Neuro: The rest of the story (neuro 4) Flashcards
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
LowerMotorNeurons Disorders
- CSF becomes blocked
- Cerebellum protrudes into spinal canal
- Cause is unknown
Varying degrees
vomit in middle of night
Arnold –Chiari malformation
- S/S: dizziness, mm weakness/paralysis, lack of skin sensation, poor balance, headaches, vision deficits
- Varying degrees
- vomit in middle of night
Arnold –Chiari malformation
Prognosis: depends on severity
MI: surgical: restore flow of CSF
PT: balance and coordination
Arnold –Chiari malformation
- Neurodevelopmental disorders
- Asperger syndrome, Rett syndrome, pervasive developmental disorders….
- Genetic and environmental
- Impaired social interaction
- Better with nonverbal expression
- Strict routine
- May be aggressive
Autistic Spectrum Disorder
- 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
Autistic Spectrum Disorder
Alcohol consumption during pregnancy
Affects 2-6/1,000 births
Fetal Alcohol Syndrome
- 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
Fetal Alcohol Syndrome
- MI: prevent by avoiding etoh
- PT: evaluate by PT: early intervention
- **Ataxia, disdiadochokinesia, tremors, posture and gait deficits,
Fetal Alcohol Syndrome
Generally affects young adults
50% from motorcycle or automobile accidents
11,000 Americans per year
Spinal cord injury
11,000 new cases of SCI in US annually
225,000-288,000 individuals with SCI living in US
Spinal Cord Injury
-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%
Demographics
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%
Traumatic
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
Nontraumatic:
these are classifications of what:
Tetraplegia: complete paralysis all 4 extremities
Paraplegia: complete/partial paralysis trunk and bilat LE’s
Spinal Cord Injury
-2 types of spinal cord injuries: How they occurred
Traumatic & Nontraumatic:
Employment for people with spinal cord injuries-10 yrs post injury
- 7% of paraplegics employed
- 4% of tetraplegics employed
- 3% of injured patients: return to private residence
care for spinal injuries post injury
Acute care 15 days
Rehab unit 40 days
Life expectancy for spinal cord injured
Depends on age at time of injury and level of injury
Cost of spinal cord injury in first year
High-low tetraplegia; $682,957-$249,549
Life time cost: 2,693,957- 1,523,204 for tetraplegia and 900,085 for paraplegia
- Compression, hyperextension, flex and rot most common
- Shearing: horizontal force
- Distraction
Mechanism of injury
What mechanism for SCI is this?
- Disrupts ligaments
- Fracture dislocation thoracolumbar region
Shearing: horizontal force
What mechanism for SCI is this?
- Least common mechanism
- Whiplash injury: significant momentum of head
- Head is pulled away from body
Distraction
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
Compression, hyperextension, flex and rot most common
What happens if the spinal cord is damaged?
1-Initial period of spinal shock (temporary)
2-Loss of function at and below the level of injury (usually permanent)
- Initially conduction of nerve impulses stop
- As inflammation subsides will start getting reflex activity
- Undamaged tracts will continue to conduct impulses
Spinal shock
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)
Injury to cervical region
- 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)
What you might see in a patient with a SCI.
How do you Determine permanent damage in spinal cord injury?
Designation of lesion level
most caudal level of spinal cord with normal motor and sensory function on right and left side of body
Neurological level
lowest level of spinal cord with normal motor function bilateral
Motor Level
Sensory level
lowest level of spinal cord with normal sensory level bilateral
Measurement of sensory and motor function
Sensation:
0=absent
1= impaired
2= normal
Muscle strength:
Test key muscles
6 point scale
test key muscle
must have 3/5 strength
Motor level measurement testing that tells us were the level of damage has started.
test key muscle: must have 3/5 strength
Next most rostral muscle: 5/5 strength
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
fyi
Sometimes level of sensory and motor function will differ from ______to ________
left to right
Depending on the level of injury what can permanent damage affect?
Cervical: motor and sensory to arms, trunk, legs,
Respiratory function
Blood pressure
Body temperature
- no sensory or motor function at lowest sacral segment
- Anal sensation, voluntary external and sphincter contraction
Complete injury
- motor and/or sensory function below neurological level, including S4-S5
- Will have variable clinical presentation
Incomplete injury
has motor and sensory function below neurological level, but no function at S4, S5
Zones of partial preservation
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
ASIA impairment scale:
know there is this scale (do not have to memorized whats in scale as per DrC)
- Skin breakdown
- Pneumonia
- Shoulder injuries
- Heterotopic Ossification (HO) weird looking hooky thing bone growing by head of femur)
Secondary complications of spinal cord injury SCI
Initially: Surgical intervention to relieve pressure on spinal cord
Stabilization (HALO, TLSO, etc)
Glucocorticoids
Compensatory rehab
Treatment for SCI
What is a CVA?
Cerebrovascular accident
Damage to brain tissue that results from a lack of blood (and oxygen) to the brain
CVA
- Can be caused by a thrombus or an embolus
- More common CVA
- Five mins can cause irreversible cell damage
Ischemic
- Caused by rupture of a cerebral artery
- Often more severe/destructive
Hemorrhagic
Ischemic, Hemorrhagic
types of stokes
TIA
Transient ischemic attach
Temporary localized reduction of blood flow in the brain
Neurological symptoms last for 24 hours or less
TIA
- Change in level of consciousness
- Impairment of sensory, motor , cognitive, perceptual and language functions
- By definition must persist > 24 hours
Stroke
-Hemiplegia
-Hemiparesis
Anything > 3 weeks: may lead to permanent disability
Motor deficit:
Hemiplegia is used generically: motor problems that result from stroke
paralysis
Hemiplegia
-Weakness
Weakness will be opposite side of lesion
Hemiparesis-
“remember it is the opposite side of lesion”
The word Hemiplegia is used generically for motor problems that result from stroke
fyi
Thrombosis(more local)
Embolus(clot that travels)
hemorrhage
**anything that lasts for more than 3 weeks:may lead to permanent damage
Strokes classified by etiology
fyi-Strokes: males vs females 1.25 times > men than women
fyi
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
fyi
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
fyi
These are risk factors for what? Hypertension Coronary artery disease Congestive heart failure Peripheral arterial disease diabetes
strokes
Early warning signs of strokes
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
- *Ischemic cascade
- Damage over 3-4 hours
- Cerebral edema: reaches maximal level at 3-4 days: should dissipate in 2-3 weeks
Pathophysiology of a stroke
Lesion occurs in cerebral hemisphere
Specific dysfunction in a discrete area
Supratentorial lesions
Located in brainstem
Small lesion may affect many motor and sensory fibers: widespread impairment
Infratentorial lesions
“think brainstem” and people don’t do so well
What side of brain that a stroke can affect.
- Logical thinking ability
- Analytical skills
- Intellectual abilities
- Communication skills
Left hemisphere damage:
What side of brain that a stroke can affect.
- Music and art appreciation
- Behavioral issues
- Spatial orientation
- Neglect of contralateral side
Right hemisphere damage
- 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
Level of consciousness
- 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
Levels of reduced consciousness
Signs related to specific area of brain or spinal cord in which lesion is located
Local effects
-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
Motor dysfunction
Can include touch, pain, temperature, position and special senses
Area of damage determines deficit
Sensory Deficits
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
Hemianopia
- Inability to comprehend or express language
- Expressive (motor)Broccas area
- Receptive (sensory) wernickes area:cant read or understand spoken word
- Global: combination
Aphasia
When stroke strikes, don’t wait. Call 911. Call 911 if you experience any one of these symptoms
- 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!
Clot buster
Ischemic CVA’s ONLY
Must be give within 3 hours of a CVA
Greatly reduces mortality and morbidity
Tissue Plasminogen Activator (tPA)
Glucocorticoids – reduce cerebral edema
Rehabilitation – PT, OT, Speech
Other Treatments for stroke
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
stroke
L motor and sensory deficits: UE, LE, or both Confusion Impulsivity Decreased safety awareness Personality changes Difficulty with problem solving Neglect
R CVA
R motor and sensory deficits: UE, LE, or both
Aphasia
L CVA
What happens if there is neuronal damage from a stroke?
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
“think”catheter got kinked- and get sick with it like bladder infection
know for test dr. c.
autonomic dysreflexia (t8 and above)
determining permanent damage with SCI is important why?
to put them in a level if they want to compete.
TLSO
thoracolumbosacral orthotic
understand difference of complete and incomplete or what spinal shock is for test
yay test
fyi-decorticate vs decerebrate posturing- know the difference. pictures are in lecture
know
what is reticular activating system-RAS
state of awareness - hard time being awake and alert. don’t stay with you very long
LMN damage- what side is affected if nerve is cut off? same or opposite?
same side
