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Diagnostics > Hoofdstuk 7 Neuropathology for neuropsychologists > Flashcards

Hoofdstuk 7 Neuropathology for neuropsychologists Flashcards

1
Q

Where does Traumatic Brain injury (TBI) reffers to?

A

Injury involving the brain resulting from some type of impact and/or acceleration/ deceleration of the brain

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2
Q

What does closed head injury (CHI) refers to?

A

Blunt head trauma or blunt injury

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3
Q

What does penetrating head injuries (PHI) refer to?

A

Sometimes called open head injuries, include injuries from any source which the skull and dura are prenetrated by

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4
Q

What does acquired brain injury (ABI) refer to?

A

Anything that can damage brain tissue (concussion)

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5
Q

Which two measurment instruments can help determine the presence and severity of a TBI?

A

The Glasgow Coma Scale & posttraumatic amnesia (PTA)

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6
Q

What are the diagnostic criteria for mild TBI?

A

At least one of the following:
- A loss of consciousness
- Any loss of memory
- Any alteration in mental state at the time of the accident
- Focal neurological deficits (problem with nerves and spinal cord resulting in vision, speech and hearing problems)

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7
Q

What are the diagnostic criteria for a severe TBI?
(Where the severity of injury exceeds being a mild TBI)

A
  • Loss of consciousness for approximately 30 min
  • After 30 min, Glasgow Coma Scale score of 13-15
  • PTA not greater than 24 hours
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8
Q

True or false: lenght of PTA tends to be more accurate than coma duration in predicting long-term cognitive status?

A

True

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9
Q

What is also a strong indicator of the severity in TBI?

A

Visual field deficits

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10
Q

What does anosmia mean?

A

Loss of the smell sense (can be a marker of severe damage with longer coma en more deficits)

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11
Q

What is traumatic axonal injury?

A

Shearing-tearing effects on axons

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12
Q

What is secondary axotomy?

A

Traumatic axonal pathology (multiple, scattered, small hemorrhagic, and/or non-hemorrhagic lesions) occuring as a result of secondary effects damaging the axon

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13
Q

Penetraiting head injuries (PHI) can give a lot of complications, what are the most common pathological ones?

A

Hypotension (abnormally low blood pressure), hypovolemia (abnormally low blood volume), contusions/ bruises (focal damage to brain tissue), cerebral edema (tissue swelling) and intracranial hematomas (swelling filled with blood)

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14
Q

Long term memory/ short term memory is especially likely to be compromised, regardless of the location in PHI?

A

Short term memory

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15
Q

Two features of TBI are impulsive loading and impact loading, what do they mean?

A

Impulsive loading: occurs when the head is not directly struck, but set into motion as a result of a force applied to another part of the body
Impact loading: in which the head either strikes a stationary object or is struck by a moving object

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16
Q

When the fine tissue covering the brain (pia, arachnoid) is torn, the injury is called?

A

A laceration

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17
Q

Inertial forces can involve translational acceleration and rotational acceleration, what do they mean?

A

Translational acceleration: when the head moves in a strait line with the brain’s center of gravity
Rotational acceleration: the brain rotating around its center of gravity and central axus (the upper brain stem)

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18
Q

What is angular acceleration?

A

Combination of translational acceleration and rotational acceleration

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19
Q

There are two types of clots that can form outside the brain, extradural (EDH) & subdural (SDH), what do they mean?

A

EDH: the clot forms in the space between te inner table of the skull and the outer surface of the dura matter
SDH: the clot forms beneath the dura and next to the surface of the brain

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20
Q

Where does migraine with aura refers to?

A

Classic migraine, a disorder with focal neurlogical symptoms clearly localizable to the cerebral cortex and/or brainstem

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21
Q

What is a (persistent) postconcussion syndrome?

A

Persistent post-concussive symptoms, also called post-concussion syndrome, occurs when symptoms of a mild traumatic brain injury last longer than expected after an injury

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22
Q

What are some typically cognitive impairments in MS?

A

Attentional processes, memory and executive functions

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23
Q

When an individual has had at least two distinct attacks plus neurologic signs confirming involvement of at least twi sites in the CNS = Relapsing form or Progressive form?

A

Relapsing form of MS

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24
Q

When patients have clinical or Ms evidence of disease progression for at least one year and supportive laboratory findings with no other plausible neurologic cause = Relapsing form or Progressive form?

A

Progressive form of MS

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25
Q

When MS begins with a clinical attack, recovering, relapses with improvement and stability inbetween attacks, we call this?

A

Relapsing-remitting MS

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26
Q

Relapsing remitting patients who start deteriorating within 15 years of their initial attack, is called?

A

Secondary progressive MS

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27
Q

Nearly continuous progressive course form the first time their first symptom appears. Not any clear-cut relapses or remission, is called?

A

Primary progressive MS

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28
Q

The patients whose MS progresses very rapidly, causing helpless dependency or death soon after disease onset, is called?

A

Maligning MS

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29
Q

Poor prognosis in MS patients is associated with?

A

Older age, incomplete recovery from the first attack, short interval between the first two attacks, frequent relapses over the first 5 years

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30
Q

What are some risk factors for developing MS?

A

Genetic, demographic (more women), geographic (dichter bij de evenaar minder MS)

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31
Q

What is the pathological hallmark of MS?

A

Demyelinated plaque, which is characterized by loss of the myelin sheath around axons

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32
Q

MS lesions can best be seen by EEG, CT or MRI?

A

MRI because lesions appear as hyperintense bright spots on MRI

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33
Q

Name three vulnerabilities (verergeren van symptomen) that MS patients experience

A

Stress, heat and fatigue

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34
Q

MS is by its very nature homogeneous/heterogeneous in both its physical and cognitive manifestations.

A

Heterogeneous

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35
Q

MS patients often report problems with ‘short-term memory’. One classic finding in MS is impaired … on tests of multitrial learning. MS may preferentially disrupt retrieval while sparing
encoding and storage processes.

A

Recall

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36
Q

MS patients often complain of (cognitive) problems with …

A

Vision, verbal fluency, verbal reasoning, mentally slowed down, mobility

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37
Q

MS patients also have disorderly problems with mood, affect and behavior. Name three of many

A
  • pathological laughing
  • euphoria
  • agitated
  • major depression
  • bipolar disorder
  • clinically significant anxiety
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38
Q

Normal pressure hydrocephalus (or communicating hydrocephalus aka waterhoofd) involves …

A

ventricular enlargement with associated white mater damage.

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39
Q

Alcohol-related disorders. Moderate alcohol intake may have beneficial health effects, in particular red wine. True/false

A

True

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40
Q

Brain changes that have been associated with excessive alcohol consumption include

A

atrophy of the cerebral cortex, reduced white matter volume, enlarged ventricles, and atrophy of subcortical structures, e.g. hypothalamus and cerebellum

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41
Q

Alcohol acts as a central nervous system stimulant/depressant

A

depressant

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42
Q

… weighs heavily as a risk factor, even when the children have been raised in a nonalcoholic environment

A

A family history if alcoholism

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43
Q

Cognitive deficits have been correlated with white/grey/both white and grey and sensory/motor/both sensory and motor abnormalities.

A

both white and gray matter / both sensory and motor

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44
Q

Which lobe and system appear to be particularly vulnerable to damage and dyusfunction associated with chronic alcohol abuse?

A

frontal lobes, limbic system, and cerebellum

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45
Q

Which cognitive and executive functioning is impaired with chronic alcohol abuse?

A

Attention, visuospatial abilities and psychomotor speed;

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46
Q

Alcoholic dementia. A condition of significant mental and personality deterioration occurring after years of alcohol abuse, alcoholic dementia, features widespread cognitive deterioration without the profound …. of Korsakoff’s syndrome

A

amnesia

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47
Q

Korsakoff’s syndrome. Wernicke’s encephalopathy symptoms: (different conditions that often occur together)

A
  • thiamine deficiency (Vitamine B1)
  • rapid eye movements,
  • gaze paresis,
  • ataxia,
  • confusion,
  • amnesia
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48
Q

Implicit/explicit memory remains relatively intact in Korsakoff’s syndrome

A

Implicit

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49
Q

Korsakoff’s syndrome executive function impairments:

A
  • decision making
  • cognitive estimation,
  • premature responding
  • diminished ability to benefit from mistakes
  • diminished ability to perceive and use cues
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50
Q

After alcohol and nicotine, …. is the most commonly used ‘recreational’ drug in Western countries and probably the most commonly used illicit drug worldwide

A

marijuana

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51
Q

Marijuana’s acute effects include …

A

hallucinatory and reactive emotional states, some pleasant, some
unpleasant and even terrifying; time disorientation; and recent-transient-memory loss.

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52
Q

Recent-transient-memory loss =

A

loss of ability to discriminate
between old and new learning

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53
Q

Marijuana’s long-term effects on cognitive abilities

A

o A comparison of test scores of college student marijuana users and nonusers on the WAIS
taken a year apart showed no difference on any measure.
o Several large-scale studies have failed to find significant long-term cognitive outcomes
associated with heavy marijuana use.
o A literature review concluded that the neuropsychological consequences of cannabis use
appear to dissipate over time, indicative of no permanent neuropsychological effects.
o Whether cannabis is truly a neurotoxin is questionable

54
Q

Marijuana’s long-term effects on personality

A

are affective blunting, mental and physical sluggishness, apathy, restlessness, some mental confusion, and poor recent memory.

55
Q

Effects of marijuana on development

A

long-term negative consequences for cognitive, behavioral, psychological, and neurological health.

Is associated with altered connectivity and reduced volume of specific brain regions

56
Q

Marijuana’s Effects on development

A

long-term negative consequences for cognitive, behavioral, psychological, and neurological health.

57
Q

Cocaine is / is not a central nervous system stimulant and is / is not highly addictive.

A

is / is

58
Q

Positive effects of cocaine are:

A

positive aspects of cocaine intoxication include increased alertness and arousal levels, increased sense of well-being and confidence, and motor activation

59
Q

Cocaine increases dopamine in reward circuits contributing to …

A

a vicious cycle of craving and ever higher thresholds for a euphoric reaction to the drug

60
Q

Name three psychiatric reactions to cocaine

A

agitation, paranoia, delusions and hallucinations, panic attacks, and
self- or other-directed violence; suicide intents

61
Q

Neuropsychological findings of slowed mental processing, memory impairments, and reduced mental flexibility. Cocaine appears to induce neurotoxicity by disrupting the …

A

blood-brain barrier

62
Q

Cognitive problems with long-term use of cocaine:

A

memory and concentration deficits and impaired executive functioning. Dysphoric.

63
Q

Dysphoric = ?

A

Dysphoria is a profound state of unease or dissatisfaction.

64
Q

Opiates cogntive impairment are generally mild/strong if any, even in persons who have had long-term addictions -
Long term opiate users can sustain permanent cognitive impairments. True/false

A

Mild / true

64
Q

Opiates cogntive impairment are generally mild/strong if any, even in persons who have had long-term addictions -
Long term opiate users can sustain permanent cognitive impairments. True/false

A

Mild / true

65
Q

A report of adverse effects of long term opiate use on executive functioning includes …

A

diminished ability to shift cognitive set and to inhibit inappropriate response tendencies.

66
Q

Chronic METH use is associated with a host of adverse medical and social consequences, as well as a range of neuropsychological impairments including deficits in:
- attention
- memory
- executive functions
- motor function
- visuospatiel capability

Which three are correct?

A
  • attention
  • memory
  • executive functions
67
Q

Intake of METH drugs can result in

A

Strokes and visual and auditory hallucinations

68
Q

Name two social drugs

A

Caffeine, nicotine

69
Q

Caffeine increases/reduces motor activity and increases/reduces reaction time

A

increases / reduces

70
Q

Name the three main environmental and industrial neurotoxins

A

o Solvents and fuels
o Pesticides
o Metals

71
Q

Long-term exposure to solvents and fuels can heighten/lower cerebral blood flow, particularly in medial temporal/frontotemporal areas

A

lower / frontotemporal

72
Q

Chronic exposure to solvents and fuels in the form of fumes can lead to (objective and subjective complaints):

A

Objective:
- Mild cognitive deficits to full-blown dementia. Executive disorders. Sensory and motor changes.
- Disordered gait, balance, and coordination along with spasticity and oculomotor defects
- White matter atrophy

And subjective complaints include:
fatigue, memory and concentration problems, emotional
lability and depression, sleep disturbances, and sensory and motor symptoms

73
Q

With acute exposure to pesticides, patients experience many symptoms associated with central nervous system involvement, such as…

A

Headaches, blurred vision, anxiety, restlessness, apathy, depression, mental slowing and confusion, slurred speech, and ataxia

74
Q

With acute exposure, pesticides have effect such as … (name at least three)

A

headaches, blurred vision, anxiety, restlessness, apathy, depression, mental slowing and confusion, slurred speech, and ataxia.

75
Q

What is most impaired in people chronicly exposed to pesticides?

A

attention, memory, and response speed

76
Q

Name two common metals dat are toxic:

A

Lead and mercury

77
Q

Lead is devastating for the CNS leading to entire dysfunction of … (denk aan schade aan prefrontal cortex, hippocampus, en cerebellum)

A

cognitive functions: attention, memory and learning, visual and verbal abilities, processing speed, and motor and coordination functions.

78
Q

Mercury toxicity leads to damage to the CNS. When acute intoxication does not result in death, it leads to …

A

motor slowing and clumsiness, parenthesias, tremor, visual
and hearing defects, agitation, and mental dulling

79
Q

HIV (human immunodeficiency virus) attacks and progressively destroys the

A

immune system

80
Q

A broad spectrum of cognitive deficits may
occur in HIV. True/false

A

True

81
Q

HIV-associated dementia (HAD): Before evolving into a full-blown dementia, … and …. deficits and slowed mental processing are the most usual cognitive impairments.

A

Concentration and memory

82
Q

Herpes simplex encephalitis (HSE) has a profound effect on which cognitive domain?

A

Memory

83
Q

Neurologic disorders, such as aseptic meningitis, facial nerve palsy, motor and sensory nerve inflammation, and encephalitis, may occur in 15-20% of patients of which disease?

A

Lyme

84
Q

Statement 1: One of the effects Lyme disease can have is personality change.
Statement 2: Sleep disturbances does not belong to Lyme disease symptoms

a. Statement 1 is true, statement 2 is false
b. Statement 1 is false, statement 2 is true
c. 1 and 2 true
d. 1 and 2 false

A

A

85
Q

Chronic fatigue syndrome (CFS). Cognitive impairment often involves (name at least two)

A

poor concentration, impaired learning, and word finding
difficulty.

86
Q

What is common effects in the brain in radiation therapy for cancer patients?

A

Acute effects (i.e. transient confusion), a decrease of cognitive and functional status and cerebral atrophy

87
Q

Name three primary brain tumors:

A

Gliomas
Meningiomas
CNS lymphoma

88
Q

Which major brain tumor is the most common in adults?

A

Gliomas

89
Q

Gliomas arise from which cells?

A

Glial cells, forming the connective tissue of the brain

90
Q

Meningiomas grow between … and …. And are more common in women / men

A

brain and skull / women

91
Q

What are secondary brain tumors?

A

Brain tumor originate elsewhere in the body and travel into the CNS and settle in brain tissue

92
Q

Brain tumors can comporomise brain function in one or more of four distinct ways:

A

o By producing generalized symptoms associated with increased ICP (intracranial pressure) – such as headache, occasionally nausea and vomiting, and sixth nerve palsy (paralysis of lateral eye movements)
o By inducing seizures, which are typically focal or secondarily generalized
o By producing focal symptoms – such as hemiparesis and aphasia – that reflect progressive invasion or displacement of brain tissue and can suggest tumor location
o By secreting hormones or altering endocrine patterns involving a variety of body functions

93
Q

Name two kinds of therapy that are applied as cancer treatment

A

Radiation and chemotherapy

94
Q

Radiation therapy leads to what kind of atrophy?

A

cerebral atrophy - leading to ‘variety’ of white matter cahgnes and neuropsychological deficits (aka vanalles)

95
Q

What are anoxia, hypoxic and anoxemia examples of?

A

oxygen deprivation

96
Q

What is hypoxia?

A

reduced oxygen availability

97
Q

Which brain areas are particularly vulnerable to oxygen deprivation?

A

The hippocampus, basal ganglia, and cerebral cortex

98
Q

What is COPD?

A

chronic obstructive pulmonary
disease / chronic hypoxia - oftewel chronisch zuurstof tekort

99
Q

Name some effects of carbon monoxide

A

disorientation, headache, a racing heartbeat, dizziness,
fainting, and somnolence,

100
Q

Impaired nutrition during childhood can have long-standing consequences for health and cognitive performance. True/False

A

True

101
Q

Statement 1: Lack of vitamin D is another substance that could contribute to cognitive impairment and mental health
problems, especially in older adults
Statement 2: diets high in fruits, vegetables, cereals and fish are associated with better cognitive function and lower dementia risk

a. Statement 1 is true, statement 2 is false
b. Statement 1 is false, statement 2 is true
c. 1 and 2 true
d. 1 and 2 false

A

C

102
Q

True or false: the pathophysiological effects of a mild brain injury may actually be a predisposing factor for the development of PTSD

A

True

103
Q

What is the most important moderator variable contributing to TBI outcome?

A

Age

104
Q

What are some less common sources of brain injury?

A

Electrical injury, lightning strike & blast injuries

105
Q

What is defined as the rapid development of clinical signs of focal or global disturbance of cerebral function lasting 24 hours or longer, with no apparent cause other than vascualr origin?

A

A stroke (or CVA), later in de tekst gedefinieerd als: focal neurological disorder of arubpt development due to pathological processes in blood vessels

106
Q

What is defined as a focal neurological deficit lasting less than 24 hours?

A

A transient ischemic attack (TIA)

107
Q

What is a myocardial infarction?

A

Heart attack

108
Q

What are examples of not modifiable and modifiable risk factors?

A

Not modifiable = age, sex, race etc. and modifiable = smoking, diabetes, psysical activity etc.

109
Q

The process of tissue damage resulting from blockage of normal blood flow in a blood vessel is know as ….., and the area of damaged tissue caused by this is called an ….

A

Infarction, infarct

110
Q

What are ischemic infarctions?

A

Infarctions due to tissue starvation resulting from insufficient or absent blood flow

111
Q

What are two prominent mechanisms that account for tissue starvations of strokes?

A

Obstruction of blood vessels (thrombus or embolus) or hemorrhage (burst of blood vessel)

112
Q

What is the most common source of obstruction of blood flow to the brain and is called atherosclerotic

A

Arteriosclerotic plaques or the build up of fat deposits

113
Q

When in a stroke, the middel cerebral atery is involved, the most apparent cognitive disorders associated with left hemisphere damage wil be disturbances in?

A

Speech and langauge (aphasia)

114
Q

Which kind of stroke has the worst prognosis?

A

Hemorrhagic stroke

115
Q

What occurs when part of an artery wall weakens, allowing it to abnormally balloon out or widen?

A

An aneurysm (common in resulting to a hemorrhage)

116
Q

What is the main risk factor in increasing a hemorrhagic stroke?

A

Hypertension

117
Q

What is the key variable seperating TIA’s from diagnosable strokes?

A

The absence of permanent brain injury, duration is second

118
Q

Left/ right hemisphere strokes are unlikely to espace notice unless they are small (lacunar infarct)

A

Left

119
Q

Where does Hypertension refers to

A

high blood pressure described as systolic blood pressure > 140 mm and
diastolic pressure > 90

120
Q

Which two forms of Vascualr dementia (VaD) are there?

A

Large vessel disease: includes emboli, thromboli, and atherosclerosis

Small vessel disease: includes subcortical lacunes, strategic infarcts, watershed infarcts,
and subcortical arteriosclerosis

121
Q

The defining cognitive features of VaD are?

A

Psychomotor slowing and executive dysfunction, often
accompanied by depression

122
Q

Migraine have at least two of the following pain
characteristics

A

Unilateral location, pulsating quality, moderate to severe intensity, and aggravation by routine physical activity

123
Q

Where does migraine with aura refers to?

A

Classic migraine, a disorder with focal neurological symptoms clearly localizable to the cerebral cortex and/or brainstem

124
Q

Is migraine heritable and which people are most at risk?

A

Caucasian women are most at risk for migraines. Up to 61% of migraine is heritable

125
Q

What is Transient global amnesia (TGA)?

A

Transient global amnesia (TGA) is associated with an increased rate of migraine but this disorder
differs from common migraine in age of onset and fewer symptoms such as nausea and headache.

126
Q

What is the primary symptom of progressive supranuclear palsy (PSP)?

A

The primary symptom of PSP is an inability to look downward on command (veritcal gaze palsy = condition in which neither eye moves fully upward or downward)

127
Q

What are the common symptoms of PSP?

A

Falling and postural instability

128
Q

How do the memory deficits of PSP patients compare to those of Alzheimer patients?

A

PSP patients’ memory deficits tend not to be as severe as those of Alzheimer patients.

129
Q

What is the most commonly reported personality feature of PSP patients?

A

Apathy and inertia (traagheid)

130
Q

How does the diagnosis of Parkinson’s disease with dementia differ from other forms of dementia?

A

Parkinson’s disease with dementia is the preferred diagnosis if motor symptoms of Parkinson’s disease go before cognitive deficits by at least one year.

131
Q

How does FTD differ from Alzheimer’s disease?

A

The defining early feature for most patients with Alzheimer’s disease is impaired new learning and retention. Patients with frontotemporal dementia have executive deficits greater than memory deficits.

Diagnostics (8 decks)

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