Final Exam Flashcards
biomechanical cascade for concussion
increased glutamate
increased intracellular K
need ATP to pump out K
need glucose to make ATP
(HIGH GLUCOSE NEED, LOW GLUCOSE DELIVERY)
concussion pathophysiology
mitochondrial dysfx 2/2 excessive Ca
axonal damage
neuro mechanical imbalance
unmyelinated nerve fibers more vulnerable to damage
upregulationof inflammatory cells
adult concussion recovery
7-14 days
children concussion recvoery
4 weeks
concussion education
expectation is recovery
BCTT
20 min/day, 80% of threshold, 2 wks
increase target HR by 5-10
repeat until at 85-90% for 20min w/out Sx exacerbation
stage 1 return to school
short phase of physical and cognitive rest with symptom guided activity (24-48 hours)
stage 2 return to school
getting ready to go back to school, begin cog activity for max of 30 min w/o S/E
stage 3 return to school
back to school with environmental accommodations and modified academics
may last days to months depending on rate of recovery
stage 4 return to school
normal routines with some restrictions
back to full days of school (student NOT required to catch up on missed work)
stage 5 return to school
fully back to school
stage 1 return to activity
short phase of physical and cognitive rest with symptom guided activity 24-48 hours
symptom group A
Sx decrease within an hour after injury
take at least 24 hours for each stage as you complete the rest of guidelines
symptom group B
Sx free/decr within 1-4 weeks
take at least 2 days for each stage
symptom group C
Sx for more than 4 weeks
take at least 1 week for each stage
stage 2 return to activity
light exercise (no contact)
stage 3 return to activity
individual sport-specific activity (no contact)
stage 4 return to activity
sport specific practice with team (no contact)
stage 5 return to activity
sport specific practice with team (contact)
stage 6 return to activity
return to full sport, activity, game play
goals of early PD
prevention of inactivity
prevention of fear to move or fall
preserve of improve physical capacity
early PD H&Y
1-2.5
middle PD H&Y
2-4
late PD H&Y
5
middle PD goals
preserve or improve activities (function)
address function through compensatory strategies
late PD goals
preserve vital functions and prevent complications such as pressure sores and contractures
what parts of the brain are involved in tremor production
GPi, SubThN, ventral intermediate nucleus of thalamus
physiology of rigidity
combination of spinal reflex and brainstem dysfunction including non-dopaminergic NT systems
physiology of bradykinesia
“network” dysfunction in circuitry of BG, motor cortex, and cerebellum
what does bradykinesia look like during a discrete movement
decreased size of initial agonist burst
series of small agonist bursts
PD muscle activation
more- co-contract ag/antag
less- show sequential muscle activation
H&Y 1
unilateral involvement
H&Y 1.5
unilateral and axial involvement
H&Y 2
bilateral w/o balance impairment
H&Y 2.5
mild bilateral dx with recovery on pull test
H&Y 3
mild to moderate bilateral disease, some postural instability, physically independent
H&Y 4
severe disability, still able to walk or stand unassisted
H&Y 5
wheelchair bound or bedridden unless aided
define GBS
autoimmune disorder of PNS 2/2 rapid loss of myelin: progressive weakness and diminished reflexes
etiology of GBS
macrophages attack Schwann cells- affects sensory, motor, and autonomic systems
S/S of GBS
sensory loss, paresthesias, pain
motor paresis or paralysis
dysarthria, dysphasia, diplopia, facial weakness
interventions for GBS in acute phase
respiratory care
passive movement
positioning
splinting
gentle strengthening
progression of Sx GBS
progresses usually over a few days ot weeks, usually ascending symptoms
most regain function
management of physical deconditioning GBS
-avoidance of overwork
-avoidance of ECCENTRIC contractions
-wait until antigravity strength achieved to start stressing
disease of LMN
loss of anterior horn cells in SC and motor cranial nuclei in brainstem
disease of UMN
demyelination and gliosis of corticospinal and corticobulbar tracts in motor cortex
bulbar signs
dysarthria, dysphagia
respiratory signs
nocturnal respiratory difficulty, exertional dyspnea, accessory msucle use, paradoxical breathing
ALS most frequent initial symptoms
focal weakness beginning in the arm, leg, or bulbar muscles
relapsing remitting
specific attack of deficits
full or partial recovery
periods between relapses characterized by lack of disease progression
primary progressive
disease progression and a deterioration of function from onset
may have slight fluctuations but specific attacks do not occur
secondary progressive
initial relapsing remitting stage
change to a progressive ego curse with steady decline in function and impairments increase with or without specific attacks
progressive relapsing
steady deterioration in disease from onset with occassional attacks
time between attacks has continuing progression
clinically isolated syndrome
first episode of inflammatory demyelination in the CNS that could become MS if additional activity occurs/progresses
roles of the cerebellum
motor learning and skill accquisition
modifying movement based on learning
gaze stabiltiy
postural responses
learning
superior peduncle
primary motor efferent effect limb movement
middle peduncle
sensory afferent including proprioception, auditory, visual, and somatosensory information
inferior peduncle
afferent tracts of proprioception information, efferents affecting axial muscle activity and postural control `
spinocerebellum
output focused on axial and limb musculature
procedures adaptive motor coordination- error correction
cerebrocerebellum
planning and timing of movements
cognitive functions related to cerebellum/important in visually guided movements
ipsilateral Sx typical
flocculonodular lober
central vestibular symptoms- poor eye pursuit, VOR, impaired hand-eye coordination
gait and trunk ataxia, poor postural control, wide based gait
AICA cerebellar stroke
hemifacial paralysis, horner syndrome, gait and ipsilateral limb ataxia
vertigo with auditory symptoms such as hearing loss
superior cerebellar artery stroke
acute gait or trunk instability with associated dysarthria, nausea, vomiting
PICA stroke
isolated acute vestibular syndrome without auditory symptoms (vertigo)
lateropulsion (to ipsilateral side)
arnold chiari malformations
neck pain (type 1)
unsteady gait
poor coordination
numbness/tingling
dizziness
swallowing issues
speech and breathing problems
dyssynergia
decomposition of movements
action tremor
impairment due to alternating contractions of agonists and antagonists
postural trmor
seen when trying to maintain a posture
intention tremor
seen when moving, oscilaltory movement about a joint
most marked at end range
hallmark of PICA stroke
ipsilateral lateropulsion
lateropulsion scale- 1
head and body tilt without imbalance
lateropulsion scale- 2
head and body tilt with considerable sway/imbalance
lateropulsion scale- 3
head and body tilt, falls with only eyes closed
lateropulsion scale- 4
head and body tilt- falls with eyes open
reduced ability to learn from movement error
- impaired plasticity between purkinje cells and parallel fibers
- simultaneous firing of climbing fiber and parallel fiber causes a long-term depressing of synapses that control that movement
meningitis
inflammation of the membranes of the brain or spinal cord, may be caused by an infection
meningitis symtpoms
headache, fever, stiff neck, irritiability, confusion, light sensitivity, increase HR and RR, lethargy
encephalitis
inflammation of the brain often due to infection
primary cause by virus or mosquito borne
secondary- faulty immune reaction
encephalitis symptoms
may be mild such as fever, headaches, achy muscle/joints, fatigue, weakness
transverse myelitis
inflammation of one section of the spinal cord
etiology- viral, bacterial, fungal, immune system disorder, autoimmune disorder
transverse myelitis symptoms
pain, sharp shooting back pain or down extremities, abnormal sensation, weakness to progressing paralyis, stiffnes to spasticity, fatigue
putting on order
gown
mask
goggles
glove
taking off order
gloves
goggles
gown
mask
most common primary sites for metastatic spread to the brain
lung
breast
melanoma
colon
renal carcinomas
arise from precursors of astrocytes or oligodendrocytes
glioma
low grade or diffuse astrocytoma
very slow growing
found in cerebrum
progression variable
surgical resection
anaplastic astrocytoma
malignant tumor- cerebral hemisphere
surgical resection w/ radiation and chemo
presents with seixure, symptoms of increased ICP, focal neurological dysfunction
anaplastic astrocytoma
glioblastoma
PRIMARY malignant tumor; undifferentiated
poor prognosis
cerebral hemisphere- “butterfly” appearance
SR, C, R
presents with increased ICP, focal neurological dysfunction
glioblastoma
oligodendroglioma
arise in frontal lobe or white matter- tend to infiltrate the cortex
not distinguishable from astrocytomas on imaging
over time transform into anaplastic tumors= death
meningiomas
arise from meningothelial arachnoid cap cells of the meninges
majority are benign slow-growing
surgery= gold standard
can penetrate bone and present as a scalp mass
meningiomas
presents with focal seizures, neurological deficitis from brain and spinal cord compression
meningiomas
extradural tumors
OUTSIDE the dura mater in the vertebral bodies and arches
lesions may be osteoblastic, osteolytic, or mixed
spinal cord compression symtoms: extradural tumors
- localized, mechanical, radicular pain
- motor weakness
- sensory impairments
- autonomic symptoms
- gait and trunk ataxia
intradural extramedullary tumors
primary- located within the dura mater but outside of the spinal cord parenchyma
- most commonly benign
arise from peripheral nerves, nerve sheaths, and sympathetic ganglion
intradural extramedullary tumors
extramedullary metastases common site of involvement
dorsal aspect of spinal cord at level of cauda equina
spinal cord compression symtoms: intradural extramedullary tumors
- similar presentation o epidural spinal cord compression BUT with higher incidence of neuro Sx
- pain= initial symptoms
- weakness
- motor deficitis in the absence of pain
- sensory involvement
- bowel, bladder, and sexual dysfx
intradural intramedullary tumors
located within spinal cord parenchyma; arise from glial cells, neuronal cells, and other CT
- typically benign
- can be found anywhere but C and T favored
spinal cord compression symtoms: intradural intramedullary tumors
- similar to extradural tumors
- pain= most common
- neuro deficits
- sensory deficits
- bowel, bladder, sexual dysfx
presenting signs and symptoms; Cx
initial symptoms are often focal- generalized symptoms as the tumor spreads and gets bigger
Sx 2/2 increased ICP
tension type HA (4–80%)
migraine (10%)
epileptic seizures
steroids
minimize symptom burden due to associated vasogenic edema (edema due to increase in extracellular fluid and plasma)
gamma knife radiosurgery
concrentration radiation dose-201 beams of radiation interact to treat a small area of tissue in the brain
steroids side effects
steroid induced myopathy, anxiety, insomnia, psychosis, delirium, Cushing’s syndrome, steroid-induced hyperglycemia, fractures of the spine and hip, avascular necrosis of the hip
acute radiation encephalopathy symptoms
HA, nausea, lethargy, new onset or worsening of symptoms
responds to increase in corticosteroids
signs of cerebral edema/herniation
increase in lethargy/unable to arouse, dilated pupils, headache, change in posture, change in relfexes, coma
epidural cord compression
d/t hematogenous spread of tumor cells through bone marrow leading to vertebral collapse
signs of epidural cord compression
pain precedes other Sx by 1-2 months, weakness (symmetric), ascending numbness, autonomic dysfunction (commonly urinary retention)
signs of venous thromboembolism
heat, swelling, pain
red flag HA Sx
- change in HA intensity or duration
- association with fever
- occuring wiht new neuro signs
paraneoplastic cerebellar degeneration
severe truncal and limb ataxia and dysarthria
hydrocephalus Sx
- confusion, disorientation, or both
- lethargy
- HA
- irritability or personality changes
- blurred or double vision
- seizures
- urinary incontinence
- walking/balance difficulties
side effects of anemia
fatigue, dyspnea on exertion
nociceptive pain
pain triggered by activation of peripheral receptive terminals in response to noxious irritants
neuropathic pain
pain that includes sensory abnormalities such as thermal allodynia, paresthesia, hyperalgesia, dysthesia- may be decrobed as bruning, stabbing, pins and needles
vincristine
may result in polyneuropahty or buening of hands and feet
myofascial
pain that arises from myofascial trigger points
thamalmic
pain that is a central pain syndrom characterized by a burning, may be activated by changes in temp
funicular
pain that is a central pain syndrome characterized by excruciating pain that does not follow any fixed dermatome pattern and occurs caudal to lesion due to lesion to ascedning spinothalmic tracts
parietal lobe common findings
-sensation loss
- tactile localization
- sterognosia
- autopagnosia
- anognosia
- aphasia
temporal lobe common findings
- difficulty with recognizing sounds
- memory impairments
- vision impairments
basal ganglion common findings
- contralateral choreoathetosis
- contralateral dystonia
- movement disorders
corpus collosum common findings
- apraxia
- agrpahia
cerebellum common findings
- ataxia
- dysmetria
- nystagmus
brainstem common findings
- cranial nerve dysfx
- ataxia
- papillary abnormalities
- nystagmus
- hemiparesis
- autonomic dysfx
