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NEUROPATH 1 > Lecture 8 - Cerebral Palsy & Epilepsy > Flashcards

Lecture 8 - Cerebral Palsy & Epilepsy Flashcards

1
Q

What is cerebral palsy?

A

A NON- PROGRESSIVE brain lesion occurring prior to 2 years of age leading to a disorder of muscle movement, body posture and coordination (possible direct damage to brain cortex - primary motor area/pyramidal and cerebellum)

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2
Q

Does cerebral palsy reduce life expectancy?

A

No

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3
Q

What are 5 other impairments that may accompany cerebral palsy?

A
  1. visual/ hearing deficits
  2. seizure disorders
  3. Hydrocephalus/microcephaly
  4. Scoliosis/ hip dislocations
  5. mental retardation
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4
Q

What is the cause of cerebral palsy?

A

unknown - multifactorial etiology (3 factors)

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5
Q

What are 3 broad categories for risk factors of cerebral palsy?

A
  1. prenatal (ex. maternal infection - rubella, cytomegalovirus, herpes, toxoplasmosis)
  2. perinatal (ex. prematurity, obstetric complications)
  3. postnatal (ex. neonatal infection - meningitis, encephalitis)
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6
Q

What are 5 different types of cerebral palsy?

A
  1. spastic
  2. dyskinetic
  3. ataxic
  4. hypotonic
  5. mixed
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7
Q

What is the most common type of cerebral palsy?

A

Spastic CP

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8
Q

How is spastic CP characterized?

A

movement discrepancies - i.e. exaggerated reflexes, involuntary mm. movements, mm. stiffness - categorized into 5 additional subsets, based on distribution

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9
Q

What are the 5 sub-categories of SPASTIC CP?

A
  1. hemiplegia (one-side affected)
  2. diplegia (all 4 limbs affected, legs>arms)
  3. quadriplegia (all 4 limbs equally involved)
  4. monoplegia (1 limb, usually arm)
  5. triplegia (3 limbs, usually both arms and ONE leg)
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10
Q

What two categories is dyskinetic CP divided into?

A
  1. athetoid CP: involuntary, slow, writhing movement - mixed muscle tone
  2. Dystonic CP: trunk movements are more affected than limbs = TWISTED posture
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11
Q

What does ataxic CP result from?

A

damage to cerebellum

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12
Q

How does ataxic CP present?

A

Voluntary movements are NOT well coordinated, therefore wide-based gait, depth-perception is affected, tremor and imbalances are common, muscles are usually HYPOTONED (vision and hearing may also be impaired)

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13
Q

How does HYPOtonic CP present?

A

muscle tone is decreased or floppy

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14
Q

What is mixed CP?

A

a combination of symptoms from the other 4 CP type (spastic, dyskinetic, ataxic and hypotonic)

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15
Q

What is the least common type of CP?

A

Ataxic (5-10%)

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16
Q

What is the gross motor function classification system?

A

(GMFCS) universal standard for the determining of physical capabilities of pt’s with CP - designed by WHO and focuses on abilities rather than inabilities.

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17
Q

How many levels are listed in the gross motor function classification system?

A

5 levels (level 1 = highest ability, level 5 = lowest ability of independence)

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18
Q

What are 3 components leading to the development (pathogenesis) of CP?

A
  1. intraventricular hemorrhage
  2. hypoxic-ischemic injury causing encephalopathy
  3. malformation of CNS (immaturity of cerebral cortex)
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19
Q

What is the most common lesion that can contribute to CP?

A

intraventricular hemorrhage

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20
Q

What are 3 things that can lead to hypoxic-ischemic injury causing encephalopathy and contributing to CP?

A
  1. systemic HYPOTENSION
  2. emboli
  3. clotting
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21
Q

What are 5 motor impairments that may become more apparent with growth in those with CP?

A
  1. muscle tone abnormalities (can lead to MSK problems)
  2. persistent primitive reflexes
  3. postural instabilities
  4. delayed motor development
  5. abnormal motor performance
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22
Q

What are 5 cognitive impairments that may present with CP?

A
  1. mental retardation
  2. learning disabilities
  3. seizure disorders
  4. sensory impairment (visual and hearing)
  5. constipation/ bowel or bladder incontinence
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23
Q

What are 3 related behavioral signs related to micro or hydrocephalus associated with CP?

A
  1. extreme irritability
  2. vomiting (high intracranial pressure and medulla oblongata compression lead to vomiting)
  3. developmental retardation
24
Q

What are 4 strategies used to manage/treat CP?

A
  1. medications (muscle relaxants or pump implant in spinal cord)
  2. orthopedic surgery (muscle lengthening, releases or transfers)
  3. botox - local injections to reduce spasticity and drooling
  4. assistive aids (glasses, hearing aids, braces, wheelchairs - orthotic devices can help stability, alignment or flexibility)
25
Q

What are 4 common causes of death associated with CP?

A
  1. infections
  2. aspiration
  3. heart disease
  4. respiratory compromise
    (mild to moderate CP have normal life spans)
26
Q

What is epilepsy?

A

CNS- Neurological disorder in which nerve cell activity in the brain becomes disrupted causing seizures or periods of unusual behavior, sensations, and sometimes LOC (interaction of brain pathology and genetic predisposition - only 1% genetics)

27
Q

What are 6 possible causes of epilepsy?

A
  1. congenital malformations
  2. infections
  3. tumors
  4. vascular disease
  5. degenerative disease
  6. injury
28
Q

Which gender is more likely to be affected by epilepsy?

A

men, slightly more –> 1.5 : 1

highest incidence seen in children and elderly

29
Q

What is the third most common neurological disease of old age?

A

Epilepsy - after dementia and stroke

30
Q

what is the most common symptom of epilepsy?

A

seizures

31
Q

What are the 2 types of epilepsy?

A
  1. idiopathic / primary

2. secondary

32
Q

What is the cause and onset of PRIMARY epilepsy?

A

it is idiopathic in most cases - no identifiable lesion in the brain.
Onset = begins in childhood

33
Q

Where in the brain do generalized seizures come from?

A

bilateral cerebral cortex’s

34
Q

How do tonic-clonic convulsions present in generalized epilepsy?

A

LOC, mm stiffness, jerking movements are seen.

35
Q

How long can generalized seizures last?

A

usually 1-3 minutes (much longer recovery time)

36
Q

What can precede a generalized seizure?

A

aura (subjective sensation)

37
Q

What is a postictal state?

A

The time seen after a generalized seizure/epilepsy that involves deep sleep, confusion, HA’s and/or mm. soreness

38
Q

With focal epilepsy (secondary), where do electric discharges originate from?

A

a well-defined cortical area (may occur at any age)

39
Q

What are 3 defined events that focal/secondary epilepsy is related to?

A
  1. viral infection - meningitis
  2. traumatism
  3. tumor - FIRST SIGN
40
Q

How can a partial/ focal seizure present in regards to the temporal lobe?

A

deja vu, usual taste/smell, feeling of fear

41
Q

How can a partial/ focal seizure present in regards to the frontal lobe?

A

motor signs such as twitching or stiffness

42
Q

How can a partial/ focal seizure present in regards to the parietal lobe?

A

burning, numbness, tingling

43
Q

How can a partial/ focal seizure present in regards to the occipital lobe?

A

visual disturbances/ hallucinations

44
Q

Do simple, partial seizures have an effect on conciousness?

A

NOPE

45
Q

What are 7 causes of SECONDARY epilepsy?

A
  1. drugs/ toxins (alcohol, psychotropic drugs, lead poisioning)
  2. CNS infections (meningitis, encephalitis, abscess)
  3. CNS tumor (glioma, metastatic tumor)
  4. brain trauma (accidents, intracranial surgery, birth trauma)
  5. intracranial bleeding (subdural hematoma)
  6. Metabolic disorders (hyper/hyperglycemia, hypocalcemia)
  7. fever - especially in kids (infection, heat stroke)
46
Q

What are 2 ways to manage epilepsy?

A
  1. control seizure - anti epileptic meds are a challenge due to adverse effects
  2. support and education
47
Q

What is the prognosis for epilepsy?

A

there is an increased mortality rate - death by asphyxia may occur (eating/drowning); strong correlation with depression and epilepsy (higher incidence of suicide)

48
Q

Myth or Fact: You can swallow your tongue during a seizure.

A

MYTH - its physically impossible

49
Q

Myth or Fact: Do not use restraints when someone is seizing.

A

FACT - the seizure will run its course and stop

50
Q

Myth or Fact: People with epilepsy often do not inform others of their disorder

A

FACT - people with epilepsy hold many jobs and often do not inform others of it

51
Q

Myth or Fact: You can’t tell what a person may do during a seizure

A

MYTH - the characteristics of a seizure is consistent during each episode - behavior may be inappropriate for time and place, but will likely not cause harm.

52
Q

Myth or Fact: You can die from epilepsy

A

FACT - status epilepticus (lasts longer than 5 min) can cause death, should be treated as a medical emergency

53
Q

What is the time frame post birth that classifies an initial infantile seizure?

A

first 24-72 hours after birth

seizure is unilateral and focal cerebral origin

54
Q

What is the most common cause of infantile seizures?

A

hypoxic-ischemic brain injury

55
Q

What can be a deficit in gestational immature babies that can result in infantile seizures?

A

hypoglycemia

56
Q

What deficit can result in a new born having tetanus that can lead to infantile seizures?

A

hypocalcemia

NEUROPATH 1 (11 decks)

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