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Fundamentals of disease > Neuro: The rest of the story (neuro 4) > Flashcards

Neuro: The rest of the story (neuro 4) Flashcards

1
Q

Cranial nerves(are LMNs), anterior horn cell of spinal cord, spinal nerve roots, peripheral nerves
Polio, guillain-barre, peripheral nerve injury, peripheral neuropathy, radiculopathy
Hypotonia, flaccidity (floppy)
Hyporeflexia

A

LowerMotorNeurons Disorders

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2
Q
  • CSF becomes blocked
  • Cerebellum protrudes into spinal canal
  • Cause is unknown

Varying degrees
vomit in middle of night

A

Arnold –Chiari malformation

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3
Q
  • S/S: dizziness, mm weakness/paralysis, lack of skin sensation, poor balance, headaches, vision deficits
  • Varying degrees
  • vomit in middle of night
A

Arnold –Chiari malformation

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4
Q

Prognosis: depends on severity
MI: surgical: restore flow of CSF
PT: balance and coordination

A

Arnold –Chiari malformation

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5
Q
  • Neurodevelopmental disorders
    • Asperger syndrome, Rett syndrome, pervasive developmental disorders….
  • Genetic and environmental
  • Impaired social interaction
  • Better with nonverbal expression
  • Strict routine
  • May be aggressive
A

Autistic Spectrum Disorder

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6
Q
  • No cure
  • MI: mutlidisciplinary: speech, OT, PT, Hearing tests,psych, may use meds
  • PT: normal movement patterns; motor planning
  • Helps if family is extremely proactive
A

Autistic Spectrum Disorder

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7
Q

Alcohol consumption during pregnancy

Affects 2-6/1,000 births

A

Fetal Alcohol Syndrome

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8
Q
  • S/S: physical, behavioral and cognitive
  • Physical: small eyes, wide/flat nasal bridge, small jaw, cleft palate/lip, eye and ear abnormalities, cardiac defects, low IQ
  • Poor attention, concentration, memory
A

Fetal Alcohol Syndrome

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9
Q
  • MI: prevent by avoiding etoh
  • PT: evaluate by PT: early intervention
  • **Ataxia, disdiadochokinesia, tremors, posture and gait deficits,
A

Fetal Alcohol Syndrome

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10
Q

Generally affects young adults
50% from motorcycle or automobile accidents
11,000 Americans per year

A

Spinal cord injury

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11
Q

11,000 new cases of SCI in US annually

225,000-288,000 individuals with SCI living in US

A

Spinal Cord Injury

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12
Q 
-The National spinal injury database: provides What type of information about spinal cord injuries?
such as : 
51% Cervical lesions: 
34.6% Thoracic lesions: 
10.8%: lumbo-sacral lesions
\:Neurological Outcome
Incomplete paraplegia: 18.6%
Incomplete tetraplegia: 29.4%
Complete paraplegia: 26.3%
Complete tetraplegia: 20.7%
A

Demographics

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13
Q 
what type of Spinal Cord Injury:
MVA, fall or gunshot wound
MVA: 45.6%
Falls: 19.6%
Violence 17.8%
Recreational sports injuries 10.7%
Other etiologies: 6.3%
A

Traumatic

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14
Q

what type of Spinal Cord Injury:
Disease or pathological influence
AVM, thrombosis, embolus, hemorrhag, vertebral subluxation, infection, neoplasm, syringomyelia, abscess, neurodisease
Accounts for 30% of SCI

Statistics:
Men 16-30 yrs old, white

A

Nontraumatic:

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15
Q

these are classifications of what:
Tetraplegia: complete paralysis all 4 extremities
Paraplegia: complete/partial paralysis trunk and bilat LE’s

A

Spinal Cord Injury

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16
Q

-2 types of spinal cord injuries: How they occurred

A

Traumatic & Nontraumatic:

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17
Q

Employment for people with spinal cord injuries-10 yrs post injury

A
  1. 7% of paraplegics employed
  2. 4% of tetraplegics employed
  3. 3% of injured patients: return to private residence
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18
Q

care for spinal injuries post injury

A

Acute care 15 days

Rehab unit 40 days

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19
Q

Life expectancy for spinal cord injured

A

Depends on age at time of injury and level of injury

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20
Q

Cost of spinal cord injury in first year

A

High-low tetraplegia; $682,957-$249,549

Life time cost: 2,693,957- 1,523,204 for tetraplegia and 900,085 for paraplegia

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21
Q
  • Compression, hyperextension, flex and rot most common
  • Shearing: horizontal force
  • Distraction
A

Mechanism of injury

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22
Q

What mechanism for SCI is this?

  • Disrupts ligaments
  • Fracture dislocation thoracolumbar region
A

Shearing: horizontal force

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23
Q

What mechanism for SCI is this?

  • Least common mechanism
  • Whiplash injury: significant momentum of head
  • Head is pulled away from body
A

Distraction

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24
Q

What mechanism for SCI is this?

  • Result in fx or dislocation
  • Highest frequency of injury: C5-7 , T 12-L-2
  • Forces typically occur in combination
A

Compression, hyperextension, flex and rot most common

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25
Q

What happens if the spinal cord is damaged?

A

1-Initial period of spinal shock (temporary)

2-Loss of function at and below the level of injury (usually permanent)

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26
Q
  • Initially conduction of nerve impulses stop
  • As inflammation subsides will start getting reflex activity
  • Undamaged tracts will continue to conduct impulses
A

Spinal shock

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27
Q

Injury to cervical region Inflammation may extend upward

  • May affect as high as C-3 to C-5
  • If affects are at C-5 or even higher (breathing because of the phrenic nerve is affected)
A

Injury to cervical region

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28
Q
  • Flaccid paralysis initially(floppy)
  • Spastic paralysis as spinal shock resolves
  • Sensory loss at and below the level of the lesion
  • Bowel and bladder function loss (reflexive/neurogenic B&B)
  • Orthostatic hypotension
  • Autonomic dysreflexia (T8 and above)
A

What you might see in a patient with a SCI.

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29
Q

How do you Determine permanent damage in spinal cord injury?

A

Designation of lesion level

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30
Q

most caudal level of spinal cord with normal motor and sensory function on right and left side of body

A

Neurological level

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31
Q

lowest level of spinal cord with normal motor function bilateral

A

Motor Level

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32
Q

Sensory level

A

lowest level of spinal cord with normal sensory level bilateral

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33
Q

Measurement of sensory and motor function

A

Sensation:
0=absent
1= impaired
2= normal

Muscle strength:
Test key muscles
6 point scale

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34
Q

test key muscle

A

must have 3/5 strength

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35
Q

Motor level measurement testing that tells us were the level of damage has started.

A

test key muscle: must have 3/5 strength

Next most rostral muscle: 5/5 strength

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36
Q

fyi
Certain levels of injury are more difficult to measure intact innervation, so it may be defined as same level as sensory level: C1-C4, T2-L1,S2-S5a

A

fyi

37
Q

Sometimes level of sensory and motor function will differ from ______to ________

A

left to right

38
Q

Depending on the level of injury what can permanent damage affect?

A

Cervical: motor and sensory to arms, trunk, legs,
Respiratory function
Blood pressure
Body temperature

39
Q
  • no sensory or motor function at lowest sacral segment

- Anal sensation, voluntary external and sphincter contraction

A

Complete injury

40
Q
  • motor and/or sensory function below neurological level, including S4-S5
  • Will have variable clinical presentation
A

Incomplete injury

41
Q

has motor and sensory function below neurological level, but no function at S4, S5

A

Zones of partial preservation

42
Q

A: complete: no motor or sensory function at S4-S5
B: incomplete: sensory but no motor below the neurological level, includes S4-S5
C: incomplete: motor function preserved below neurological level with more than ½ of key mm below neuro level have muscle grade less than 3
D: incomplete: motor function present below neuro level, ½ of key mm below neuro level have muscle grade greater than 3
E: normal: motor and sensory function is normal

A

ASIA impairment scale:

know there is this scale (do not have to memorized whats in scale as per DrC)

43
Q
  • Skin breakdown
  • Pneumonia
  • Shoulder injuries
  • Heterotopic Ossification (HO) weird looking hooky thing bone growing by head of femur)
A

Secondary complications of spinal cord injury SCI

44
Q

Initially: Surgical intervention to relieve pressure on spinal cord
Stabilization (HALO, TLSO, etc)
Glucocorticoids
Compensatory rehab

A

Treatment for SCI

45
Q

What is a CVA?

A

Cerebrovascular accident

46
Q

Damage to brain tissue that results from a lack of blood (and oxygen) to the brain

A

CVA

47
Q
  • Can be caused by a thrombus or an embolus
  • More common CVA
  • Five mins can cause irreversible cell damage
A

Ischemic

48
Q
  • Caused by rupture of a cerebral artery

- Often more severe/destructive

A

Hemorrhagic

49
Q

Ischemic, Hemorrhagic

A

types of stokes

50
Q

TIA

A

Transient ischemic attach

51
Q

Temporary localized reduction of blood flow in the brain

Neurological symptoms last for 24 hours or less

A

TIA

52
Q
  • Change in level of consciousness
  • Impairment of sensory, motor , cognitive, perceptual and language functions
  • By definition must persist > 24 hours
A

Stroke

53
Q

-Hemiplegia
-Hemiparesis
Anything > 3 weeks: may lead to permanent disability

A

Motor deficit:

Hemiplegia is used generically: motor problems that result from stroke

54
Q

paralysis

A

Hemiplegia

55
Q

-Weakness

Weakness will be opposite side of lesion

A

Hemiparesis-

“remember it is the opposite side of lesion”

56
Q

The word Hemiplegia is used generically for motor problems that result from stroke

A

fyi

57
Q

Thrombosis(more local)
Embolus(clot that travels)
hemorrhage
**anything that lasts for more than 3 weeks:may lead to permanent damage

A

Strokes classified by etiology

58
Q

fyi-Strokes: males vs females 1.25 times > men than women

A

fyi

59
Q 
fyi-3rd leading cause of death, most common cause of disability
700,000 strokes per year
500,000 new strokes
200,000 recurrent strokes
540,000 stroke survivors
A

fyi

60
Q 
fyi-African-American: twice the risk
Also higher in:
Mexican American
American Indian
Alaska Native

Stroke incidence: inc with age
22% of men and 25% of women die within 1 year of initial stroke

A

fyi

61
Q 
These are risk factors for what?
Hypertension
Coronary artery disease
Congestive heart failure
Peripheral arterial disease
diabetes
A

strokes

62
Q

Early warning signs of strokes

A

Sudden numbness or weakness of face, arm, or leg, especially on one side of body
Sudden confusion, trouble speaking/understanding
Sudden trouble seeing (this could be several things, most of which are dangerous!)
Sudden trouble walking, dizziness, loss of balance, or coordination
Sudden SEVERE headache (worst headache of my life)
Sudden nausea/fever/vomiting
Brief LOC or decreased consciousness

63
Q
  • *Ischemic cascade
  • Damage over 3-4 hours
  • Cerebral edema: reaches maximal level at 3-4 days: should dissipate in 2-3 weeks
A

Pathophysiology of a stroke

64
Q

Lesion occurs in cerebral hemisphere

Specific dysfunction in a discrete area

A

Supratentorial lesions

65
Q

Located in brainstem

Small lesion may affect many motor and sensory fibers: widespread impairment

A

Infratentorial lesions

“think brainstem” and people don’t do so well

66
Q

What side of brain that a stroke can affect.

  • Logical thinking ability
  • Analytical skills
  • Intellectual abilities
  • Communication skills
A

Left hemisphere damage:

67
Q

What side of brain that a stroke can affect.

  • Music and art appreciation
  • Behavioral issues
  • Spatial orientation
  • Neglect of contralateral side
A

Right hemisphere damage

68
Q
  • Determined by cerebral cortex and RAS
  • With acute brain disorder can have decrease LOC
  • Extensive supratentorial lesion: LOC
  • Small lesions in infratentorial lesion: affect RAS
A

Level of consciousness

69
Q
  • Lethargy, confusion, disorientation, memory loss, unresponsive to verbal stimuli
  • Glasgow coma scale
  • Coma: no response to verbal or painful stimuli
  • Vegetative state: loss of awareness and mental capabilities: diffuse brain damage but brain stem function continues
  • Sleep wake cycle but unresponsive
A

Levels of reduced consciousness

70
Q

Signs related to specific area of brain or spinal cord in which lesion is located

A

Local effects

71
Q

-Damage in cerebral cortex: what kind of dysfunction?
weakness or paralysis on opposite side (tracts cross in medulla)
-UMN: hyperreflexia
-LMN:flaccid, weakness on same side

A

Motor dysfunction

72
Q

Can include touch, pain, temperature, position and special senses
Area of damage determines deficit

A

Sensory Deficits

73
Q

Optic chiasma: fibers come together and divide
Depending on where damage is will determine what visual field is lost
Lose vision on medial half of one eye and lateral half of other eye

A

Hemianopia

74
Q
  • Inability to comprehend or express language
  • Expressive (motor)Broccas area
  • Receptive (sensory) wernickes area:cant read or understand spoken word
  • Global: combination
A

Aphasia

75
Q

When stroke strikes, don’t wait. Call 911.
Call 911 if you experience any one of these symptoms

A
  • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
  • Sudden confusion, trouble speaking or understanding.
  • Sudden trouble seeing in one or both eyes.
  • Sudden trouble walking, dizziness, loss of balance or coordination.
  • Sudden, severe headache with no known cause.

**Early medical treatment can reduce your risk of death or disability from stroke!
76
Q

Clot buster
Ischemic CVA’s ONLY
Must be give within 3 hours of a CVA
Greatly reduces mortality and morbidity

A

Tissue Plasminogen Activator (tPA)

77
Q

Glucocorticoids – reduce cerebral edema

Rehabilitation – PT, OT, Speech

A

Other Treatments for stroke

78
Q

S/S of what

  • Paresis/plegia opposite arm, leg, or both
  • Flaccid to spastic paralysis
  • Coma/LOC
  • Sensory impairments
  • Visual impairments
  • Speech deficits
  • Confusion
  • Personality changes
  • Depression
A

stroke

79
Q 
L motor and sensory deficits:  UE, LE, or both
Confusion
Impulsivity
Decreased safety awareness
Personality changes
Difficulty with problem solving
Neglect
A

R CVA

80
Q

R motor and sensory deficits: UE, LE, or both

Aphasia

A

L CVA

81
Q

What happens if there is neuronal damage from a stroke?

A

There will be an area of residual scar tissue in the brain

New neuronal pathways may form (remember, the brain is plastic!!)

These pathways have the potential to form for an indefinite amount of time after a CVA

82
Q

“think”catheter got kinked- and get sick with it like bladder infection
know for test dr. c.

A

autonomic dysreflexia (t8 and above)

83
Q

determining permanent damage with SCI is important why?

A

to put them in a level if they want to compete.

84
Q

TLSO

A

thoracolumbosacral orthotic

85
Q

understand difference of complete and incomplete or what spinal shock is for test

A

yay test

86
Q

fyi-decorticate vs decerebrate posturing- know the difference. pictures are in lecture

A

know

87
Q

what is reticular activating system-RAS

A

state of awareness - hard time being awake and alert. don’t stay with you very long

88
Q

LMN damage- what side is affected if nerve is cut off? same or opposite?

A

same side

Fundamentals of disease (19 decks)

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