Hoofdstuk 7 Neuropathology for neuropsychologists Flashcards
Where does Traumatic Brain injury (TBI) reffers to?
Injury involving the brain resulting from some type of impact and/or acceleration/ deceleration of the brain
What does closed head injury (CHI) refers to?
Blunt head trauma or blunt injury
What does penetrating head injuries (PHI) refer to?
Sometimes called open head injuries, include injuries from any source which the skull and dura are prenetrated by
What does acquired brain injury (ABI) refer to?
Anything that can damage brain tissue (concussion)
Which two measurment instruments can help determine the presence and severity of a TBI?
The Glasgow Coma Scale & posttraumatic amnesia (PTA)
What are the diagnostic criteria for mild TBI?
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)
What are the diagnostic criteria for a severe TBI?
(Where the severity of injury exceeds being a mild TBI)
- Loss of consciousness for approximately 30 min
- After 30 min, Glasgow Coma Scale score of 13-15
- PTA not greater than 24 hours
True or false: lenght of PTA tends to be more accurate than coma duration in predicting long-term cognitive status?
True
What is also a strong indicator of the severity in TBI?
Visual field deficits
What does anosmia mean?
Loss of the smell sense (can be a marker of severe damage with longer coma en more deficits)
What is traumatic axonal injury?
Shearing-tearing effects on axons
What is secondary axotomy?
Traumatic axonal pathology (multiple, scattered, small hemorrhagic, and/or non-hemorrhagic lesions) occuring as a result of secondary effects damaging the axon
Penetraiting head injuries (PHI) can give a lot of complications, what are the most common pathological ones?
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)
Long term memory/ short term memory is especially likely to be compromised, regardless of the location in PHI?
Short term memory
Two features of TBI are impulsive loading and impact loading, what do they mean?
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
When the fine tissue covering the brain (pia, arachnoid) is torn, the injury is called?
A laceration
Inertial forces can involve translational acceleration and rotational acceleration, what do they mean?
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)
What is angular acceleration?
Combination of translational acceleration and rotational acceleration
There are two types of clots that can form outside the brain, extradural (EDH) & subdural (SDH), what do they mean?
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
Where does migraine with aura refers to?
Classic migraine, a disorder with focal neurlogical symptoms clearly localizable to the cerebral cortex and/or brainstem
What is a (persistent) postconcussion syndrome?
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
What are some typically cognitive impairments in MS?
Attentional processes, memory and executive functions
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?
Relapsing form of MS
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?
Progressive form of MS
When MS begins with a clinical attack, recovering, relapses with improvement and stability inbetween attacks, we call this?
Relapsing-remitting MS
Relapsing remitting patients who start deteriorating within 15 years of their initial attack, is called?
Secondary progressive MS
Nearly continuous progressive course form the first time their first symptom appears. Not any clear-cut relapses or remission, is called?
Primary progressive MS
The patients whose MS progresses very rapidly, causing helpless dependency or death soon after disease onset, is called?
Maligning MS
Poor prognosis in MS patients is associated with?
Older age, incomplete recovery from the first attack, short interval between the first two attacks, frequent relapses over the first 5 years
What are some risk factors for developing MS?
Genetic, demographic (more women), geographic (dichter bij de evenaar minder MS)
What is the pathological hallmark of MS?
Demyelinated plaque, which is characterized by loss of the myelin sheath around axons
MS lesions can best be seen by EEG, CT or MRI?
MRI because lesions appear as hyperintense bright spots on MRI
Name three vulnerabilities (verergeren van symptomen) that MS patients experience
Stress, heat and fatigue
MS is by its very nature homogeneous/heterogeneous in both its physical and cognitive manifestations.
Heterogeneous
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.
Recall
MS patients often complain of (cognitive) problems with …
Vision, verbal fluency, verbal reasoning, mentally slowed down, mobility
MS patients also have disorderly problems with mood, affect and behavior. Name three of many
- pathological laughing
- euphoria
- agitated
- major depression
- bipolar disorder
- clinically significant anxiety
Normal pressure hydrocephalus (or communicating hydrocephalus aka waterhoofd) involves …
ventricular enlargement with associated white mater damage.
Alcohol-related disorders. Moderate alcohol intake may have beneficial health effects, in particular red wine. True/false
True
Brain changes that have been associated with excessive alcohol consumption include
atrophy of the cerebral cortex, reduced white matter volume, enlarged ventricles, and atrophy of subcortical structures, e.g. hypothalamus and cerebellum
Alcohol acts as a central nervous system stimulant/depressant
depressant
… weighs heavily as a risk factor, even when the children have been raised in a nonalcoholic environment
A family history if alcoholism
Cognitive deficits have been correlated with white/grey/both white and grey and sensory/motor/both sensory and motor abnormalities.
both white and gray matter / both sensory and motor
Which lobe and system appear to be particularly vulnerable to damage and dyusfunction associated with chronic alcohol abuse?
frontal lobes, limbic system, and cerebellum
Which cognitive and executive functioning is impaired with chronic alcohol abuse?
Attention, visuospatial abilities and psychomotor speed;
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
amnesia
Korsakoff’s syndrome. Wernicke’s encephalopathy symptoms: (different conditions that often occur together)
- thiamine deficiency (Vitamine B1)
- rapid eye movements,
- gaze paresis,
- ataxia,
- confusion,
- amnesia
Implicit/explicit memory remains relatively intact in Korsakoff’s syndrome
Implicit
Korsakoff’s syndrome executive function impairments:
- decision making
- cognitive estimation,
- premature responding
- diminished ability to benefit from mistakes
- diminished ability to perceive and use cues
After alcohol and nicotine, …. is the most commonly used ‘recreational’ drug in Western countries and probably the most commonly used illicit drug worldwide
marijuana
Marijuana’s acute effects include …
hallucinatory and reactive emotional states, some pleasant, some
unpleasant and even terrifying; time disorientation; and recent-transient-memory loss.
Recent-transient-memory loss =
loss of ability to discriminate
between old and new learning
Marijuana’s long-term effects on cognitive abilities
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
Marijuana’s long-term effects on personality
are affective blunting, mental and physical sluggishness, apathy, restlessness, some mental confusion, and poor recent memory.
Effects of marijuana on development
long-term negative consequences for cognitive, behavioral, psychological, and neurological health.
Is associated with altered connectivity and reduced volume of specific brain regions
Marijuana’s Effects on development
long-term negative consequences for cognitive, behavioral, psychological, and neurological health.
Cocaine is / is not a central nervous system stimulant and is / is not highly addictive.
is / is
Positive effects of cocaine are:
positive aspects of cocaine intoxication include increased alertness and arousal levels, increased sense of well-being and confidence, and motor activation
Cocaine increases dopamine in reward circuits contributing to …
a vicious cycle of craving and ever higher thresholds for a euphoric reaction to the drug
Name three psychiatric reactions to cocaine
agitation, paranoia, delusions and hallucinations, panic attacks, and
self- or other-directed violence; suicide intents
Neuropsychological findings of slowed mental processing, memory impairments, and reduced mental flexibility. Cocaine appears to induce neurotoxicity by disrupting the …
blood-brain barrier
Cognitive problems with long-term use of cocaine:
memory and concentration deficits and impaired executive functioning. Dysphoric.
Dysphoric = ?
Dysphoria is a profound state of unease or dissatisfaction.
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
Mild / true
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
Mild / true
A report of adverse effects of long term opiate use on executive functioning includes …
diminished ability to shift cognitive set and to inhibit inappropriate response tendencies.
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?
- attention
- memory
- executive functions
Intake of METH drugs can result in
Strokes and visual and auditory hallucinations
Name two social drugs
Caffeine, nicotine
Caffeine increases/reduces motor activity and increases/reduces reaction time
increases / reduces
Name the three main environmental and industrial neurotoxins
o Solvents and fuels
o Pesticides
o Metals
Long-term exposure to solvents and fuels can heighten/lower cerebral blood flow, particularly in medial temporal/frontotemporal areas
lower / frontotemporal
Chronic exposure to solvents and fuels in the form of fumes can lead to (objective and subjective complaints):
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
With acute exposure to pesticides, patients experience many symptoms associated with central nervous system involvement, such as…
Headaches, blurred vision, anxiety, restlessness, apathy, depression, mental slowing and confusion, slurred speech, and ataxia
With acute exposure, pesticides have effect such as … (name at least three)
headaches, blurred vision, anxiety, restlessness, apathy, depression, mental slowing and confusion, slurred speech, and ataxia.
What is most impaired in people chronicly exposed to pesticides?
attention, memory, and response speed
Name two common metals dat are toxic:
Lead and mercury
Lead is devastating for the CNS leading to entire dysfunction of … (denk aan schade aan prefrontal cortex, hippocampus, en cerebellum)
cognitive functions: attention, memory and learning, visual and verbal abilities, processing speed, and motor and coordination functions.
Mercury toxicity leads to damage to the CNS. When acute intoxication does not result in death, it leads to …
motor slowing and clumsiness, parenthesias, tremor, visual
and hearing defects, agitation, and mental dulling
HIV (human immunodeficiency virus) attacks and progressively destroys the
immune system
A broad spectrum of cognitive deficits may
occur in HIV. True/false
True
HIV-associated dementia (HAD): Before evolving into a full-blown dementia, … and …. deficits and slowed mental processing are the most usual cognitive impairments.
Concentration and memory
Herpes simplex encephalitis (HSE) has a profound effect on which cognitive domain?
Memory
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?
Lyme
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
Chronic fatigue syndrome (CFS). Cognitive impairment often involves (name at least two)
poor concentration, impaired learning, and word finding
difficulty.
What is common effects in the brain in radiation therapy for cancer patients?
Acute effects (i.e. transient confusion), a decrease of cognitive and functional status and cerebral atrophy
Name three primary brain tumors:
Gliomas
Meningiomas
CNS lymphoma
Which major brain tumor is the most common in adults?
Gliomas
Gliomas arise from which cells?
Glial cells, forming the connective tissue of the brain
Meningiomas grow between … and …. And are more common in women / men
brain and skull / women
What are secondary brain tumors?
Brain tumor originate elsewhere in the body and travel into the CNS and settle in brain tissue
Brain tumors can comporomise brain function in one or more of four distinct ways:
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
Name two kinds of therapy that are applied as cancer treatment
Radiation and chemotherapy
Radiation therapy leads to what kind of atrophy?
cerebral atrophy - leading to ‘variety’ of white matter cahgnes and neuropsychological deficits (aka vanalles)
What are anoxia, hypoxic and anoxemia examples of?
oxygen deprivation
What is hypoxia?
reduced oxygen availability
Which brain areas are particularly vulnerable to oxygen deprivation?
The hippocampus, basal ganglia, and cerebral cortex
What is COPD?
chronic obstructive pulmonary
disease / chronic hypoxia - oftewel chronisch zuurstof tekort
Name some effects of carbon monoxide
disorientation, headache, a racing heartbeat, dizziness,
fainting, and somnolence,
Impaired nutrition during childhood can have long-standing consequences for health and cognitive performance. True/False
True
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
C
True or false: the pathophysiological effects of a mild brain injury may actually be a predisposing factor for the development of PTSD
True
What is the most important moderator variable contributing to TBI outcome?
Age
What are some less common sources of brain injury?
Electrical injury, lightning strike & blast injuries
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 stroke (or CVA), later in de tekst gedefinieerd als: focal neurological disorder of arubpt development due to pathological processes in blood vessels
What is defined as a focal neurological deficit lasting less than 24 hours?
A transient ischemic attack (TIA)
What is a myocardial infarction?
Heart attack
What are examples of not modifiable and modifiable risk factors?
Not modifiable = age, sex, race etc. and modifiable = smoking, diabetes, psysical activity etc.
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 ….
Infarction, infarct
What are ischemic infarctions?
Infarctions due to tissue starvation resulting from insufficient or absent blood flow
What are two prominent mechanisms that account for tissue starvations of strokes?
Obstruction of blood vessels (thrombus or embolus) or hemorrhage (burst of blood vessel)
What is the most common source of obstruction of blood flow to the brain and is called atherosclerotic
Arteriosclerotic plaques or the build up of fat deposits
When in a stroke, the middel cerebral atery is involved, the most apparent cognitive disorders associated with left hemisphere damage wil be disturbances in?
Speech and langauge (aphasia)
Which kind of stroke has the worst prognosis?
Hemorrhagic stroke
What occurs when part of an artery wall weakens, allowing it to abnormally balloon out or widen?
An aneurysm (common in resulting to a hemorrhage)
What is the main risk factor in increasing a hemorrhagic stroke?
Hypertension
What is the key variable seperating TIA’s from diagnosable strokes?
The absence of permanent brain injury, duration is second
Left/ right hemisphere strokes are unlikely to espace notice unless they are small (lacunar infarct)
Left
Where does Hypertension refers to
high blood pressure described as systolic blood pressure > 140 mm and
diastolic pressure > 90
Which two forms of Vascualr dementia (VaD) are there?
Large vessel disease: includes emboli, thromboli, and atherosclerosis
Small vessel disease: includes subcortical lacunes, strategic infarcts, watershed infarcts,
and subcortical arteriosclerosis
The defining cognitive features of VaD are?
Psychomotor slowing and executive dysfunction, often
accompanied by depression
Migraine have at least two of the following pain
characteristics
Unilateral location, pulsating quality, moderate to severe intensity, and aggravation by routine physical activity
Where does migraine with aura refers to?
Classic migraine, a disorder with focal neurological symptoms clearly localizable to the cerebral cortex and/or brainstem
Is migraine heritable and which people are most at risk?
Caucasian women are most at risk for migraines. Up to 61% of migraine is heritable
What is Transient global amnesia (TGA)?
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.
What is the primary symptom of progressive supranuclear palsy (PSP)?
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)
What are the common symptoms of PSP?
Falling and postural instability
How do the memory deficits of PSP patients compare to those of Alzheimer patients?
PSP patients’ memory deficits tend not to be as severe as those of Alzheimer patients.
What is the most commonly reported personality feature of PSP patients?
Apathy and inertia (traagheid)
How does the diagnosis of Parkinson’s disease with dementia differ from other forms of dementia?
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.
How does FTD differ from Alzheimer’s disease?
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.
