Neurological Function and Dysfunction Flashcards
What are the four divisions of the brain?
cerebrum
diencephalon
cerebellum
brainstem
Which of the following is incorrect?
A: Meningitis is more common than encephalitis
B: Ischemic events are a more common cause of stroke than hemorrhagic events
C: A lumbar puncture in an individual with raised ICP could be problematic
D: A lesion in the left motor cortex would result in left sided paralysis
D
A cerebellar stroke might result in which of the following?
A. Left sided lower leg paralysis
B. Difficulty speaking and slurred speech
C. Vertigo and postural imbalance
D. Facial drooping
C
Which of the following is correct?
A. Hemorrhagic strokes are more common than ischemic strokes
B. An embolic stroke is exactly the same thing as a thrombotic stroke
C. The most common cause of a hemorrhagic stroke is an arterio-venous malformation
D. The middle cerebral artery is one of the more commonly involved cerebral arteries in ischemic strokes
D
Which of the following is correct regarding intra-cranial bleeds?
A. Subdural bleeding is usually arterial
B. Epidural bleeding is usually venous
C. Epidural bleeds are usually post-traumatic, where as subdural bleeds may occur spontaneously in some situations
D. Epidural bleeding rarely affects intra-cranial pressure…Although it may result in brain herniation
C
Unilateral paralysis involving which cranial nerve might mimic a stroke?
A. CN X
B. CN XIII
C. CN VII
D. CN XII
C (facial nerve that results in facial droop)
what is in the cell and what is out of the cell?
potassium IN, sodium OUT
dura mater
outermost meningeal later that is a thick, tough, and collagenous membrane
venous sinuses collect blood from the cerebral veins between the two layers of the dura at the base of the septum
arachnoid mater
thin, delicate membrane that is weblike that has CSF flowing within it
pia mater
attached to the brain and is very thin
carotid arteries
supply the anterior portion of the brain
vertebral arteries
posterior portion of the brain
trabecular
strands of collagenous connective tissue that extend down to the pia mater that forms the subarachnoid space
circle of willis
where the four arteries intersect and distributes the blood to the rest of the brain
what are the beings that return the deoxygenated blood?
internal jugular and subclavian
dorsal column tract
fine touch and pressure sensory
anterolateral tract
pain response sensory
corticospinal tract
voluntary motor
what is the most common type of stroke?
ischemic
thrombus (ischemic stroke)
blood clot formed in place that blocks blood flow that is often a result of hypercoagulation or stiffened/narrow blood vessels
clot travels
atherosclerosis (ischemic stroke)
build-up of fats/cholesterol on the artery walls
ischemic (embolus stroke)
obstruction of an artery by blood or air
associated with cardiac dysrhythmias and carotid arteries
clot doesnt travel
what are the two hemorrhagic stroke types?
subarachnoid and parenchymal
AVM (hemorrhagic stroke)
congenital vascular lesions that cause swelling
initial manifestation is hemorrhage in half the cases
aneurysm (hemorrhagic stroke)
not totally understood but is a weakness in the vessel that causes an out-pouching
high mortality rate
worst headache ever (meningeal irritation)
anterior cerebral (frontal) stroke signs
Motor and sensory loss on the opposite side with speech abnormality
middle cerebellar stroke signs
Motor and sensory loss on the opposite side with speech abnormality
posterior cerebral (occipital) stroke pattern
visual disturbance
vertebro-basillar (cerebellum/brainstem) stoke signs
disturbance of gait and visuals
umbra
core of the stroke
penumbra
the more reversible perimeter of the stroke
typical stroke manifestations
dysphagia
aphasia
middle cerebral artery or smaller branch involvement
BE FAST
epidural hematoma
blood sits above the dura
blunt force trauma to the temple
lucent interval
middl meningeal artery
Lucent interval
the section of time after the initial trauma of an epidural hematoma when the person is normal and conscious
subdural hematoma
sits IN the dura in the subarachnoid space
shearing forces
bridging veins
slow onset of symptoms
brain herniation
the protrusion of brain tissue through an opening in the supporting dura in the brain
Cushing triad:
bradycardia
irregular respirations
widened pulse pressure
glasgow coma scale
3-15 score
Eyes
Open
Open in response to speech
To pain
Never
Verbal
Oriented x 3
Confused speech
Inappropriate
Incomprehensible sounds
None
Motor
Obeys commands
Localized withdrawal from pain
Withdrawal from pain
Decorticate
Decerebrate
None (flaccidity)
meningitis
inflammation of the menninges that is most commonly caused by a bacteria
headache, fever, stiff neck, altered mental status
encephalitis
inflammation of the brain parenchyma that is most commonly caused by a virus (strep pneumonia, n meningitides, h influenza b)
typically evolve over several days and commonly include fever, headache, seizure, confusion, stupor, and coma
altered mental status is possible
seizure disorder causes
Electrolyte disturbances (most common)
Structural lesions (tumors)
Infection
Hypoxia
Acidosis
Acute Alcohol Withdrawal
Idiopathic
generalized seizure
involves the whole brain
motor/grandmal/ tonic-clonic
nonmoter/petit/absence syndromes (mostly kids)
focal seizures
involves part of the brain
simple is no impairment of consciousness but odd sensations, hearing troubles, etc
complex is imparted awareness
epileptic seizure
problem is primarily in the brain
causes:
Head trauma
Stroke
Infection
Tumor
Congenital
non-epileptic seizure causes
Fainting (hypoxic seizure)
Physiological
Hypoglycemia
Alcohol withdrawal
Electrolyte imbalance (MOST common)
dementia
progressive deterioration and decline of memory and other cognitive changes like personality and behavior changes that has a slow onset
dementia clinical manifestations
The slow progression from memory loss and forgetfulness to the inability to self-care
Cognitive deficits
Anxiety
Depression
Psychosis
Inability to complete activities of daily living
Alzheimer’s disease etiology
Amyloid plaques
Amyloid precursor protein= involved in normal cell membranes, but if beta-amyloid is produced wrong, the protein is cut in the wrong place which causes aggregates of B-amyloid form to create plaques in the brain
causes neurofibrillary tangles
atrophy of the brain
acetylcholine imbalance
vascular dementia
results from multiple infarctions of the brain
Parkinson’s disease
basal ganglia are affected but dopamine deficiency is big while acetylcholine is up (major imbalance)
acquired Parkinson’s disease
rapid onset of symptoms that tense to be due to infection, drug toxicity, or trauma
idiopathic Parkinson’s disease
insidious onset of symptoms that is likely from a genetic component
A synuclein gene- a major component of Lewy bodies
Parkin gene- protein degradation and clearance
what happens before the onset of symptoms of Parkinson’s?
75-80% of dopamine neurons in substantia nigra are dead
Parkinson’s clinical manifestations
Loss of flexibility
Tremor
Cogwheel rigidity
Bradykinesia
Micrographia
Mask faces
Low volume and monotone speech pattern
Autonomic dysfunction
tardive kinesia
older term for tic-type things that were associated with anti-psychotics
Cerebral palsy
conditions to the upper motor neurons that control muscle movement and often appear during childhood and are permanent
spastic CP
Most common
Rigidity/Hyperreflexia/Clonus
Hemiplegia/Paraplegia/Quadriplegia
dyskinetic/athenoid CP
Second Most Common
Slow, Jerky, uncoordinated purposeful movements
ataxic CP
Rare
Gait disturbance
Truncal stiffness
CP neurological complications
Seizures
Intellectual Impairment
Visual Problems
Hearing Problems
hydrocephalus
abnormal accumulation of CSF that is often associated with neural tube defects
normal pressure hydrocephalus
On-set late in life
Classic clinical triad:
Gait instability
Urinary incontinence
Dementia
obstructive hydrocephalus
usually congenital
communicating hydrocephalus
Aquired
cerebellar disorders
clinical hallmark is ataxia and uncoordinated movement
multiple sclerosis
chronic autoimmune demyelinating disease of the CNS with a female predominance
most are relapsing-remitting MS cases
MS clinical manifestations
Highly variable
Optic and oculomotor nerves are commonly effective
Lack of coordination
Diplopia
Paresthesias
spina bifida
failure of the neural tube to close
folate is important prenatally for prevention
spina bifida cystic
protrusion of a sac-like structure
spina bifida occulta
the anomaly is not visible
amyotrophic sclerosis
degradation of motor neurons of the lateral columns (cortico-spinal tract)
ALS clinical manifestations
Weakness
Atrophy
Cramps
Twitching
Hyperreflexia in a weak, atrophic extremity
Muscles of swallowing/breathing are affected
spinal shock
transient loss of function below the level of injury
Flaccid Paralysis
Loss of Reflexes
Loss of Pain Sensation
Loss of Bowel/Bladder Control
Guillain-barre syndrome
acute demyelination of the PNS that is often associated with infections triggers like C. jejuni
how does Guillain-barre syndrome progress?
Ascending pattern of paralysis that begins in the legs and progresses toward the head
spontaneous recovery in the reverse direction of the onset
Bells palsy
paralysis of the facial nerve VII that tends to affect one side
focal injury
localized at the site of impact on the skull
can be polar or diffuse
concussion
minor brain injury with no evidence on a scan but an alteration in LOC for less than 30 min
contusion
when brain tissue damage is seen
Polar injuries (coup contrecoup)
consequences of the brain shifting within the skull and meninges during acceleration-deceleration movement which results in injury at two opposite poles of the brain
Polar injuries (coup contrecoup)
consequences of the brain shifting within the skull and meninges during acceleration-deceleration movement which results in injury at two opposite poles of the brain
Monro-Kellie doctrine
the compensatory responses to a change in volume of any three components (CSF, brain tissue, and blood)
hemorrhagic strokes
hemorrhage within the brain parenchyma and usually occurs in the context of severe and often long-standing hypertension in approximately 60% of cases
ischemic stroke
sudden occlusion of a cerebral artery
thrombotic strokes
associated with atherosclerosis in extra or intracranial vasculature and hypercoagulable states
embolic strokes
from cardiac source
stages of a seizure
aura
tonic- stiff body, incontinence
clonic- jerky movements
postictal- exhaustion and weak limbs
Which of the following is incorrect?
A: Most seizures are probably idiopathic or hypoxic
B: Most cases of dementia are a result of the abnormal production of a normal protein
C: A patient presenting with a vertigo and ataxia is more likely to be having a cerebellar stroke than an inner ear problem
D: In a woman of childbearing age, a little extra folate isn’t a bad idea
C
Which of the following statements regarding Multiple Sclerosis is correct?
A. It is exactly the same disease as Guillan-Barre Syndrome, except MS is chronic and GB is not
B. Males tend to get MS more than Females
C. There is no cure for MS
D. MS almost always initially presents with diplopia
C
Which of the following signs and symptoms would be atypical for Parkinson’s disease?
A. A transient intention tremor in the right arm
B. Muscular rigidity
C. Depression
D. Kyphosis
A
Which of the following statements regarding ALS is correct?
A. It’s another non-specific demyelinating disease, like MS
B. The disease primarily affects upper and lower motor neurons
C. The disease primarily affects sensory neurons
D. Most cases are related to one specific identified genetic mutation, with autosomal dominant inheritance
A
