Exam III Flashcards

Question

Cervicogenic headache signs and symptoms

Answer 1

Limited cervical ROM, headache with sudden cervical movement or when neck remains in the same position for extended time (FHP in dentists, carpenters)

Answer 2

sudden paroxysmal excessive discharge of cerebral neurons resulting in transient sensory, motor or cognitive impairment Can happen in normal brains, or secondary to acute conditions finite event, has a beginning and end

Answer 3

a chronic neurological disorder, a condition characterized by sudden recurrent episodes of seizures associated with abnormal electrical activity in the brain that manifest as sensory disturbance, motor impairments, loss of consciousness, or convulsions.

Answer 4

neuroplastic phenomenon, Repeated exposure to low-intensity electrical or chemical stimuli results in facilitation/potentiation of connections, leading to seizure activity and increasing severity at later times.

Answer 5

occur unpredictably w/o any warning signs in most. In others there are prodromal signs (headache, mood, unusual sensations/feelings). In some, seizures are provoked by specific stimuli such as flashing light or a flickering television (triggers)

Answer 6

Classic type, aka grand mal seizure, involves both hemispheres, loss of consciousness. Starts with generalized rigidity, sustained contractions of limb extensors, arching of back lasting 10-30secs (tonic phase), a cry may be heard due to contraction of chest muscles, may turn blue to due to cyanosis from hypoxia Followed by generalized rapid jerky movements of limbs (clonic phase) Followed by period of recovery (post-ictal phase), can last minutes to hours, may feel tired, with headache, confusion, difficulty speaking, may fall into deep sleep with heavy breathing, salivary frothing

Answer 7

petit mal seizures, generalized seizure, Loss of conscious control, but person is unaware of it. Sudden cessation of ongoing conscious activity, often stares into space. Not preceded by aura, followed by return to normal activity immediately. Occur mostly in children and disappear with adolescence

Answer 8

Characterized by locus of onset, neuronal activity restricted to a local structure or within networks limited to one hemisphere. EEG shows activity in a focal area. Symptoms will depend on the lobe the focus is present – frontal lobe (bizarre movements, thrashing of arms, pelvic thrusting, pedaling of legs), temporal lobe (feeling of deja-vu, jamais-vu), parietal lobe (numbness or tingling, agnosia, spatial perceptual distortion), occipital lobe (visual distortions or hallucinations)

Answer 9

Individual retain consciousness, Typically lasts briefly (60-120secs). Individuals get unusual sensations/feelings, altered sense of hearing, smelling, tasting, seeing, tactile perception or involuntary movements. labored speech or inability to speak at all. May progress to involve additional cortical area ipsilaterally. If somatosensory or motor area are involved, tingling or clonic jerks can progress or ‘march’ from distal to proximal parts (or reverse) known as Jacksonian March.

Answer 10

Sudden brief single or repetitive muscle contractions involving one body part or entire body, myoclonic jerks. Repeated myoclonic jerks may get severe and turn into generalized tonic-clonic seizures with convulsions Can happen anytime, but often observed shortly after waking up or while falling asleep.

Answer 11

Dyscognitive seizures -Loss of consciousness or impairment of awareness or responsiveness -Often preceded by aura Once consciousness is lost, may show ‘automatisms’ like lip smacking, chewing, swallowing, may show random walking, pulling at clothes. May show amnesia about details surrounding event of seizure

Answer 12

Aka ‘drop attacks’ Brief loss of consciousness and postural control Most often in children Characterized by sudden loss of muscle tone that may result in falls with injury Sometimes loss of muscle tone happens in neck muscles, causing head drop

Answer 13

When person has generalized tonic-clonic seizures that are so long or so repeated that there is no recovery or return of consciousness Medical emergency, can cause death Often occurs due to tumor, CNS infection or drug abuse Febrile seizures in children under 3 years are also a common cause.

Answer 14

Relapsing-remitting MS (RRMS) Secondary progressive MS (SPMS) Primary progressive MS (PPMS) Progressive relapsing MS (PRMS)

Answer 15

most common type Definition of a ‘relapsing attack’ - new symptoms must last at least 24 hours and be separated from other symptoms by at least 30 days to qualify as a new attack.

Answer 16

child of MS parent has 5 fold increased risk of developing MS, increased presence of gene for HLA-DR2 (immune system protein) which is responsible for for identifying and binding to foreign molecules. Families with hx of MS also have other autoimmune diseases – it appears MS develops on a background of increased susceptibility to autoimmune disorders

Answer 17

Vitamin D deficiency, Viral infections are also thought to trigger MS – more than 1/3rd relapses are preceded by infections

Answer 18

Immune system erroneously attacks myelin basic protein (MBP) in the lipid membrane. Primary pathology is demyelination of CNS nerve fibers

Answer 19

Optic neuritis is one of the first manifestations. It typically presents as unilateral painful decrease in vision. Other ocular problems – gaze palsies, nystagmus, inability to fix gaze – caused by lesions in the pons, vestibular nuclei of brainstem or cerebellum

Answer 20

single most common and disabling symptom in MS, often precedes diagnosis by years. Presents as severe tiredness, along with mental fatigue/fuzziness. Fatigue may not be related to level of effort, unpredictable, tends to be aggravated by heat and humidity

Answer 21

due to demyelination, nerve fibers start to short-circuit after repetitive firing when called upon to do repetitive task. So, repetitive exercises w/o rest could lead to feeling of increased weakness – should be avoided

Answer 22

Somatosensory symptoms ( hypoesthesia, parasthesia, dysethesia), other sensory losses such as vibration, position, 2 point discrimination. Symptoms may NOT be substantiated by objective findings, as remission might have happened by the time pt shows up for examination

Answer 23

Result of decreased neuromuscular firing secondary to demyelination and axonal loss Loss of orderly recruitment of motor units Muscle activation patterns and agonist-antagonist relationships are disturbed Heat increases weakness – due to conduction block Cooling improves strength and function

Answer 24

Extremely common in MS (UMN lesion), more common in lower extremities. Severity of spasticity can vary from non-existent to severe in same person from to time to time, making it challenging to manage with meds. Often, MS patients can use their spasticity to walk, transfer and manage ADLs

Answer 25

Due to cerebellar lesions, axonal loss and/or atrophy Incoordination, tremor and ataxia – involving the extremities or the trunk May be symmetric or asymmetric Dysarthria – scanning speech Cerebellar signs occur mostly during progressive phases

Answer 26

impairments in balance regulating systems, fatigue, body temperature, or from BBPV

Answer 27

When lesions are in brainstem, affecting CN nuclei, can involve CNs III to XII at the nuclei level.

Answer 28

memory loss, Attention deficits, difficulty in understanding conversations and critical thinking, depression, medications can also cause this.

Answer 29

usually neuropathic type pain, may or may not follow sensory pattern. Fairly constant with nocturnal worsening. Trigeminal neuralgia and Lhermitte sign

Answer 30

shock-like pain in trigeminal’s branches in face, characteristic in young person

Answer 31

momentary electric shock-like sensation evoked by flexing neck or cough. Like other symptoms, more likely to occur when fatigued or overheated

Answer 32

can have urge incontinence, overflow incontinence, or stress incontinence. Also can have bowel incontinence (diarrhea or constipation) but less common

Answer 33

showing presence >1 lesions in different CNS regions in an MRI, OR an additional relapse showing new symptoms that implicate another CNS region. For MS, lesions/symptoms required in the MS-typical regions.

Answer 34

showing simultaneous presence of active (inflammatory) and inactive (old) lesions in different CNS regions in an MRI scan, done using contrast-enhancing technique using Gadolinium, OR by doing a CSF test (for oligoclonal bands)

Answer 35

inflammatory attack of the brain and spinal cord that damages myelin, with features of encephalitis (fever, headache, seizures and coma) - usually occurs just once, could be the ‘clinically isolated attack’.

Answer 36

motor and cerebellar symptoms, short time between attacks, numerous attacks within first year or initial years, rapid disability after first attacks

Answer 37

sensory symptoms, infrequent attacks, full recovery after a relapse, low level of disability after 5-7 years of onset

Answer 38

Mild disability fully ambulatory w/o AD

Answer 39

moderate disability – ambulatory to specific distances w/o or w/ AD

Answer 40

severe disability – very limited ambulation even w/ aid, W/C or bed bound

Answer 41

Amyotrophic lateral sclerosis, also known as Lou Gehrig's disease. Severely progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord. Adult-onset type of progressive motor neuron disease Both upper (cortical neurons) and low motor neurons (anterior horn cells) and axons can be affected Damage/loss of motor neurons lead to profound muscle weakness and wasting/atrophy

Answer 42

Corticospinal tracts are affected first – limb muscles are affected – 70% cases

Answer 43

cortico-bulbar (brainstem) tracts are affected first - muscles of throat, mouth, face are affected – 25% cases

Answer 44

early signs could be trouble grasping a pen/lifting a coffee cup from loss of pincer grip due to APB, FDI weakness – may lead to split-hand sign Also can be tripping/falls, muscle cramps/twitches, a change in vocal pitch when speaking, and/or uncontrollable periods of laughing or crying (pseudo-bulbar sign). Muscle atrophy, extensors become weaker than flexors

Answer 45

weakness, muscle wasting (atrophy), muscle fasciculations, cramping

Answer 46

spasticity, positive Babinski, exaggerated reflexes, clonus

Answer 47

LMN and UMN signs, cervical extensor weakness, weakness followed by deformities. Cognitive impairment in half of cases In later stages respiratory muscles get affected – accessory breathing replaces diaphragmatic breathing – respiratory distress can occur at night Sensory functions, eye movements, bladder and bowel functions are mostly preserved

Answer 48

dysarthria, hoarse and whispering voice, nasal tone difficulty with swallowing, drooling (made worse by forward head position), choking facial and tongue muscle weakness/low tone - difficulty manipulating food in mouth

Answer 49

known as pseudobulbar palsy – corticobulbar tracts to brainstem are affected – slurred speech, difficulty chewing/swallowing, spastic tongue, uncontrolled emotional outbursts

Answer 50

fibrillations, positive waveforms, fasciculations, polyphasic motor unit potentials in at least 3 limbs and paraspinal muscles

Answer 51

Only LMN are affected, anterior horn cells of spinal cord affected beginning with cervical area, weakness/wasting of muscles, fasciculations present, can later turn into ALS

Answer 52

rarest type of motor neuron disease, only UMN are affected, corticospinal tract involvement, spastic presentation, weakness, increased reflexes, no muscle atrophy, no fasciculations, outcome is less severe compared to ALS (people usually do not die from it), can later turn into ALS