Neuro Pathologies Flashcards
What does the Medial Cerebral Artery Supply?
- Most Outer Surface
- Sensorimotor Cortex
- Basal Ganglia
- Internal Capsule
- Brocas Area ( on left)
What does the Anterior Cerebral Artery Supply?
- Frontal Lobe
- Medial part of sensorimotor cortex
What does the Posterior Cerebral Artery supply?
- Occipital lobe
- Temporal Lobe
- Thalamus - Sensory lobe
What does the Basillar Artery supply?
- All of the Brain stem
- Cerebellum
- Nuclei of Cranial Nerve , facial nerve and Vagus nerve.
Give the 4 Types of Hemorrhagic Stroke
- Intracerebral
- Subarachnoid
- Subdural
- Extradural
What is Haemorrhage?
Bleeding due to rupture of congenital aneurysm. AVM or Trauma. Leading to sudden intense vomiting ( Vestibular Disturbance), stiff neck and loss of consciousness.
Give the background pathology of a Intracerebral Haemorrhage
- Deep bleed
-Associated with Hypertension
-Arterial wall weaken = Micro aneurysm , leading to rupture and bleed
= Severe headache and Vomiting.
Give the background pathology of a Subdural Haemorrhage
-Subdural space
-Trauma
Headache,Drowsiness,Stupor
(Unconsciousness ), Hemiparesis, Coma
Give the background pathology of a Subarachnoid Haemorrhage
A subarachnoid hemorrhage is bleeding from a damaged artery at the surface of the brain. This bleeding often causes a sudden, severe headache
Give the background pathology of a Extradural Haemorrhage
- Trauma
- Tearing of Meningeal Artery
How are strokes treated?
- Medical emergency
- MRI/CT
- SAH , surgery
- SDH,EDH,IDH = Treat Hypertension
- Osmotic agents
- Other tests,Blood tests , echo-cardiology.
What is Hemiplegia?
- Paralysis of 1 side
- Right CVA - Left hemiplegia
- Left CVA- right hemiplegia
Give the Motor Pathway
- Motor Cortex
- Cortico-spinal tract
- 80% fibres cross
- Synapses w/alpha motor neurone
- Peripheral motor nerve
Give the Motor Symptoms associated with a Stroke
- Low tone
- High tone
- Weakness
- Hemiplegia/Asymmetry
- Decrease in normal movement patterns
- Decrease balance
- Ataxia - Uncoordinated movement - Compensatory movements used to counterbalance
State the incidence rate of Hypo and Hypertonicity
- 5% in the first 10 ten days
- 8/10 experience weakness
Give the Sensory Pathway
- Sensory receptors
- Sensory peripheral nerves
- Dorsal tracts
- Thalamus
- Sensory cortex - front of the parietal lobe
Give the Sensory symptoms associated with a Stroke
- Impaired cutaneous sensation
- Stereognosis - objects and depth perception
- Proprioceptive impairment
- Homonygous hemianopia
- Visual field loss
What is Expressive Dysphasia ?
- Decreased ability to produce speech
- Brocas area
What is Receptive Dysphasia?
- Decreased ability to understand speech
- Wernikes area in the temporal lobe
Give the Cognitive Symptoms associated with Stroke
- Agnosia - inability to recognise objects
- Astereognosis - Inability to recognise objected using active hand touch without sensory input
- Visual and Auditory Agnosia - can bring up safety issues
- Depth perception
- Apraxia - Out of order
- Anosagnosia- Not recognising that they have had a stroke
- Inattention and neglect
Why is it important to identify neglect in a stroke patient/
- Can be Cog , Sensory or Visual
- Poor Prognosis
- Left hemiplegia
- Fails to attend stimuli from functional problems
- Left side = Self care , eating , dressing , walking
Give Other related problems with Stroke
- Disorder of emotion
- Dysphasia - x swallow
- Incontinence
- Secondary musculoskeletal problem
- Balance/gait problems
- Functional difficulties
- Social problems
Factors affecting Stroke recovery
- Extend and nature of lesion
- Integrity of collateral circulation
- Pre-morbidity
- Age
- Capacity of nervous system to reorganise
- Environment
- Motivation and attitude
- Patient participation
- Patient experience
- Co-existing conditions
- Nutrition/Hydration
What is a Stroke?
- Also know as a CVA
- Rapid loss of brain function due to disturbance in the blood supply to the brain
- Can be due to ischemia (lack of blood flow)caused by a blockage or Haemorrhage
What is a Transient Ischaemic attack ( TIA)
- Part of the brain not receiving enough blood
- Risk of more serious stroke in the future
- Symptoms lasting less then 2 hours , any more = Stroke
What is Neuroplasticity?
- Primary recovery following stroke
- Adaptive capacity of the CNS
- Discovering new pathways
- Phantom limb
- Learning of new skills
- Unmasking of dormant pathways to increase synaptic strength
What is the formations of New Synapses called
- Collateral Sprouting from intact nerve cells- Derivation
Risk Factors of Stroke
- Stroke
- Hight Cholesterol
- Age
- Hypertension
- AF
- Diabetes
- Hight salt diet
- Contraceptive
What is Parkinson’s disease?
- Degeneration of dopamine producing neurones in the Substantia basal ganglia
Give the Epidemiology of Parkinson’s disease
- increase likelihood with age
- men more than women
- 15% genetic
- influences by environmental factors
What does the Basal Ganglia do?
- Movement memory
- Initiation and Planning
- Regulation of muscle tone
- Inhibit antagonistic/unnecessary movements
Explain the effect of Dopamine on Direct and indirect pathways
Direct = promotes movement
Indirect =Inhibits movement
Dopamine excites the direct pathway and inhibits the indirect pathway.
- in Parkinson’s a lack of dopamine = lack of movement.
Give the Primary Clinical features of Parkinson’s Disease
Bradykinesia/Akinesia
Resting Tremor - Pill rolling tremor
Rigidity- Stiff inflexible , resistance to passive movement, lead pipe or cog wheel
Give 5 secondary features of Parkinson’s Disease
- loss of facial expressions
- Monotone speech
- Problems w/swallowing
- depression
- Sleep disorders
What is Postural Instability in relation to Parkinson’s disease
- Develops later
- Flexed posture
- Flexed hips and knees
- Unable to access balance reactions
What medications are used in the management of Parkinson’s Disease
Dopamine replacements - Sinemet -Madopar -Levadopar Dopamine copycats - Apomorphine -Dopamine Protectors -Anticholinergics
What surgeries are used in the treatment of Parkinson’s
- Pallidotomy
- Thalamotomy
- Stem cell research.
What outcome measure is used in Parkinson’s Disease
Hoehn and Yahr Scale
Measures from 0 - 5 ( including stages 1.5 and 2.5)
Give the background Epidemiology of Multiple Sclerosis
- Chronic demyelinating disease
- 20-40s
- 3 x as likely in females
- no cure , medicines can help
- more common in temperate climate, socioeconomic and caucasian
Give the background pathology of Multiple Sclerosis
- disruption of blood brain barrier
- leakage of inflammatory cells
- Destruction of Myelin sheath and Oligodendrocytes
- Destruction of nerve signals , rate of conduction of nerves decreases
- Plaques can then form through out CNS- no conduction
Signs and Symptoms of MS
- Visual problems
- Weakness
- Spasticity
- Ataxia
- Sensory loss
- poor balance
- Dizziness
- Sexual Dysfunction
- Fatigue
- Limbic system
Give the four stages of MS
1 - Benign MS
2-Relapsing Remitting MS
3-Secondary Chronic MS
4-Primary Progressive
Give the features of a MS relapse
- Lasts 24hrs
- Objective findings
- 30 days after prior
- Multiple Paroxysmal episode
What methods are used in the Diagnosis of MS?
- Lumbar puncture
- MRI - plaque formation
- nerve conduction
Give the initial symptoms of MS
- Limb weakness - 40%
- Optic neuritis
- Parasthaesia
- Diplopia
- Vertigo
- Micturition problems
Give same of the medications used to treat MS
- IV methyl prednisolone
- Ranitidine
- Plasmapheresis
Give the overly prognosis for MS
- Highly variable
- 50% walking unaided 15 years after diagnosis
- 30% decreased quality of life
- Suicide 7.5 time national average
- Wide variation in impact on lifespan - risk of infection
What is the Spinothalamic tract?
Ascending
- Pain and Temperature
What is the dorsal columns? Cuneatus and Gracillis.
Ascending
- Touch , position sense , Vibration
- Cross in the medulla
What is the Spinocerebellar tract?
Ascending
- Proprioceptive information
- Most uncrossed
What is the Corticospinal Tract?
- lateral , motor info for limbs
- Anterior , motor info for axial muscles
What is the Vestibulospinal tract?
Integration of head and neck and trunk extremities
- Uncrossed
What is the Reticulospinal tract
- Lateral - facilities flexion and inhibits extension
- Medial - opposite
What is the Rubrospinal tract?
Control of fine movements
What is Tectospinal tract?
Controls muscles in response to visual stimuli
What results in a non-traumatic SCI
- Degenerative disc problems
- infarct/bleed
- Tumour
- injection/inflammation
- developmental/congenital problems
What are the vulnerable areas of the spine?
- Cervical spine - C5-7 -55%
- Thoracolumbar - T12
- Mid thoracic T4-7
What are the 3 different mechanisms of a SCI
- Destruction from direct trauma
- compression by bone fragmentation, hematoma or disc material.
- Ischemia from damage or impingement on the spinal cord arteries
What is Tetraplegia?
- all 4 limbs - cervical
What is paraplegia?
- Trunk , legs , pelvis
- Thoracic/lumbar/sacral segments
What is an complete spinal cord injury
- Complete loss of function below point of injury
- outcome more predictable
What is an incomplete spinal cord injury?
- Some neural activity with a less predictable outcome
- now more common 55 - 65%
What will total complete lesion lead to?
- damage to descending - UMU
- Damage to anterior motor neurone and LMU
- Spinal shock
- Flaccidity
- Spasticity and spasms
What will total transection lead to?
- Impairment of deep and superficial sensation.
- Autonomic dysfunction
- Vasomotor control
- postural hypotension
- Autonomic Dysreflexia - sudden onset of high blood pressure
- Problems with bladder and bowel function
- Problems with sexual function
What is Central Cord Syndrome?
- Whip lash
- Motor dysfunction in upper limb
- Bladder dysfunction
- Corticospinal and Spinothalamic tacts
What is Anterior Cord Syndrome?
- Disc herniation
- Motor paralysis
- decreased pain and temp
- Retained proprioception and vibration
What is Brown-Sequard Syndrome ?
- Stab or Gun-shot wound
- Motor deficit and Numbness
- Loss of pain and temp sensation on opposite side.
What is ABI?
- Anoxic brain injury
- Acquired
- Trauma and non - traumatic , stroke, infections , tumours and seizures.
What is a TBI?
Traumatic Brain injury
- Accidents , suicide , assault, shaken , strike to the head
- Countercoup - affect side of the brain opposite to impact
What is an open-wound injury in relation to TBI
- Life threatening
- Skull penetrating
- Linear, diastatic , depressed , Basilar Skull fracture
What is a Closed head injury?
- Majority of head injuries
- Demyelination
- Diffuse axonal injury
- Concussion
- Intracranial haematoma
- Cerebral contusion
What is the Crushing Injury?
- Compression
- Rare but most damaging
