Neuro Conditions Flashcards by Megan Gooder

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

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What are the 2 categories of stroke and their causes?

Ischemic = thrombosis, embolism
Hemorrhagic = aneurysm, AVM, etc.

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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

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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)

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What are the signs of a basal skull #?

Blood or CSF out the nose, raccoon eyes, battle sign

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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)

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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

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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

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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

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What is zone of partial preservation?

Dermatomes below sensory level and myotomes below motor level that remain partially innervated (in complete injury)

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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

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Posterior cord syndrome

Loss of fine touch, vibration, conscious proprio below lesion

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Central cord syndrome

Generally in hyperextension injuries; upper motor and sensory function more impaired than LE; stiff trunk (invisible disability)

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Brown Sequard

Hemi section of cord = ipsi loss of dorsal column and motor function; C/L loss of pain and temp below lesion

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Cauda Equina

More LMN lesion; bowel and bladder signs, saddle parasthesia, B/L symptoms

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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