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OT 441: Neuroscience - Summer 2017 > TBI & CVA (16) EXAM 4 > Flashcards

TBI & CVA (16) EXAM 4 Flashcards

1
Q

What is an insult to the brain caused by external physical force? (Not of degenerative or congenital nature)

A

Traumatic Brain Injury

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2
Q

What is the prognosis in a TBI dependent on?

A
  1. Age
  2. Length of time in coma
  3. Length of time of post-traumatic amnesia
  4. Size of brain injury
  5. Location of brain injury
  6. Cause of injury (i.e. fall vs. gun)
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3
Q

What is a closed TBI?

A

Closed head injury

Skull is intact; no penetration of the skull

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4
Q

What is an open TBI?

A

Open head injury

penetration of the skull with direct injury to the brain

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5
Q

What is the most common type of TBI?

A

Focal (damage confined to a specific area)

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6
Q

What is a Focal Injury (TBI)?

A

Direct impact of short duration. typically related to acceleration/deceleration forces

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7
Q

What is coup-contra-coup and what classification of TBI is it seen in?

A

Brain is hurled against the skull; then it ricochets in the opposite direction (force may fracture skull)
Seen in Focal Injury

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8
Q

In coup-contra-coup, what lobes are most often damaged?

A

Frontal and temporal loves

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9
Q

What do focal injuries cause to happen?

A

Conusions (bruises) and hematomas (collections of blood - usually clotted)

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10
Q

What kind of TBI is diffuse and impacts several areas of the brain?

A

Diffuse Injury (actually multifocal because damage is not symmetrical)

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11
Q

What can diffuse injury (TBI) occur from?

A

Hypoxia, damage to blood vessels, rotational forces

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12
Q

What is the secondary damage in diffuse TBI?

A

Increased intracranial pressure, swelling, hemorrhage, oxygen deprivation

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13
Q

What is a stretch injury to the membrane of an axon, ultimately leading to axon breakage?

A

Diffuse axonal injury

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14
Q

What is a localized collection of blood, usually clotted, in a tissue or organ?

A

Hematoma

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15
Q

Epidural hematoma

A

Above dura (collection of blood)

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16
Q

Subdural hematoma

A

Below dura (collection of blood)

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17
Q

Intracerebral hematoma

A

In brain (collection of blood)

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18
Q

Contusion

A

Brusing brain

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19
Q

T or F: Impairments resulting from TBI are unpredictable; each outcome is unique?

A

True, symptoms can range from:
Loss of consciousness
Cognitive impairment
Communication, memory, neuromuscular, Personality/emotional, perceptual, sensory or visual

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20
Q

A state in which a person makes no purposeful response to the environment and from which he/she can not be aroused

A

Coma

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21
Q

How long does coma usually last?

What follows it?

A

Hours or days and usually followed by semi-coma (confusion)

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22
Q

Glasgow coma scale:

A

Way to record the conscious state of a person

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23
Q

Vegetative state

A

Unconscious with eyes open (TBIs)

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24
Q

A state of inconsistent, erratic responsiveness, generally unable to communicate with outside world

A

Minimally conscious state

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25
Q

Communication problems with TBI

A

Dysarthria (Slurred speech)

Aphasia (Deficit in language)

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26
Q

Memory problems with TBI

A

Anterograde vs retrograde

seen in severe injuries usually

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27
Q

Neuromuscular problems with TBI

A
  1. Spasticity, atypical (hyper reflexia) (UMN)
  2. Poor balance and equilibrium
  3. Abnormal posture
  4. Difficulty swallowing
  5. Extraneous Movements (tremors)
  6. Paresis/paralysis
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28
Q

With neuromuscular problems in TBI’s, how are the reflexes?

A

Atypical, spasticity (hyperreflexia) due to UMN damage

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29
Q

Personality/Emotional Changes with TBI:

A
  1. Impulsive and poor judgement
  2. Irritable
  3. Apathy
  4. Altered sex drive
  5. Decrease in goal-directed behavior
  6. Impaired social skills
  7. Limited self-awareness
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30
Q

Perceptual problems with TBI

A
  1. Visual spatial
  2. Poor body awareness
  3. Apraxia
  4. Unilateral neglect (R PTO)
  5. Agnosias (R PTO)
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31
Q

Somatosensory problems with TBI

A
  1. Feeling
  2. Discriminative touch
  3. Vibration
  4. Temperature
  5. Pain
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32
Q

Visual problems with TBI

A
  1. Diplopia (double vision)
  2. Visual field loss
  3. Acuity loss
  4. Poor eye movements
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33
Q

How much total blood volume circulates to the brain?

A

15-18% (even though brain is only about 2% of our body weight)

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34
Q

Arterial Supply of the brain:

A
  1. Internal Carotid (anterior)

2. Vertebral-Basilar (posterior)

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35
Q

Internal Carotid Artery supplies:

A

Majority of cerebral hemispheres

36
Q

Vertebral-Basilar Supplies:

A

Brainstem, cerebellum and some of the cerebral hemispheres

37
Q

Which artery merges at the brainstem to form the basilar artery?

A

Vertebral-Basilar artery

38
Q

What makes up the circle of Willis?

A

The branches of the internal carotid and basilar arteries (posterior, anterior and middle cerebral arteries)
(they form a circle)

39
Q

Anastomosis

A

Ring of nine arteries that supply ALL the blood the the brain

40
Q

What are the nine arteries that supply all the blood to the brain?

A
  • 6 large arteries (2 posterior/anterior and middle) (each has a cortical and a deep branch)
  • 3 small communicating arteries
41
Q

What does the internal carotid branch into?

A 
Anterior cerebral (medial)
Middle cerebral (lateral)
42
Q

What do the vertebral arteries join together to form?

A

Basilar artery

43
Q

What does the basilar artery branch into?

A

Posterior cerebral artery (PCA)

44
Q

What does the middle cerebral artery supply on the surface?

A

Lateral surface of most of the lateral hemispheres: frontal, parietal and temporal lobes (not inferior temporal lobes though)

45
Q

What does the middle cerebral artery supply deep?

A

Deep structures of the internal capsule, basal ganglia, indirectly optic tract and radiations

46
Q

What does the anterior cerebral artery supply?

A

Medial aspect of frontal and parietal lobes

47
Q

What part of brain do the branches of the anterior cerebral artery reach?

A

Diencephalon, limbic, caudate, internal capsule, undersurface of parietal lobe and part of frontal

48
Q

What is the anterior cerebral artery formed from?

A

Internal carotid

49
Q

What is the posterior cerebral artery formed from?

A

basilar artery

50
Q

Posterior Cerebral Artery supplies what?

A

Supplies undersurface and posterior surface of the temporal lobes and occipital lobes

51
Q

Where is the basilar artery?

A

Runs along the posterior surface of brainstem at level of pons

52
Q

Where do the branches of the Basilar Artery wrap around to?

A

Cerebellum and internal auditory artery

53
Q

Is there one or two basilar arteries?

A

ONE

54
Q

Complete occlusion of Basilar Artery:

A

Death due to ischemia of brainstem nuclei and tracts that control vital functions

55
Q

Partial occlusion of Basilar Artery:

A

Tetraplegia, loss of sensation, coma, CN signs (bilateral)

56
Q

Severe partial occlusion of Basilar Artery:

A

Locked-in syndrome

57
Q

Damage to cerebellar arteries (not getting into specific names)

A

Bad balance, lack of coordination, nystagmus, dizziness

58
Q

Anterior Supply of arteries:

A

Internal Carotid System
Middle cerebral artery (MCA)
Anterior Cerebral Artery (ACA)

59
Q

Posterior Supply of arteries:

A

Vertebral-Basilar system
Posterior cerebral artery (PCA)
Cerebellar Arteries

60
Q

Ischemia

A

Local, temporary loss of blood supply
(lose consciousness after about 10 seconds)
(electrical signal ceases after about 20 seconds)

61
Q

Infarct:

A

Area of tissue death due to loss of blood supply

62
Q

Cerebrovascular Accident (CVA): What is it?

A

Focal neurological disorder of relatively abrupt onset due to a pathological process in a blood vessel, usually within one hemisphere of the brain

63
Q

CVA: Aka?

A

Stroke or brain attack

64
Q

CVA: Transient Ischemic Attack (TIA)

A

Brief, focal loss of brain function
Usually full recovery w/in 24 hours
Sign of risk for stroke

65
Q

What is the leading cause of serious long-term disability?

A

Stroke

66
Q

CVA: Completed Stroke:

A

Neurologic deficits from vascular disorders that persist more than 1 day and are stable

67
Q

CVA: Progressive Stroke:

A

Deficits increase intermittently over time

68
Q

Types of Strokes: Brain Infarction - Caused by??

Ischemic/non-hemorrhagic/Occlusive

A

Blockage of blood vessel producing ischemia, resulting in infarct

69
Q

What % of strokes are ischemic?

A

90%

70
Q

What causes blockage in Brain Infarction stroke?

A

Thrombus

Embolism

71
Q

Thrombus (Thrombotic Stroke)

A

Formation of blood clot within an artery (it stays there and doesnt travel)

72
Q

Embolism (Embolic stroke)

A

Blood clot formed, was dislodged, traveled in the blood stream and then became trapped in arteries closer to the brain

73
Q

Which type of stroke is a rupture of blood vessel, with bleeding into or around cerebral tissue?

A

Hemorrhagic Stroke

bleeding irritates brain tissue, causing swelling

74
Q

What displaces normal brain tissue in a hemorrhagic stroke?

A

swelling and hematoma compressing

75
Q

What causes hemorrhagic stroke?

A

High blood pressure

76
Q

Aneurysm:

A

Weak spot in an artery wall

Eventually it can burst and cause serious harm

77
Q

Amyloid Protein in hemorrhagic stroke:

Who is it commonly seen in?

A

Makes vessels more prone to bursting

Seen in elderly

78
Q

Stroke Symptoms

A

Face (uneven smile)
Arm (weakness or inability to move)
Speech (Slurred)
Time (call 911)

79
Q

Prognosis of Stroke: If neuronal cell death occurs

A

If neuronal cell death occurs, permanent impairment

80
Q

Prognosis of Stroke: After edema (swelling) subsides

A

Spontaneous recovery

likely to take place within 6 months

81
Q

Stroke: Common deficits:

Motor

A

UMNs affected

  1. Flaccidity first (cerebral shock) then spasticity (b/c UMN not turning reflex arc off)
  2. Paresis/paralysis
  3. Hemiplegia (paralysis one side of body)
  4. Apraxia
82
Q

Stroke: Common deficits:

Sensory

A
  1. Rarely in isolation (usually associated w motor)

2. Depends on where lesion is

83
Q

Stroke: Common deficits:

Visual

A

Contralateral homonymous hemianopia

84
Q

Stroke: Common deficits:

Emotional

A
  1. Depression
  2. Fear/Anxiety
  3. Emotional changes
  4. Apathy
85
Q

Stroke: Common deficits:

Perception

A
  1. Agnosia
  2. Body Schema
  3. Visual-spatial
  4. Constructional Praxis
86
Q

Stroke: Common deficits:

Cognition

A

Various

87
Q

Stroke: Common deficits:

Language

A
  1. Aphasia (loss of ability to understand or express speech)

2. Dysarthria (slurred speech)

OT 441: Neuroscience - Summer 2017 (11 decks)

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