Long Term Effects of Chronic Neurological Disability Flashcards

1
Q

What is the epidemiology surrounding chronic neurological disability?

A

10 million in UK with neurological disability

1 million in UK disabled by neurological condition

350, 000 require help with ADLs

Neurological conditions are the most common cause of serious disability

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2
Q

How many children have an acquired brain injury?

A

200, 000

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3
Q

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

A

850, 000

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4
Q

Who first described spina bifida?

A

Nicholas Tulp

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5
Q

What is the incidence of spina bifida?

A

1-1.5/2000 births

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6
Q

What are some of the proposed causes of spina bifida?

A

Multi-factorial inheritance
Potato blight

Vitamin, folate, mineral and zinc deficiencies

Maternal fever

Viral infection

Alcohol

Medication e.g. phenytoin, epilim

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7
Q

What is cerebral palsy?

A

Spectrum of motor disorders affecting posture, movement and coordination

Caused by brain lesion resulting in abnormal development of the CNS

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8
Q

What is the incidence of spina bifida?

A

2-3 per 1000 live births

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9
Q

When do the neuropores close?

A

Rostral - 26 days

Caudal - 29 days

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10
Q

What may a sacral dimple indicate?

A

Spina bifida

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11
Q

What are the consequences of severe spina bifida?

A

Lower motor neurone lesion leading to paralysis, loss of sensation and reflexes distal to the abnormality

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12
Q

Describe the spectrum of abnormality of spina bifida (mild-severe)

A

Minor/ not clinically important - spina bifida occulta, sacral dimple

Mild - cord remains in neural canal, herniated meninges and CSF, but not cord

Severe - cord displaced from the neural canal or cord not developed

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13
Q

What are the neonatal consequences of severe spina bifida?

A

High risk of meningitis in open lesions

Hydrocephalus due to interruption of circulation of CSF

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14
Q

How can spina bifida be detected antenatally?

A

Ultrasound at 16-18 weeks

Alpha fetoprotein at 16-20 weeks

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15
Q

How would an L4 lesion affect motor response?

A

No motor function below knee apart from tibialis anterior

Weak glutei

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16
Q

What are the sensory effects of an L4 lesion?

A

No sensation distal to L4 i.e. below knee and back of leg

17
Q

Which nerves control the sphincters?

A

S2, 3, 4

18
Q

What are the musculoskeletal problems associated with an L4 lesion?

A

LMN signs

Muscle weakness and paralysis

Difficulty walking

Spinal deformity possible

Disuse osteoporosis

Skin ulceration (particularly f immobile)

19
Q

What is scoliosis?

A

Lateral curvature of the spine due to combination of congenital abnormalities of the spine and spinal muscle weakness

20
Q

When is scoliosis correction surgery done and why?

A

10 years

To allow sufficient spinal growth before hand

21
Q

What is flexed knee gait?

A

Paralysed calf muscles result in excess ankle dorsiflexion

Patient relies on quadriceps for mobility

22
Q

Why is there mobility changes when patients become adult?

A

Increased height and weight as child grows but the muscle strength stays the same

Muscle fatigue and knee pain may worsen and adult become more reliant on wheelchair

23
Q

Can people with an L4 lesion drive?

A

Yes

May need adapted vehicle

24
Q

What are charcot joints?

A

Loss of protective sensation and proprioception in joint can lead to destruction

25
Q

What is a neurogenic bladder?

A

Incomplete bladder emptying leads to back pressure on the ureters and eventual renal parenchymal damage and failure

26
Q

Why is permanent bladder catheterisation not a long term solution to urinary incontinence in children with L4 lesion?

A

High risk of UTI

27
Q

What is the best option for urinary incontinence?

A

Clean intermittent catheterisation

28
Q

Why do people with L4 lesion develop faecal incontinence?

A

Paralysis of external anal sphincter

Loss of sensation to indicate full rectum

Some patients will have weak abdo and perineal muscles

29
Q

How is faecal incontinence in L4 lesions treated?

A

Daily rectal enema

Laxatives for constipation

30
Q

What sexual potential is there in L4 lesion patients?

A

Libido normal

Sensation absent (S2-4)

Erections may be possible due to spinal reflex

Fertility normal in females, males usually sterile