week 9 part 1 neuro Flashcards
Define Cord concussion:
Results in a temporary disruption of cord-mediated functions
Define Cord contusion:
Bruising of the neural tissue causing swelling and temporary loss of cord-mediated function
Define Cord compression:
Pressure on the cord causing ischemia to tissues; must be relieved (decompression) to prevent permanent damage to the spinal cord
Define Laceration as it results to spinal cord injuries:
Tearing of the neural tissues of the spinal cord; may be reversible if only slight damage is sustained by the neural tissues; may result in permanent loss of cord-mediated functions if spinal tracts are disrupted
Define Transection as it relates to spinal cord injuries:
Severing of the spinal cord, causing permanent loss of function
When all tracts in the spinal cord completely disrupted; all cord-mediated functions below the transection are completely and permanently lost this is defined as:
A complete transection
When some tracts in the spinal cord remain intact, together with functions mediated by these tracts; has the potential for recovery although function is temporarily lost this is defined as:
Incomplete transection
When there is some demonstrable sensation below the level of injury this is defined as:
A transection with preserved sensation only
When preserved motor function without useful purpose; sensory function may or may not be preserved this is defined as:
Transection with preserved motor nonfunctional
When a spinal injury occurs with preserved voluntary motor function that is functionally useful this is defined as:
Preserved motor functional
Define hemorrhage as it relates to spinal cord injuries:
Bleeding into the neural tissue because of blood vessel damage; usually no major loss of function
Damage or obstruction of spinal blood supply causes:
local ischemia
T or F: All forms of injury can cause spinal cord edema, further decreasing blood flow and oxygenation.
TRUE
Direct compression of neural elements by bone fragments, disc material, and ligaments damages (the CNS, PNS or both)?
both the central and peripheral nervous systems.
Loss of autoregulation and spinal shock cause_______________________________
systemic hypotension and exacerbate ischemia
T or F: All motor, sensory, reflex, and autonomic functions cease below any transected area and may cease below concussive, contused, compressed, or ischemic areas.
TRUE
Loss of motor and sensory function depends on________________
the level of injury.
The result of this type of spinal cord injury is absent motor function, sensory, and pressured (“touch”) sensation and position and vibratory perception to all body areas innervated by the spinal cord tissue below the level of disruption.
A complete injury
This type of injury results in spinal cord injury can be defined as one in which there is a variable degree of loss of function secondary to partial cord disruption of the spinal cord (some pathways of neurological function are intact, some are disrupted either permanently or transiently).
An incomplete injury
Define Central Cord Syndrome:
Type of injury that results from hyperextension
______________ is Characterized by disproportionately greater motor impairment of the upper than the lower extremities with variable sensory loss below the level of injury, and central hemorrhagic necrosis and swelling
central cord syndrome
Define Sacral Sparing:
Important determinants of an incomplete lesion of the spinal cord are preservation of voluntary rectal sphincter tone and perianal sensation
____________ is a type of injury that results from hyperflexion
Anterior Cord Syndrome
This type of injury is characterized by variable loss of motor and sensory function below the level of injury, posterior column function is maintained. Patient will present with a variable degree, perhaps even complete loss of motor and sensory function below the level of injury to the spinal cord, but the ability to perceive light touch and position sense distal to the injury is maintained.
Anterior Cord Syndrome
This injury is typically the result of a penetrating injury which has damaged one side of the cord and is characterized by motor loss on the same side and sensory loss on the opposite side of the injury.
Brown Sequard Syndrome
T or F: Damage to the spinal cord can affect the area corresponding to the dermatomes but not the area below it.
FALSE. Damage to the spinal cord can affect the area corresponding to the dermatomes and the area below it.
What will happen if cervical spinal nerves are damaged?
cervical spinal nerves affect the head, arms, and hands, so these areas of the body will be affected
What will happen if the thoracic spinal nerves are damaged?
the thoracic spinal nerves affect the chest and abdominal region of the body
What will happen if lumbar spinal nerves are damaged?
lumbar spinal nerves generally innervates the legs-damage to this region of the body
The_____________ nerves generally innervate the groin.
sacral spinal
What effects does multiple sclerosis have on the myelin sheath?
The myelin sheath and conduction pathways of the CNS are damaged
Blurred vision (diplopia), tremors, paresthesias, ataxia, dysarthia, and dysphagia are all s/s of:
Multiple sclerosis
T or F: The initial syndrome in MS is the same in all patients.
FALSE. The initial syndrome depends on the portion of the CNS that is most involved
In MS, the ___________ ______________ _____________ or “clinically isolated syndrome” is a single episode of neurologic dysfunction lasting greater than 24 hours that can be a prelude to MS.
first demylinating event
What type of MS is described: Clear relapses with either full recovery, or with partial recovery and lasting disability. Between attacks there is no progression of disease. This is the most common course of MS.
Relapse-Remitting (RR) MS
Steady progression from onset, with only occasional plateaus or minor recovery. THis is a fairly uncommon disease course and one that may involve different brain and spinal cord damage than do other forms of MS decribes:
Primary Progressive (PP) MS
______________ Begins with a pattern of clear cut relapses and recovery but becomes steadily progressive over time with continued worsening between acute attacks.
Secondary Progressive (SP) MS
This type of MS is a rare type that is steadily progressive from onset but also has clear acute attacks.
Progressive Relapsing (PR) MS
What is Guillain-Barre syndrome?
Autoimmune attacks on myelin sheath that surrounds axons
Acute Guillain-Barre lasts ______________ with a _________ recovery period
1-6 weeks, 4-6 months
T or F: Guillain-Barre occurs randomly, with no known cause.
FALSE. Gullian-Barre is strongly associated with a prior infection
Abrupt weakness, pain, Paresthesias from lower extremities to upper, Mild paresis to quadriplegia, respiratory compromise, Cranial nerve: visual, swallow, gag, expressions, vagal nerve, blood pressure, pulse are all clinical manesfestations of:
Gullian-Barre syndrome
What does ALS stand for?
Amyotrophic Lateral Sclerosis
ALS differs from other motor neuron disorders in that:
upper and lower motor neurons are involved.
ALS is named for:
its underlying pathophysiology
Amyotrophy refers to:
the atrophy of muscle fibers, and refers to the lower motor neuron component of ALS
In ALS, what happens when muscle fibers atrophy?
They are de-enervated as their corresponsing anterior horn cells degenerate
Lateral sclerosis refers to:
hardening of the anterior and lateral columns of the spinal cord; motor neurons in these areas degenerate and are replaced by fibrous astrocytes (gliosis), refers to the upper motor neuron part of ALS
Fasciculation, foot drop, hand weakness or clumsiness, muscle cramps and twitching in the arms, shoulders, and tongue are all s/s of:
ALS
The lower motor neuron syndrome involved in ALS refers to:
flaccid paresis consists of weakness of individual muscles, progressing to paralysis associated with hypotonia and primary muscle atrophy
The upper motor neuron syndrome of spastic paresis consists of:
weakness of movement patterns, progressing to paralysis, associated with spasticity and, in some cases, atrophy secondary to disuse.
Myasthenia gravis
is a chronic progressive disorder of peripheral nervous system affecting transmission of nerve impulses to voluntary muscles, causing muscle weakness and fatigue that increased with exertion and improves w/ rest; eventually leads to fatigue w/o relief from rest
An autoimmune process triggers formation of autoantibodies that decrease number of acetylcholine receptors and widen gap btw axon ending and muscle fiber in neuromuscular junction; muscle contractions is hindered b/c autoantibodies prevent Ach from binding w/ receptors; destruction of receptors at neuromuscular junction occurs
myasthenia gravis
Autoimmune process attacks acetylcholine receptors (in charge of voluntary movements) Êin the muscles. Impulses are NOT transmitted to skeletal muscles at neuromuscular junction.
pathology of myastenia gravis
Multifactorial causes; no known cause to prevent it.
etiology of Parkinson’s disease
genes associated with parkinson’s disease
Alpha-synuclein, Parkin, DJ-1, PINK1, DRDN
Enviornmental factors such as ________ and ________ are associated with Parksinson’s disease
toxins and agriculture
Name three drugs associated with inducing Parkinson’s disease
Amoxapine, Haloperidol, Promethazine
Name the cardinal s/sx of Parkinsons
tremor, rigidity, akinesia, postural instability, cogwheeling
Describe the pathopysiology of Parkinson’s disease
degeneration of substantia negra leads to a decrease in dopamine, a neurotransmitter that helps to control voluntary movement as a neuron impulse inhibitor, less dopamine and noram Ach which leads to more excitiation of neurons. When dopamine levels that inhibit motor activity are depleted, Ach is not inhibited, allowing increased excitation that leads to motor symptoms, may affect SNS and norepinephrine levels - hypotension
Describe the overall s/sx of cerebral palsy
lack of muscle coordination w/ voluntary movements, stiff or tight muscles, spasticity (exaggerated reflex movements), early signs appear before child reaches 3, walking with one foot or leg dragging, walking on toes, crouched/scissored gait, muscle tone is too stiff or floppy
Describe spastic cerebral palsy
increased muscle tone, muscles are stiff, prolonged primitive reflexes, exaggerated deep tendon reflexes, clonus, rigidity of the extremities, scoliosis, contractures
Describe dyskinetic cerebral palsy
extreme difficulty in fine motor coordination and purposeful movemements - movemements are jerky, uncontrolled and abrupt, involuntary abnormal movements in the arms, legs, face and trunk
Describe ataxic cerebral palsy
manifests with gait disturbances and instability, poor balance and coordination
Describe mixed cerebral palsy
some people have symptns of more than one type of CP; the most common type is spastic dyskinetic CP
