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NPTE Study Practice > Neuro Pathology Pt. 1 > Flashcards

Neuro Pathology Pt. 1 Flashcards

Stroke, Cerebellum lesions, MS, & Parkinson's Disease (PD)

1
Q

Define a stroke

A
  • Occurs when the blood supply to the brain is interrupted or reduced
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2
Q

Define an ischemic stroke

A
  • Makes up 80% of cases
  • Cerebral thrombosis: formation or development of a blood clot or thrombus within the cerebral arteries or their branches
  • Cerebral embolism: traveling bits of matter that produce occlusion & infarction in the cerebral arteries
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3
Q

Define a hemorrhagic stroke

A
  • Abnormal bleeding as a result of rupture of a blood vessel
  • Occurs in about 20% of cases
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4
Q

Define a TIA (transient ischemic attack)

A
  • A temporary period of symptoms resulting from decrease blood supply to the brain
  • Precursor to major stroke; lasts <24hrs
  • No permanent damage
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5
Q

Risk factors for a stroke

A
  • Atherosclerosis
  • HTN
  • Cardiac disease
  • DM, metabolic syndrome
  • TIAs
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6
Q

What are the 4 after effects/pathophysiology of a stroke

A
  • Cerebral anoxia: lack of O2 supply to the brain (irreversible damage begins after 4-6 min)
  • Cerebral infarction: irreversible cellular damage
  • Cerebral edema: accumulation of fluids within brain causes further dysfunction, elevates ICP, can result in herniation & death
  • Secondary cell death: death of neurons around the specific area of damage
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7
Q

Characteristics of a MCA stroke

A
  • UEs affected more than LEs
  • Contralateral hemiplegia of face
  • Contralateral hemisensory loss
  • Homonymous hemianopsia
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8
Q

Characteristics of a ICA (internal carotid artery) syndrome stroke

A
  • ICA comes off the common carotid artery and gives off an ophthalmic branch and terminates in the ACA (anterior cerebral artery)
  • Has signs and symptoms similar to MCA involvement with reduced levels of consciousness
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9
Q

Characteristics of an ACA stroke

A
  • LEs affected more than UEs
  • Contralateral hemiplegia
  • Contralateral hemisensory loss
  • Urinary incontinence
  • Problems with bimanual tasks
  • Apraxia (inability to perform particular purposeful actions)
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10
Q

Characteristics of a PCA stroke

A
  • Contralateral sensory loss
  • Involuntary movements: choreoathetosis, tremor, hemiballismus
  • Transient contralateral hemiparesis
  • Homonymous hemianopsia
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11
Q

Characteristics of an internal capsule lesion posterior limb stroke

A
  • Lacunar (pure motor) stroke
  • Contralateral hemiplegia UE and LE
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12
Q

Describe the different types of vertebrobasilar artery syndrome

A
  • Medial medullary syndrome: occlusion of the vertebral anterior branch of the lower basilar artery
  • Lateral medullary (Wallenberg’s) syndrome: occlusion of vertebral, posterior inferior cerebellar, or basilar artery
  • Basilar artery syndrome: occlusion at the level of the pons; locked-in syndrome
  • Medial inferior pontine syndrome: occlusion of the paramedic branch of basilar artery
  • Lateral inferior pontine syndrome: occlusion of the anterior inferior cerebellar artery (AICA)
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13
Q

Characteristics of a midbrain stroke

A
  • Contralateral hemiplegia
  • Possible contralateral CN III palsy
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14
Q

Characteristics of a medial pontine syndrome stroke

A
  • Ipsilateral: nystagmus, cerebellar ataxia, paralysis of conjugate gaze to side of lesion, diplopia
  • Contralateral: hemiparesis UE/LE, impaired sensation
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15
Q

Characteristics of a lateral pontine syndrome (AICA) stroke

A
  • Ipsilateral: ataxia, nystagmus, vertigo, facial paralysis, paralysis of conjugate gaze to the side of the lesion, deafness, tinnitus, impaired facial sensation
  • Contralateral: impaired pain & temperature sensation half of body
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16
Q

Characteristics of a medial medullary syndrome stroke

A
  • Ipsilateral: paralysis of half of tongue
  • Contralateral: hemiplegia UE/LE, impaired sensation
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17
Q

Characteristics of a lateral medullary (Wallenberg’s) syndrome stroke

A
  • Ipsilateral: ataxia, nystagmus, vertigo, loss of pain & temperature to face, sensory loss UE/trunk/LE
  • Contralateral: loss of pain & temperature to body & face
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18
Q

What parts of the brain are involved in a pure sensory lacunar stroke

A
  • Involvement of the ventrolateral thalamus or thalamocortical projections
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19
Q

What parts of the brain are involved in a dysrthria/clumsy hand syndrome stroke

A
  • Involving the base of the pons, genu of anterior limb, or the internal capsule
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20
Q

What parts of the brain are involved in a ataxic hemiparesis stroke

A
  • Involving the pons, genu of internal capsule, corona radiata, or cerebellum
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21
Q

What are the 6 sequential recovery stages of a stroke

A
  • Stage 1: initial flaccidity, no voluntary movement
  • Stage 2: emergence of spasticity, hyperreflexia, synergies (mass patterns of movement)
  • Stage 3: voluntary movement possible, but only in synergies; spasticity strong
  • Stage 4: voluntary control in isolated joint movements emerging, corresponding decline of spasticity & synergies
  • Stage 5: increasing voluntary control out of synergy; coordination deficits present
  • Stage 6: control & coordination near normal
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22
Q

Behaviors of a left hemisphere lesion (right hemiplegia)

A
  • Slow
  • Cautious
  • Hesitant
  • Insecure
  • Often aware of their impairments resulting in frustration
  • Aphasia
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23
Q

Behaviors of a right hemisphere lesion (left hemiplegia)

A
  • Impulsive
  • Quick
  • Indifferent
  • Often exhibit poor judgement & safety, overestimating their abilities while understanding their problems
  • Perceptual deficits
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24
Q

Describe the components of an UE flexion synergy

A
  • Scapular retraction/elevation
  • Shoulder abduction, ER
  • Elbow flexion
  • Forearm supination
  • Wrist and finger flexion
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25
Describe the components of an UE extension synergy
- Scapular protraction - Shoulder adduction, IR - Elbow extension - Forearm pronation - Wrist and finger flexion
26
Describe the components of an LE flexion synergy
- Hip flexion, abduction, ER - Knee flexion - Ankle DF/inversion
27
Describe the components of an LE extension synergy
- Hip extension, adduction, IR - Knee extension - Ankle PF/inversion
28
What are some typical gait deficits in stroke patients
- Retracted/flexed hip - Trendelennburg limp - Scissoring - Insufficient pelvic rotation during swing - Circumduction - Knee hyperextension - Footdrop - Unequal step lengths - Decreased cadence, uneven timing
29
Key red flags/PT implications for stroke patients
- Avoid traction or overhead activity when pts have flaccid shoulder muscles with risk of subluxation/dislocation - Emphasize compensation strategies for pts with sensory & perceptual losses to prevent additional injury & functional losses - Monitor HR and BP closely during exercise or activity training; monitor for signs?symptoms of cardiovascular compromise
30
Common outcome measures used/specific for stroke patients
- Fugl-Meyer assessment of motor performance - Functional independence measure (FIM): motor & cognitive tasks - Postural assessment scale for stroke patients - Trunk impairment scale - Stroke impact scale: self report
31
Interventions for stroke patients
- Promote active problem solving independence - Focus one goal directed tasks - Compensatory strategies - Improve cardiopulmonary endurance & aerobic conditioning - BWS (body weight support) and motorized treadmill training - Constraint induced movement therapy (CIMT) - AFO - FES (functional electrical stimulation)
32
Common drugs and their purpose used for strokes
- t-PA: indicated for acute ischemic stroke; monitor BP - Baclofen, Tizanidine, Dantrolene sodium (anti-spasticity): indicated to relax skeletal muscle/anti-spasticity; fall risk, monitor functional ability & limitations - Diazepam: indicated for anti-spasticity, seizure prevention; fall risk, reduced psychomotor ability - Botulinum (botox): indicated for local relief of muscle tone & spasms; rare systemic effects including generalized weakness, flaccidity, difficulty speaking, dysphagia, and/or respiratory distress
33
How to promote learning in left hemisphere lesions (right hemiplegia)
- Develop an appropriate communication base: words, gestures, pantomime; assess level of understanding - Give frequent feedback & support - Do not underestimate ability to learn
34
How to promote learning in right hemisphere lesson (left hemiplegia)
- Use verbal cues; demonstrations or gestures may confuse pts with visuospatial deficits - Give frequent feedback: focus on slowing down & controlling movement - Focus on safety - Avoid environmental clutter - Do not overestimate ability to learn
35
What are the 4 types of primary brain injury for a TBI
- Diffuse axonal injury: disruption/tearing of axons & small blood vessels - Focal injury: contusions, lacerations, mass effect from hemorrhage, & edema - Coup-contracoup: injury at point of impact & opposite point of impact - Closed or open injury: with fracture of the skull
36
What are the secondary brain damage to TBI
- Hypoxic-ischemic injury: results from systemic problems that compromise cerebral circulation - Swelling/edema: can cause mass effect with increased ICP, brain herniation, & death - Electrolyte imbalance and mass release of damaging neurotransmitters
37
Define a concussion
- Loss of consciousness either temporary or permanent resulting from injury or blow to head with impaired functioning of the brainstem reticular activating system (RAS) - May see changes in HR, BP, & RR
38
What re the CPG recommendations for AFO/FES use post-stroke
- Chronic FES: increase tibialis anterior activation, improve dynamic balance, improve walking endurance, improve mobility, improve gait speed - Acute FES: improve mobility - Chronic AFO: improve gait speed, mobility, walking endurance, dynamic balance, QoL for footdrop - Acute AFO: improve gait speed
39
What are the recovery stages from diffuse axonal injury
- Coma: unable to arouse - Unresponsive wakefulness syndrome/vegetative state: return of sleep/wake cycles - Mute responsiveness/minimally responsive: pt shows signs of fluctuating awareness - Confusional state: all cognitive operations are affected; pt is unable to form new memories - Emerging independence: some memory possible, frequently uninhibited social behaviors - Intellectual/social competence: increasing independence although cognitive difficulties persist along with behavior/social problems
40
Describe a signs/symptoms of a mild TBI
- LOC ≤30 min - Alteration of consciousness is brief; >24hrs - Posttraumatic amnesia <1 day - Glasgow Coma Scale 13-15 - Imaging is normal
41
Describe a signs/symptoms of a moderate TBI
- LOC >30 min but <24hrs - Alteration of consciousness >24hrs - Posttraumatic amnesia 1-7 days - Glasgow coma scale 9-12 - Imaging can be normal or abnormal
42
Describe a signs/symptoms of a severe TBI
- LOC >24hrs - Alteration of consciousness >24hrs - Posttraumatic amnesia >7 days - Glasgow coma scale <9 - Imaging can be normal or abnormal
43
Outcome measures recommended for TBI
- Functional Independence Measure (FIM) - Rancho's Levels of Cognitive Functioning (LOCF) - Coma Recovery Scale - Agitated Behavior Scale - Mass Attention Rating Scale - Modified Ashworth Scale - Action Research Arm Test (ARAT) - High Level Mobility Assessment (Hi-mat) - Community Balance & Mobility Scale - Dizziness Handicap Inventory (DHI) - Community Integration Questionnaire
44
What are the levels of the Rancho's Levels of Cognitive Function (LOCF)
- I: no response - II: Generalized response - III: Localized response - IV: confused, agitated response - V: confused, inappropriate, non agitated response - VI: confused, appropriate response - VII: automatic, appropriate response - VIII: purposeful, appropriate response
45
Define sympathetic storming and what to examine for
- The result of hypothalamic stimulation of the SNS with an increase in circulating corticoids & catecholamines (stress response) - Examine for alterations in LOC, increased posturing, dystonia, HTN, hyperthermia, tachycardia, tachypnea, diaphoresis, & agitation
46
Common drugs used for TBI/SCI management
- Baclofen, Tizanidine, Dantrolene sodium: relax skeletal muscle, anti-spasticity - Diazepam: anti-spasticity, seizure prevention - Botulinum toxin (Botox): local relief of muscle tone & spasms - Carbamazepine, Gabapentin, Pregabalin: seizure prevention, spasticity (gabapentin); fall risk, monitor seizure Hx, functional ability, & limitations
47
Concussion signs observed
- Appears dazed or stunned - Can't recall events prior to or after a hit/fall - Forgets an instruction, appears confused - Moves clumsily - Answers questions slowly - Loses consciousness - Shows mood, behavior, or personality changes
48
Concussion symptoms reported
- HA or pressure in head - Nausea or vomiting - Balance problems, dizziness, blurry vision - Bothered by light or noise - Feeling sluggish, hazy, foggy, or groggy - Confusion, concentration or memory problems - Just not "feeling right" or "feeling down"
49
Seek immediate emergency care if the adult or child experiences any of the following after a blow/hit to the head (possible TBI)
- Drowsiness or inability to wake up - One pupil larger than the other - Repeat vomiting or nausea, convulsions, or seizures - LOC lasting longer than 30 secs - HA that gets worse over time - Slurred speech, numbness, or decreased coordination - Changes in behavior: irritability, restlessness, agitation - Confusion, disorientation, or amnesia
50
Describe second impact syndrome
- A 2nd concussion is experienced before the brain has a chance to heal from the first event
51
Describe post concussion syndrome
- Persistent post concussion symptoms lasting ≥3 months - Symptoms may include post-traumatic seizures, increased risk of depression, and mild-cognitive impairment later in life
52
Define chronic traumatic encephalopathy (CTE)
- A progressive neurodegenerative brain disease resulting form repetitive head trauma - Seen in athletes & boxers with a Hx of multiple concussions & repeated head injury
53
Level A evidence for examination and treatment of concussion/mild TBI
- Assess Dix-Hallpike test or other appropriate positional test(s) - Use carnality repositioning intervention for vestibulo-oculomotor impairments - Provide symptom guided, progressive, aerobic exercise training program
54
Typical signs and symptoms of chronic traumatic encephalopathy (CTE)
- Recurrent HA and dizziness - Cognitive impairments: memory loss, difficulty thinking, planning, & carrying out tasks eventually progressing to dementia - Mood or behavioral disturbances - Impaired judgement & impulse control, aggression, irritability, anger - Movement disorders (late)
55
Signs and symptoms of epilepsy
-Altered consciousness - Altered motor activity (convulsion): tonic - stiffening & rigidity or muscles; clonic - rhythmic jerking or extremities - Sensory phenomena - Autonomic phenomena: sudden attack of anxiety, tachycardia, sweating, abnormal sensation rising up in upper abdomen & chest - Cognitive phenomena: sudden failure of comprehension, inability to communicate, hallucinations
56
Describe a grand mal/generalized seizure
- All areas of brain are involved - Dramatic LOC with stiffening then rhythmic movements of arms/legs - Eyes are generally open - Altered breathing - Loos of urine - Typically lasts 2-5 minutes
57
Describe an absence/petit mal seizure
- Posture is maintained - Repetitive blinking or other small movements may be present - Typically brief only lasts a few seconds - Can occur multiple times throughout the day
58
Describe a partial/focal seizure
- Only one part of the brain is involved - Symptoms are focal (specific are of the body)
59
Define status epilepticus
- Prolonged seizure or a series of seizures (lasting >30 minutes) with very little recovery between attacks - May be life threatening - Medical emergency
60
Signs and symptoms of a vestibulocerebellar/flocculonodular lobe (archicerebellum) lesion
- Ocular dysmetria - Poor smooth pursuit - Dysfunctional vestibulo-ocular reflex (VOR) - Impaired eye/hand coordination - Gait/trunk ataxia - Little change in tone or dyssynergia or extremity movements
61
Signs and symptoms of a spinocerebellum/rostral cerebellum/anterior lobe (paleocerebellum) lesion
- Hypotonia with weakness/fatigue - Truncal ataxia: dysequilibrium, static postural tremor, high guard arm position - Ataxic gait: unsteady, increased falls
62
Signs and symptoms of a hemisphere/posterior lobe (neocerebellum) lesion
- Intention tremor - Dysdiadochokinesia: impaired RAM - Dysmetria: overshooting, errors of force, direction, amplitude - Dyssynergia: abnormal timing of movement (errors in onset, stop, and velocity)
63
General signs and symptoms of a cerebellum lesion
- Asthenia: generalized weakness (3-4/5 MMT) - Hypotonia: difficulty with postural control of proximal (axial) muscles - Motor learning impairments: decreased anticipatory control, feedback, & learning delays - Cognition deficits in info procession, attention deficits - Emotional dysregulation: changes in emotional behaviors
64
What kind of motor learning strategy is useful in treatment of patients with a cerebellum lesion
- Low-stimulus environment (closed environment) ideal - Focus on practice & repetition - Distributed practice (endurance may be low)
65
Describe multiple sclerosis (MS)
- Chronic, progressive, demyelinating disease of the CNS affecting mostly young adults (20-50 yrs) - Female affected more than males - Characterized by demyelinating lesions (plaques) with variable symptoms - Exacerbating factors include infections, trauma, pregnancy, and stress
66
Things that cause transient worsening of MS symptoms
- Adverse reactions to heat - Hyperventilation - Dehydration - Fatigue
67
What re the 4 types of MS
- Relapsing remitting: discrete attacks of neurological deficits with either full/partial recovery (85% of cases); lack of disease progression when in remission - Primary progressive: disease progression & a deterioration in function from onset - Secondary progressive: initial relapsing-remitting course followed by a change to a progressive course with a steady decline in function - Progressive relapsing: steady deterioration in disease from onset but with occasional acute attacks; continuation of disease progression when in remission
68
Define clinically isolated syndrome (CIS) for MS
- 1st episode of inflammatory demyelination in the CNS that could become MS if additional activity occurs; can progress to relapse remitting MS
69
What re 2 common causes of death in MS patients
- Urinary tract infection (UTI) - Respiratory infection
70
Classic signs and symptoms of Parkinson's disease (PD)
- Rigidity (leadpipe or cogwheel) - Bradykinesia (hypokinesia/slow movements) - Resting tremor - Impaired postural reflexes
71
What are the 5 stages of PD (Hoehn and Yahr classification)
- I: minimal or absent disability, unilateral symptoms - II: minimal bilateral or midline involvement, no balance involvement - III: impaired balance, some restrictions in activity - IV: all sx present & severe, stands & walks only with assistance - V: confinement to bed or wheelchair
72
Pharmacology for Parkinson's disease
- Levodopa & Carbidopa: help with PD motor sx - COMT inhibitors (Catecholo-Methyl Transferase): prolongs levodopa effects - Dopamine agonists: may slow early disease progression - Anticholinergics: help control tremors, rigidity, & dystonia - Amantadine: enhances dopamine release - Monoamine Oxidase inhibitor (MAO)/Selegiline: increases dopamine; used during early disease to slow progression

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