Block 4 neuro part 3 Flashcards
(198 cards)
1
Q
Global developmental delay-
A
children under the age of 5 who are >2 standard deviations below the mean on age related, standardized developmental assessments
2
Q
IQ: Mild mental retardation- Moderate mental retardation- Severe mental retardation- Profound mental retardation-
A
-50-69
-35-49
-20-34
-
3
Q
Big developmental milestone of 4 months-
A
head control
4
Q
Big developmental milestone of 6 months-
A
sits up
5
Q
Big developmental milestone of 9 months-
A
crawls
6
Q
Big developmental milestone of 1 year-
A
walks, first words
7
Q
Big developmental milestone of 2 years-
A
2 word phrases
8
Q
Big developmental milestone of 3 years-
A
3 word phrases
9
Q
Which of these developmental screening tools is NOT recommended? Ages and Stages, Parental evaluation of developmental status, Brignance screen, Denver II
A
Brignance Screen
10
Q
Static encephalopathy-
A
developmental milestones reached, just at slower pace
11
Q
Neurodegenerative disease effect on development-
A
development starts off normal but you reach a plateu and possible regression
12
Q
Pervasive developmental delay-
A
motor skills intact, but delay in social/behavioral delays
13
Q
Pervasive developmental delay-
A
motor skills intact, but delay in social/behavioral delays
14
Q
the TORCH infections-
A
Toxoplasmosis, Rubella, CMV, HSV
15
Q
most common cause of hydrocephalus in premature babies-
A
intraventricular hemorrhage
16
Q
We used to thing that all CP was caused by ___________ due to a mistake by doctor. Since then, we have found that this is the case only _____% of the time, and it is usually not the doctor’s fault.
A
- Hypoxic Ischemic Encephalopathy
- 20%
17
Q
Timing of hypoxic Ischemic Encephalopathy (percentages) for term infants Antepartum- Intrapartum- Intrapartum/Antepartum- Postnatal-
A
- 20%
- 35%
- 35%
- 10%
18
Q
Kwashiorkor is caused by a _____ deficiency
A
protein
19
Q
kernicterus-
A
a buildup of bilirubin from postnatal liver failure/insufficiency
20
Q
Adenoma sebaceum, cortical tubers, ash leaf macule, and giant cell astrocytoma are consistent with a diagnosis of
A
Tuberous sclerosis
21
Q
cafe-au-lait macules, lisch nodules, optic nerve gliomas and fibroma molluscum are consistent with a diagnosis of:
A
neurofibromatosis type I
22
Q
Sturge Weber Syndrome-
A
contralateral hemiparesis, seizures, cognitive delays, due to meninges stealing blood from brain, leading to cortical calcifications and whatnot
23
Q
Sturge Weber Syndrome-
A
contralateral hemiparesis, seizures, cognitive delays, due to meninges stealing blood from brain, leading to cortical calcifications and whatnot
24
Q
Consciousness has 2 components:
A
level of alertness and content of consciousness
25
If someone has decreased consciousness, think of damage to ______ or ______
bilateral cortical hemispheres or RAS
26
with delirium, ____ is intact but person has disturbed content of consciousness
alertness
27
Delerium is caused by generalized or multifocal process affecting _______
both hemispheres
28
all patients in coma will change after _____ weeks, for better or worse
2-4
29
Patients who have survived the coma state without gaining higher cognitive function =
vegetative state
30
person is considered to be in a persistent vegetative state if they are in vegetative state for longer than _____
3 months
31
difference between vegetative state and minimally conscious state =
minimally conscious person has definite behavioral evidence of awarenenss of self and environment. Pt is able to follow simple commands, verbalize intelligibly, responses to stimuli are not just reflexes
32
what eye movements can occur in locked in state?
blinking and vertical eye movements
33
will a vegetative person respond to noxious stimuli?
yes
34
Subfalcine herniation will damage _____, leading to coma
RAS
35
first sign of an uncal herniation:
blown pupil from CN III damage
36
triad of uncal herniation:
blown pupil, contralateral hemiparesis, altered mental status
37
the same signs are observed in bilateral uncal herniation and ______ herniation
central
38
Duret Hemorrhages result from:
tearing of penetrating arteries of teh basilar artery that innervate the brainstem
39
Mass effect-
a growing mass which results in secondary pathological effects like herniation, midline shift, or increased intracranial pressure
40
important parts of History when evaluating a coma patient (after stabilizing them of course). 6 things
duration, onset, trauma, past medical Hx, Family Hx, Medications
41
Glasgow Coma Scale: Eye Opening
spontaneous 4
to speech 3
to pain 2
none 1
42
Glasgow Coma Scale: Verbal Response
```
oriented and converses 5
confused conversation 4
inappropriate words 3
incomprehensible sounds 2
none 1
```
43
Glasgow Coma Scale: Motor Response
```
obeys commands 6
localizes pain 5
withdraws to pain 4
decorticate posture 3
decerebrate posture 2
none 1
```
44
Glasgow Coma Scale (infants): Verbal Response
```
coos/babbles 5
irritable 4
cries to pain 3
moans to pain 2
none 1
```
45
Glasgow Coma Scale (infants): motor response
```
normal spontaneous movements 6
withdraws to touch 5
withdraws to pain 4
abnormal flexion 3
abnormal extension 2
none 1
```
46
oculocephalic reflex/Dolls eye tests connection between CN ____ and CN's ___, ____, and ____
- VIII
| - III, IV, VI
47
If Pt responds to cold caloric test, cortex is out but ____ is intact
brainstem (vestibulocular reflex)
48
If only abducens works in cold calorics test, then there is a disease process of ______
MLF
49
afferent and efferent nerves of gag reflex are
IX and X
50
Cheyne-Strokes breathing-
hyperventilation followed by hypoventilation bec. CO2 receptors are dissociated
51
Apea Test-
ventilate with 100% O2, then disconnect ventilator but continue with O2, monitor ABG to check for signs of ventilation
52
when testing for pain and thermal sensation in coma patient, watch for changes in _______ while eliciting deep painful stimulation
pulse or blood pressure
53
4 steps in assessing brain death:
- determine lack of cortical functioning by exam
- lack of brainstem function by exam (includes apnea test)
- observation period (varies based on age and whether mechanism of brain death is known)
- Ancillary testing (EEG, cerebral blood flow, evoked potentials)
54
4 steps in assessing brain death:
- determine lack of cortical functioning by exam
- lack of brainstem function by exam (includes apnea test)
- observation period (varies based on age and whether mechanism of brain death is known)
- Ancillary testing (EEG, cerebral blood flow, evoked potentials)
55
4 steps in assessing brain death:
- determine lack of cortical functioning by exam
- lack of brainstem function by exam (includes apnea test)
- observation period (varies based on age and whether mechanism of brain death is known)
- Ancillary testing (EEG, cerebral blood flow, evoked potentials)
56
attention selectivity is highest in ____ arousal stage
medium
57
attentional stream paradigm-
two or more segregated series of stimuli are presented and subjects selectively attend to one over the other to perform a task
58
the 2 hypotheses between selective attention
early selection and late selection
59
early selection-
filter out irrelevant information before completion of perceptual and sensory analysis (short term storage of info, then info is bottlenecked and only certain things pass through)
60
late selection-
all stimuli are processed through completion of sensory and perceptual processing before selection occurs (Executive function decides what to filter)
61
Result of late selection is that signals from higher order cortical areas flow back down to sensory cortical areas to facilitate ______________
the sensory representation of the attended stimulus
62
Result of late selection is that signals from higher order cortical areas flow back down to sensory cortical areas to facilitate ______________
the sensory representation of the attended stimulus
63
Attentional Blink-
when target and probe are presented either very close or very far temporally from each other, they are are more accurately responded to, than when they are an intermediate amount of time apart (100-300 ms)
64
endogenous attention-
ability to voluntarily direct attention to specific aspects of the environment, typically based on an individuals goals.
65
exogenous attention-
stimuli arising from the environment attract our attention involuntarily
66
Locations of endogenous attention (2):
parietal areas (intraparietal sulcus) and frontal areas (including FEF and lateral prefrontal cortex)
67
Locations of exogenous attention (2):
temporo-parietal junction and right ventral frontal cortex
68
in a visual spatial attention test, unattended stimuli peak at P100, which correlates with the ______ cortex, while attended stimuli peak at N100 which correlates with the _______ areas
- extrastriate visual
| - parietal visual
69
Gist of the visual attention test is that the same stimulus elicits different neural responses due to _____
attention differences
70
recent evidence indicates that when there is no cue, arbitrarily stimuli elicit activity in the ____ and _____
LGN and thalamus
71
Balint's syndrome-
bilateral damage to the posterior parietal/lateral occipital cortex. leads to simultanagnosia, optic ataxia, oculomotor apraxia, inability to respond to exogenous stimuli
72
simultanagnosia-
inability to attend to more than 1 object at a time
73
optic ataxia-
inability to reach for an object under visual guidance
74
oculomotor apraxia-
difficulty looking at objects using saccades
75
______ cortex dominates visual attention
right parietal
76
difference in neglect between right and left parietal lesion-
right parietal lesion leads to total left sided neglect, whereas left parietal lesion leads to only partial neglect because you still have representation from the right parietal
77
difference in neglect between right and left parietal lesion-
right parietal lesion leads to total left sided neglect, whereas left parietal lesion leads to only partial neglect because you still have representation from the right parietal
78
damage to supramarginal gyrus leads to
conduction aphasia
79
If wernicke's area is spared but there is damage to angular gyrus, symptoms include-
alexia, anomia, constructional apraxia, agraphia, finger agnosia, confusion of left and right personal space
80
angular gyrus is BA ___
39
81
Gertsmann syndrome-
damage in BA 39 that includes acalculia, finger agnosia, right/left disorientation
82
during endogenous attentional tasks, ____ cortex organizes attentional control, and ______ cortex carries out attentional modulation
- Frontal
| - Parietal
83
When you tell someone to look left, ___ lobe makes decision to look left and ____ lobe mediates the attention being paid to the left
- frontal
| - parietal
84
The ______ cortex exerts top down regulation of attention and behavior
prefrontal
85
too much catecholamine = _______ attention. Too little = ______ attention
- disorganized
| - distracted
86
Attention modulation is a balance between NE acting on ____ receptors and dopamine acting on _____ receptors
- alpha 2A
| - D1
87
Attention modulation is a balance between NE acting on ____ receptors and dopamine acting on _____ receptors
- alpha 2A
| - D1
88
how does methylpheidate (ritalin work)
DA reuptake inhibitor
89
how does Adderall work?
enhances DA release
90
schizophrenics have poor mismatch negativity, meaning
they are unable to distinguish btw common and rare stimuli. Everything is sensed as background noise
91
schizophrenics have poor mismatch negativity, meaning
they are unable to distinguish btw common and rare stimuli. Everything is sensed as background noise
92
3 kinds of focal seizures-
simple partial, complex partial, secondary generalized convulsive
93
simple partial seizure-
no impairment of consciousness, sometimes aura or sensory phenom. before seizure
94
complex partial seizure-
with aura and some degree of LOC/bilateral involvement
95
secondary generalized convulsive seizure-
complex partial spreads to involve all of the bilateral cortical hemispheres
96
6 types of generalized seizures-
absence, tonic, clonic, atonic, myoclonic, and generalized convulsive
97
absence seizure-
very short and can occur frequently and repeatedly if unrecognized
98
tonic seizures-
characterized by stiffness and non-responsiveness
99
clonic seizures-
jerking, noted amplitude vs frequency changes
100
atonic seizure-
body goes limp
101
myoclonic seizure-
jerky movements
102
generalized convulsive seizure-
rare; no aura; all over happens suddenly
103
first step in the diagnostic work up of a seizure is to:
check to make sure it isn't provoked. If so, treat the cause
104
If patient has returned to baseline neuro. status after a seizure, diagnostic workup is pretty minimal. Includes these 5 things:
*you are checking for provoked cause of seizure before you classify as epilepsy
comprehensive metabolic panel, urine tox, LP, neuroimaging, EEG
105
If someone has had a seizure, do emergent CT scan in these 5 cases:
1. someone has altered mental status w/o improvement
2. focal neurological deficits
3. kids under 2 yrs age (to rule out shaken baby)
4. head trauma
5. metastatic brain cancer (if person already diagnosed with cancer)
106
If Pt is a young, otherwise healthy person, do an MRI to pick up on subtleties such as: (3)
low grade glioma, developmental brain malformation, small vascular malformation
107
Outpatient MRI is done when there's: (3)
historical evidence of a focal SZ, focality is detected on EEG, or after a second unprovoked seizure
108
____ must be done on everyone following first unprovoked seizure
EEG
109
important not to get EEG too early because:
transient, post-ictal changes can occur after a seizure that may show up on the EEG
110
3 reasons to do an EEG
method of diagnosing grand mal seizure, determines focality, checks for epilepsy syndrome
111
If Pt is determined to be having unprovokes seizures, they are diagnosed with ______, then the next decision to be made is:
- epilepsy
| - whether to give them AED's or not
112
If Pt is determined to be having unprovokes seizures, they are diagnosed with ______, then the next decision to be made is:
- epilepsy
| - whether to give them AED's or not
113
AED should only be used for ______ seizures
unprovoked
114
AED should only be used for ______ seizures
unprovoked
115
risk of having first unprovoked seizure is 10%, second is ___, third is ____
30%
| 80%
116
Stevens-Johnson Syndrome can be a side effect of
anticonvulsant drugs
117
seizure kindling-
if seizures start early in life, there is evidence that you can have secondary changes to the hippocampus that make it epileptogenic
118
The difficult treatment balance to figure out for children with epilepsy is:
treating the seizures without causing cognitive hindrance/decline/slowing down
119
Febrile Seizure-
A Sz occurring between 6 months and 6 years of age associated with fever but without evidence of intracranial infection or other defined cause
120
Doctors must differentiate benign febrile seizures from seizures triggered in the setting of:
a febrile illness
121
febrile seizures are considered provoked/unprovoked?
provoked
122
risk of developing epilepsy after a febrile seizure is
3%
123
3 things that increase risk of developing epilepsy in Pt that has had febrile seizure:
1. baseline neurological deficits
2. family history of epilepsy
3. complex febrile seizures
124
The biggest thing to determine with a febrile seizure is:
whether or not it could be meningitis
125
Do we do an EEG for a febrile seizure?
no, it is a provoked seizure.
126
How do we rule out meningitis for a febrile seizure?
Do a CT then LP
127
Why are AED's not recommended to treat febrile seizures?
bc it will mess with cognitive development
128
Status epilepticus-
a condition characterized by an epileptic seizure that is sufficiently prolonged or repeated at sufficiently brief intervals so as to produce an unvarying and enduring epileptic condition
129
Status epilepticus-
a condition characterized by an epileptic seizure that is sufficiently prolonged or repeated at sufficiently brief intervals so as to produce an unvarying and enduring epileptic condition
130
working definition of status epilepticus is a seizure lasting more than ____ minutes. Any longer than this, you can reasonably assume it isn't going to resolve on its own and could lead to brain damage
10
131
4 kinds of status epilepticus seizures
- generalized convulsive (grand mal)
- generalized non-convulsive (absence)
- focal non convulsive (this one is tricky, as ppl can be diagnosed with psichiatric disorder bec. their focal seizure went on for days)
- and epilepsia partialis continua (focal, usually in motor cortex)
132
Lifetime risk among epilepsy patients: for SE:
15%
133
risk of SE among epileptics whose seizures start under 1 year of age
70%
134
risk of first time seizures going into status epilepticus
10%
135
highest recurrent risk of status epilepticus-
remote symptomatic (brain injury a few months ago) or neurodegenerative etiologies
136
lowest risk of recurrent status epilepticus-
idiopathic or febrile etiology
137
most important etiology of status epilepticus-
acute symptomatic, because you need to treat the underlying provocation
138
Pathophysiology of status epilepticus brain injury:
cardiac output increases 3 fold to meet increased fuel demands. Over time, metabolic demand will outstrip supply and ________ damage will ensue, leading to _______, _______, _______. The excessive release of glutamate from the seizure will cause excess Ca++ influx that leads to ________ neuronal damage including the activation of _______ and _______ that cause cell breakdown.
Pathophysiology of status epilepticus brain injury:
cardiac output increases 3 fold to meet increased fuel demands. Over time, metabolic demand will outstrip supply and mitochondrial damage will ensue, leading to lactic acidosis, impaired cerebral autoregulation, and cerebral edema. The excessive release of glutamate from the seizure will cause excess Ca++ influx that leads to excitotoxic neuronal damage including the activation of proteases and lipases that cause cell breakdown.
139
Pathophysiology of status epilepticus brain injury:
cardiac output increases 3 fold to meet increased fuel demands. Over time, metabolic demand will outstrip supply and ________ damage will ensue, leading to _______, _______, _______. The excessive release of glutamate from the seizure will cause excess Ca++ influx that leads to ________ neuronal damage including the activation of _______ and _______ that cause cell breakdown.
Pathophysiology of status epilepticus brain injury:
cardiac output increases 3 fold to meet increased fuel demands. Over time, metabolic demand will outstrip supply and mitochondrial damage will ensue, leading to lactic acidosis, impaired cerebral autoregulation, and cerebral edema. The excessive release of glutamate from the seizure will cause excess Ca++ influx that leads to excitotoxic neuronal damage including the activation of proteases and lipases that cause cell breakdown.
140
3 layers most susceptible to to excitotoxic injury during SE-
purkinje cell layer of cerebellum, thalamic neurons, and CA1 neurons of the hippocampus
141
Management of SE- what do the ABCD's stand for?
Airway, Breathing, Cardiovascular, Dextrose (for hypoglycemia)
142
After doing the ABCD's for SE, do a medical history that looks for: (4)
prior epilepsy, use of AED's, infection, trauma
143
After doing a medical history for SE, do a physical exam that looks for: (3)
trauma, meningitis, focal seizures
144
first round of drugs for SE
Fast acting; give within 10 minutes; Benzodiazepines
145
2 examples of benzodiazepines
lorazepam and diazepam
146
second round of drugs for SE are given if:
still seizing after 2x admin of benzos
147
3 examples of second round drugs for SE
Pheytoin, fosphenytoin, phenobarbital
148
what must you watch for if you choose to do second round drugs for SE?
respiratory distress, since you mixed with benzos
149
what must you watch for if you choose to do second round drugs for SE?
respiratory distress, since you mixed with benzos
150
what must you watch for if you choose to do second round drugs for SE?
respiratory distress, since you mixed with benzos
151
reticulospinal tract controls
breathing and urination
152
brown-sequard syndrome-
spinal cord hemisection; loss of fine touch and vibration on ipsilateral side of lesion, pain and temp on contralateral side, and movement ipsilateral side
153
plegia-
complete lesion, no function below that level
154
paresis-
some muscle strength preserved
155
tetraplegia or quadriplegia-
injury of the cervical spinal cord anywhere above C8
156
paraplegia-
injury of the thoracic, lumbo-sacral cord or cauda equina
157
hemiplegia-
paralysis of one half of the body
158
hemiplegia-
paralysis of one half of the body
159
match the muscle to spinal cord segment: C5
deltoid or biceps
160
match the muscle to spinal cord segment: C6
wrist extensors
161
match the muscle to spinal cord segment: C7
triceps
162
match the muscle to spinal cord segment: C8
flexor digitorum profundus
163
match the muscle to spinal cord segment: T1
hand intrinsics
164
match the muscle to spinal cord segment: L2
iliopsoas
165
match the muscle to spinal cord segment: L3
quadriceps
166
match the muscle to spinal cord segment: L4
tibialis anterior
167
match the muscle to spinal cord segment: L5
EHL
168
match the muscle to spinal cord segment: S1
gastrocnemius
169
```
ASIA strength scoring breakdown
Grade 0-
1-
2-
3-
4-
5-
```
```
0- no contraction
1- contraction without movement
2- movement with gravity eliminated
3- movement against gravity
4- movement close to normal but when you compare left to right there is a difference
5- normal strength
```
170
```
Deep tendon reflexes spinal segment
Arm-
Styloradial-
Triceps-
patellar-
achilles-
```
```
C5
C6
C7
L3
S1
```
171
Hoffman reflex-
tap of the nail on patients middle or fourth finger and thumb flexes. should not happen normally
172
clonus-
series of involuntary muscular contractions and relaxations. test by rapidly flexing the foot upward. only sustained clonus is considered abnormal
173
level of motor injury is graded as last level with ____ strength
3/5
174
sensory level of injury is measured as
last level with preserved sensation
175
as long as ___ spinal segment is intact, can still shrug shoulders
C2
176
inability to breath means spinal injury is above ___
C3
177
if a patient can breathe but needs to be intubated later on, what does that tell us about spinal cord lesion?
it is below C5
178
why would someone with a spinal cord injury be able to breathe but then later not be able to?
edema/swelling of the spinal cord
179
Midcervical injuries result in:
varying degrees of diaphragm dysfunction and neurogenic and spinal shock
180
spinal shock-
just the los of reflexes after an injury before UMN signs take over
181
Neurogenic shock-
loss of sympathetic tone; seen in cervical injuries; due to interruption of the sympathetic input from the hypothalamus to the cardiovascular centers
182
hypotension due to neurogenic shock is associated with _____cardia due to inability to convey information to vasomotor centers of spinal cord
brady
183
hypovolemic shock-
hypotension with tachycardia
184
4 things to expect with a cervical lesion-
quadriplegia, bowel/bladder retention, breathing difficulties, neurogenic/spinal shock
185
after a thoracic spinal injury, you will see UMN signs in affected muscles with the exception of:
if there is spinal shock, you will initially see areflexia
186
central cord lesion-
type of lesion where arms are more affected than legs
187
cervical traction-
stretching of neck to realign it
188
cauda equina syndrome-
LMN paralysis
189
C-spine myelopathy-
UMN paralysis
190
lumbar herniation localization:
Big toe pain
Heel/little toe pain-
little finger pain-
- L5
- S1
- L4
191
```
Cervical herniation localization:
Shoulder pain-
thumb pain-
middle finger pain-
little finger pain-
```
- C5
- C6
- C7
- C8
192
T2 MRI what color are CSF and water?
white
193
osteophytes-
bony spurs that form to counteract and stabilize area of disc degeneration
194
spinal claudication-
pain after walking for certain distances
195
MILD procedure stands for
minimally invasive lumbar decompression
196
how do you treat an osteoporotic vertebrae?
inflate a balloon in the body of the vertebra and fill it with cement
197
in reference to spinal problems, when pt has leg pain, think _____. When they have back pain think _______
- disc herniation
| - disc degeneration
198
posterior approach to surgical correction of cervical spinal pain is reserved for:
extensive spinal stenosis
