma scale
- 3-15 scale for acute brain injury
- eye response, verbal response, motor response
- lower score is worse.
- mild, moderate, or severe
Pathophys of brain injury (flow chart thing)
injury to brain -> swelling or bleeding increase volume -> increases pressure -> causes blood flow to slow -> cerebral hypoxia and ischemia -> brain may herniate -> cerebral blood flow stops.
What is CT used to identify?
- hematomas
- ventricular enlargements
- atrophy
What is MRI used to identify?
better at discriminating soft tissue trauma
-diffusion weighted imaging
What is PET, SPECT, fMRI used for?
-can look at active areas and blood flow during a single activity
Subdural hematomas
- venous
- brain starts to shrink after age 45, stretch or tear of bridging veins causes bleeding
*watch ICP (nl=5-15 mmHg)
Epidural hematoma
- arterial
- above dura
- more deadly
- progress a lot faster.
- usually middle meningeal artery
*watch ICP (nl=5-15 mmHg)
Subarachnoid hemorrhage
- acute bleeding under the arachnoid
- may occur spontaneously or as a result of trauma
Diffuse axonal injury - DAI
-widely scattered shearing of subcortical axons within their myelin sheaths. has cumulative effect.
if brain injury affects 3rd cranial nerve =
disruption of parasympathetic input
-“blown pupil????”
Anterograde amnesia
- unable to create new memories
- usually last to recover after coma
Post-traumatic amnesia
-cant remember events from injury to point of recovery
Retrograde amnesia
- inability to remember event prior to injury
- decreases with recovery
Decorticate rigidity
- corticospinal lesion at level of diencephalon
- flexion of UE, ext of trunk and LE
**flex UE up like praying they don’t go to jail while in court.
Decerebrate rigidity
- cortical spinal lesion at level of brainstem
- ext of trunk and all extremities
(reminder of saying: **flex UE up like praying they don’t go to jail while in court. = deCORTicate)
Emotional lability
- characteristic of R hemispheres lesion
- inability to control emotions with inappropriate laughing or crying
The chance of having a 2nd concussion after having one in an athlete is?
3-6 times greater chance of having another after having one
When to refer to ER after concussion
- any trouble with ABCs (airway, breathing, circulation)
- unable, or unfamiliar with, assessing near function in all limbs
- repeated vomiting
- severe or worsening headache
- seizure
- unsteady gait
- slurred speech
- GCS
80-90% of concussions in adults will resolve in
7-10 days
return to play post concussion stages
1-no activity 2- light aerobic 3 - sport-specific exercises 4- non-contract drills 5 - full contact practice 6- return to play
Pediatric Rancho scale
- levels 1-5
- level 1 is highest function
- level 5 is no response.
Shaken baby syndrome
- 50% of the time it is from parents
- age, median income, medicaid were strongly associated with occurrence
***Key sign = retinal hemorrhage. (bleeding in light sensitive area in back of eye)
Near Drowning
- survival for at least 24 hours following submersion incident
- lose consciousness after 2 mins (child)
- areas most susceptible to injury = CNS, kidney, heart.
- good outcome (88%) if submerged for less than 6 mins.
- *water temp not associated with outcome (time is)
Brain abscess (focal and multiple)
-microorganism reaches the brain tissue by a penetrating wound
-Focal = impacted tooth
Multiple = via bloodstream
Meningitis
-infection spread through CSF involving pia and arachnoid matters, subarachnoid space and the superficial layers of the brain and spinal cord.
Bacterial meningitis clinical features
- fever
- severe headache
- altered consciousness
- convulsions
- nuchal rigidity
- blood cultures with inc protein and dec glucose level
- memingism (triad): neck stiffness, photophobia, headache
Kernig’s sign
- bend a knee up to 90/90
- ent knee
- (+) = causes pain and restriction past 135 degrees
Brudzinski contralateral leg sign
- passive flexion of one extremity
- causes the opposite LE to have a reflex into flexion
Brudzinski neck sign
- passive flex neck
- reflexive flexion of hips and knees
Encephalitis
- inflammation of parenchyma and surrounding meninges
- viral (common)
seizures can be caused by?
-high fever, TBI, drugs, tumors, cardiac disorders, developmental disorders, metabolic
When is it considered epilepsy?
patient has 2 or more seizures
Epilepsy prognosis
- cannot be cured
- most do not cause damage. If untreated it can
- commonly have co-morbidities
Partial seizures - simple vs complex
simple = consciousness NOT impaired
complex = conscious IS impaired
Generalized seizures
- indicate both hemispheres are initially involved
- consciousness is usually impaired
What is a ketogenic diet?
- high in fat
- low in carbs
- can help control seizures in some people
Function of basal ganglia
-purposeful motor activity
-slow, sustained contractions
-timing of movements
-sequencing
-resting/postural tone
-problem solving
-organizing behavior
-procedural (motor) learning
empathetic, socially appropriate behaviors
SMA function stuff
postural movement/learned automatic responses without visual input. (typing)
Premotor function stuff
-automatic experience which requires more coordination and visual input (throwing darts)
Limbic system main areas?
anterior cingulate cortex
dorsal lateral prefrontal area
orbitofrontal area
Anterior cingulate cortex
- part of limbic
- rationale cognitive functions, decision making, empathy and emotion, procedural learning
Dorsal lateral prefrontal areas
- part of limbic
- integrating sensory
- attention switching
Orbitofrontal areas
- part of limbic
- critical frontal region for memory formation
Parkinson’s disease (what is it, and 4 signs)
-loss/decrease of dopamine neurons in SN (substantial nigra)
=lose excitation on direct, and inhibition of indirect (increase inhibition of thalamus -> less movement)
**overactive indirect pathway
- ***TRAP
- Tremor
- Rigidity
- Akinesia/bradykinesia
- postural instability
Huntington’s disease (what does it do?)
- loss of indirect pathway (*overactive direct)
- inhibits at level of GPe
- degeneration of Striatum
- loss of GABA secretion neurons.
**too much glutamate. Have excessive movements
Parkinson’s vs Huntington’s
PD = rigidity, resting tremor, bradykinesia/akinesia
HD = involuntary mvmt, chorea, sensorimotor deficits, cognitive changes, psychiatric disorders
Hemiballismus
- injury to STN
- decreased inhibition (indirect pathway)
- **uncontrolled flinging (violent, uncontrolled mvmt)
- treat with dopamine antagonist
Pyramidal vs extrapyramidal signs and symptoms
Pyramidal - spasticity
Extra - tramor, athetosis, dystonia, chorea
Hoehn and Yahr scale for parkinson’s
Stage 1 = tremor, one side of body
Stage 2 = both sides of body, “facial masking”
Stage 3 = worse. problems with balance
Stage 4 = need help with some or all ADLs
Stage 5 = confined to w/c or bed. Need total assist.
What is the hallmark sign of parkinson’s?
-bradykinesia
What is the gold standard to drug treatment in PD?
dopamine replacement. L-dopa/cabidopa (use dopamine agonists prior to using)
PD- anticholinergics help with treating
moderate tremor and dystonia only
LSVT LOUD - first and second half of session
- first = “ah” (sustained, high/low, phrases)
- second = core exercises
PWR Moves (4)
- posture (power up)
- weight shift (power rock)
- axial mobility (power twist)
- transitions (power step)
