Quiz 2- Neurological Disorders Flashcards
1
Q
Lobes of the brain and their functions
A
Frontal - speech Parietal - sensory Temporal - auditory Occipital - vision Cerebellum - proprioception, fine muscle mvmnt Brain stem - midbrain, pons, medulla
2
Q
gyri
A
bulges
3
Q
sulci
A
small indentations
4
Q
fissures
A
large indentations
5
Q
cerebellar disorders
A
ataxia decreased tendon reflexes asthenia (muscles tire more easily than normal) tremor nystagmus
6
Q
Ascending pathway: spinocerebellar tract
A
unconscious proprioception
tracts come from the same side and do not cross
ipsilateral sx
7
Q
Ascending pathway: spinothalamic tract
A
pain, temp, light touch
crosses over
loss of pain-temp contralaterally
8
Q
Spinal cord comprised of
A
grey matter- neuronal cell bodies and synapses
white matter - ascending and descending tracts
9
Q
Descending Tracts (Motor): Corticospinal Pathway
A
Upper Motor Neuron (UMN): pathway from brain to spinal cord before synapse
Lower Motor Neuron (LMN): postsynaptic pathway from spinal cord to periphery (peripheral nerve)
10
Q
Damage to a UMN causes
A
- hypertonia or spasticity
- decreased motor control and inability to perform fine motor movements
- reflexes can be spastic
- (+) Babinski
11
Q
Damage to a LMN causes
A
- decreased tone (hypotonia)
- decreased strength (weakness)
- decreased reflexes in affected areas
12
Q
Within the CNS a bundle of pathway axons is known as
A
a tract
13
Q
Outside the CNS (in the peripheral nerves, which connect the CNS with skin, muscles and other organ systems) a bundle of pathway axons are called
A
a nerve
14
Q
Superior Sagittal Sinus
A
Spinal fluid drains here
15
Q
Cavernous Sinus
A
Drains the eye; potential source into the brain of infx from eye or face
16
Q
Transverse Sinus
A
Runs by the ear: may become involved in inner ear infx
17
Q
for ROS in regards to HEENT make sure to ask __________?
A
Headache?
Visual changes?
dizziness
18
Q
for ROS in regards to neuro make sure to ask______?
A
Tremor? Weakness or sensory loss? LOC? Motor dysfunction Speech or swallowing concern
19
Q
mental status exam includes________?
A
FOGS F: family story of memory loss O: orientation to time G: general info S: spelling
20
Q
what are the two types of MSE?
A
Mini Mental Status Exam (MMSE)- shorter
Montreal Cognitive Assessment (MoCA)- spatial info
21
Q
key motor tests:
A
-Drift of upper extremity (and lower if necessary)
Have pt. close eyes and hold arms horizontally forward, palm up for 15-30 sec
If +, hand will drop and rotate in (if neurological problem pronator muscles with override supinator muscles)
-Hand grasp and toe dorsiflexion
Weakness is commonly seen in upper motor neuron lesion
Cross hands, have pt. grasp index and middle fingers
Move toe and foot against resistance
22
Q
We all need 2 out of the following 3 senses to maintain balance
A
Vision
Vestibular sense
Proprioception
23
Q
We all need 2 out of the following 3 senses to maintain balance
A
Vision
Vestibular sense
Proprioception
*Rhomberg test
+ test is when pt sways when eyes are closed (either vestibular or proprioception defect)
24
Q
A + Babinski indicates a lesion where?
A
UMN lesion
25
What are the tests to rule out meningeal irritation?
Kernig
(+) -> pain in low back on straightened lower extremity)
Brudzinski
(+) -> flexion of the head results in marked neck pain and involuntary flexion of the hip and lower extremities
26
Basic labs to consider for neurological problems?
CBC
CMP
TSH
Bedside glucose
27
Additional labs to consider for neurological problems?
Celiac (anti-gluten Abs, TTG)
Heavy metal testing (whole blood, hair analysis, urine with and without provocation)
Environmental testing for solvents, pesticides, etc
28
Top 3 imaging to order for neurological disorders?
Lumbar puncture
CT
MRI
29
stroke that involves the anterior artery supply typically have
unilateral involvement
30
stroke that involves the posterior supply typically have
unilateral or bilateral
| more likely to affect consciousness (LOC)
31
risk factors for stroke
```
Prior stroke
Older age
Family history of stroke
Alcoholism
Male sex
Hypertension
Cigarette smoking
Hypercholesterolemia
Diabetes
Use of certain drugs (eg, cocaine, amphetamines)
```
32
Ischemic stroke
thrombotic
embolic
lacunar
TIAs
33
embolic stroke
quicker onset
during day
H/A may precede neurological deficit
34
thrombotic stroke
slower onset, "evolving stroke" - unilateral neurologic dysfunction often beginning in one arm and then spreading ipsilaterally
occurs at night, usu noticed upon waking
extends w/out H/A
35
lacunar stroke
Pure motor hemiparesis
Pure sensory hemianesthesia
Ataxic hemiparesis
36
how to dx for a stroke?
clinical - FAST (facial drooping, arm drop, speech difficulties, timing (if all the above occur, call 911)
imaging - CT (1st), MRI (2nd)
bedside glucose testing - to r/o hypoglycemia
37
ddx for stroke
```
Hypoglycemia
Postictal paralysis
Hemorrhagic stroke
Migraine
Tumor
Systemic condition: Guillian Barre, Bell’s Palsy
syncope
```
38
types of hemorrhagic stroke
intracerebral hemorrhage
| subarachnoid hemorrhage
39
definition of intracerebral hemorrhage
Focal bleeding from a blood vessel in the brain parenchyma
40
causes of intracerebral hemorrhage
```
HTN (most common)
less common
Arteriovenous Malformations (AVMs)
Aneurysm
Trauma
Brain tumor
Bleeding disorder
```
41
ssx of intracerebral hemorrhage
focal neurological deficit wi
H/A
nausea
impairment of consciousness
42
definition of subarachnoid hemorrhage
sudden bleeding into the subarachnoid space
43
cause of subarachnoid hemorrhage
ruptured aneurysm
44
ssx of subarachnoid hemorrhage
sudden severe H/A with LOC
| severe neurologic deficitis
45
dx of subarachnoid hemorrhage
non-contrast CT
| if neg, follow with lumbar puncture (to r/o meningitis)
46
broad differences between ischemic and hemorrhagic stroke
hemorrhagic stroke is more severe, sudden onset and more often involves LOC
47
both dementia and delirium are characterized by disordered thinking, but they differ in
dementia- affects memory, progressive
| delirium- affects attention, usu reversible if can remove cause
48
delirium
caused by
prognosis
incidence
acute illness or drug toxicity, or dehydration
often reversible
more common in elderly (if in young ppl, usu due to drug use or life threatening systemic disorder)
49
SSX of delirium
Difficulty focusing, maintaining or shifting attention
Fluctuating consciousness
Disorientated to time and sometimes to place
May have hallucinations, delusions, and paranoia
Confusion
Changes in personality or affect
50
want to rule out DDX in order to arrive at delirium (it's a tricky one to arrive at). What's the nemonic for a DDX?
```
I WATCH DEATH
Infectious
withdrawal
acute metabolic disorder
trauma
CNS pathology
Hypoxia
Deficiencies
Endocrinopathies
Acute vascular
Toxins
Heavy metals
```
51
which 3 things must be present to dx delirium?
- acute change in cognition that fluctuates throughout the day
- inattention (difficulty focussing or following what is said)
- plus one of the following (disturbance of consciousness or an altered level of consciousness or disorganized thinking)
52
labs/imaging for delirium
```
First Set:
CT or MRI
Tests for suspected infection (CBC, Blood Cultures, UA)
Chest film
Electrolytes
BUN
Creatinine
Plasma glucose
Blood levels of any drugs
Urine drug screen
```
53
PE for delirium
vitals, neurologic exam, hydration status
54
prognosis for delirium
Delirium due to certain conditions typically resolves with treatment but resolution may be slow
For up to 2 yr after a delirium event: risk of further decline is increased
55
dementia
caused by
prognosis
caused by anatomic changes in the brain
| irreversible
56
dementia most often results from which neurologic progressive diseases?
```
Alzheimer’s Dementia
Vascular Dementia
Lewy Body Dementia and Parkinson Disease Dementia
HIV-associated Dementia
Frontotemoral Dementia
```
57
SSX of dementia
Impairs cognition globally
Onset is gradual
Short-term memory loss may be the first sign
Personality and behavioral disturbances may develop early or late
Motor and other neurological deficits (occur at different stages depending on the type of dementia)
Incidence of seizure is increased
Psychosis in 10%
58
early stage of dementia
Recent memory is impaired
May have progressive difficulty with independently doing ADLs (balancing checkbook, remembering where they put things, etc.)
May have agnosia, apraxia, aphasia
May have beginning of personality changes
59
intermediate stage of dementia
Inability to learn and recall new info
Memory of remote events reduced but not lost
May need help with basic ADLs (bathing, eating, dressing, toileting)
Loss of sense of time and place
Are ambulatory but often get lost and are at risk of falls due to confusion
60
late stage of dementia
Cannot walk, feed themselves, or do any other ADLs
May become incontinent
May be unable to swallow
End-stage usually results in coma or death, usually from infection
61
dx for dementia
Requires all of the following:
Cognitive or behavioral (neuropsychiatric) symptoms interfere with the ability to function at work or do usual daily activities.
These symptoms represent a decline from previous levels of functioning.
These symptoms are not explained by delirium or a major psychiatric disorder.
And cognitive or behavioral impairment should have ≥ 2 of the following:
Impaired ability to acquire and remember new information (amnesia)
Language dysfunction (aphasia)
Visuospatial dysfunction (agnosia; eg, inability to recognize faces or common objects)
Impaired executive function, including reasoning, handling of complex tasks, and/or judgment (apraxia)
Changes in personality, behavior, or comportment.
62
Alzheimer's disease caused by
beta-amyloid deposits and neurofibrillary tangles
63
genetic component of Alzheimer's- which loci is involved that is also implicated in Down syndrome?
21 (amongst others)
64
best predictor of AD?
age
65
what finding is directly related to severity of dementia?
number and distribution of neurofibrillary tangles
66
risk factors for AD
```
Advanced age
Family history (esp. if seen in 1st deg. relatives)
ApoE genotype
Trisomy 21 (AD develops in all patients by age 35 because of increased deposition of β-amyloid)
```
67
SSX for AD
Early, intermediate and late stages (see Dementia in general)
Loss of short term memory is typically the first sign
Increasing forgetfulness (can’t remember words, names, disorganization of bills and medications, burnt pots on the stove)
Increasing repetitiveness
Asking the same question over and over or having the same conversation minutes after it was completed
Behavioral sxs become common
Suspicious or paranoid behavior
Agitation, yelling, wandering
68
DDX for AD
The absence of motor deficits helps to differentiate AD from most other dementias
However, as AD progresses, Parkinsonism can become evident making differentiating AD from Lewy body dementia more difficult
69
Traditional Criteria for Dx includes all of the following:
Dementia established clinically and documented by a formal mental status examination
Deficits in ≥ 2 areas of cognition
Gradual onset and progressive worsening of memory and other cognitive functions
No disturbance of consciousness
Onset after age 40, most often after age 65
No systemic or brain disorders that could account for the progressive deficits in memory and cognition
+really know this
70
AD
labs
PE
imaging
no standard labs
neuro exam
CT or MRI (may show loss of volume)
71
Vascular dementia
due to cerebral infarction
| 2nd most common cause of dementia in elderly
72
vascular dementia is the most common in those with vascular risk factors of
```
HTN
hyperlipidemia
DM
smoking
several strokes
```
73
SSX of vascular dementia
similar to other dementias
Exaggeration of deep tendon reflexes (UMN lesion)
Extensor plantar response (Babinski response)
Gait abnormalities
Weakness of an extremity
Hemiplegias
Pseudobulbar palsy with pathologic laughing and crying
74
DX
history
imaging
hx: reveals history of stroke
imaging: CT and MRI may show multiple BL infarcts
75
Lewy Body Dementia is characterized by
cellular inclusions called lewy bodies in the cytoplasm of cortical neurons
76
Parkinson Disease Dementia is typically characterized as a
movement disorder but dementia can form late in the disease. Dementia is from lwey bodis in the substantia nigra
77
comparing and contrasting Lewy Body Dementia with Parkinson Disease Dementia
Lewy Body Dementia- cognitive and extrapyramidal (gate) sxs usu begin within 1 year of each other
Parkinson Disease Dementia- cognitive sxs don't begin until 10-15 years after motor sxs, psychiatric sxs (hallucinations, delusions) less frequent than Lewy Body Dementia
78
what is the definitive dx for Lewy Body Dementia and Parkinson Disease Dementia?
autopsy samples of brain tissue
| CT and MRI not helpful except to rule out other conditions
79
what's the thing that differentiates HIV-associated dementia from all other forms of dementia?
Unlike almost all other forms of dementia, tend to occur in younger people
