Neuro Conditions Flashcards
List the non-modifiable and modifiable risk factors for stroke.
Non = age, M>F, family hx, prev TIA/stroke Mod = HTN, cardiac disease, DM, hypercholesterolemia, smoking, inc BMI, oral contraceptives, drug use
What are the 2 categories of stroke and their causes?
Ischemic = thrombosis, embolism Hemorrhagic = aneurysm, AVM, etc.
What are the 5 mechanisms of traumatic brain injury?
Coup - occurs at area hit/injured
Contracoup - occurs opposite to area injured
Diffuse Axonal Injury - shearing/tearing from rotational forces in areas of density change
Contusion
Anoxic injury
Describe the 4 types of hematomas
Epidural - outside the dura (usually from skull #); arterial
Subdural - below dura; venous bleed
Subarachnoid - between arachnoid and pia
Intracranial - within the brain (below pia)
What are the signs of a basal skull #?
Blood or CSF out the nose, raccoon eyes, battle sign
Describe the 2 types of abnormal posturing.
Decerebrate - indicates brain stem damage (below red nucleus), extension of UE + LE (worse prognosis)
Decorticate - damage to cerebrum, internal capsule or thalamus (could be midbrain as well but red nucleus not intact)
Describe spinal shock and its symptoms
Temporary suppression of all reflex activity below level of injury; can last weeks to months
Symptoms: areflexia, flaccid paralysis, loss of sensation
Describe neurogenic shock and its symptoms
Body’s reaction to sudden loss of sympathetic control; occurs with injuries above T6
Symptoms: decreased vasomotor tone (hypotension, hypothermia despite normal blood volume), bradycardia, can lead to metabolic issues
Describe the levels of the ASIA scale
A = complete B = sensory incomplete (sensory but not motor preserved below level) C = motor incomplete (more than half of key muscles have less than grade 3) D = motor incomplete (more than half of key muscles have grade 3 or more) E = normal
What is zone of partial preservation?
Dermatomes below sensory level and myotomes below motor level that remain partially innervated (in complete injury)
Anterior cord syndrome
Caused by flexion injuries or vascular occlusion, loss of motor function, B/L loss of pain and temp below lesion, dorsal column spared
Posterior cord syndrome
Loss of fine touch, vibration, conscious proprio below lesion
Central cord syndrome
Generally in hyperextension injuries; upper motor and sensory function more impaired than LE; stiff trunk (invisible disability)
Brown Sequard
Hemi section of cord = ipsi loss of dorsal column and motor function; C/L loss of pain and temp below lesion
Cauda Equina
More LMN lesion; bowel and bladder signs, saddle parasthesia, B/L symptoms
Conus Medullaris
Can affect conus and root = varied picture
What are some common health risks in SCI?
DVT/PE, heterotopic ossification, osteoporosis, post traumatic syringomyelia (formation of abnormal tubular cavity in spinal cord)
What are 3 effects of Duchenne Muscular Dystrophy?
- muscle cells replaced by fat and CT
- progressive symmetrical wasting
- in w/c by 10-12, death by 20
What are 2 classic signs of DMD?
Gower’s sign - pushing on thighs to get off of floor
Calf pseudohypertrophy - well defined calves but with fat and CT
Name the 4 classic signs of Parkinson’s and 5 other signs
Classic = bradykinesia, resting tremor, rigidity, postural instability Other = micrographia, loss of automatic movement, hypokinesia/akinesia, mask face, postural hypotension, sleep disturbance, fatigue
Describe the 4 types of MS
Relapsing Remitting - new or old symptoms resurface or worsen; full or partial recovery between relapses; each flare up may cause more loss of function
Primary Progressive - gradual worsening of symptoms over time
Secondary Progressive - begins as relapsing remitting but steadily worsens
Progressive Relapsing - between relapses the disease slowly gets worse
What are the 3 types of meningitis?
Aseptic - fungus, virus, parasite
Tuberculosis - abscess or edema
Bacterial - in child or infant considered medical emergency
What are 2 signs used to rule in meningitis?
Brudzinski’s sign - involuntary flexion of hips and knees when neck is passively flexed
Kernig’s sign - painful knee ext from position of 90 deg hip and knee flexion
Creutzfeldt Jakob Disease
Caused by prions - movement disorder/dementia - rapidly progressive and fatal
Post Polio Syndrome (initial effect and after years)
Attacks neurons in brainstem and ant horn
Initial - death of motor neurons for skeletal muscles (those that survive sprout new terminals to make up for loss = some movement recovery and enlarged motor units)
Years later - gradual deterioration of sprouted fibers due to metabolic stress from larger motor units = muscle weakness and paralysis
Describe the 3 types of cerebellar lesions
Archicerebellum/vestibulo = vestibular control of head and body position = gait and trunk ataxia (fall toward side of lesion) Paleocerebellum/spino = synergy of agonists/antagonists/postural correction = hypotonia, trunk ataxia, ataxic gait - lose core activity, jerky movements Neocerebellum/cerebro = coordination of fine skilled movements = intention tremor, dysdiadochokinesia, dysmetria
Describe the 3 stages of complex regional pain syndrome
1 (0-3 months) - puffy, swelling, redness, warmth, stiffness, allodynia, positive bone scan
2 (3-6 months) - inc pain and stiffness, firm edema, cyanosis, atrophy, osteopenia
3 (6 months+) - tight, smooth, glossy, cool, pale skin - stiffness and contractures, nail and hair changes, severe osteopenia
What are 6 risk factors for CP?
- Prenatal (maternal infection, malnutrition, maternal seizures)
- Perinatal (prematurity, obstetric complications)
- Low birth weight
- Low APGAR
- Multiple births
- Post natal infection, environmental toxins, anoxia, brain tumour, CVA
Describe the 4 types of CP and their subtypes
Spastic:
Diplegia - affects legs more than arms (most walk independently or with gait aid and milestones delayed)
Hemiplegia - arm and leg of same side; leading cause is perinatal stroke; most walk independently
Quadriplegia - all 4 limbs; global damage; majority non ambulatory
Dyskinetic:
Athetosis - slow, continuous, involuntary writhing movement that prevents stable posture
Ataxia - intention tremor and poor coordination
Mixed:
- typically entire body affected and has spastic and dyskinetic characteristics
What are the 4 types of spina bifida?
Occulta - no cord involvement - may have hair tuft
Cyctica - visible or open lesion
Meningocele - cyst includes CSF; cord intact
Myelomeningocele - cyst includes CSF and herniated cord
Erb’s Palsy
C5/6 injury - arm usually at side, medially rotated, can’t bring arm away (no biceps, brachialis, delt)
Klumpke’s Palsy
C7, C8, T1 injury - affects intrinsic hand muscles - have claw hand (flexed fingers)
Median Nerve Palsy
C6-8, T1 - thenar muscles affected - ape hand (can’t bring thumb away from hand)
What causes vascular cognitive dementia?
Secondary to poor blood flow = multiple small lesions (usually high BP, atherosclerosis)
Describe the difference between spastic and flaccid bladder.
Spastic - injuries above conus - reflex arc still intact
- bladder can be trained to empty on its own (can manage with IC or Foley)
Flaccid - below T12 - messages don’t travel between cord and bladder because reflex arc not intact - loses ability to fill and must be catheterized
Describe the difference between spastic and flaccid bowel.
Spastic - peristalsis and reflex propulsion still in tact - reflex contraction can lead to stool retention - need suppository or digital stim
Flaccid - peristalsis and reflex propulsion not intact - slow propulsion, risk of incontinence - need to balance consistency of stool usually go more solid
