Neuropsych Flashcards
Epilepsy
Two or more unprovoked seizure, occurring less than 24 hours apart
Seizure disorders are caused by abnormal electrical activity in the brain; sudden electrical discharge in brain; leads to altered behaviour, consciousness or sensation
Causes for epilepsy
- Symptomatic - Structural abnormality in the brain (tumour) or symptom of comorbid condition (dementia or encephalitis)
- Idiopathic - Genetic; no other known cause
- Cryptogenic - Unknown cause
Stages of a seizure
Pre-ictal or prodrome – time before you get hit by the seizure
Ictal – when you experience your seizure
Inter-ictal period - Report emotional disturbances (anxiety & depression); characteristic patterns of brain waves associated with this
Post-ictal period - Brain activity back to normal; left feeling fatigued; vary in duration; confusion
Partial seizures
Simple partial - Twitching & posturing; sweating & altered heart rate; deja vu or jamais vu; pins and needles, olfactory sensation, electrical sensations
Complex partial - Lose consciousness; confused after seizure; automatisms; staring spells, screaming, running
Generalized seizures
Absence seizures - Mostly found in children; brief loss of awareness; sudden onset & no warning; staring episode (less than 15 seconds, looks like daydreaming, come back to normal alertness levels)
Tonic Clonic seizures - Jerky movements; tonic phase (body stiffens, loss of consciousness, upward rolling of eyes); clonic phase (muscle spasm, elbows, legs and head flexes)
Atonic seizure - Sudden loss of muscle tone (go limp); consciousness preserved; drop attacks; start in childhood till older (need to wear helmets to protect head)
Myoclonic seizures - Muscle jerks; muscles contract and relax; mistaken for clumsiness
Tonic seizures - Muscles become rigid; mostly while sleeping; might fall if standing
West’s syndrome
- Pediatric epilepsy syndrome
- Characterized by infantile spasms – head nods; developmental delay
- 5-30 seconds
- Mental retardation is common
- Progressive disorder
- Kids don’t survive beyond 5 years of age
Dravet’s syndrome
- Syndrome of infancy
- Genetic
- 5 seizures before 12 months
- Onset by 7 months
- Last longer than 10 min
- Learning difficulties common
Temporal lobe epilepsy
- Begins with aura
- Blank state
- Oromotor automatisms
- Tonic or dystonic (abnormal tone) upper limb posturing
- Head and/or eye deviations
- Speech arrest
Frontal lobe epilepsy
- Second most common type of focal epilepsy
- Seizures typically brief (< 30 seconds)
- Occurs in clusters, often multiple times a day
- Post ictal confusion is minimal or absent
- Semiology is often ‘bizarre’
- Abrupt onset of stereotyped hypermotor behaviour
- May look like individual is laughing or crying
- Jacksonian march – look like they’re marching
Ischemic stroke
Caused due to narrowing or blockage of blood supply, leading to loss of blood flow
Hemmohragic stroke
Burst of blood vessel leading to infarction
Thrombosis
Blockage of blood vessel due to coagulated blood
Embolism
Blockage in blood vessel due to other reason - fatty tissue, air, hardened tissue
Types of strokes
Lacunar infarcts - silent strokes, small parts of the brain lose blood
Massive strokes - large parts lose blood
Transient Ischemic Attack - Becoming amnesiac for period; less than 10 min; pins & needles; transient deficit in cognitive and physical abilities
Post stroke cognitive profile
- White and grey matter cell death
- Psychological symptoms
- Fall in attention, info processing, executive abilities
- Localized deficits
Common effects post stroke
Paralysis - can’t move or feel parst of body
Hemiplegia - can’t move or feel one side of body
Hemiparesis - weakness on one side of body
Hemianopia - info from one half of visual field doesn’t reach visual cortex
Types of Aphasia
Symptom of stroke
- Broca’s: articulation difficulties; telegraphic speech
- Wernicke’s: Comprehension difficulties; irrelevant speech
- Conduction: trouble repeating info; damage to arcuate fasciculus that connect Broca’s & Wernicke’s
Prosopagnosia
- Face blindness
- Inability to identify faces
- Caused by damage to the fusiform face area (located at the occipito-temporal junction)
Post traumatic amnesia
- Period of confusion after traumatic brain injury
- Disorientation, memory difficulties, confusion
- Last from minutes to day
- Reasons:
- Memories are often lost due to psychological repression of unpleasant memories
- Info may be incompletely encoded if events interrupt normal process of transfer from short to long term (transfer from hippocampus to frontal lobe is interrupted; things that have already made that transition aren’t affected)
- Traumatic stress events lead to long term physical reduction of volume of hippocampus
Retrograde amnesia
- Loss of memory for events before impact
- Follows damage to any part of the brain other than the hippocampus (for new memories) since long term memory is stored in neurons and synapses of various different brain regions.
- Results from damage to brain regions more closely related with declarative and episodic memory (temporal lobe and prefrontal cortex)
- Damage from blow to the head, stroke, tumor, hypoxia, chronic alcoholism
Cognitive deficits post traumatic brain injury
- Attention
- Information processing speed
- Executive functioning
Physical deficits post traumatic brain injury
- Coordination
- Fatigue easily
- Limb dysfunction
- Speech difficulty
- Sensory loss
Behavioural & emotional deficits post traumatic brain injury
- Sleep disturbance
- Personality change
- Irritability
- Depression
- PTSD
Deficits post traumatic brain injury in children
- Cognitive: Attention, info processing speed, emerging executive functioning, academic difficulties
- Physical: Coordination, fatigue, limb dysfunction, sensory loss, change in handedness
- Behavioral and emotional: Sleep disturbance, irritability, social skills, ADHD
Factors affecting recovery from traumatic brain injury
- Age: later injury (in life), less vulnerable the brain
- Genetic make-up
- Number of prior TBIs
- Severity of injury
- Cognitive reserve (education, IQ)
- Mental health
Wernicke’s encephalopathy
- Reversible dementia
- Characterized by any 2 of the following: Dietary deficiency; eye related signs; cerebellar dysfunction (balance); altered mental state/mild memory impairment
- Typically caused by excessive alcohol consumption
- Thiamine (vitamin B1) deficiency
Korsakoff’s syndrome
- Partially reversible dementia
- Anterograde and retrograde amnesia, gait difficulties
- Linked to long term alcohol abuse
- Impaired anterograde and partial retrograde memory; disorientation; confabulation; executive dysfunction
Parkinson’s disease dementia
• Distinguishing features
- Masked facies (facial expressions)
- Attention deficits
- Slowed processing speed
- Executive dysfunction
- Bradykinesia – slowed movement
- Bradyphrenia – slowed thinking
- Chief complaints – processing speed, executive functioning, attention
- Movement – tremors
Huntington’s disease
- Neurodegenerative disease
- Movement: Choreic movements – quick involuntary movement of feet and hand (comparable to dancing)
- Defining features: executive dysfunction, psychiatric symptoms
- Disease will eventually progress to dementia
• Primary complaints
- Psychiatric features
- Difficulty with coordination and balance
- Visuospatial difficulties
- Poor articulation and low volume (hypophonia)
Lewy-body dementia
• Chief complaints: disproportionate visuo-constructional difficulties
- Pathology: Lewy bodies (abnormal aggregates of protein created in nerve cells in Parkinson’s disease)
- Starts in cortical regions and moves to sub-cortical regions
• Neuropsychological profile
- Visual hallucinations
- Disproportionate visuospatial impairment
- Fluctuations in cognition
- Fronto subcortical profile – impaired executive function, apathy and impulsivity
Vascular cognitive impairment
• Patchy profile – inconsistent deficits (good on some and bad on others that tap the same skill)
• Low mood
• Symptoms depend on brain region affected
• Onset: sudden or gradual
• Progression: step wise
• General structural changes: white matter changes
• General features:
- Attention, processing speed, executive functioning, mood
- Motor symptoms – depending on where damage has been
