Week 3

Question 1

Significance of neurological disorders

Answer 1

Neurological disorders include developmental and acquired disorders which result in impaired functioning (abnormal development, delay, loss of function)

Sudden versus gradual onset

Progressive versus non-progressive

The population of people living with neurological disorders is increasing

Psychologists have an important role in assessment, clinical management and research

Question 2

ABI: External

acquired brain injury

TBI

Answer 2

Traumatic brain injury (TBI)
Motor vehicle and other traffic accidents
Falls
Hit by an object
Assault
Sports related
Work-related or industrial accidents

Question 3

External Causes of ABI

Answer 3

Poisoning
Inhalation of organic solvents
Hypoxia/anoxia (e.g. near drowning, cardiac arrest)
Alcohol and drug abuse
Infections and diseases
HIV/AIDS
Bacterial (e.g. meningitis and brain abscesses)
Viral (e.g. herpes simplex)
Parasitic (e.g. cerebral malaria)
Encephalitis (inflammation of CNS due to infection)

Question 4

Internal Causes of abi

Answer 4

Strokes and aneurysms
Tumours
Epilepsy
Metabolic disturbance (e.g., diabetic coma)
Dementia

Secondary effects of TBI

• –Haemorrhage or haematoma
• –Intracranial pressure
• –Oedema or brain swelling
• –Post-traumatic epilepsy

Question 5

Gradual and (usually) Progressive Conditions

Answer 5

Alzheimer’s disease (and other dementia-type conditions)
Parkinson’s disease
Multiple sclerosis
Huntington’s disease
Wernicke Korsakoff’s syndrome

Question 6

Australian Statistics

Answer 6

Rate per 100,000

TBI — 150male, 65female, 22,000 new cases per year

Stroke — 175 male, 172 female, 50000 new cases per year

dementia — 325 male, 449 female, 93000 new cases per year

Question 7

Head Injury: TBI

Open Head Injury

Answer 7

Penetration of skull and protective membrane
—eg. Gun shot, sharp objects

Symptoms:

• Often no loss of consciousness
• Localised symptoms
• Relatively rapid and spontaneous recovery

Question 8

TBI: Head Injury

Closed Head Injury

Answer 8

No penetration of skull or protective membrane

Damage results from mechanical forces

Diffuse axonal injury and contusion in frontal and temporal area

Car accident, fall, assault, sport

Question 9

Concussion

Answer 9

a violent jarring or shaking that results in the disturbance of brain function:

Concussion, also known as mild traumatic brain injury (mTBI), is typically defined as a head injury that temporarily affects brain functioning.[8] Symptoms may include loss of consciousness (LOC); memory loss; headaches; difficulty with thinking, concentration or balance; nausea; blurred vision; sleep disturbances; and mood changes.[1] Any of these symptoms may begin immediately, or appear days after the injury,[1] and it is not unusual for symptoms to last four weeks.[2] Fewer than 10% of sports-related concussions among children are associated with loss of consciousness.[9] (wikipedia)

Question 10

Secondary Injury

from something like a car crash where ones head goes forward then backward

Answer 10

Haematoma
Subdural
Epidural
Intracerebral

Question 11

Traumatic Brain Injury

Classification – Severity

Answer 11

Outcomes are predicted using various factors

1) GCS (glasgow coma scale) – presence and depth of coma
2) Post-traumatic amnesia (PTA) – period of time prior to return of ongoing memory
3) Results of neuroimaging

Question 12

GCS severity

Answer 12

if pta < 5 mins - - very mild

5-60 mins — gcs 13-15 — mild

1-24 hours — gcs 9-12 — moderate

1-7 days —- gcs 3-8 – severe

1-4 weeks –gcs…– very severe

over 4 weeks = extremely severe

Question 13

tbi consequences

Answer 13

Consequences vary markedly 
Alterations in consciousness – coma, fatigue/drowsiness
Cognitive deficits 
Physical deficits
Emotional/Behavioural deficits

Question 14

Role of Neuropsychology

Answer 14

Not generally involved in the initial weeks/months following severe TBI

Role to assess the extent of persisting symptoms – cognitive and behavioral and infer their impact on functioning

Educate clients and families about expected outcome and management

Design and implement strategies to assist clients to manage their deficits in daily life (rehabilitation)

Question 15

Brain Tumour (Neoplasm)

Answer 15

Diagnosis: headache, vomiting, mental dullness, seizures, increase in ICP, brain scans

Biopsy and histopathology analysis of tumour cells to identify type and grade

Prognosis: varies with age, tumour type, grade, treatment regime and genetics

Treatment: active monitoring & surveillance, surgery, chemotherapy, radiation therapy

Question 16

Brain Tumour (Neoplasm)

Benign (2,000 new cases per year in Aus)

Answer 16

Not likely to recur after removal

Encapsulated or distinct border

Compression/displacement effects

Can still be very serious depending on size and location (e.g., brain stem, midline or medial)

Question 17

Distribution of All Primary Brain and CNS Tumors by Site

Answer 17

majority = Meninges

Question 18

Brain Tumour – Malignant (Grades III-IV)1,800 new cases in Australia per year

Answer 18

Cancerous

Likely to recur after removal

Gliomas and metastatic tumours are most serious (fast growing)

Metastatic tumours originate in other parts of the body

Lacks a distinct border and infiltrates surrounding tissue

Complete removal is not possible (microscopic cancer cells beyond the tumour edge) and may metastasize

Question 19

types of malignant brain tumours

Answer 19

Glioblastoma multiforme (this is what andrew had)

Anaplastic astrocytoma

Oligodendro-glioma (III-IV)

Question 20

Tumour-Related Brain Damage

Answer 20

Compression and displacement effects

Raised intracranial pressure, impaired CSF flow, swelling (steroid effects) and bleeding

Infiltration or invasion of surrounding brain tissue and cell necrosis

• –Mass effects: widespread damage or disruption to brain functioning - more generalised impairment
• —Focal effects: more localised damage and specific cognitive deficits

Neurotoxic effects of treatment: damage to healthy tissue, e.g., white matter abnormalities due to chemotherapy or radiation exposure

Question 21

Gliolan

Answer 21

drug used for surgeons to visualise brain tumours more clearly during surgery - surgery is done in the dark.

Question 22

Making Sense of Brain Tumour Psychotherapy trial

Answer 22

10 week home-based therapy program

RCT with 50 people and family members

Person-centred focus on sense of coherence

• –Understanding of their illness
• –Management of its effects
• –Ability to find meaning

Significantly greater reduction in depressive symptoms and improvement in existential well-being and quality of life compared to wait list controls (Ownsworth et al., 2015)

Endorsed by the International Palliative Care Guidelines for adults with glioma (Pace et al., 2017)

Question 23

Important Facts About Stroke

Answer 23

Australia’s 2nd leading
cause of death after
coronary heart disease

1 in 6 people will have a stroke in their lifetime.

In 2012 about 50,000 Australians suffered new and recurrent strokes = 1000 strokes every week or one stroke every 10 minutes

The total financial costs of stroke in Australia were estimated to be $5 billion in 2012.

Close to 20 per cent of all strokes occur to people under 55 years old.

Question 24

Stroke: Important Facts

FAST

Answer 24

The FAST test is an easy way to recognise and remember the signs of stroke. Using the FAST test involves four simple questions:

• Face – Check their face. Has their mouth drooped?
• Arms – Can they lift both arms?
• Speech – Is their speech slurred? Do they understand you?
• Time – Time is critical. If you see any of these signs call 000 now!

Question 25

Cerebrovascular Disorder or Stroke type 1 (CI)

Answer 25

``` Sudden appearance of neurological symptoms as a result of severe interruption of blood supply to the brain. Types 1. Cerebral ischaemia ----Thrombosis ---Embolism ---Arteriosclerosis ```

Question 26

Ischemic Stroke: Thrombosis

Answer 26

Fat deposit build-up in the walls of the arteries (atherosclerosis) Deposits thicken and produce blockage in artery Blood forms over clots and leads to total obstruction Usually arise from lesions in the internal carotid (MCA – frontal, parietal and temporal structures) or vertebrobasilar arteries (brain stem, temporal and occipital)

Question 27

Embolism

Answer 27

Plug of material breaks away (e.g., post-surgery), fatty tissue, debris or air bubbles. Microemboli – tiny bits of plaque that obstruct the smallest arteries of the brain.

Question 28

Cerebrovascular Disorders 2. Cerebral haemorrhage

Answer 28

Cerebral haemorrhage: (Causes) - --High blood pressure - --Aneurysm - --Arteriovenous malformation (AVM) - --Angioma

Question 29

Circle of willis | ha

Answer 29

the underside of the brain where the arteries interconnect

Question 30

Cerebrovascular Disorders diagnosis and treatment

Answer 30

Diagnosis Symptoms (headache, dizziness, impaired consciousness, loss of sensation, loss of or impaired speech) Scans Treatment Surgery (e.g., coils, clipping) Medication (e.g., anticoagulants) Rehabilitation (physical, speech, cognitive, emotional)

Question 31

Stroke Types

Answer 31

Hemorrhagic stroke: bleeding occurs inside or around brain tissue Ischemic: clot blocks blood flow to an area of the brain

Question 32

Symptoms depend on cause, location and severity of blockage –

Answer 32

loss of consciousness (death) to slight confusion/headache Generally – lower down/larger, bilateral & more generalised deficits Mostly unilateral effects Left – right sided weakness, language deficits, Right – left sided weakness, visuo-perceptual deficits

Question 33

Cerebral Aneurysm: weakening and ballooning of a blood vessel

Answer 33

Cerebral aneurysm is the most common cause of subarachnoid haemorrhage (SAH), but also can be intracranial Usually caused by congenital abnormality Est. 2% of population have these (unruptured), 10% with multiple Peak risk – 40-60 years, female, hypertension, artherosclerosis, smoking, stress 40-50% die immediately or within one month. 50% of survivors have long-term impairments Rupture: Sudden explosive headache Damage caused by pressure effects may result in focal damage and blood in the brain Generally asymptomatic until rupture (not known), Ruptured - Explosive headache (usually while doing something energetic), altered consciousness, vomiting Unruptured – found incidentally or may experience some headache, lethargy or other neurological deficits attributed to the site of lesion

Question 34

Angiography

Answer 34

radiography of blood or lymph vessels, carried out after introduction of a radiopaque substance. An angiogram is a test in which fluid is injected into the bloodstream to make blood vessels visible on a scan. Angiograms help doctors detect abnormal blood vessels, clots and other problems.

Question 35

Treatment | of anuerism

Answer 35

Craniotomy and repair – goal to repair the aneurysm and prevent re-bleed Clipping requires craniotomy and brain retraction surgical clip is placed across the neck of the aneurysm once secure – aneurysm ruptured and suctioned Coiling procedure carried out under angiography (dye injection) - micro-catheter placed in neck of aneurysm - fine stainless steel coiled wire is fed through catheter – coil released, numerous coils placed until tightly packed - coils promote clotting

Question 36

Common Effects of Stroke

Answer 36

Occipital lobe – hemianopia (left or right visual field) Temporal lobe: visual agnosia (object recognition), specific to faces (prosopagnosia – less common), amnesia or modality-specific memory impairment Right parietal – loss of sensation, somatosensory cortex (hemiparesis); Hemi-inattention or unilateral neglect Left or bilateral parietal: Multimodal integration (IPL) – reading, writing, maths, skilled movement Left temporal: Auditory processing and comprehension Right temporal: agnosia for sound, music Left frontal: Speech production and executive deficits Frontal motor areas: hemiplegia, apraxia

Question 37

Seizure Disorders

Answer 37

Recurrent, episodic, uncontrolled electrical discharges in the brain ``` Symptoms Aura or warning Loss of consciousness Amnesia Movement ```

Question 38

Seizure Disorder causes, focal simple/complex vs generalised (grand mal etc)

Answer 38

Symptomatic (cause known) vs Idiopathic (cause unknown) Common causes: scarring, drugs (e.g., sudden withdrawal) and infections Partial (focal) seizures (simple, complex): - --Localised or progressive motor - --Sensory (olfactory/gustatory, tactile, visual, auditory) - --Psychic (cognitive and emotional) - --Autonomic (sweating, salivating) - --Usually don’t lose consciousness (but may be altered) Generalised seizures (absence/petit mal, grand mal)

Question 39

Seizure Disorders effect, diagnosis and treatment

Answer 39

Effect Depends on type and area grand mal seizure - tonic clonic Status epilepticus” may causes serious brain damage Diagnosis Symptoms and EEG ``` Treatment Medication (anti-epileptic - Dilantin, Tegretol, Epilim, phenytoin) or surgery in some cases (often the medial temporal region ```

Question 40

Status epilepticus”

Answer 40

a dangerous condition in which epileptic fits follow one another without recovery of consciousness between them.

Question 41

treatment medication vs surgery

Answer 41

Treatment: Medication –long term use may have detrimental effects on CNS Surgery – temporal lobectomy – lesion the brain to remove the focus of the epileptiform activity (e.g. temporal lobe)

Question 42

grand mal seizure

Answer 42

A grand mal seizure is usually caused by epilepsy, but may have other triggers, such as very low blood sugar, high fever or a stroke. The seizure has two stages. Loss of consciousness occurs first and lasts about 10 to 20 seconds, followed by muscle convulsions that usually last for less than two minutes.

Question 43

Neuropsychologist’s Role (in epilepsy)

Answer 43

Surgery Pre-surgery testing of cognition Often require a WADA (sodium amytal) – systematic deactivation of hemisphere functions (1-3 mins) during which cognitive functioning is grossly assessed Post-surgery assessment Generalised seizures tend to show greatest degree of cognitive deficits (depending on management, age of onset) Focal seizures tend to show lateralised effects (i.e. left – language and verbal memory, right – visuoperceptual and visual memory) Personality changes and emotional disorders are common (emotions can trigger seizure, but also anxiety and depression can develop as a consequence – neurologically-based or reactive)