Acquired Brain Injury - Tumors and Common Symptoms of ABI in Adults

Question 1

CNS Tumors - Environmental Factors Increasing the Risk of Cancer (4)

Answer 1

X radiation.
Direct contact with formaldehyde.
Consumption of N-Nitroso compounds (cooked ham, pork, bacon).
SV40 polio vaccine and development of neoplasms.

Question 2

CNS Tumors - Environmental Factors Showing No Significant Increased Risk of Cancer (3)

Answer 2

Electrical and electromagnetic fields exposition.
Radio frequency waves.
Smoking (weak association), increased risk for children of mothers who smoked during pregnancy.

Question 3

Grading of Tumors - Grade 1

Answer 3

Slow growing, usually non-metastatic.
Surgical removal is possible depending on the area.

Question 4

Grading of Tumors - Grade 2

Answer 4

Less likely to grow and usually non-metastatic. Surgical removal can be an option, but very often develop again in other places, needing more aggressive and wider medical treatment.

Question 5

Grading of Tumors - Grade 3

Answer 5

Grow quickly with rapidly dividing cells, usually without signs of apoptosis.

Question 6

Grading of Tumors - Grade 4

Answer 6

Progressive apoptosis, mixing areas of dead (creating a inflammatory process) and vascularized pathological tissue, with rapid spread.

Question 7

Oncotherapy - Surgery - Complications

Answer 7

Complete or partial removal of affected tissue.
Most harmful. Damaging tissue on the way to the tumor and around it.
Complications of acute nature, vascular damage, coagulopathies, hemorrhage and/or cerebral edema with herniation.

Question 8

Oncotherapy - Radiation/Chemotherapy

Answer 8

Destruction of tumorous cells and surrounding tissue.

Question 9

Oncotherapy Related Neurological Problems (9)

Answer 9

Disorder of consciousness
Memory and attention deficits
Perceptual and reasoning deficits
Aphasia (unable to communicate properly) (broca and wernicke damage)
Sensorimotor deficits related to neocortical injuries
Disbalance and involuntary movements
Seizures
Changes in the visual filed
Depression and personality disorders (vm/vlPFC damage or because of situation)

Question 10

Symptoms and General Correlations - Stroke

Answer 10

Sensorimotor and cognitive symptoms will usually correlate with the irrigation site of the affected artery.

Question 11

Symptoms and General Correlations - TBI

Answer 11

In chronic phase, symptoms will correlate with affected cortical areas. In case of compression of subcortical structures, the patient might present symptoms related to cerebellar function.

Question 12

ACA Injury - Main areas affected (8)

Answer 12

vlPFC: Adaptive behavior
vmPFC: Social behavior
dlPFC: Left: motor strategy, Right: behavior strategy
SMA: Spatial navigation, short term procedural memory
S1: Receives somatosensory imput, anesthesia, hypoesthesia, paresthesia. Lesser sensation in lower limb, l trunk.
M1: Upper motor neuron syndrome (losing motor control, not strength), balance impaired.
Portion of Broca: only on left, aphasia, word finding deficit.
aCC: Attention, decision making, can’t inhibit AM -> Anxiety.

Question 13

MCA Injury - Main Areas Affected (8)

Answer 13

PMC: Lose ability to do complex tasks, motor procedures, memory consolidation.
S1: Receives somatosensory input, anesthesia, hypoesthesia, paresthesia. Lesser sensation in upper limbs and upper trunk.
M1: Upper motor neuron syndrome (losing motor control, not strength), balance impaired.
ps/piPC: Balance deficit, creating a mental pic of an activity. Motor recovery. Spatial orientation.
TP: right: perception of environment and self. Able to act on perception.
Broca: Left: Speech production
Wernicke: Left: Speech understanding

Question 14

PCA Injury - Main Areas Affected (5)

Answer 14

V1: Hemianopia: loss of one half of a vertical visual field. Still able to perceive a person but not able to see them. Visual deficit.
V2
V3
Posterior portion of temporal lobe.
Hippocampal formation: posterior. Consolidating memory in the beginning.

Question 15

PICA/AICA Injury - Main Areas Affected (4)

Answer 15

Cerebellar Vermis: Automatic reaction
Anterior cerebellar lobe: can have ataxia
Posterior cerebellar lobe: can have ataxia
Flocculondular lobe

Question 16

Upper Motor Neuron Syndrome - Signs

Answer 16

Hypertonia (spasticity, M1 damage) (rigidity, cerebellar damage)
Hyperreflexia
Pathological reflexes (grasping, babinski sign)
Myoclonus (plantar to dorsiflexion in high amplitude, low frequency.
Paresia(some movement)/Plegia(no movement)

Question 17

Hypertonia in stroke patients

Answer 17

Patients usually experience hypotonia in the first 6-8 weeks after the stroke, acute phase. As the brain starts to recover and movement is being created, hypertonicity starts accompanied by hyperreflexia.

Question 18

ABI Symptoms in Relation to Areas Affected (9)

Answer 18

M1: UMNS
S1: hypoesthesia, paresthesia, anesthesia.
V1: Hemianopia
TP, PFC: Visuospatial disorder
Broca: speech production deficit
Wernicke: speech understanding deficit
piPC, PFC: spatial orientation deficit
SMA, PMC: Procedural memory deficit
PFC, Hippocampal formation: declarative memory deficit

Question 19

Precautions and Red Flags: UL Dysfunction (4)

Answer 19

Shoulder luxation/sub-luxation(unstable): concerns for positioning and transfers.
Loss of mobility and shoulder-hand syndrome related to positioning and non-use.
Repetitive movement against resistance in patients with spasticity (increases the spasticity!)
Reduced activity and immobility (patients will want to use unaffected limb for everything)

Question 20

Shoulder Hand Syndrome (7)

Answer 20

Reduced limb representation in S1.
Compression of the axillar neurovascular bundle.
Increased spinal sensitization.
Decreased sympathetic outflow.
Reduced motor activity
Positioning
Calcification

Question 21

Precautions and Red Flags: Positioning (2)

Answer 21

Lack of variations in positioning of patient with paresis or plegia can lead to msk, dermatologic or respiratory complications.
Positioning of a patient with a perceptual disorder, that compromises their access to proper sensory stimulation.