Chapter 26 Flashcards
1
Q
Neurological disorders are associated with
A
abnormality of or injury to the brain
2
Q
A neurologist asks about
A
the history of the patient and their family history
3
Q
A neurologist observes
A
behaviors while taking the history to assess mental status, motor control, and speech abnormalities
4
Q
Neurologist can perform basic
A
cognitive tests, such as memory and attention
5
Q
The function of all 12 cranial nerves can be assessed in
A
about 2 minutes
6
Q
Follow-up testing can use
A
EEG, CT, or MRI scans
7
Q
Incidence of TBI is difficult to determine because
A
many go unreported
8
Q
Males between the ages
A
of 15 and 30 are at higher risk of TBI from sports injuries and car accidents
9
Q
following TBI
A
There is a long-term decrease in glucose metabolism
10
Q
Open Head Injuries
A
Traumatic brain injuries where the skull is penetrated by an object
11
Q
Closed Head Injuries
A
A blow to the head that does not penetrate the skull
12
Q
Coup
A
damage to the brain at the site of the blow caused by the brain impacting with the skull
13
Q
Contrecoup
A
damage to the brain at the side of the brain opposite the site of the blow, caused by the brain rebounding from the initial injury and impacting the skull
14
Q
Shearing
A
the twisting or breaking of nerve fibers caused by the rapid movement of the brain inside the skull
15
Q
Hematoma
A
mass of blood trapped in the skull
16
Q
Edema
A
swelling that can result in pressure on the delicate nervous tissue
17
Q
Effects of Closed Head Injury
A
Coma, impact functions located at the site of the coup or contrecoup injuries, Injuries can also result from the widespread trauma throughout the brain and are associated with loss of complex cognitive functions and efficiency
18
Q
patients with closed head injuries report
A
difficulty concentrating, Personality and social behaviors are also impacted, Behavioral changes from head injuries may make patients more susceptible to further head injuries
19
Q
Behavioral Assessment of Head Injury
A
Neuroimaging can provide some information about TBI, but behavioral assessments are most valuable
20
Q
2 kinds of behavioral effects result from closed head injuries
A
- discrete impairments 2. more generalized impairments
21
Q
generalized impairments
A
minute lesions and lacerations scattered throughout the brain, loss of complex cognitive functions, including reductions in mental speed, concentration, and overall cognitive efficiency
22
Q
Discrete Impairment’s
A
damage to the frontal and temporal lobes, the areas most susceptible to closed head injuries
23
Q
Glasgow Coma Scale
A
used to quantify unconsciousness and recovery of consciousness using three scales
24
Q
3 scales of the Glasgow Coma Scale
A
eye opening, motor response, verbal response
25
Glasgow Coma Scale 8 or less - 9-12 - 13+
8 or less associated with severe head injury, 9-12 indicates moderate head injury, 13+ indicate mild head injury, but these individuals still experience consequences related to their injury
26
recovery from TBI
can occur over 2 to 3 years, but most recovery occurs within the first 6 to 9 months
27
Memory recovers
more slowly than other cognitive functions
28
If the damage involves the brainstem
the prognosis for recovery is not as good
29
Most head injuries are
preventable, such as using safer practices and better equipment in sports and education in the workplace
30
Assessment of symptoms using
smartphones and wearable technology is helping assess severity for auto accidents and combat injuries
31
Primary brain injuries, immediate on impact
coup, countercoup, fiber shearing or stretching, macro/microscopic lesions, Primary brain injuries, immediate on impact
32
Secondary injuries
Intracranial hemorrhage and edema, Ischemic or bleed-induced damage, Increased intracranial pressure or distortion, Effects of multiple injuries and hypoxia
33
Injurious effects, delayed
Degeneration of gray and white matter, Hydrocephalus
34
Epilepsy
is a brain disorder caused by seizure
35
Seizure
spontaneous, abnormal discharges of brain neurons as a result of scarring from injury, infections, or tumors.
36
Epilepsy is diagnosed after
at least one seizure, but typically after multiple seizures
37
Seizures occur in about
1 in 20 individuals during their lifetime
38
Symptomatic seizures are
associated with a known cause, such as infection, trauma, fever, or other disorder
39
Idiopathic seizures are
spontaneous and without any known or obvious cause
40
genetics and seizures
There is likely a genetic predisposition to seizures; influenced by numerous genes
41
Aura
a subjective sensation, perception, or motor experience associated with seizure onset
42
consciousness and seizures
Loss of consciousness, ranging from staring into space to complete loss
43
Movement
many seizures include full body movements or repetitive behaviors
44
Precipitating factors in susceptible individuals
drugs, emotional stress, fever, hormonal changes, hyperventilation, sensory stimuli, sleep, sleep deprivation, trauma
45
Classifying Seizures
EEG typically confirms the diagnosis of epilepsy
46
t/f not everyone with an abnormal EEG has seizures
True
47
Focal seizures
seizures begin in one location in the brain and the electrical activity spreads to involve other brain regions
48
focal aware seizures
the person is conscious throughout the seizure
49
focal impaired awareness seizure, or complex partial seizure
the person is generally aware that a seizure is beginning, performs automatic behaviors, has a fixed posture, and loses conscious awareness of the condition
50
Automatic behaviors
onreflexive actions performed without conscious volition associated with focal impaired awareness seizures
51
Generalized seizures
Seizure activity occurs in both hemispheres without a clear focus
52
Generalized seizures typically cycle through a number of stages (3)
tonic stage, clonic stage, postseizure, a postictal depression
53
Tonic stage
body stiffens and breathing stops
54
Clonic stage
rhythmic shaking occurs
55
postseizure, a postictal depression
during which the patient loses affect and is confused
56
Grand mal
also known as a generalized tonic-clonic seizure
57
Akinetic seizures
ordinarily seen only in children, child collapses suddenly, seizures are often of very short duration, and the child may get up after only a few seconds
58
Myoclonic spasm
massive seizures that basically consist of sudden flexion or extension of the body and often begin with a cry
59
Dissociative seizures
are seizures or attacks that feature many of the characteristics associated with focal seizures but that are accompanied by no discernable change in EEG or any other brain-scan measure
60
Incidence of dissociative seizures is about
2 to 3 per 10,000 people
61
epileptic seizures self-
terminate
62
when a seizure does not stop
GABA agonists or glutamate antagonists can be administered to end the seizure
63
Drugs are used to
inhibit the development of seizures or their propagation
64
drugs used to prevent seizures
GABA agonists, Sodium-channel blockers,
65
Most common drugs are
anesthetics and anticonvulsants
66
Drugs are not effective for
30% to 40% of the population, who rely on deep brain stimulation or surgery to remove the brain regions where seizures start
67
Tumors
Mass of new tissue that grows independent of surrounding cells and does not have a physiological purpose
68
Brain tumors originate from
glia or other supporting cells, as the neurons do not grow and divide
69
Benign tumors generally
do not reoccur after removal
70
malignant tumors
are progressive
71
Encapsulated tumors
are localized in a distinct location, but put pressure on surrounding tissue
72
Infiltrating tumors
interact with surrounding cells and either destroy them or interfere with their function
73
Meningioma
encapsulating tumor
74
Glioblastoma
Infliltrating tumor
75
Glioblastoma
Infiltrating tumor
76
Glioma
Any brain tumor that arises from glial cells and infiltrate the surrounding brain
77
Glioma accounts for
45% of brain tumors
78
Meningioma
An encapsulated brain tumor that grows from the meninges
79
Meningioma are
Benign and encapsulated
80
Meningioma cause symptoms by
by compressing adjacent brain tissue
81
Metastatic tumor
Tumor cells from elsewhere in the body start to grow in the brain
82
prognosis of metastatic tumor
multiple tumors that have a poor prognosis and are difficult to treat
83
factors of Headache
stress, neurological diseases such as tumors, or migraines
84
pain of headaches occurs in
dura mater, the arteries and veins of the brain, and the cranial and cervical nerves
85
headache Pain results from
pressure, displacement, or inflammation
86
Migraine impacts
5% to 20% of the population at some point in their lives
87
Migraines are often
Often unilateral and preceded by an aura or mood disturbance
88
Classic migraines
Start with an aura, thought to be caused by vasoconstriction of the cerebral arteries that results in loss of blood flow to the occipital cortex, Depolarization spreads to surrounding neurons, Headache is associated with blood flow returning to normal
89
Common migraines are not associated
with an aura
90
Cluster headaches are
unilateral and recur for days or weeks before disappearing
91
Muscle-contraction headaches
results from persistent contraction of the muscles of the scalp and neck due to stress
92
hemiplegic migraine
A migraine that leads to paralysis of one side of the body
93
ophthalmologic migraine
A migraine that affects vision
94
Nonmigrainous vascular headaches
associated with dilation of the arteries and can be caused by fever, eating disorders, high altitude, food, or chemicals
95
Infections
Pathogenic microorganisms that invade the brain and evoke reactions by the tissue to their presence and to the toxins they generate
96
treating migraines
ergotamine compounds, which block vasodilation-producing serotonin receptors on blood vessels, are often given in conjunction with caffeine
97
Infections kill neural cells via several processes
interference, disturbing processes, altering neuronal characteristics, pus, edema
98
Interference of infection
Interfering with the neuronal blood supply to produce thrombosis, hemorrhaging of capillaries, or even complete choking off of larger blood vessels.
99
Disturbing processes of infections
Disturbing glucose or oxygen metabolism in brain cells severely enough to kill them.
100
Altering characteristics of infections
Altering the characteristics of neural-cell membranes, thus changing the neurons’ electrical properties or interfering with their basic enzymatic processes, producing an array of abnormal conditions.
101
pus and infections
it changes the composition of the extracellular fluids surrounding a neuron, thus altering neuronal function, and its presence increases pressure on the brain, disturbing normal functioning
102
edema and infections
leads to compression of the brain tissues, resulting in dysfunction.
103
4 Types of CNS Infection
Viral infections, Bacterial infections, Mycotic infections, Parasitic infections
104
viral infections
A virus has an RNA or a DNA genome and invades host cells to replicate
105
vectors for viral infections
mosquitos for West Nile virus and Zika virus
106
Bacterial infections
Bacteria replicate by cell division
107
Bacterial meninges
the meninges are infected by the bacteria and become inflamed
108
Brain abscesses
are pockets of pus produced by bacteria that destroy the cells in the area
109
Mycotic infections
Fungal infections of the brain by yeasts, molds, and mushrooms
110
Is the brain resistant to mycotic infections
Normally, the brain is resistant to such infections, but can be susceptible following cancer or tuberculosis
111
Parasitic infections
Parasites are living organisms that live inside another organism
112
Malaria
a parasite transmitted by mosquitos; infects the capillaries of the brain and results in local hemorrhages
113
Toxoplasma gondii
causes toxoplasmosis and is transmitted from rats through domestic cats to humans who clean up after the cats
114
Treating CNS Infections
Many treatments involve managing symptoms more than removing the infectious agent, particularly for viruses
115
bacterial infections are treated well with
antibiotics
116
Apraxia damaged area
neocortex
117
Apraxia
neurological disorder characterized by the inability to perform learned (familiar) movements on command, even though the command is understood and there is a willingness to perform the movement
118
Ataxia damaged area
cerebellar damage
119
Ataxia
Failure of muscular coordination or irregularity of muscular action
120
Athetosis damaged area
abnormal function of the extrapyramidal system.
121
Athetosis
Ceaseless slow, sinuous, writhing movements, especially in the hands
122
Catalepsy damaged area
due to dopamine loss.
123
A feature of Parkinson disease, due to dopamine loss
Catalepsy
124
Cataplexy
Complete loss of movement and posture during which muscle tone is absent but consciousness is spared
125
Chorea
Literally, “to dance”; refers to a wide variety of ceaseless, jerky movements that appear well coordinated but that are performed involuntarily
126
Hemiplegia damaged area
contralateral motor cortex
127
hemiplegia
Complete or partial paralysis to one half of the body
128
Palsy
Usually refers to persisting movement disorders due to brain damage acquired perinatally
129
Paralysis
Complete loss of movement (more commonly) or sensation in a part of the body
130
Paralysis damaged region
permanent after damage to motor neurons; temporary after damage to motor cortex
131
Paraplegia
Paralysis or paresis of the lower torso and legs following spinal-cord damage.
132
Spasticity
Increased tone in certain muscle groups that maintain posture against the force of gravity. If the limb is moved against the rigidity, resistance will initially increase and then tone will suddenly melt .
133
Spasticity damaged area
damage to the extrapyramidal motor fibers.
134
(clasp-knife reflex)
Muscle resistance will initially increase and then tone will suddenly melt
135
Tardive dyskinesia
Slow, persistent movements, particularly of the mouth and tongue. Usually follows long-term treatment with antipsychotic drugs.
136
Myasthenia Gravis
This is a severe muscle weakness characterized by muscle fatigue after little activity or exercise
137
Myasthenia Gravis most common in
females than males and age of onset is typically in the 30s
138
first muscles to show weakness in Myasthenia Gravis
Muscles innervated by the cranial nerves are the first to show symptoms, with initial symptoms including drooping eyelids and difficulty chewing and swallowing
139
when do symptoms of Myasthenia Gravis occur?
Symptoms initially occur at the end of day and are relieved by sleep
140
Myasthenia Gravis cause
Acetylcholine receptors at the neuromuscular junction are destroyed by the immune system
141
Multiple Sclerosis
Myelin is attacked and destroyed in the motor and sensory tracts
142
Means of attach in MS
could be bacteria, viruses, or antibodies
143
Is myelin loss caused by MS universal
not universal, but occurs in patches throughout the nervous system
144
How is MS spotted
Disease tends to show symptoms, then the symptoms go away for a while, then they come back
145
MS is more common in
in females than males (3:2) and more common in the northern hemisphere
146
innervation in quadra/paraplegia
Initially, all innervation is lost, including reflexes and even thermoregulation, but some reflexes return over time
147
Brown–Séquard syndrome
occurs if just one side of the spinal cord is damaged, impacting only some of the ascending and descending pathways
148
Hemiplegia
Loss of voluntary movements on one side of the body and changes to some reflexes
149
Hemiplegia damage
damage to the cortex and basal ganglia contralateral to the side of motor impairment
150
Cases of hemiplegia
can occur in infants but mostly in older adults with high blood pressure
151
Babinski sign in intact individuals
they will flex their toes downward after a stimulus to the bottom of the foot
152
Babinski sign in intact individuals with hemiplegia
Individuals with hemiplegia extend their toes
153
Hyperkinetic–dystonic syndromes
increase motor activity
154
Hyperkinetic–dystonic syndromes (2)
huntingtons disease, Tourette's
155
Hypokinetic–rigid syndrome
decreases movement
156
Hypokinetic–rigid syndrome (1)
Parkinsons disease
157
Huntington Disease
Behaviors include writhing and twisting movements (choreas), Results in intellectual deterioration and personality changes
158
Huntington's age of onset
typically 30 to 50 years old
159
Huntington impairments
Impairments of recent memory, slowed information processing, and emotional changes such as depression and anxiety
160
Huntington cause
Caused by a mutation in the huntingtin gene, a dominant gene, which results in a defective protein that accumulates in the basal ganglia
161
Huntingtons physical characteristics of the brain
The cortex of patients shows shrinkage and thinning, particularly the basal ganglia
162
Role of the Basal Ganglia
Basal ganglia contain multiple pathways to influence movement
163
Indirect pathway of basil ganglia
inhibitory for voluntary movement
164
Basil ganglia and huntingtons disease
Huntington disease is associated with a decrease in activity in the indirect pathway due to cell loss in the putamen and globus pallidus, resulting in a decrease in inhibition of movement
165
Huntingtons disease impaired tests
Performance is also impaired on tests of frontal-lobe function
166
Tourette Syndrome stage I
Initially the symptoms are tics of the face, limbs, or body
167
Tourette Syndrome stage II
the tics are accompanied by inarticulate cries
168
Tourette Syndrome stage
echolalia and coprolalia are added to the tics and cries
169
echolalia
repeating what others have said, as well as repeating actions
170
coprolalia
The utterance of obscene or lewd words
171
Tourette syndrome does run in families, so is assumed to have
a genetic component
172
Tourette's age of onset
between ages 2 and 15
173
physical brain makeup in individuals with Tourette's
have a larger putamen and smaller thalamus
174
In addition to the tics, patients have visuospatial difficulties
on tests and in the real world
175
Parkinsons disease
Symptoms include tremor, muscular rigidity, involuntary movement, and postural disturbance; these can occur in different parts of the body
176
Parkinsons positive symptoms
describe abnormal behaviors that have been gained
177
Parkinsons negative symptoms
or normal behaviors that have been lost
178
Positive symptoms of Parkinsons
Tremors , Muscular rigidity, Involuntary movements,
179
Negative symptoms of Parkinsons
Postural disorders, Righting disorders, Locomotive disorders, Speech disturbances, Akinesia
180
Tremors
Alternating movements of the limbs when they are at rest stop during voluntary movements or during sleep
181
Muscular rigidity
Simultaneously increased muscle tone in both extensor and flexor muscles is particularly evident when the limbs are moved passively at a joint
182
Involuntary movements sometimes referred to as Akathesia or cruel restlessness
These movements may consist of continual changes in posture, sometimes to relieve tremor and sometimes to relieve stiffness but often for no apparent reason
183
Postural disorders
An inability to maintain or difficulty in maintaining a body part (head, limbs, and so forth) in its normal position in relation to other body parts is referred to as a disorder of fixation
184
Disorders of equilibrium
consist of difficulties in standing or even sitting unsupported
185
Righting disorders
Patients have difficulty standing from a supine position
186
Locomotive disorders
difficulty initiating stepping
187
Festination
take faster and faster steps and end up running forward.
188
Speech disturbances
almost complete absence of tone (prosody) in the speaker’s voice
189
Akinesia
poverty or slowness of movement may manifest in a blank facial expression or lack of blinking, swinging the arms when walking, spontaneous speech, or typical fidgeting movements
190
cause of Parkinsons
cause is unknown, or idiopathic
191
Postencephalitic form of Parkinsons
due to damage to cells of the substantia nigra following encephalitis
192
Drug-induced Parkinson disease
can result from drugs used to treat schizophrenia, and is reversible
193
Recreational drugs, such as a synthetic form of heroin, can cause
permanent damage to dopamine cells, resulting in Parkinsons
194
Parkinson disease is observed when dopamine levels
are reduced by more than 90% below normal levels
195
There may be a genetic influence to Parkinsonism, but
most cases are likely not genetic
196
is there a cure for Parkinsons?
no
197
Pharmaceutical treatment therapy of Parkinsons
includes l-dopa, which will cross the blood–brain barrier and be converted to dopamine to supplement what has been lost
198
Monoamine oxidase inhibitory and tricyclic antidepressants enhance
dopamine neurotransmission
199
Anticholinergic drugs are used to block the
acetylcholine signaling that increases when dopamine decreases
200
Newer treatments for parkinsons include
DBS, stem cells to replace lost dopamine neurons
201
Cerebral Vascular Disorders
Damage to the blood vessels can reduce or eliminate blood flow to a region
202
Cerebral Vascular Disorders damge
most often occurs in the arteries, due to the higher blood pressure
203
Cerebral vascular accident (stroke)
sudden appearance of neurological symptoms as a result of blood supply being interrupted
204
infarct
is the region of the brain that is directly impacted by the stroke and is characterized by dead and dying cells
205
Types of Cerebral Vascular Disorders
Cerebral ischemia
Migraine stroke
Cerebral hemorrhage
206
Cerebral hemorrhage
Blood vessel fails, resulting in bleeding into the brain
207
Cerebral hemorrhage causes
high blood pressure, trauma, or toxic chemicals
208
Migraine stroke
Blood flow is interrupted by a constriction of the blood vessel
209
Migraine stroke causes
Cause of the vascular spasm is not known
210
Cerebral ischemia
Blood vessel is blocked, preventing enough blood from reaching the brain
211
thrombosis
a clot in the vessel that has remained where it was formed
212
Embolism
a clot or other plug that formed in a larger vessel and got stuck in a smaller vessel
213
cerebral arteriosclerosis
arteries thicken and harden, restricting blood flow
214
Angiomas
Abnormal blood vessels that divert the normal flow of blood Result in abnormalities in the pattern and amount of blood flow
215
Aneurysms
The walls of blood vessels are normally elastic to withstand the blood pressure, An aneurysm is a region where that elasticity is defective, leading to the vessel walls ballooning out and weakening the structure of the vessel
216
Treating Cerebral Vascular Disorders
Ideal treatment is to restore blood supply, but this is not always possible
217
drugs to prevent cell death
Drugs to block excitation and calcium channels can be effective to block cell death
218
how to handle and aneurism
Surgery to support an aneurysm or remove blood that is putting pressure on surrounding tissue may be effective
