Neurological Disorders Flashcards
Acquired Brain Injury
Cause of TBI
Caused from: Motor vehicle and other traffic accidents Falls Hit by an object Assault Sports related Work-related or industrial accidents
External cause of Acquired brain injury
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)
Internal cause of Acquired brain injury
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
Traumatic Brain Injury
Types and Symptoms
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
Traumatic Brain Injury
Classification
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
Traumatic Brain Injury
Functional Consequences
Alterations in consciousness – coma, fatigue/drowsiness
Cognitive deficits
Physical deficits
Emotional/Behavioural deficits
Traumatic Brain Injury
Role of Neuropsychologists
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)
Brain Tumour
Diagnosed Symptoms
headache, vomiting, mental dullness, seizures, increase in intra cranial pressure, brain scans
Biopsy analysis of tumour cells to identify type and grade
Brain Tumour
Prognosis
varies with age, tumour type, grade, treatment regime and genetics
Brain Tumour
Treatment
active monitoring & surveillance, surgery, chemotherapy, radiation therapy
Brain Tumour
Types of Brain Tumour
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)
Brain Tumour
Characteristics of benign tumour
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)
Brain Tumour
Characteristics of malignant tumour
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
Tumour Related Brain Damage
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
What is used to recognise signs of stroke?
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!
Symptoms of Stroke
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
Types of Stroke
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
Types of Stroke
Ischemic Stroke: Thrombosis
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)
Types of Stroke
Ischemic Stroke: Embolism
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.
Symptoms of Aneurysm
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
Treatment for Stroke
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
Functional consequences of stroke related to brain regions
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
Prognosis of Seizures
Recurrent, episodic
What is seizure disorder?
uncontrolled electrical
discharges in the brain
Symptoms of seizure disorder
Aura or warning
Loss of consciousness
Amnesia
Movement
Common Causes of Seizures
scarring
drugs (e.g., sudden withdrawal)
infections
What are the different types of seizures?
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)
Functional Effects Seizure disorder
Depends on type and area
Diagnosis Seizure Disorder
Symptoms
EEG
Treatment Seizure Disorder
Medication (anti-epileptic - Dilantin, Tegretol, Epilim, phenytoin)
surgery in some cases (often the medial temporal region)
Role of Neuropsychologist with Seizure Disorder
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)
Onset of definition of Dementia
A gradual ongoing decline in memory and related cognitive functions, such as language, reasoning and decision making skills
Symptoms of Dementia
Progressive changes in: Orientation Memory and learning Verbal communication Perception Abstract thinking Judgement and social behaviour Motor behaviour Personality Decline in self-care, independence & interests
Types of Dementia
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
What is Alzheimer and what are risk factors?
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
What is Parkinsons Disease?
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
Symptoms of Parkinsons
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
Diagnosis of Dementia
Community Aged Care Assessment Team Medical history Medical laboratory tests Mental Status Examination Comprehensive neuropsychological assessment Brain scans (MRI) Diagnosis by exclusion (80-90%)
What is mild cognitive Impairment?
a degree of cognitive impairment that is of insufficient severity to constitute dementia
5 Stages of Dementia
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.
Prognosis of Dementia
Progressive and irreversible
Alzheimer’s dementia course: approximately 7- 10 years
Treatment of Dementia
Medications (ease symptoms and slow progression) Caregiving - Education and support - memory aids, structure - monitor wandering - enhance communication - safe environment - exercise - stimulation
