Exam #3

Question 1

MS: diagnosis requires “dissemination in time and space”

Answer 1

• Space: evidence of scarring (plaques) in at least two separate areas of the CNS
• Time: evidence that the plaques occurred at different points in time
• Must be no other explanation

Question 2

Fazekas scale

Answer 2

Measures white matter in brain for people with MS

Question 3

Relapsing remitting

Answer 3

Most common, ups and downs

Question 4

Secondary progressive

Answer 4

Develops over time, no remissions

Question 5

Primary progressive

Answer 5

No eventual recovery, worsen

Question 6

Progressive relapsing

Answer 6

No remission

Question 7

Pathogenesis of MS (3)

Answer 7

1. BBB: abnormally activated lymphocytes disrupt BBB
2. Autoimmune: lymphocytes enter brain, activate local immune response
3. Inflammation: t-cells attack on myelin and triggers inflammatory processes

Question 8

Treatment of MS (5)

Answer 8

1. Treatment of relapses
2. Symptom management
3. Disease modification
4. Rehab
5. Psychosocial support

Question 9

What do disease-modifying drugs do for MS?

Answer 9

All reduce attack frequency and severity, reduce scarring on MRI, and probably slow disease progression

Question 10

What does MS medications NOT do? (3)

Answer 10

1. Cure the disease
2. Make people feel better
3. Alleviate symptoms

Question 11

Where is seizure onset usually?

Answer 11

Left posterior medial temporal lobe

Question 12

Ictal activity (during a seizure)

Answer 12

Stereotyped, driven behavior, not consciously controlled

Question 13

Post-ictal activity (after a seizure)

Answer 13

Brain is “re-booting”, confusion, headache, fatigue

Question 14

Inter-ictal (between seizures)

Answer 14

Ranges between normal and impaired, degree and type of dysfunction depends on location and severity of underlying abnormality

Question 15

Treatment goal of epilepsy

Answer 15

Prevent start or spread of seizure activity

Question 16

Treatment options for epilepsy (3)

Answer 16

1. AED
2. Neurostimulators
3. Surgery

Question 17

Medial temporal lobe epilepsy (MTLE)

Answer 17

• onset in 1st two decades
• cryptogenic etiology
• “stuttering” course
• doesn’t respond well to medical treatment
• significant psychosocial burden
• 60-90% seizure free with surgery
• memory worse in 25-40%

Question 18

Functional adequacy

Answer 18

Ability of MLT structures ipsilateral to seizure focus to support memory-how good the tissue is that you are removing, high functional adequacy associated with higher likelihood of post-op memory deficits, “the more you have, the more you have to lose”

Question 19

Functional reserve

Answer 19

Ability of MLT structure contralateral to seizure focus to support memory- making sure one side is good enough to function on its own, higher functional reserve associated with lower likelihood of post-op memory deficits, “the more you have left, the more you can make up for what is lost”

Question 20

Mechanism of TBI (3)

Answer 20

1. Direct blow to head
2. Indirect blow
3. External force/blast wave

Question 21

4 mechanisms of blast injuries

Answer 21

1. Primary blast mechanisms
2. Secondary blast mechanisms
3. Injury to the brain opposite side of impact (countrecoup)
4. Site of impact (coup)

Question 22

Behaviors to classify TBI (3)

Answer 22

1. Eye opening response
2. Best verbal response
3. Best motor response

Question 23

5 Parameters of TBI

Answer 23

1. Loss of consciousness
2. Altered consciousness
3. Initial glasgow coma scale
4. Neurological exam
5. Imaging/EEG

Question 24

Shearing force

Answer 24

Unaligned forces pushing one part of the brain in one direction and another part of the brain in opposite direction

Question 25

Rotational force

Answer 25

The head and the brain are being rotated, which causes the axons to twist resulting in either temporary or permanent damage to the axon and neuron

Question 26

Where do contusions usually occur in the brain?

Answer 26

Prefrontal or anterior temporal region

Question 27

For moderate and severe TBIs, the primary pathophysiology includes (4)

Answer 27

1. Diffuse axonal injury (DAI) 2. Contusions 3. Diffuse micro/small vessel injury 4. Widespread cellular dysfunction, neurochemical disregulation, neurometabolic disruption, NT imbalances

Question 28

Secondary/delayed consequences of TBI (5)

Answer 28

1. Hematoma 2. Infection 3. Anoxia/hypoxia 4. Seizures 5. Raised intracranial pressure

Question 29

Categories of cognitive rehab (2)

Answer 29

1. Retraining (process): if circuits have been partially spared after injury, they can be retrained, takes time 2. Develop compensatory skills (strategy): retained skills and functional reorganization used to learn new strategies, external tools (cognitive support tools)

Question 30

Compensatory approaches (4)

Answer 30

1. Remediation (practice, memory tasks) 2. Substitution (smart phone) 3. Accommodation (adjust priorities, set new goals) 4. Assimilation (adjust expectations of others)