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Neuropsychology > Neurological Disorders > Flashcards

Neurological Disorders Flashcards

1
Q

Acquired Brain Injury

Cause of TBI

A 
Caused from:
Motor vehicle and other traffic accidents
Falls
Hit by an object
Assault
Sports related
Work-related or industrial accidents
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2
Q

External cause of Acquired brain injury

A

Poisoning
Inhalation of organic solvents
Hypoxia/anoxia (e.g. near drowning, cardiac arrest)
Alcohol and drug abuse
Infections and diseases
HIV/AIDS
Bacterial (e.g. meningitis and brain abscesses)
Viral (e.g. herpes simplex)
Parasitic (e.g. cerebral malaria)
Encephalitis (inflammation of CNS due to infection)

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3
Q

Internal cause of Acquired brain injury

A 
Strokes and aneurysms
Tumours
Epilepsy
Metabolic disturbance (e.g., diabetic coma)
Dementia
Secondary effects of TBI
Haemorrhage or haematoma
Intracranial pressure
Oedema or brain swelling
Post-traumatic epilepsy
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4
Q

Traumatic Brain Injury

Types and Symptoms

A 
Open Head Injury:
- Penetration of skull and protective membrane
- Gun shot, sharp objects
Symptoms:
- Often no loss of consciousness
- Localised symptoms
- Relatively rapid and spontaneous recovery
Closed Head Injury:
- No penetration of skull or protective membrane
- Damage results from mechanical forces
- Diffuse axonal injury and contusion in frontal and temporal area
- Car accident, fall, assault, sport
Secondary Injury:
- Haematoma
- Subdural
- Epidural
- Intracerebral
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5
Q

Traumatic Brain Injury

Classification

A

1) GCS – presence and depth of coma
2) Post-traumatic amnesia (PTA) – period of time prior to return of ongoing memory
3) Results of neuroimaging

PTA Duration 	         	Severity
< 5 mins				Very Mild
5-60 mins			Mild
1-24 hours			Moderate
1-7 days		                Severe
1-4 weeks			Very Severe
>4 weeks 			Extremely Severe
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6
Q

Traumatic Brain Injury

Functional Consequences

A

Alterations in consciousness – coma, fatigue/drowsiness
Cognitive deficits
Physical deficits
Emotional/Behavioural deficits

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7
Q

Traumatic Brain Injury

Role of Neuropsychologists

A

Role to assess the extent of persisting symptoms – cognitive and behavioral and infer their impact on functioning
Educate clients and families about expected outcome and management
Design and implement strategies to assist clients to manage their deficits in daily life (rehabilitation)

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8
Q

Brain Tumour

Diagnosed Symptoms

A

headache, vomiting, mental dullness, seizures, increase in intra cranial pressure, brain scans
Biopsy analysis of tumour cells to identify type and grade

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9
Q

Brain Tumour

Prognosis

A

varies with age, tumour type, grade, treatment regime and genetics

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10
Q

Brain Tumour

Treatment

A

active monitoring & surveillance, surgery, chemotherapy, radiation therapy

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11
Q

Brain Tumour

Types of Brain Tumour

A 
Benign:
Meningioma (Most common, 95% benign)
Pituitary tumour
Colloid cyst (3rd Ventricle)
Oligodendroglioma (I-II)
Low grade glioma (I-II) (Potential for re-growth and progression)
Malignant:
Glioblastoma multiforme
Anaplastic astrocytoma
Oligodendro-glioma (III-IV)
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12
Q

Brain Tumour

Characteristics of benign tumour

A

Not likely to recur after removal
Encapsulated or distinct border
Compression/displacement effects
Can still be very serious depending on size and location (e.g., brain stem, midline or medial)

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13
Q

Brain Tumour

Characteristics of malignant tumour

A

Cancerous
Likely to recur after removal
Gliomas and metastatic tumours are most serious (fast growing)
Metastatic tumours originate in other parts of the body
Lacks a distinct border and infiltrates surrounding tissue
Complete removal is not possible (microscopic cancer cells beyond the tumour edge) and may metastasize

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14
Q

Tumour Related Brain Damage

A

Compression and displacement effects
Raised intracranial pressure, impaired CSF flow, swelling (steroid effects) and bleeding
Infiltration or invasion of surrounding brain tissue and cell necrosis
Mass effects: widespread damage or disruption to brain functioning - more generalised impairment
Focal effects: more localised damage and specific cognitive deficits
Neurotoxic effects of treatment: damage to healthy tissue, e.g., white matter abnormalities due to chemotherapy or radiation exposure

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15
Q

What is used to recognise signs of stroke?

A

The FAST test is an easy way to recognise and remember the signs of stroke
Face – Check their face. Has their mouth drooped? Arms – Can they lift both arms?
Speech – Is their speech slurred? Do they understand you?
Time – Time is critical. If you see any of these signs call 000 now!

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16
Q

Symptoms of Stroke

A

Sudden appearance of neurological symptoms as a result of severe interruption of blood supply to the brain.
headache, dizziness, impaired consciousness, loss of sensation, loss of or impaired speech
Scans

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17
Q

Types of Stroke

A 
1. Cerebral ischaemia (Clot blocks blood flow to an area of the brain)
Thrombosis
Embolism
Arteriosclerosis
2. Cerebral haemorrhage (Bleeding occurs inside or around brain tissue)
High blood pressure
Aneurysm
Arteriovenous malformation (AVM)
Angioma
18
Q

Types of Stroke

Ischemic Stroke: Thrombosis

A

Fat deposit build-up in the walls of the arteries (atherosclerosis)
Deposits thicken and produce blockage in artery
Blood forms over clots and leads to total obstruction
Usually arise from lesions in the internal carotid (MCA – frontal, parietal and temporal structures) or vertebrobasilar arteries (brain stem, temporal and occipital)

19
Q

Types of Stroke

Ischemic Stroke: Embolism

A

Plug of material breaks away (e.g., post-surgery), fatty tissue, debris or air bubbles
Microemboli – tiny bits of plaque that obstruct the smallest arteries of the brain.

20
Q

Symptoms of Aneurysm

A

Symptoms depend on cause, location and severity of blockage – loss of consciousness (death) to slight confusion/headache
Generally – lower down/larger, bilateral & more generalised deficits
Left – right sided weakness, language deficits,
Right – left sided weakness, visuo-perceptual deficits

21
Q

Treatment for Stroke

A

Surgery (e.g., coils, clipping)
Medication (e.g., anticoagulants)
Rehabilitation (physical, speech, cognitive, emotional)
Craniotomy and repair – goal to repair the aneurysm and prevent re-bleed

22
Q

Functional consequences of stroke related to brain regions

A

Occipital lobe – hemianopia (left or right visual field)
Temporal lobe: visual agnosia (object recognition), specific to faces (prosopagnosia – less common), amnesia or modality-specific memory impairment
Right parietal – loss of sensation, somatosensory cortex (hemiparesis); Hemi-inattention or unilateral neglect
Left or bilateral parietal: Multimodal integration (IPL) – reading, writing, maths, skilled movement
Left temporal: Auditory processing and comprehension
Right temporal: agnosia for sound, music
Left frontal: Speech production and executive deficits
Frontal motor areas: hemiplegia, apraxia

23
Q

Prognosis of Seizures

A

Recurrent, episodic

24
Q

What is seizure disorder?

A

uncontrolled electrical

discharges in the brain

25
Q

Symptoms of seizure disorder

A

Aura or warning
Loss of consciousness
Amnesia
Movement

26
Q

Common Causes of Seizures

A

scarring
drugs (e.g., sudden withdrawal)
infections

27
Q

What are the different types of seizures?

A

Partial (focal) seizures (simple, complex):
- Localised or progressive motor
- Sensory (olfactory/gustatory, tactile, visual, auditory)
- Psychic (cognitive and emotional)
- Autonomic (sweating, salivating)
- Usually don’t lose consciousness (but may be altered)
Generalised seizures (absence/petit mal, grand mal)

28
Q

Functional Effects Seizure disorder

A

Depends on type and area

29
Q

Diagnosis Seizure Disorder

A

Symptoms

EEG

30
Q

Treatment Seizure Disorder

A

Medication (anti-epileptic - Dilantin, Tegretol, Epilim, phenytoin)
surgery in some cases (often the medial temporal region)

31
Q

Role of Neuropsychologist with Seizure Disorder

A

Surgery
Pre-surgery testing of cognition
Often require a WADA (sodium amytal) – systematic deactivation of hemisphere functions (1-3 mins) during which cognitive functioning is grossly assessed

Post-surgery assessment
Generalised seizures tend to show greatest degree of cognitive deficits (depending on management, age of onset)
Focal seizures tend to show lateralised effects (i.e. left – language and verbal memory, right – visuoperceptual and visual memory)
Personality changes and emotional disorders are common (emotions can trigger seizure, but also anxiety and depression can develop as a consequence – neurologically-based or reactive)

32
Q

Onset of definition of Dementia

A

A gradual ongoing decline in memory and related cognitive functions, such as language, reasoning and decision making skills

33
Q

Symptoms of Dementia

A 
Progressive changes in:
Orientation
Memory and learning
Verbal communication
Perception
Abstract thinking 
Judgement and social behaviour
Motor behaviour
Personality
Decline in self-care, independence &amp; interests
34
Q

Types of Dementia

A

Cortical: Alzheimer’s disease
Multi-Infarct Vascular Dementia (2nd most common 10%)
Frontotemporal Dementia (Pick’s Disease)
Dementia with Lewy bodies (tiny spherical structures in neurons)
Subcortical
Parkinson’s Disease (tremor, stiffness in limbs and joints, difficulty in initiating movement)
Huntington’s Disease (irregular, involuntary movement)
Subcortical Vascular Dementia

35
Q

What is Alzheimer and what are risk factors?

A

Degeneration of neurons due to:
Amyloid plaques: Beta amyloid (protein) => hard insoluble plaques between neurons
Neurofibrillary tangles: tau (protein)=> insoluble twisted fibres inside neurons
Risk factors
Age, being a first degree relative, Down syndrome, head injury, infection, exposure to toxic substances

36
Q

What is Parkinsons Disease?

A

Predominantly a motor disorder
Mean onset 60 years
Exact cause unknown
Deterioration of dopaminergic neurons in the substantia nigra
↓ Dopamine transferred to the caudate and putamen - inhibitory effect on movement
Imbalance in acetycholine (produced in basal ganglia) – excitatory effect on movement

37
Q

Symptoms of Parkinsons

A

Tremor (at rest, may reduce during purposeful activity), rigidity (spasticity to cogwheel symptoms), bradykinesia (freezing - poverty and slowness of movement)
Postural disturbance – head bowed, shoulders drooped, shuffling gait, small steps, poor balance
Cognitive dysfunction – slowed mentation, attention/concentration, executive function, visuospatial deficits and memory (retrieval rather than learning)
Emotional Changes – apathy and depression

38
Q

Diagnosis of Dementia

A 
Community Aged Care Assessment Team
Medical history
Medical laboratory tests
Mental Status Examination
Comprehensive neuropsychological assessment
Brain scans (MRI)
Diagnosis by exclusion (80-90%)
39
Q

What is mild cognitive Impairment?

A

a degree of cognitive impairment that is of insufficient severity to constitute dementia

40
Q

5 Stages of Dementia

A

Stage 1:No Impairment: no significant memory problems, fully oriented in time and place, normal judgment, can function out in the world, well-maintained home, and able to take care of personal needs.
Stage 2: Questionable Impairment
A score of 0.5 on the CDR scale represents very slight impairments, such as minor memory inconsistencies or struggling to solve challenging problems. Performance may be slipping at work or when engaging in social activities. However, the person can still manage his/her own personal care without any help
Stage 3: Mild Impairment
A score of 1, represents noticeable mild impairments in different areas. Memory loss for recent information and events disrupts everyday functioning in some way and the person is starting to become disoriented geographically and may have trouble with directions and getting from one place to another. He or she is like to have trouble functioning independently in activities outside the home. At home, chores may start to get neglected, and someone may need to remind them when it is time to take care of personal hygiene.
Stage 4: Moderate Impairment
A score of 2 represents moderately impaired. The person now needs help in taking care of hygiene, doing chores and attending social activities. Disorientation to time and space becomes more evident as people get lost easily and struggle to understand time relationships. Recent memory and new learning is seriously impaired (e.g., names of people they just met).
Stage 5: or Severe Impairment
The fifth stage of dementia (score of 3.0) is the most severe, as the person requires assistance with all aspects of functioning (bathing, dressing, feeding etc). They may no longer recognise familiar people and have extreme memory loss and disorientation to time and place. Activities outside of care are very limited due to both physical and cognitive decline.

41
Q

Prognosis of Dementia

A

Progressive and irreversible

Alzheimer’s dementia course: approximately 7- 10 years

42
Q

Treatment of Dementia

A 
Medications (ease symptoms and slow progression)
Caregiving
- Education and support
- memory aids, structure
- monitor wandering
- enhance communication
- safe environment
- exercise
- stimulation

Neuropsychology (4 decks)

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