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NPTE Study Practice > Neuro Pathology Pt. 2 > Flashcards

Neuro Pathology Pt. 2 Flashcards

Vestibular disorders, SCI

1
Q

Define vertigo

A
  • Sensation that the visual surrounding is spinning or flowing; can be spontaneous or triggered; if severe accompanied by nausea & vomiting
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2
Q

Define unsteadiness

A
  • Occurs when the brain receives inadequate info about the body’s position from the somatosensory, visual, & vestibular systems, may result from peripheral neuropathy, eye disease, or peripheral vestibular disorders
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3
Q

Define presyncope

A
  • Caused by cardiovascular disorders reducing cerebral perfusion
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4
Q

Define lightheadedness

A
  • Nonspecific & hard to diagnose
  • It may result from panic attacks with hyperventilation
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5
Q

Difference between internal and external vertigo

A
  • Internal: sensation of self-motion when no self-motion is occurring or the sensation of distorted self-motion during on otherwise normal head movement
  • External: the false sensation that the visual surround is spinning or flowing
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6
Q

What are some causes of an unilateral peripheral vestibular hypofunction (PVH)

A
  • Trauma
  • Vestibular neuritis/labyrinthitis: acute infection with prolonged attack of sx
  • Meniere’s disease
  • BPPV
  • Tumor: acoustic neuroma (vestibular schwannoma)
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7
Q

Define Meniere’s disease

A
  • Episodic vertigo syndrome associated with low/medium frequency sensorineural hearing loss & fluctuating aural sx (tinnitus/ear fullness) in affected ear
  • Duration of vertigo sx is between 20 min and 12 hrs
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8
Q

What are some causes of bilateral PVH

A
  • Otoxic drugs or certain chemotherapy drugs
  • Bilateral Meniere’s disease
  • Meningitis
  • Tumors
  • Autoimmune diseases
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9
Q

Characteristics of a central nervous system lesion when looking at nystagmus

A
  • Direction changing
  • Pure down-beating
  • Pure torsional with inability to walk even short distances
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10
Q

Describe how to assess for vestibulospinal reflex function

A
  • Examine posture & balance
  • Examine for instability in sitting, standing, during functional activities, and gait
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11
Q

Outcome measures for vestibular patients

A
  • Dizziness Handicap Inventory (DHI)
  • Activities Specific Balance Confidence Scale (ABC)
  • Postural stability/balance tests
  • Functional gait tests
  • Vestibular disorders activities of daily living scale (VADL)
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12
Q

Define habituation training

A
  • Repetition of movements & positions that provoke dizziness & vertigo
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13
Q

Difference between VOR x1 and VOR x2

A
  • VOR x1: head moves horizontally while eyes remain stationary
  • VOR x2: moving target while head is stationary
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14
Q

What are the 3 intervention types for BPPV

A
  • Canalith repositioning maneuver: for debris that is free-floating in the semicircular canal
  • Liberatory maneuver: for debris that is adherent to the cupula (cupulolithiasis)
  • Brandt-Daroff exercises: for residual or mild vertigo
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15
Q

Spinala read of greatest frequency of injury

A
  • C5
  • C7
  • T12
  • L1
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16
Q

Define a tetraplegia (quadriplegia)

A
  • Injury occurs between C1 and C8
  • Involves all four extremities & trunk
17
Q

Define a paraplegia

A
  • Injury occurs between T1 and T12-L1
  • Involves both lower extremities & trunk (varying levels)
18
Q

Complete versus incomplete SCI

A
  • Complete: no sensory or motor function below level of lesion
  • Incomplete: preservation of sensory or motor function below level of injury; spotty sensation, some muscle function
19
Q

Describe the ASIA SCI impairment scale

A
  • A = Complete, no motor/sensory function preserved in sacral segments S4-S5
  • B = Incomplete, sensory but no motor function preserved below the neurological level & includes the sacral segments S4-S5
  • C = Incomplete, motor function preserved below neurological level; most key muscles below lesion level have a muscle grade less than 3
  • D = Incomplete, motor function is preserved below neurological level & most key muscles below level have a muscle grade of 3 or more
  • E = Normal motor & sensory function
20
Q

Describe central cord syndrome

A
  • Loss of spinothalamic tracts with bilateral loss of pain/temperature
  • Loss of ventral horn with bilateral loss of motor function (primarily upper extremities)
  • Preservation of proprioception & discriminatory sensation
  • Typically caused by hyperextension injuries to the cervical spine
21
Q

Describe Brown-Sequard syndrome

A
  • Ipsilateral loss of DCML with loss of tactile discrimination, pressure, vibration, & proprioception
  • Ipsilateral loss of corticospinal tracts with loss of motor function & spastic paralysis below level of lesion
  • Contralateral loss of spinothalamic tract with loss of pain/temperature below level of lesion (at level of lesion is bilateral loss)
  • Hemisection of spinal cord typically caused by penetration wounds (gunshot/knife) with asymmetrical symptoms
22
Q

Describe Anterior cord syndrome

A
  • Loss of lateral corticospinal tracts with bilateral loss of motor function, spastic paralysis below level of lesion
  • Loss of spinothalamic tracts with bilateral loss of pain/temperature
  • Preservation of DCML: proprioception, kinesthesia, & vibratory sense (light touch)
  • Typically caused by flexion injuries of the cervical spine
23
Q

Describe posterior cord syndrome

A
  • Loss of DCML bilaterally
  • Bilateral loss of proprioception, vibration, pressure, & epicritic sensations (stereognosis, 2-point discrimination)
  • Preservation of motor function, pain, & light touch
  • Extremely rare
24
Q

Describe Cauda Equina syndrome

A
  • Injury below L1 resulting in LMN lesions
  • Flaccid paralysis with no spinal reflex activity
  • Flaccid paralysis of bladder & bowel
  • Potential for nerve regeneration; regeneration often incomplete, slows & stops after about 1 yr
25
Q

Define sacral sparing in SCI

A
  • Sparing of tracts to sacral segments with preservation of perianal sensation, rectal sphincter tone, or active toe flexion
26
Q

Action of diaphragm, respiratory muscles, intercostals; chest expansion, breathing pattern, cough, vital capacity; respiratory insufficiency or failure occurs in lesions above what spinal level

A
  • Above C4
  • Phrenic nerve, C3-C5 innervates diaphragm
27
Q

How to determine the spinal cord level of injury

A
  • Lowest segmental level of innovation includes muscle strength present at a grade 3+/5
28
Q

Define spinal shock

A
  • Transient period of reflex depression & flaccidity
  • May last several hours or up to 24 wks
29
Q

Signs and symptoms of autonomic dysreflexia

A
  • HTN
  • Bradycardia
  • Severe HA
  • Feeling of anxiety
  • Constricted pupils
  • Blurred vision
  • Flushing and piloerection (goosebumps)
  • Increased spasticity
30
Q

What should you do if patient is experiencing autonomic dysreflexia

A
  • Bring to an upright position
  • Loosen any tight clothing or restrictive devices
  • Examine/reduce blockage of urinary drainage
  • Monitor BP and HR
  • Notify medical and/or nursing staff ASAP
31
Q

Signs and symptoms of orthostatic hypotension

A
  • Drop in 20 SBP or drop in 10 DBP or both and an increase in HR of 10 bpm
  • Lightheadedness
  • Syncope
  • Mental or visual blurring
  • Sense of weakness
32
Q

Describe locomotor training for T6-T9 complete SCI

A
  • Supervised ambulation for short distances
  • Requires bilateral KAFOs and crutches
  • Swing to gait pattern; requires assistance
  • May prefer standing devices/standing wheelchairs for physiological standing
33
Q

Describe locomotor training for T12-L3 complete SCI

A
  • Can be independent with ambulation on all surfaces & stairs
  • Using a swing through or 4 point gait pattern & bilateral KAFOs and crutches
  • May also use reciprocating gait orthoses with walker with or without FES system
  • Typically independent household ambulators; wheelchair use for community ambulation
34
Q

Describe locomotor training for L4-L5 complete SCI

A
  • Can be independent with bilateral AFOs & crutches or canes
  • Typically independent community ambulators
  • May still use wheelchair for activities with high-endurance requirements
  • High rejection of orthoses/ambulation in favor of wheelchair mobility & energy conservation
35
Q

Define neuromodulation

A
  • Use of electrical stimulation to replace or improve function of a paralyzed or paretic limb
  • Includes FES and robotic assisted walking
36
Q

Parameters and progression of body weight support treadmill training for SCI

A
  • High intensity, high frequency training: 4-5 days/wk, 20-30mins, typically for 8-12 weeks
  • Progression: decrease BWS, increase treadmill speed, eliminate manual assistance
  • Can progress further to overground gait training for community ambulation
37
Q

What are some exercise precautions for tetraplegia/high lesion paraplegia SCI patients

A
  • Pts may experience blunted tachycardia, lack of pressor response, very low VO2 peak, & substantially higher variability of most responses
  • Monitor HR and BP closely during exercise & activity training
38
Q

Absolute contraindications to exercise testing & training of individuals with SCI

A
  • Autonomic dysreflexia
  • Severe or infected skin on weight bearing surfaces
  • Symptomatic hypotension
  • urinary tract infection (UTI)
  • Unstable fracture
  • Uncontrolled hot & humid environments
  • Insufficient ROM to perform exercise task

NPTE Study Practice (17 decks)

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