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PCE Cardio > Neuro > Flashcards

Neuro Flashcards

1
Q

Brainstem involvement

A

Ipsilateral facial impairments

contralateral trunk and limb impairments

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2
Q

Brain involvment

A

Cirtical lesion: Impairment is dependent on the location of somatosensory cortex affected
deeper lesions impacting the thalamus and adjacent structures can lead to diffuse unilateral dysfunction
Contralateral side affected (tracts cross)

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3
Q

superficial sensations

A

Light touch
pinprick (pain)
hot and cold
pressure

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4
Q

Deep sensations

A

kinesthesia
proprioception
vibraation

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5
Q

Combined sensations

A

stereognosis, tactile localization, two point discrimination, double simultaneous stimulation, graphesthesia, recognition of texture, barognosis

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6
Q 
Sensory impairment terms
Allodynia
Analgesia
Causalgia
dysesthesia
hyperalgesia
hyperasthesia
hypoalgesia
paresthesia
A

Allodynia: Non-noxious stimulus produces pain
Analgesia: Loss of pain sensitivity (Inability to feel pain)
Causalgia: Burning painful sensation ( often along a nerve distribution)
dysesthesia: Touch sensation produces pain
hyperalgesia: Heightened sensitivity to pain
hyperasthesia: Heightened sensity to sensory stimulus
hypoalgesia: Decreased sensitivity to pain
paresthesia: Abnormal sensation with no apparent cause (Numbness, tingling)

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7
Q

UMN and LMN lesions

A

UMN Weakness (spastic paralysis), hyperreflexia, hypertonia

LMN (Weakness (Flaccid paralysis), atrophy, fasiculations, hyporeflexia, hypotonia)

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8
Q

UMN conditions

A 
Traumatic brain injury (concussion)
Stroke
Cerbral Palsy
Ataxia (Cerebellar ataxia)
Spinal cord injuries
Multiple Sclerosis
Brain or spinal tumor
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9
Q

LMN conditions

A 
Guillain barre syndrome
Post polio
poliomyelitis
Bells Palsy ( Affects facial nerve)
Cauda equina syndrome
Peripheral nerve injuries
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10
Q

Which condition has S & S of both UMN and LMN lesions

A

ALS

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11
Q

Hypertonia: Rigidity (leadpipe and cogwheel) Are most common with what condition

A 
Leadpipe rigidity (Uniform rigidity through range)
Cogwheel rigidity (Rachet-like jerkiness through range
Both common in parkinsons disease
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12
Q

Decorticate rigidity

A

Corticospinal tract lesion at level of diencephalon (Likely to be in a comma)

  • Abnormal flexor response
  • Upper extremities:
  • Shoulder adduction
  • Elbow flexion
  • Wrist flexion
  • Finger flexion

Lower extremities:

  • leg extension and internally rotated
  • Plantar flexion
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13
Q

Decerebrate rigidity

A 
Corticospinal tract lesion at the level of the brainstem
Abnormal extensor response
UE:
-Shoulder adduction
-pronation
-Elbow extension
-Wrist flex
-Finger flex
LE:
-Leg extended
-Plantar flexed
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14
Q

Dystonia

A

Movement disorder characterized by involuntary twisting and repetitive movements, abnormal fixed postures, and disordered tone

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15
Q

Ischemic stroke

A

Most common form of stroke (80%)
thrombus (Most common) or an embolus that blocks an artery
TIA (Typically resolve in 24 hours) but administer thrombolytic agent within 4.5. hours

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16
Q

Hemmorhagic stroke

A

~20%
Increased mortality rate
Intracerebral (Rupture or leak of a weak blood vessel in the brain )
Subarachnoid ( Due to an arteriovenous malformation or a ruptured aneurysm which causes bleeding in the subarachnoid space)

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17
Q

Risk factors for stroke

A 
Hypertension
Heart disease
Disorders of heaert rhythm
Diabetes
Hypercholesteremia (> 240 mg/dl)
High LDL
Low HDL
Elevated hematocrit
End stage renal disease sleep apnea
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18
Q

Major risk facxtors specific to women

A

Early menmopause
estrogen supplementation
Pregnancy, birth, first 6-weeks post partum
Preeclampsia

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19
Q

Modifiable and non-modifiable risk factors for stroke

A

Modifiable

  • Smoking
  • Physical activity
  • Obesity
  • Diet
  • excessive alcohol use

Non-modifiable

  • Family Hx
  • sex (M>F)
  • Age
  • Race (African American)
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20
Q

Anterior cerebral artery syndrome (stroke)

A

If occlusion is proximal to the anterior communicating artery there will be minimal deficits
If distal then there will be greater deficits

Characteristics

  • Contralateral hemiparesis and hemi-sensory loss
  • LE>UE
  • Urinary incontinence
  • Abulia (absence of will power)
  • Akinetic mutism (Decrease moving and speaking)
  • Apraxia ( Difficulty with motor planning and movement)
  • Broca-s apashia (frontal lobeO Motor speech impairment)
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21
Q

MCA syndrome

A

Supplies lateral aspect of cerebral hemisphere (Frontal, temporal, and parietal lobes) and subcortical structures (internal capsule, corona radiate, globus pallidus, caudate, and the putamen)

  • Most common site of a stroke
  • S & S
  • Contralateral hemiparesis and hemi-sensory loss of face, UE, and LE
  • UE affected>LE
  • Contralateral HH
  • werneickes aphasia
  • Brocas aphasia
  • Global aphasia (nonfluent speech and poor comprehension)
  • Perceptual deficits (unilateral neglect, anosognosia, apraxia, spatial disorganization/depth perception) typically in the non-dominant right hemisphere so the deficits will be in the right
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22
Q

posterior carotid artery syndrome

A

PCA supplies the occipital lobe, medial and inferior temporal lobe, upper brainstem (midbrain), posterior diencephalon (includesmost of the thalamus)
common characteristics
-peripheral territory: amnesia (loss of memories), HH, visual agnosia (difficulty recognizing people, prosopagnosia (difficulty naming people based on looks), dyslexia, colour namin and discrimination problems
- Central territory: central post-stroke (thalmic pain), hemianesthesia, sensory impairments (all modalities), contralateral hemiplegia, oculomotor nerve palsy

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23
Q

vertebrobasilar artery syndrome

A

Vertebral artery supplies the cerebellum and the medulla
-basilar artery supplies the pons, internal ear, and the cerebellum
-can produce both contralateral and ipsilateral S & S
Common characteristics
-Ataxia (ipsilateral), impaired sensation over the face, impaired pain and thermal sensation (contralateral), vertigo, diploplia, dysarthria, dysphagia

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24
Q

locked in syndrome

A

Syndrome where a patient is aware and awake but has complete paralysis of nearly all voluntary muscles in the body except the eyes and are otherwise cognitively intact
-When the eyes are also paralyzed then it is known as total locked in syndrome

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25
Q

Lacunar syndrome

A

caused by occlusion of small penetrating arteries supplying the deep brain structures

  • Account for more then 20% of all strokes
  • Strongly associated with diabetes and hypertension
  • lacunar syndrome are consistent with specific anatomical sites
  • Pure motor lacunar syndrome
  • Pure sensory lacunar syndrome
  • othe lacunar syndromes: Dysarthria, clumsy hand syndrome, ataxia hemiparesis, sensory/motor stroke, dystonia/involuntary muscle.
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26
Q

Associated conditions of a stroke

A

Disorders of speech and language

  • Dysphagia
  • cognitive dysfunction
  • altered emotional status
  • hemispheric behavioural differences
  • perceptual dysfunction
  • seizures
  • bladder and bowel dysfunction
  • cardiovascular and pulmonary dysfunction
  • DVT and pulmonary embolus
  • osteoperosis and fracture risk
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27
Q

Hemispheric behavioural differenes

A

left hemisphere lesion

  • Slow, cautious, anxious, and disorganized
  • hesitant to try new tasks (require more feedback, support, and encouragement)
  • AAware of their deficits
  • difficultioes with communicating and processing information, in a sequential linear order

RRight hemisphere lesion

  • quick, impulsive, poor judgement
  • overestimate abilities, unaware of there abilities
  • increased safety risk (Feedback focused on slowing down, and recognizing risks and consequences of actions
  • Difficulties with spatial-perceptual tasks and in grasping the whole idea of an activity or task
28
Q

cerebral shock

A

Flaccid paralysis and hyporeflexia immediately following stroke

29
Q

Motor programming for stroke

A

Apraxia: Motor disorder caused by difficulty planning and performing tasks or purposeful movements (usually left hemisphere damage)
-No primary motor impairments

Ideational apraxia: Inability to produce movement on command or automatically
-No idea how to do the movement (can’t conceptualize or plan

Ideomotor apraxia: Inability to produce purposeful movement of command but is able to perform movement automatically

  • Can perform habitual tasks when not asked to do so but cant perform if asked
  • Often perservates
30
Q

Pusher syndrome

A

Disorder of postural control which may lead to a loss of balance

  • Unusual tendency to push weight from the non-hemipareetic (strong side to the hemipareetic (weak ) side with resistance to passive correction
  • Posterolateral thalamus involvemtn
31
Q

Signs of increased ICP

A

Decreased conciousnes (stupor or coma)

  • Altered vital signs
  • Widened pulse pressure
  • Irregular (cheyne stokes) breathing
  • Vommiting
  • Headache
  • non-reaccting pupils (CN III)
  • Papilledema 9optic disc or nerve swelling)
  • Progressive impairment of motor function
  • Seizure activity
32
Q

Treatment for elevated ICP

A
  • Elevate head of bed to 30 degrees
  • intubate and hyperventilate
  • IV mannitol (osmotic agent) promotes fluid removal from CNS while maintaining perfusion
  • ventricular drainaage
33
Q

coma

A

Arousal system not functioning

  • Eyes closed
  • Sleep/wake cycles absent
  • ventilator dependent
  • no auditory, visual, cognitive, or communicative function
  • abnormal motor and postural reflexes may be present (Decorticate posturing more common)
34
Q

Vegetitative state

A
  • Eyes may beopen but awareness is absent\
  • brainstem able to manage basic cardiac, respiratory and other functions (weaned offf ventilator)
  • Sleeo/wake cycles present
  • may startle to visual or auditory stimuli
  • meaningful motor, cognitive, or communication absent
  • Just react to stimuli but not aware
35
Q

Minimally concious state

A
  • Minimal evidence of awareness
  • cognitively mediated behaviour occur inconsistently
  • sleep/wake cycles present
  • will localize to noxious stimuli and may inconsistently reach for objects
  • may localize to sound location and demonstrate visual fixation and pursuit
36
Q

Stupor

A

Almost unresponsive state can be aroused briefly with vigorous repeated stimulation

37
Q

obtunded

A

Decreased alertness, sleeps oftern

38
Q

Glasgow coma scale

A

3 response scores: eye opening, motor and verbal
scores:
12-15: Mild LOC
9-12: Moderate
3-8 severe
If score is 15 then a more appropriate scale like the ranchos los amigos scale is required

39
Q

Mild, moderate, and sever TBI

A

Mild

  • GCS: 12-15
  • Loss of conciousness: 0-30 minutes
  • Altered conciousness: Brief
  • Post-traumstic amnesia: 0-24 hours
  • Neuroimaging: Normal

Moderate

  • GCS: 9-12
  • Loss of consciousness: >30 minutes-24 hours
  • Altered consciousness: >24 hours
  • Post-traumstic amnesia: 24 hours-7days
  • Neuroimaging: Normal or abnormal

Severe

  • -GCS: 3-8
  • Loss of consciousness: >24 hours
  • Altered consciousness: >24 hours
  • Post-traumstic amnesia: >7 days
  • Neuroimaging: Normal or abnormal
40
Q

special considerations for confused and agitated patients

A
  • Consistency (same place, same time, same person everyday) and create a routine
  • Expect no carryoverautomatic skills (procedural memory)
  • Model calm behavior
  • Expect egocentricity
  • Flexibility and option (have back up options in case the original activity doesn’t work, treat pt at appropriate age level, and when appropriate to do so give the patient options
  • Safety
41
Q

Cerebellar dysfunction

A

Ipsilateral and unilateral motor impairment

  • Cerebellum comparees internal feedback with external feedback and generates corrective signals to reduce errors (feedforward mechanism)
  • Cerebellar lesions

Midline S&S:

  • Truncal ataxia (coordination problem of the trunk muscles)
  • Titubation (oscillatory movements of head and trunk
  • Orthostatic tremor (shaky leg syndrome)
  • Gait imbalance

Hemispheres S&S:

  • Limb ataxia
  • dysarthria
  • hypotonia

Posterior S&S:

  • Eye movement disorders (VOR disruption and nystagmus)
  • Posture
  • Gait imbalance
42
Q

Cererbellar motor impairments

A
  • Asthenia (generalized muscle weakness)
  • Ataxic gait “huggies baby”
  • Delayed reaction time
  • dysarthria (characterized by scanning speech)
  • dysdiadachokineia
  • Dysmetria
  • Dysnergia
  • hypotonia
  • motor learning problems
  • nystagmus
  • rebound phenomenon (ability to stop active movement when resistance is removed)
  • Tremor (intention and postural)
43
Q

cerebellar vs. sensory ataxia

A

Cerebellar ataxia

  • Do dysdiadachokinesia
  • dysmetria
  • dysynergia
  • dysrhytmia
  • Will present with ataxic gait

Sensory ataxia

  • Do proprioceptive testing
  • Will have high stepping or stomping gait

Do romberg test

  • If difficulty with eyes open then patient had cerebellar ataxia
  • If had difficulty with eyes closed then shows sensory ataxia
44
Q

Spinal cord injury

Most common MOI

A 
Flexiomn (most commonn in L-spine)
Flexion + rotation (Common in C-spine (passenger MVA))
Axial compression
hyperextension
penetrating injury
45
Q

Spinal shock

A

Transient period of areflexia immediately after the injury

  • characterized by:
  • Absence of all reflex activity (~24 hours)
  • Impaired autogenic regulation
  • Piloerection (goosebumps)

spinal shock recovery

  • Total areflexia (~24 hours)
  • Gradual return of reflexes (1 to 3 days
  • Uncreasing hyperreflexia - 1 to 4 weeks
  • Final hyperreflexia - 1 to 6 months (UMN syndrome)
46
Q

Tetraplegia

Paraplegia

A

Loss of motor and or sensory function of all 4 limbs
-Results in lesion of C spine (T1 and above)

Part of thetrunk and lower extremities
-lesion of the T-spine, lumbar spine or cauda equina

47
Q

Incomplete SCI

Brown-sequard syndrome

A
  • damage to one half of the spinal cord
  • Typically due to a penetrating injury
  • Will have ipsilateral loss of motor function, (descending lateral corticospinal tract)
  • Proprioception, discriminative touch, and vibration sense (ascending dorsal column)
  • Contralateral loss of pain and temperature (ascending spinothalmic tract)
48
Q

Incomplete SCI

anterior cord syndrome

A

Damage to the anterior cord of the SC

  • Typically due to a cervical flexion injury or disruption to vascular supply (anterior spinal artwry
  • Loss of motor function, and pain and temperature below the level of the lesion
49
Q

Incomplete SCI

Central cord syndrome

A

Most common SCI injury

  • due to cervical hyperextension in the cervical region
  • compressive forces cause hemorrhage and edema damaging the central portion of the spinal cord
  • loss of motor fxn> sensory
  • motor loss (UE>LE)
  • saccral sensation spared, sacral motor fxn often spared
50
Q

Incomplete SCI

posterior cord syndrome

A
  • Very rare
  • Loss of discriminative touch, proprioception (will see sensory ataxia), and vibration sense
  • No motor loss
51
Q

Primrary complications of an SCI

A
  • Autonomic dysreflexia
  • postural hypotension
  • Impaired temperature regulation
  • blunter HR and cardiovascular response
  • Respiratory impairment
  • spasticity
  • bladder and bowel dysfunction
  • sexual dysfunction
52
Q

Autonomic dysreflexia

A

Pathological autonomic reflex causing sympathetic overactivity
-Lesions above T6 typically

Order of events:
_Noxious stimulus below level of lesion (Kinked catheter)
-Increased sympathetic outflow (mass reflex response)
-Wide spread vasoconstriction (Increase HR and BP)
-Baroreceptors stimulate leading to increase vagal output causing Decrease HR but insufficient to counteract increase in BP

Interventions:
Sit patient up to decrease BP (lying patient down is contraindicated)
-Check catheter for kink, block, fullness, (notify nurse if needs to be emptied)

53
Q

NLI C1-C4

A

-Most severe level of SCI
-paralysis of arms, hands, trunk, and legs (tetrapleegia)
-Patient require assistance with breathing C1-C3, and secretion clearance
-Dependent in all ADLs
-dependent in transfers (mechanical lift)
\
-power wheelchair
-tilt in space or reclining seat
-head, chin, or sip and puff control

54
Q

NLI C5

A

Can breathe independently but may be laboured; abdominal binder may improve breathing

  • dependent in transfers
  • manual wheelchsir with propulsionaids for short distances (flat surfscves)
  • Can drive a vsn using adaptive hand controls
  • power wheelchsir with adapted joystick for community
55
Q

NLI C6

A
  • able to perform limited self care activities with tenodesis grasp
  • Independent to min assist with sliding board
  • independent with manual cough
  • wheelchair propulsion possible with use of hand rim projections for short distances
  • powerwheelchairfor community
  • independent with pressure relief maneuvers in wheelchsir
  • can drive car or van with adaptive hand controls
  • capable of living independently
56
Q

NLI C7

A

Can extewnd elbow allowing for easier use of sliding board transfers

  • Can do m ost ADLs by themselves, bed mobility ,such easier
  • manual wheelchair with friction surface hand rims and may require assistance with ramos curbs and uneven surfaces
57
Q

NLI C8

A

Full use of intrinsic hand muscles aloowing for grasping objects with ease and less needs for adaptive equipment

  • Indepent in all ADLs may require adaptive aids
  • manual wheelchsir with standard hand rims
58
Q

NLI T1-T12

A

The lower the level of the injury in the T-spine the better the trunk control as more paraspinals and abdominals ill be functional

  • may use othoses (HKAFO, KAFO) with assistive device for short distances
  • wheelchair for community
59
Q

NLI L1-L3

A

May use orthoses (HKAFO, HAFO, AFO) with assistive devices for short distances
-wheelchair for community

60
Q

NLI L4-S1

A

AFO with assistive device. NLI L4 may choose to use wheelchair for longer distsances

61
Q

Multiple sclerosis

A

Chronic inflamatory disease, causing demyelination (oligodendrocytes) in the CNS

  • the damaged myelin becomes replaced by plaque (scar tissue)
  • sclerotic plaque prevents normal transmission of nerve impulses causing neuro S & S
  • believed to be an autoimmune disorder

4 types:

1) Relapse remmiting MS (Most common form)
2) Primrary progressive MS
3) Secondardary progressive MS
4) Progressive relapse-remitting MS

Exacerbated by:

  • Relapse (exacerbation) - new and recurrent symptoms that last for at least 24 hours
  • Aggravting factors: Viral infection, bacterial infection, disease of major systems, emotional and bodily stress
  • Pseudoexacerbation: Transient worsening of MS symptoms. episodes last <24 hours
  • Uhthoffs phenomenon - adverse reaction to heat (internal or external)

S & S

  • sensory changes (paresthesia or numbness)
  • Pain most common is trigeminal neuralgia, paroxysmal limb pain (more common in LE), and headache
  • vision changes (opyic neuritis)
  • motor dysfunction (central fatigue which is most common and debilitating symptom of MS)
  • Speech and swallowing dysfunction
  • cognitive and affective changes (Intelect not affected but rather attention and concentration

Exercise has good overall benefit but need to take fatigue and heat into consideration

  • Perform exercises in the morning
  • exercise in a cool environment
  • keep them hydrated
  • wear loose, light clothing
  • use blow fans
  • submax exercise intensities
  • take more rest intervals
  • dont overwork them
62
Q

parkinsosn disease

A

chronic neurodegenerative disorder
-due to loss of dopamine producing neurons in the pars compactia of the substantial nigra of the basal ganglia
4 cardinal signs:
Tremor at rest (pill rolling tremor of the hand)
rigidity (leadpipe and cogwheel) (asymmetrical, proximal to distal)
akinesia (freezing of gait) /bradykinesia (slowness of movement)
postural instability

-kyphosis is the most common postural deformity of PD

Gait: festinating gait

  • freezing
  • shuffling gait
  • decrease arm swing
  • decrease trunk rotation

Early S & S:

  • Very first sign will be aa loss of smell
  • masked face
  • Dyphagia
  • dysphonia
  • micrographia
  • festinnating gait
  • stooped posture

Later S & S:

  • difficulty arising from chair
  • difficulty turning over in bed
  • cognitive changes/dementia
  • sialoorhea (drooling)
  • GI dysfunction
  • foot dystonia

Intervention programming

  • Repetition
  • Blocked>random practice
  • Decrease cognitive demands
  • set up environment to reduce clutter
  • use structured instructional sets
  • Use external cues

Cues
-Patient with a shuffling gait, cue to take BIG STEPS, pt. step over small styrofoam cups, tell them to imagine taking a big step
Freezing gait: counting, instruct on the count of 3 I want you to take a step, have them step over piece of tape, tap pts leg to cue them to initiate a step
-Decreased gait speed: clap rhythmically or have a metronome for pt to step on the beat

63
Q

ALS (Amyotrophic lateral sclerosis

A

chronic degenerative disease of motor neurons in the brain , brainstem, and spinal cord(sensory system is spared)

  • Results in UMN snd LMN, the only condition. that presents as both
  • Commonly known as Lou Gehrigs disease

Pathophys:

  • Progressive degeneration and loss of motor neurons
  • UMN in motor cortex and corticospinal tracts
  • Brainstem nuclei of. CN V (trigeminal), VII (fascial), IX (glossopharyngeal), X (vagus), and and XII hypoglossal
  • LMN in anterior horn of spinal cord

Areas that are spared:

  • Sensory system, spinocerebellar tracts
  • Brainstem nuclei of CN II (oculomotor), IV (trochlear), VI (abducens) (eye movements are spared which is beneficial for communication

Most common and fatal motor neuron disease in adults (due to respiratory failure causing mortality (3-5 year life expectancy)

Characteristics:

  • UMN and LMN syndrome
  • Asymmetrical distribution
  • Distal> proximal progression
  • Caudal>rostral spread within spinal cord
  • Weakness is the cardinal sign of ALS
  • increased risk of pneumonia
  • frontotemporal dementia - cognitive impairments common with bulbar onset ALS
  • Anterior horn cells of S2
64
Q

GBS (Guillian - baree syndrome)

A

An auto-immune disorder that causes inflamation and demyelination of the cranial nerves and peripheral nerve myelin sheaths

  • GBS affects LMN, whereas MS affects LMN
  • Acute inflammatory polyneuropathy due to an auto-immune response
  • Primarily involves schwann cells causing demyelination of peripheral nerves
  • Demyelination causes impulse conduction to be slowed down, become dispersed, or blocked
  • Potential axonal damage due to inflammation
  • Prgresses from distal to proximal
  • But recovers from proximal to distal
  • Often occurs after recovering from recent infection or illness
  • Most often after an upper respiratory tract infection

3 phases
1) progressive deterioration - demyelination and potential axonal damage (don’t do strength, its pointless)
lasts 1-4 weeks
2)Plateau - disease peaks and there is no further progression
3) Recovery - Axonal regeneration and myelination, progressive recovery usually lasts 6 months - 2 years, complete recovery is common, low mortality rate

S & S:
-ANS dysfunction : high risk of CRPS d/t immobility
-Atrophy
-fatigue (one of most debilitating symptoms
-Hyporeflexia and hypotonia
-Pain : Low back and leg muscles most common
-Paresis: Distal to proximal with LE affected more then UE, may include fascial nerve
-Paresthesia : Glove and stocking pattern
-Repiratory: Possible phrenic nerve involvement
-

65
Q

primrary functions of the vestibular system

A

1) Gaze stabilization
2) postural stabilization
3) spatial orientatiuon

PCE Cardio (5 decks)

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