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Neuro pathology Flashcards

1
Q

What structures make up the basal ganglia?

A

Striatum (Caudate and Putamen)
Globus Pallidus
Subthalamic nucleus
Substantia nigra

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2
Q

Explain what dopamine pathways do and the 3 main ones

A

They are neuronal connections in which dopamine (a neurotransmitter) travels to areas of the brain and body to convey important information
1. Mesolimbic Dopamine Pathways
This pathway is highly involved in dopamine’s most commonly thought of function: pleasure and reward.
2. Mesocortical Dopamine Pathways
This pathway is highly involved in cognition, working memory, and decision making
3. Nigrostriatal Dopamine Pathways
This pathway is involved in motor planning and movement control

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3
Q

Describe the circuitry of the basal ganglia

A

Receives info from several sources, including the cerebral cortex. The input info enters via the straitum and leaves via the Globus Pallidus and feeds the info to the cortex via the thalamus.
Provides a feedback circuit.

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4
Q

Briefly describe what causes Parkinsons Disease.

A

There is a programeddestructionof>70%of neurons resultingin depletion of the neurotransmitter dopamine in the substantianigra in the basal ganglia

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5
Q

What are the 3 stages of PD?

A
  1. Preclinical
    neurodegeneration presentbut asymptomatic (no symptoms)
  2. Prodromal Parkin’s disease
    motor and non-motorsymptoms arepresent with clinical diagnosis
  3. Clinical Parkinson’s Disease
    bradykinesia begins (slowness of movement)
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6
Q

What are some clinical features of PD and what causes them to occur?

A

Large numbers of dopamine-producing neurons are damaged, so communication across neurons in this circuit is disrupted and the motor symptoms of PD appear

  1. Bradykinesia (slowness of movement)
  2. Rigidity (stiffness)
  3. Tremor
  4. Postural instability (flexed posture)
  5. Gait (short step length)
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7
Q

Name some non-motor features of PD

A
  • Neuropsychiatric symptoms: Depression, Anxiety
  • SleepDisorders:restless legs,insomnia
  • AutonomicSymptoms: bladder andbowel,excessive sweating
  • Gastrointestinal:dibbling,constipation
  • Fatigue, weight loss
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8
Q

What can physios offer to those with PD?

A 
Muscle weakness
Stiffness
Falls and Fractures
Balance
Functional practice
Pain
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9
Q

What is included in a subjective assessment of PD?

A
  1. Expectations, priorities
  2. HPC
    - previous treatments,(freezing, stiffness, slowness, falls/ gait,tremor) body function/structures, activities, participation. Non-motorquestions.
  3. SH
    - support, carers, environment
  4. PMH
    - diabetes, cardiac, depression,surgery
  5. DH
    - PD medication& timings
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10
Q

What is included in an objective assessment of PD?

A
  1. Observation during functional activities
    - tremor, bradykinesia, balance, vision, speech, hearing
  2. Range of movement and activity/power
    - trunk, LL and UL.
  3. Coordination
    - finger tonose
  4. Balance
    - sitting balance, standing balance, move outside BoS
  5. Gait
    - freezing,dual tasking,outdoor/ uneven
  6. Functional
    - on/off floor,rolling, ly-sit,running, cycling,
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11
Q

Explain what MS is and who it is most common in

A

Multiple Sclerosis is a progressive long-term neurologicaldisorder of theCNS
Higher levels of incidencein North America and Europe.

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12
Q

Explain the pathology of MS

A
  • An autoimmune response, attacking myelin resulting ineither areduction or complete loss ofnerve conduction
  • Lymphocytescross the blood-brain barrierand targetmyelin leading to inflammatory response
  • Resulting inplaques throughout the CNS
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13
Q

Describe the classification of MS

A

RelapseRemitting: around 90% of patients initially have relapsing-remitting disease, most of them ultimately developing secondary progression.
Around 10% of patients have primary progressive multiple sclerosis, for which there is currently no disease-modifying treatment.

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14
Q

How can MS be diagnosed?

A

The patient will present with neurological symptoms and signs
MRI is central now to the diagnosis
Cerebrospinalfluid via a lumbar puncture can be reviewed for the presence of inflammation.

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15
Q

Name some symptoms of MS

A 
Numbness and tingling (63.5%)
Fatigue (40.1%)
Walking difficulty (48.9%)
Depression (14.7%)
Weakness (25.3%)
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16
Q

How can physios help those with MS?

A 
Falls and Fractures
Balance
Functional practice
Fatigue
Weakness
17
Q

What is included in a subjective assessment for someone with MS?

A
  1. Expectations, priorities
  2. HPC
    - RRMS, PPMS, SPMS. Previous treatments,(pain, stiffness, weakness, bladder/bowel,cognition, swallow) body function/structures, activities, participation.
  3. SH
    - support, carers, environment, employment
  4. PMH
    - previous relapses, THREADS
  5. DH
    - DMT medication& timings
18
Q

What is included in an objective assessment for someone with MS?

A
  1. Observation during functional activities
    - tremor, stiffness, cognition, balance, vision, speech
  2. Range of movement and activity/power
    - AROM and PROM
  3. Coordination
    - finger to nose
  4. Sensation and proprioception
    - light touch
  5. Balance
    - sitting balance, standing balance, outside of BoS
  6. Gait
    - stride, technique
  7. Functional- on/off floor,rolling, ly-sit
19
Q

What are some different types of treatment that can be offered to those with MS?

A
  • Stretching program
  • Strengthening
  • Aerobictraining - 30 minutes mod- intensity aerobic exercise2 days a week
  • Upper Limb-gaming, dexterity,task specific practice
  • Painmanagement
  • Balance re-education, fallsstrategies
20
Q

Briefly describe what causes a stroke

A

The damaging or killing of brain cells starved of oxygen as a result of the blood supply to part of the brain being cut off.

21
Q

What is another name for a stroke?

A

Cerebrovascular Accident - CVA

22
Q

Name and describe the 2 types of stroke

A

Ischaemic (due to a clot / blockage), accounts for 80% of CVAs
Haemorrhagic (bleeding within the brain), accounts for 20% of CVAs.

23
Q

GIve some stroke risk factors

A 
Age
Hypertension
Raised Cholesterol
Smoking / Alcohol
Diabetes
24
Q

Name and describe the classifications of Ischemic strokes

A
  1. Total Anterior Circulation Infarct
    All three of the following need to be present for a diagnosis of TACS:
    - unilateral weakness of the face, arm and leg
    - homonymous hemianopia (only sees one side)
    - higher cerebral dysfunction (dysphasia)
  2. Partial anterior circulation stroke (PACS)
    A less severe form of TACS.
    Two of the following need to be present for a diagnosis of PACS:
    - unilateral weakness of the face, arm and leg
    - homonymous hemianopia (only sees one side)
    - higher cerebral dysfunction (dysphasia)
3. Posterior circulation syndrome (POCS)
One of the following need to be present for a diagnosis of POCS:
 - cranial nerve palsy 
 - bilateral motor/sensory deficit
 - conjugate eye movement disorder
 - cerebellar dysfunction
  1. Lacunar syndrome (LACS)
    There is no loss of higher cerebral functions (e.g. dysphasia).
    One of the following needs to be present for a diagnosis of LACS:
    - pure sensory stroke
    - pure motor stroke
    - senori-motor stroke
    - ataxic hemiparesis (weakness and ataxia on the same side)
25
Q

What is dysphasia?

A

language disorder marked by deficiency in the generation of speech

26
Q

What is ataxia?

A 
Ataxia is a term for a group of disorders that affect co-ordination, balance and speech.
Often have difficulties with:
 - balance and walking
 - speaking
 - swallowing
 - tasks that require a high degree of control, such as 
 - writing and eating
 - vision
27
Q

What are some medical management techniques for stroke patients?

A

Thrombolysis – clot-busting drug ideally within 6 hr of CVA
Thrombectomy – mechanical removal of the clot
Neurosurgery option if a haemorrhagic stroke

28
Q

What is the patient pathway for a stroke patient?

A
  1. Acute Stroke Unit
  2. Rehab Unit
  3. Community
29
Q

How can physios help stroke patients?

A

Safe seating
Transferring
Mobilising & Balance
Upper limb re-education

30
Q

What is included in a subjective assessment of a stroke patient?

A
  1. Expectations, priorities
  2. HPC
    - infarct/bleed, investigations, Current issues: pain, weakness, ataxia,visual, bladder/bowel,cognition, body function/structures, activities, participation
  3. SH
    - support, carers, environment, employment
  4. PMH
    - cardiovascular risk factors, THREADS
  5. DH
    - anticoagulants
31
Q

What is included in an objective assessment of a stroke patient?

A
  1. Observation during functional activities
    - tone, spasm, vision, cognition, hearing
  2. Range of movement and activity/power
    - AROM and PROM
  3. Coordination
    - finger tonose, fast repeating movements
  4. Sensation
    - light touch, 2 point, temperature, proprioception
  5. Balance
    - sitting balance, standing balance, outside of BoS
  6. Gait
    - outdoor/ uneven, stairs
  7. Functional
    - on/off floor,rolling, ly-sit,running, cycling

1 PY1004 (19 decks)

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