Prognosis in Patients with Neuromuscular Diagnosis Flashcards
1
Q
What are some factors that may impact prognosis
A
- Age: growth/develop Or experience
- lesion: site, location etc
- effect of experience/prior level of function
- comorbidities
- training
- motivation
- cognition
- depression/psychological issues
2
Q
Social determinants of health examples
A
- economic stability
- social and community context
- gender equity
- early child development/education
- globalization/urbanization
- health literacy and access to healthcare
- neighborhood and build environment
- stress
- income
- education
- work
- social support
- addiction
- transportation
3
Q
Prognostic imaging: CT
A
- on CT two signs have been correlated with prognosis:
- hyper dense middle cerebral artery (HMCA) shows bright on CT
- MCA “dot” sign
4
Q
HMCA sign
A
- significant stroke in that area
- positive when the MCA on one side appears denser than its counterpart and any other vascular structure
- associated with significant infarction of the MCA
- associated with severe ischemia and with poorer outcomes
- studies have shown that a positive HMCA alone is not a good prognosis indicator for poor function
5
Q
MCA dot sign
A
- MCA dot sign is smaller the HMCA sign
- associated with occlusion of the distal branches of the MCA
- on CT seen as hyper density of an arterial structure (seen as a dot) in the Sylvia fissure relative to the contralateral side or to other vessels within the Sylvia fissure
- the MCA dot sign with the HMCA sign is associated with a good prognosis
6
Q
Prognostic imaging: fMRI
A
- the activation pattern used by a patient after a stroke is well-correlated with level of recovery and outcomes
- activation maps similar to control associated with fewer residual impairments
- activation of motor areas in lesioned cortex associated with best recovery
7
Q
fMRI sign of good prognosis
A
- asked to move and there is B/L involvement on the brain
8
Q
Diffusion Tensor imaging
A
- uses diffusion of water at microscopic level to specifically view white matter (myelinated tracts)
- some association between corticospinal activity in acute stroke and functional outcomes at 3 months
- also used to look at brain activity in more severe injuries
9
Q
Determining infant prognosis
A
- MRI
- cranial ultrasound
10
Q
Pharmacology: prognosis and plasticity
A
- drugs for comorbidities
- drugs to enhance or promote recovery
11
Q
Name drugs that have been used to enhance or promote recovery
A
- serotonin
- dopamine
- antioxidants
- Bo Tox
- Gabapentin
12
Q
serotonin
what does it naturally do in the body
A
- important in modulating cognitive functions
- memory consolidation
- response inhibition: seeing something and it signs to stop
- learning and emotion
13
Q
Serotonin: SSRIs
A
- primarily used as anti-depressants
- inhibit removal of serotonin from synaptic cleft
- long-term use thought to desensitize and down regulate receptors
- may reduce neural inflammation, increase neurogenesis and increase neurotrophic activity
14
Q
FLAME study: SSRI fluoxetine (prozac)
A
- Fluoxetine for motor recovery after ischemic stroke
- subjects given fluoxetine after CVA
- improvement in arm and leg function after 3 months
15
Q
Dopamine
A
- important for movement (initiation, motor programs)
- important for learning, plasticity
- internal motivation and reward system
- studies using dopaminergic drugs or drugs that enhance dopamine have been inconclusive for improving motor recovery after stroke
- can lead to unwanted movement
