Long term effects of Chronic Neurological Conditions

Question 1

How many people in the UK are living with a neurological condition?

Answer 1

10 million

Question 2

How many people in the UK are disabled by their neurological condition?

Answer 2

1 million (2%)

Question 3

How many people in the UK require help for most of their daily activities due to a neurological condition?

Answer 3

350,000

Question 4

What conditions are the most common cause of serious disability?

Answer 4

Neurological conditions

Question 5

What percentage of GP consultations are for neuro symptoms?

Answer 5

17%

Question 6

What percentage of hospital admissions are for neurological problem requiring treatment from a neurologist or neurosurgeon

Answer 6

19%

Question 7

What percentage of disabled people living in residential care have a nerological condition?

Answer 7

33%

Question 8

How many children have an acquired brain injury?

Answer 8

200,000

Question 9

How many people in the UK care for someone with a neurological condition?

Answer 9

~ 850,000

Question 10

What percentage of people aged 16-24 with chronic disability have a neurological condition?

Answer 10

25%

Question 11

What is spina bifida?

Answer 11

• Developmental abnormality in utero
• Incomplete development or covering of the brain and/or spinal cord, caused by a failure of the foetal spine to close normally in the first month of pregnancy

Question 12

How common is spina bifida?

Answer 12

1-1.5 / 2000 births

Question 13

What condition is spina bifida linked with?

Answer 13

Hydrocephalus

Question 14

What are the proposed factors the contribute to spina bifida?

Answer 14

• Folate deficiency
• Multi-factorial inheritance
• Potato blight
• Vitamin deficiency
• Maternal fever
• Zinc deficiency
• High sound intensity
• Viral infection
• Alcohol
• Mineral deficiency
• Medication - phenytoin, epillim etc.

Question 15

When does the neural plate close over?

Answer 15

20-29 days

• Anterior neuropore closes at 26 days
• Posterior neuropore closes at 29 days

Question 16

What is spina bifoda called if it is not apparent?

Answer 16

Spina Bifida occulta - small cleft sacral dimble - almosr zero clinical consequences

Question 17

What is anencephalus?

Answer 17

Neural tube defect that occurs when the rostral (head) end of the neural tube fails to close, usually between the 23rd and 26th day following conception

Question 18

What are the neurological consequences of severe spina bifida?

Answer 18

• Paralysis, loss of sensation and reflexes distal to the abnormality
• High risk of meningitis
• Hydrocephalus in 70-90% because of the interuption of the circulation of CSF

Question 19

How is hydrocephalus treated?

Answer 19

• Neurosurgeon will put a small shunt in which will drain it from the ventricular system into the peritoneum or chest which will drain the CSF

Question 20

What are the problems associated with shunts?

Answer 20

They can become blocked or infected (associated with dizziness, cognitive decline, headaches in those with shunts)

Question 21

How can spina bifida be diagnosed antenatally?

Answer 21

Ultrasound
- Spinal anomalies identifiable at 16-18 wks
Alpha fetoprotein raised in neural tube defects
- Maternal serum at 16-20 wks amniocentesis

Question 22

What are the associated conditions of spina bifida?

Answer 22

• Renal anomalies
• Sphincter function
• Intellectual impairments
• Musculoskeletal

Question 23

What are conditions are associated with spina bifida?

Answer 23

• Renal anomalies
• Sphincter function
• Intellectual impairments
• Musculoskeletal

Question 24

WHat are the deformaties of the feet called in individuals with spina bifida?

Answer 24

Paralytic deformaties of feet

• Difficulties with shoe wear
• Plantar ulceration

Question 25

What is scoliosis though to be due to?

Answer 25

Combination of congenital abnormalities of the spine and spinal muscle weakness

Question 26

If surgery is required for scoliosis when is it done?

Answer 26

Usually after the age of 10 years to allow sufficient spinal growth beforehand Rods put through vertebral bodies

Question 27

What are the consequences of an L4 lesion on the lower limbs?

Answer 27

- Paralysed calf muscles result in excess ankle dorsiflexion - Muscle fatigue - Energy inefficient gait - Knee pain

Question 28

What are charcot joints?

Answer 28

- Loss of cartilage and and therefore joint destruction | - In an L4 lesion there is a loss of protective sensation and proprioception resulting in these joints

Question 29

What are the expectations of lower urinary tracts?

Answer 29

- That bladder should fill to good capacity - Should wmpty to completion - Emptying should be under voluntary control - That filling and emptying should not be detrimental to renal function

Question 30

What does incomplete bladder emptying lead to?

Answer 30

Back pressure on ureters and eventual renal parenchymal damage and failure, if left untreated

Question 31

Why is permenant bladder catheterisation not a satisfactoy long term solution to urinary incontinance?

Answer 31

High risk of UTIs | - Clean intermittent catheterisation often the best option - carer or patient self catheterisation

Question 32

Damage to what spinal cord levels cause urinary incontinance?

Answer 32

S2-4

Question 33

What levels of the spinal cord control sexual sensation?

Answer 33

S2-4

Question 34

How can serections be made possible in tose with spinal injuries?

Answer 34

Through a spinal reflex

Question 35

What factors lead to an optimal outcome for adults living independantly?

Answer 35

- Normal intellect - Social continance stable - Independantly mobile, can drive an adapted vehicle and use walking aids - Independant living - household adaptations, telecare and other technologies - Employed

Question 36

What are the challenges to independant living as an adult?

Answer 36

- Learning difficulties - Behavioural difficulties - Social continance not achieved - Cannot transfer independantly - Ageing parents - Some parents will live in a sheltered/residential facility and be looked after by a team of carers - options for community living are limited though in reality

Question 37

What is cerebral palsy?

Answer 37

- Spectrum of motor disorders affecting posture, movement and co-ordination - Caused by brain lesion resulting in abnormal development of CNS - Higher risk in oremature birth, twins

Question 38

How common is Cerebral Palsy in the UK?

Answer 38

2-3 per 1000 live births

Question 39

Do older or younger individuals with crebral palsy feel less socially integrated?

Answer 39

Older people with CP feel less socially integrated - Vocational status - Living situation - Musculoskeletal pain

Question 40

What is spastic diplegia?

Answer 40

- Type of cerebral palsy | - Hypertonia and spasticity in lower limbs