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EPPP (2017) > Neurological Disorders > Flashcards

Neurological Disorders Flashcards

1
Q

Brain imaging techniques are divided into two types. What are they?

A
  1. Structural

2. Functional

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2
Q

What is the purpose of structural techniques?

A

Structural techniques are used to identify structural changes due to tumors, strokes, degenerative diseases, inflammation, infection, and other abnormalities.
Include: Computerized axial tomography (CT or CAT scan) and Magnetic Resonance Imaging (MRI).

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3
Q

What are the differences between a CT and a MRI scan? Advantages and Disadvantages?

A

CT scan uses x-rays while a MRI scan uses a magnetic field and radio waves.
Advantages of a CT scan are that it costs less than an MRI, provides images more quickly, and, unlike an MRI, doesn’t require the patient to remain motionless for an extended period of time.
An MRI produces three-dimensional images, provides images with more precise detail and doesn’t require the use of x-rays.

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4
Q

What is the purpose of functional techniques?

A

Functional techniques provide information about brain structure and activity and include:

  1. Positron Emission Tomography (PET)
  2. Single Photon Emission Computed Tomography (SPECT)
  3. Functional MRI (fMRI)
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5
Q

What are the differences among PET, SPECT and fMRI? Discuss the Advantages and Disadvantages.

A

PET uses small amounts of injected radioactive material to assess neural activity by measuring regional cerebral blood flow, glucose metabolism, or oxygen consumption. PET scans are useful for mapping the distribution of neurotransmitters and identifying brain dysfunction due to stroke, epilepsy, tumor, Major or Mild Neurocognitive Disorder, and other conditions.
SPECT is similar to PET but provides images with lower resolution
fMRI is similar to MRI but also provides information on brain activity by detecting changes in blood oxygenation.

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6
Q

Describe a Stroke

A

Stroke (Cerebrovascular accident (CVA), is an onset of neurological symptoms caused by an interruption or severe reduction of blood flow to the brain.
The two main types of stroke are:
1. Ischemic strokes
2. Hemorrhagic strokes

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7
Q

What is the difference between an Ischemic stroke and a Hemorrhagic stroke?

A

Ischemic strokes are most common and occur when an artery that supplies blood to the brain becomes blocked.
Hemorrhagic strokes occur when a weakened blood vessel in the brain ruptures or leaks.

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8
Q

What is the leading risk factor for stroke?

A

Hypertension.

Other risk factors include:
Atherosclerosis 
(thickening of the lining of the arterial walls)
Atrial fibrillation and other types of heart disease
Diabetes mellitus
Cigarette smoking
Age over 55
Male gender
African American race
Family history of stroke
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9
Q

Describe the symptoms and consequences of a stroke due to damages involving the middle cerebral artery.

A

The middle cerebral artery supplies blood to parts of the frontal, temporal, and parietal lobes and the basal ganglia.
It is the artery most often involved in a stroke.
Common consequences include: Contralateral hemiplegia and hemiparesis (in the face and arm); contralateral visual field loss in both eyes and aphasia if the dominant hemisphere is affected or contralateral neglect and denial of deficit if the non-dominant hemisphere is affected.

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10
Q

Describe the symptoms and consequences of a stroke due to damages involving the anterior cerebral artery.

A

The anterior cerebral artery supplies areas of the frontal and parietal lobes, the corpus callosum, and the caudate nucleus. Consequences of this type of stroke include: contralateral hemiplegia, usually in the leg; impaired judgment and insight; personality change; and incontinence.

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11
Q

Describe the symptoms and consequences of a stroke due to damages involving the posterior cerebral artery.

A

The posterior cerebral artery supplies blood to the thalamus, temporal lobe, and occipital lobe. A stroke involving this artery can cause cortical blindness, visual agnosia and other visual deficits; language impairment; and memory loss.

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12
Q

For individuals who survive a stroke, the greatest improvement in symptoms occurs when?

A

During the first three to six months.

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13
Q

There are two forms of Traumatic Brain Injury (TBI). What are they?

A

Open Head Injury

Closed Head Injury

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14
Q

What is the difference between an open head injury and a closed head injury?

A

Open head injury occurs when the skull is penetrated by, for example, a gunshot or knife. Symptoms are usually focal (related to the area of brain damage) and may resolve relatively rapidly. Many people with an open head injury do not lose consciousness.
Closed head injury occurs when a blow to the head does not penetrate the skull. It usually causes more widespread damage than an open head injury and is often followed by a loss of consciousness.

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15
Q

TBI is classified as mild, moderate, or severe. How does one go about determining one’s severity of TBI? (Hint: Measurements used)

A
  1. Score on the Glasgow Coma Scale (GCS)
  2. Duration of post-traumatic amnesia (PTA)
  3. Duration of loss of consciousness (LOC)
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16
Q

How does one fall into the category of mild, moderate, or severe TBI?

A

Mild TBI - GCS score 13 - 15; PTA less than one hour; LOC 30 minutes or less or none.
Moderate TBI - GCS score 9 to 12; PTA 1 to 24 hours; LOC 30 minutes to 24 hours.
Severe: GCS score 8 or less; PTA more than 24 hours; LOC more than 24 hours.

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17
Q

What is considered to be a good prediction of outcome?

A

The duration of the individual’s post-traumatic (anterograde) amnesia

18
Q

What is Post-concussional Syndrome?

A

Many people with TBI (especially mTBI) develop a postconcussional syndrome (PCS) that lasts for several months and involves multiple symptoms such as: dizziness, headaches, memory impairment, fatigue, and emotional instability.

19
Q

What diagnostic criteria must the individual meet prior to receiving a DSM-5 diagnosis of PCS?

A

A person with PCS would receive the DSM-5 diagnosis of Major or Mild Neurocognitive Disorder due to Traumatic Brain Injury when he or she meets:

  1. His/her symptoms meet the criteria for Major/Mild Neurocognitive Disorder
  2. There is evidence of a traumatic brain injury with one or more of the following symptoms - loss of consciousness, posttraumatic amnesia, disorientation and confusion, neurological signs (e.g., a new onset of seizures, visual field cuts, hemiparesis)
  3. The neurocognitive disorder presents immediately after the TBI or recovery of consciousness and persists past the acute post-injury period.
20
Q

Motor disorders can be caused by damage to ___________, ______________ or ____________.

A
  1. The spinal cord
  2. Structures of the extrapyramidal motor system
  3. Motor areas of the cortex
21
Q

Which two diseases are motor disorders involving the extrapyramidal system?

A
  1. Huntington’s Disease

2. Parkinson’s Disease

22
Q

Describe Huntington’s Disease (Overview)

A

Huntington’s disease is a degenerative disease that involves a combination of affective and personality changes, cognitive deterioration, and abnormalities in movement.
It is caused by an autosomal dominant gene, and offspring of a person carrying the gene have a 50% chance of inheriting the disorder.
Huntington’s disease has been linked to abnormalities in the basal ganglia and cortex.
Glutamate, ACh, GABA, and dopamine abnormalities have all been implicated in Huntington’s disease.

23
Q

What are the symptoms of Huntington’s Disease?

A

Symptoms are first apparent between 30 and 50 years of age. The initial signs are usually affective (e.g., depression, anxiety, mania, emotional lability) and may be erroneously diagnosed as an affective disorder.
The symptoms are then followed by forgetfulness, personality changes, and motor symptoms (clumsiness, fidgeting, and incoordination).
Later, athetosis (slow writhing movements) and chorea (involuntary rapid, jerky movements of the face, limbs and trunk) become increasingly prominent.
In the later stages, individuals may develop dysarthria (difficulty with articulating words), dysphagia (difficulty swallowing), immobility, and Major or Mild Neurocognitive DIsorder.
Suicide risk is high, especially among younger individuals.

24
Q

Describe Parkinson’s Disease (Overview)

A

Parkinson’s Disease is a degenerative brain disorder characterized by abnormalities in movement. It is caused by a loss of dopamine-producing cells in the substantia nigra which, in turn affects the functioning of the basal ganglia, thalamus, and cortex.
Although there are no known cure, symptoms are alleviated by L-dopa and other drugs that increase dopamine levels in the brain.

25
Q

Symptoms of Parkinson’s Disease fall into four categories. What are they?

A
  1. Tremor
  2. Rigidity
  3. Postural Instability
  4. Bradykinesia
26
Q

Define each of the four categories of Parkinson’s symptoms.

A 
Tremor - Occurs in the hands, arms, and legs and is often an initial symptom. "Pill-rolling" involves movements of the thumb and forefinger and is a common resting tremor associated with Parkinson's.
Rigidity - Affects the muscles of the neck, arms, and legs. "Cogwheel rigidity" is a combination of rigidity and tremor and is characterized by short, jerky (ratchet-like) movements. 
Postural instability (impaired balance and equilibrium) causes unsteadiness, a stooped posture, and gait disturbances. 
Bradykinesia - Slowness of voluntary movement causes difficulty initiating and completing movements and affects both fine and gross motor functions. In the face, it produces a blank (mask-like) facial expression.
27
Q

About __% of people with Parkinson’s disease have co morbid depression; and in __% of these cases, depressive symptoms precede the onset of motor impairments by an average of five years.

A
  1. 40%

2. 20%

28
Q

What are Epileptic Seizures?

A

An epileptic seizure is caused by abnormal electrical activity in the brain that causes transient symptoms which may include a loss of consciousness, sensory changes, and/or motor disturbances. Seizures are categorized as partial or generalized.

29
Q

Describe Partial Seizures

A

Partial (focal) seizures originate in a localized area in one side of the brain and affect one side of the body (although they may spread and become generalized). There are two types of partial seizures:

  1. Simple partial seizures
  2. Complex partial seizures

Partial seizures arise in various regions of the brain but are most often due to abnormal electrical activity in one of the lobes of the cerebral cortex, especially the temporal lobe. Temporal lobe seizures are characterized by automatisms, auditory hallucinations, or other sensory phenomena, a sense of deja vu or depersonalization, and autonomic symptoms.

30
Q

What is simple partial seizures?

A

Simple partial seizures do not cause a loss of consciousness and involve uncontrollable movements, sensory symptoms (e.g., paresthesias, visual or auditory hallucinations), and/or autonomic symptoms (e.g., nausea, sweating)

31
Q

What is complex partial seizures?

A

Complex partial seizures may begin with an aura, include some alteration in consciousness, and often include automatism, which are involuntary complex movements that may include lip smacking, involuntary chewing, or walking in circles.

32
Q

Generalized Seizures

A

Generalized seizures are bilaterally symmetric and do not have a focal onset. Included in this category are tonic-clonic and absence seizures.

33
Q

Tonic-Clonic Seizures

A

Tonic-clonic seizures are also known as Grand Mal Seizures. They involve an alteration in consciousness and include a tonic stage that involves a stiffening of muscles in the face and limbs followed by a clonic stage that involves jerky rhythmic movements in the arms and legs.

34
Q

Absence Seizures

A

Absence seizures are alow known as Petit Mal Seizures. They are characterized by a brief loss of consciousness with a “vacant stare” but few or no other symptoms.

35
Q

There are 4 types of headaches. What are they?

A
  1. Migraine
  2. Tension
  3. Cluster
  4. Sinus Headache
36
Q

Migraine Headaches

A

Migraine headaches are characterized by an intense, throbbing pain that is usually on one side of the head and may be accompanied by nausea/vomiting, dizziness, and sensitivity to sound, light and odors. There are two types of migraines: Classic migraine and common migraine.
Classic migraine starts with an aura (specific visual, motor, or sensory symptoms) and a common migraine which does not begin with an aura.

37
Q

What are some triggers for migraines?

A

Migraines may be triggered by a variety of factors:
1. Emotional stress or Relaxation after stress
2.Abrupt weather changes
3. Alcohol (beer and red wine)
4. Certain food and food additives (e.g., aged meat and cheese, chocolate, MSG)
Their intensity may be increased by routine physical activity such as walking or climbing stairs.

38
Q

One theory has been proposed to explain the occurrence of migraine. What is this theory?

A

The theory about the cause of migraines is that they are related to a low level of serotonin that produces a constriction of blood vessels in the brain.

39
Q

How can migraines be treated?

A

Nonsteroidal anti-inflammatory drugs (NSAIDs)
Ergotamine
Sumatriptan
SSRIs
Other drugs that act at serotonin receptors
Beta-blockers
Combination of thermal biofeedback and autogenic training.

40
Q

What are Tension headaches?

A

Tension headaches are characterized by dull and diffuse mild to moderate pain that is experienced as a tight band (pressure) around the head. For some, tension headaches may be due to sustained contractions of muscles in the forehead, scalp, and neck, but for others, the cause is unknown. There is some evidence that, abnormalities in serotonin or other neurotransmitters may be involved. Treatments include over-the-counter and prescription pain relievers, EMG biofeedback, and, for chronic tension headaches, antidepressants.

41
Q

Cluster Headaches

A

Cluster headaches involve severe (often burning or piercing) non-throbbing pain that lasts for 15 to 90 minutes and occurs more than once each day over several weeks or months. The pain is unilateral and usually located behind one eye but may spread to the face, cheek, and/or temple. Treatments include oxygen therapy (breathing 100% oxygen through a mask), sumatriptan or other triptan, and lidocaine or other local anesthetic.

42
Q

Sinus Headaches

A

Sinus headaches are caused by sinusitis, which is an inflammation of the membranes that line the sinuses (the cavities around the nose, eyes, and cheeks).
Sinus headaches produce a dull throbbing pain and pressure around the eyes and in the cheeks and forehead, with the pain being worsened by a sudden movement of the head, leaning forward, and cold, damp weather. Common accompanying symptoms include a runny or stuffy nose, coughing, sneezing, a mild to moderate fever, sore throat, and fatigue. Sinusitis is treated with antihistamines, decongestants, antibiotics and corticosteroids.

EPPP (2017) (2 decks)

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