Special topics Flashcards
transient (moves around) event caused by abnormal excessive activity in the brain; sudden, excessive, abnormal electrical discharge of aggregates of neurons in the brain; 10% of population have one in their lifetime
Seizure
What can cause seizures?
- Mechanical: birth injuries, head trauma, tumors, vascular abnormalities (stroke)
- Metabolic: electrolyte disturbances, glucose abnormalities, inborn errors of metabolism
- Genetic: benign familial neonatal seizures, juvenile myoclonic epilepsy,
- Other: fever, infection
chronic disorder of recurrent seizures; Caused by genetics, TBI, stroke, brain tumor, cerebral palsy, infectious diseases; Cause can also be unknown
Epilepsy
What are the 3 questions you must ask in order to classify a seizure?
- Where does it start?
- Focal (one side of brain), Generalized (crosses over to different segments of the brain), or unknown - [if answer is focal] Do they have an impaired awareness or were they aware the entire time?
- Does it affect the motor abilities or not while the seizure occurs?
Inflammation of the meninges of brain and meninges of spinal cord; Swelling triggers symptoms (blockage of CSF flow); Fever, stiff neck, severe headache; Confusion and decreased alertness in severe cases; Can be viral, bacterial, or fungal
Meningitis
What are the viral causes of meningitis?
- Arbovirus
- Tibovirus (from ticks)
- enterovirus
- herpes simplex 2
- Epstein-Barr
When performing a lumbar puncture procedure, the CSF is cloudy. What does this indicate?
Bacterial infection causing meningitis
What are the bacterial causes of meningitis?
Streptococcal Pneumonia
What is kernig sign?
A hamstring stretch that causes non-hamstring sign
- pulls on inflamed meninges
What is brudzinski sign?
cervical flexion causing pain or hip flexion with knee flexion
Acute inflammation of the brain itself (primarily viral, but can be bacterial, parasitic, toxic drug rxns); Headache, fever, body aches, fatigue; Symptoms of altered brain function sooner compare to meningitis – confusion, decreased alertness (Immediate or latent)
Encephalitis
What are the viral causes of encephalitis?
- Herpes virus
- mosquito and tick-borne
- measles
- mumps
- rubella
Pathogenesis of inflammatory process in focal area that causes signs and symptoms at a greater rate than a brain tumor; Uncommon infectious disorder; Capsule has too much presser; some S and S are Fever, HA, Hemiparesis, disturbed consciousness
Brain abscess/ abscessi
Up to 5% of headaches have a serious cause. What are they?
- Tumors
- Infections of the CNS
- Brain hematoma or hemorrhage
What are the types of primary headaches (not caused by other diseases)?
Tension
migraine
cluster
Headaches caused by other diseases, resolve when the underlying problem is identified and treated
Secondary headache
Most common primary headache; Primarily a response to stress; Described as dull, non-throbbing, tightness, pressure; Whole head or neck; Caused by stress and fatigue
Tension-type headache
Familial disorder; Recurrent attacks; Widely variable in intensity, frequency and duration; Often unilateral; Dull or throbbing pain; Usually associated with nausea and vomiting; Pain builds up gradually; Last 4-72 hours; 12% of population; Increased risk of stroke especially when combined with aura type migraines and estrogen containing oral contraceptives; May be preceded by neurological and mood disturbances (aura); More common in women; Usually develop before age 40
Migraine
What are the theories on genesis of migraines?
- Peripheral sensitization
- Central sensitization
- Endocrine
- Serotonin/neurotransmitter
Rare but most painful of primary headaches; Men 20-50 years (27-30 most common); Correlation with prior head trauma; Weak genetic link; Sudden onset, severe pain; Pain remains on one side throughout life; Usually one eye and fronts-temporal region; Boring and non-throbbing; Autonomic symptoms are photophobia, tearing, nasal congestion; Induced by awakening from sleep
Cluster headache
What are typical patient characteristics of those with cluster headache/
- Hypermasculine appearance
- Increased and asymmetrical facial wrinkles
- Thick orange peel skin
- 3 inches taller
- Smokes cigarettes and drinks alcohol
- Anxiety, compulsivity and hypochondria
What are some types of secondary headaches?
- Cervicogenic (Tension headache that starts back here and moves up or starts “right here”)
- Posttraumatic (Whiplash)
- Medication overuse
- Sinusitis (Sinus Headache)
- Postdural puncture (due to changes in CSF pressure or amount)
Localized to neck and occipital region, usually bilateral, often starts in occipital region and moves anteriorly; Pain with certain neck movements - often ext and rotation or sustained neck positions; Trigger points – suboccipital, cervical or shoulder muscles – refer to head; Pain fluctuates between mild and severe; Whiplash—instability
Cervicogenic headache
What are headaches of pathological conditions
- Subdural/epidural hemorrhage (Usually more mild, intermittent, Fluctuating consciousness)
- Subarachnoid hemorrhage (Sudden, severe, and constant, Elevated BP, change in consciousness)
- Meningitis (Severe w/ radiation down neck, acute illness and fever)
- Increased cranial pressure (Mild to severe, Hemiparesis, visual changes, vomiting, change in consciousness)
- Brain tumor
Unilateral or focal followed by generalized ; Pain described as dull, aching, throbbing; Interrupts sleep or is worse upon awakening; Elicited by postural changes (especially lying down), coughing, or sneezing; Associated with nausea/vomiting or focal neurological signs; Recent onset; Become more frequent and severe over time
Brain Tumor Headache
What are the classifications of peripheral nerve injury?
- Neurapraxia
- Axonotmesis
- Neurotmesis
- Wallerian degeneration
segmental demyelination, slow or blocks nerve conduction at specific point, often occurs after nerve compression resulting in mild ischemia
Neurapraxia
axon damaged, connective tissue remain intact, occurs after prolonged compression resulting in necrosis, slow regeneration
Axonotmesis
most severe, complete disruption of nerve and connective tissue, occurs from trauma, see atrophy of muscle
Neurotmesis
in axono and neurotmesis axons distal to lesion degenerate, regenerate in axonotmesis
Wallerian degeneration
What are the neuropathy classifications?
- Mononeuropathy – single peripheral nerve
- Polyneuropathy – several peripheral nerves
- Radiculopathy – follows nerve distribution, involvement of nerve root as it branches from spinal cord
What are S andS of peripheral nerve dysfunction?
- Sensory loss follows nerve distribution
- Motor loss of muscles distal to the lesion
- No signs of CNS dysfunction
- Tingling, prickling, or burning paresthesias distal to the lesion
- Decreased or absent DTR’s
- ANS dysfunction (sweating/ vascular control)
What is the difference between myopathy and neuropathy?
- Myopathy – weakness tends to be more proximal (MD, Mitochondrial Disorders)
- Neuropathy – weakness first occurs distally (Carpal tunnel, radial tunnel, osteophyte)
similarities - weakness and hypotonia
Most common inherited disorder affecting motor and sensory nerves; Variable chromosomal defects (50 different spots); Change in protein involved in myelination
Initially involves the peroneal nerve and muscles of the foot and lower leg; Progresses to muscles of forearms and hands
Charcot-Marie-Tooth Disease
What disease do these clinical features indicate:
- Distal, symmetric muscle weakness and atrophy
- Diminished DTR’s
- Pes cavus deformities with hammer toes
- Foot drop
- Some patients experience diminished proprioception and sensation
- Symptomatic treatment (orthotics, arthrodesis)
Charcot-Marie-Tooth Disease
What is a common complication associated with diabetes mellitus?
Diabetic neuropathy
PT treatment:
- EDUCATION
- Wound care
- Gait training
- Aerobic exercise
Rapidly Reversible Neuropathy (can be reversed if caught early); Generalized Symmetric Polyneuropathies; Focal Neuropathies; Chronic metabolic disturbances; Hyperglycemia can be a factor; Nerve fiber loss/atrophy
Diabetic neuropathy
What are clinical features of diabetic neuropathy?
- Sensory loss
- Small fibers – burning pain
- Large fibers – painless paresthesia, impaired vibration, proprioception, touch, and pressure, loss of ankle DTR’s
- Motor weakness is mild
- Starts distally
What are some characteristics of a typical diabetic wound?
- round
- quick movement into depth
- bottom of the foot
Chronic Alcoholism leading peripheral neuropathy
Poor dietary habits, vitamin deficiency
Alcohol neuropathy
What do we need to watch out for with people who are laying and not moving a lot (i.e., people with chronic migraines, meningitis, west nile, alcohol neuropathy patient)?
Immobilized induced myopathy
Causalgia or Reflex Sympathetic Dystrophy (RSD)
Complex Regional Pain Syndrome (CRPS)
What are the types of CRPS?
- CRPS I: No apparent nerve injury – approx. 90% of cases
- CRPS II: Associated with a peripheral nerve injury
- Other
Precipitated by trauma of some sort, UMN lesion, or LMN lesion; Injury at one somatic level initiates sympathetic efferent activity that affects many levels
CRPS
What are the clinical features of CRPS
- Intense pain out of proportion to the severity of the injury (if an injury has occurred)
- Pain gets worse rather than better over time
- Most often affects one of the extremities (arms, legs, hands, or feet)
- Peripheral sensitization - Increased skin sensitivity
- Changes in skin temperature, color, texture
- Swelling and stiffness in affected joints
- Motor disability with decreased ability to move the affected body part
What medical treatments are done for CRPS?
- Psychotherapy
- Sympathetic nerve block
- Medications
- Spinal cord stimulation
- Intrathecal drug pumps
- Acupuncture
What PT treatments are used for systemic pathology of CRPS?
- Modalities for pain control
- ROM exercises
- Compression/elevation/massage
- Mobilizations
- Exercise program/Graded Motor Imagery/Aquatic
- Worst thing a patient can do is immobilize the extremity
