Special topics

Question 1

transient (moves around) event caused by abnormal excessive activity in the brain; sudden, excessive, abnormal electrical discharge of aggregates of neurons in the brain; 10% of population have one in their lifetime

Answer 1

Seizure

Question 2

What can cause seizures?

Answer 2

1. Mechanical: birth injuries, head trauma, tumors, vascular abnormalities (stroke)
2. Metabolic: electrolyte disturbances, glucose abnormalities, inborn errors of metabolism
3. Genetic: benign familial neonatal seizures, juvenile myoclonic epilepsy,
4. Other: fever, infection

Question 3

chronic disorder of recurrent seizures; Caused by genetics, TBI, stroke, brain tumor, cerebral palsy, infectious diseases; Cause can also be unknown

Answer 3

Epilepsy

Question 4

What are the 3 questions you must ask in order to classify a seizure?

Answer 4

1. Where does it start?
   - Focal (one side of brain), Generalized (crosses over to different segments of the brain), or unknown
2. [if answer is focal] Do they have an impaired awareness or were they aware the entire time?
3. Does it affect the motor abilities or not while the seizure occurs?

Question 5

Inflammation of the meninges of brain and meninges of spinal cord; Swelling triggers symptoms (blockage of CSF flow); Fever, stiff neck, severe headache; Confusion and decreased alertness in severe cases; Can be viral, bacterial, or fungal

Answer 5

Meningitis

Question 6

What are the viral causes of meningitis?

Answer 6

1. Arbovirus
2. Tibovirus (from ticks)
3. enterovirus
4. herpes simplex 2
5. Epstein-Barr

Question 7

When performing a lumbar puncture procedure, the CSF is cloudy. What does this indicate?

Answer 7

Bacterial infection causing meningitis

Question 8

What are the bacterial causes of meningitis?

Answer 8

Streptococcal Pneumonia

Question 9

What is kernig sign?

Answer 9

A hamstring stretch that causes non-hamstring sign

- pulls on inflamed meninges

Question 10

What is brudzinski sign?

Answer 10

cervical flexion causing pain or hip flexion with knee flexion

Question 11

Acute inflammation of the brain itself (primarily viral, but can be bacterial, parasitic, toxic drug rxns); Headache, fever, body aches, fatigue; Symptoms of altered brain function sooner compare to meningitis – confusion, decreased alertness (Immediate or latent)

Answer 11

Encephalitis

Question 12

What are the viral causes of encephalitis?

Answer 12

1. Herpes virus
2. mosquito and tick-borne
3. measles
4. mumps
5. rubella

Question 13

Pathogenesis of inflammatory process in focal area that causes signs and symptoms at a greater rate than a brain tumor; Uncommon infectious disorder; Capsule has too much presser; some S and S are Fever, HA, Hemiparesis, disturbed consciousness

Answer 13

Brain abscess/ abscessi

Question 14

Up to 5% of headaches have a serious cause. What are they?

Answer 14

1. Tumors
2. Infections of the CNS
3. Brain hematoma or hemorrhage

Question 15

What are the types of primary headaches (not caused by other diseases)?

Answer 15

Tension
migraine
cluster

Question 16

Headaches caused by other diseases, resolve when the underlying problem is identified and treated

Answer 16

Secondary headache

Question 17

Most common primary headache; Primarily a response to stress; Described as dull, non-throbbing, tightness, pressure; Whole head or neck; Caused by stress and fatigue

Answer 17

Tension-type headache

Question 18

Familial disorder; Recurrent attacks; Widely variable in intensity, frequency and duration; Often unilateral; Dull or throbbing pain; Usually associated with nausea and vomiting; Pain builds up gradually; Last 4-72 hours; 12% of population; Increased risk of stroke especially when combined with aura type migraines and estrogen containing oral contraceptives; May be preceded by neurological and mood disturbances (aura); More common in women; Usually develop before age 40

Answer 18

Migraine

Question 19

What are the theories on genesis of migraines?

Answer 19

1. Peripheral sensitization
2. Central sensitization
3. Endocrine
4. Serotonin/neurotransmitter

Question 20

Rare but most painful of primary headaches; Men 20-50 years (27-30 most common); Correlation with prior head trauma; Weak genetic link; Sudden onset, severe pain; Pain remains on one side throughout life; Usually one eye and fronts-temporal region; Boring and non-throbbing; Autonomic symptoms are photophobia, tearing, nasal congestion; Induced by awakening from sleep

Answer 20

Cluster headache

Question 21

What are typical patient characteristics of those with cluster headache/

Answer 21

1. Hypermasculine appearance
2. Increased and asymmetrical facial wrinkles
3. Thick orange peel skin
4. 3 inches taller
5. Smokes cigarettes and drinks alcohol
6. Anxiety, compulsivity and hypochondria

Question 22

What are some types of secondary headaches?

Answer 22

1. Cervicogenic (Tension headache that starts back here and moves up or starts “right here”)
2. Posttraumatic (Whiplash)
3. Medication overuse
4. Sinusitis (Sinus Headache)
5. Postdural puncture (due to changes in CSF pressure or amount)

Question 23

Localized to neck and occipital region, usually bilateral, often starts in occipital region and moves anteriorly; Pain with certain neck movements - often ext and rotation or sustained neck positions; Trigger points – suboccipital, cervical or shoulder muscles – refer to head; Pain fluctuates between mild and severe; Whiplash—instability

Answer 23

Cervicogenic headache

Question 24

What are headaches of pathological conditions

Answer 24

1. Subdural/epidural hemorrhage (Usually more mild, intermittent, Fluctuating consciousness)
2. Subarachnoid hemorrhage (Sudden, severe, and constant, Elevated BP, change in consciousness)
3. Meningitis (Severe w/ radiation down neck, acute illness and fever)
4. Increased cranial pressure (Mild to severe, Hemiparesis, visual changes, vomiting, change in consciousness)
5. Brain tumor

Question 25

Unilateral or focal followed by generalized ; Pain described as dull, aching, throbbing; Interrupts sleep or is worse upon awakening; Elicited by postural changes (especially lying down), coughing, or sneezing; Associated with nausea/vomiting or focal neurological signs; Recent onset; Become more frequent and severe over time

Answer 25

Brain Tumor Headache

Question 26

What are the classifications of peripheral nerve injury?

Answer 26

1. Neurapraxia 2. Axonotmesis 3. Neurotmesis 4. Wallerian degeneration

Question 27

segmental demyelination, slow or blocks nerve conduction at specific point, often occurs after nerve compression resulting in mild ischemia

Answer 27

Neurapraxia

Question 28

axon damaged, connective tissue remain intact, occurs after prolonged compression resulting in necrosis, slow regeneration

Answer 28

Axonotmesis

Question 29

most severe, complete disruption of nerve and connective tissue, occurs from trauma, see atrophy of muscle

Answer 29

Neurotmesis

Question 30

in axono and neurotmesis axons distal to lesion degenerate, regenerate in axonotmesis

Answer 30

Wallerian degeneration

Question 31

What are the neuropathy classifications?

Answer 31

1. Mononeuropathy – single peripheral nerve 2. Polyneuropathy – several peripheral nerves 3. Radiculopathy – follows nerve distribution, involvement of nerve root as it branches from spinal cord

Question 32

What are S andS of peripheral nerve dysfunction?

Answer 32

1. Sensory loss follows nerve distribution 2. Motor loss of muscles distal to the lesion 3. No signs of CNS dysfunction 4. Tingling, prickling, or burning paresthesias distal to the lesion 5. Decreased or absent DTR’s 6. ANS dysfunction (sweating/ vascular control)

Question 33

What is the difference between myopathy and neuropathy?

Answer 33

1. Myopathy – weakness tends to be more proximal (MD, Mitochondrial Disorders) 2. Neuropathy – weakness first occurs distally (Carpal tunnel, radial tunnel, osteophyte) similarities - weakness and hypotonia

Question 34

Most common inherited disorder affecting motor and sensory nerves; Variable chromosomal defects (50 different spots); Change in protein involved in myelination Initially involves the peroneal nerve and muscles of the foot and lower leg; Progresses to muscles of forearms and hands

Answer 34

Charcot-Marie-Tooth Disease

Question 35

What disease do these clinical features indicate: - Distal, symmetric muscle weakness and atrophy - Diminished DTR’s - Pes cavus deformities with hammer toes - Foot drop - Some patients experience diminished proprioception and sensation - Symptomatic treatment (orthotics, arthrodesis)

Answer 35

Charcot-Marie-Tooth Disease

Question 36

What is a common complication associated with diabetes mellitus?

Answer 36

Diabetic neuropathy PT treatment: - EDUCATION - Wound care - Gait training - Aerobic exercise

Question 37

Rapidly Reversible Neuropathy (can be reversed if caught early); Generalized Symmetric Polyneuropathies; Focal Neuropathies; Chronic metabolic disturbances; Hyperglycemia can be a factor; Nerve fiber loss/atrophy

Answer 37

Diabetic neuropathy

Question 38

What are clinical features of diabetic neuropathy?

Answer 38

1. Sensory loss 2. Small fibers – burning pain 3. Large fibers – painless paresthesia, impaired vibration, proprioception, touch, and pressure, loss of ankle DTR’s 4. Motor weakness is mild 5. Starts distally

Question 39

What are some characteristics of a typical diabetic wound?

Answer 39

- round - quick movement into depth - bottom of the foot

Question 40

Chronic Alcoholism leading peripheral neuropathy | Poor dietary habits, vitamin deficiency

Answer 40

Alcohol neuropathy

Question 41

What do we need to watch out for with people who are laying and not moving a lot (i.e., people with chronic migraines, meningitis, west nile, alcohol neuropathy patient)?

Answer 41

Immobilized induced myopathy

Question 42

Causalgia or Reflex Sympathetic Dystrophy (RSD)

Answer 42

Complex Regional Pain Syndrome (CRPS)

Question 43

What are the types of CRPS?

Answer 43

1. CRPS I: No apparent nerve injury – approx. 90% of cases 2. CRPS II: Associated with a peripheral nerve injury 3. Other

Question 44

Precipitated by trauma of some sort, UMN lesion, or LMN lesion; Injury at one somatic level initiates sympathetic efferent activity that affects many levels

Answer 44

CRPS

Question 45

What are the clinical features of CRPS

Answer 45

1. Intense pain out of proportion to the severity of the injury (if an injury has occurred) 2. Pain gets worse rather than better over time 3. Most often affects one of the extremities (arms, legs, hands, or feet) 4. Peripheral sensitization - Increased skin sensitivity 5. Changes in skin temperature, color, texture 6. Swelling and stiffness in affected joints 7. Motor disability with decreased ability to move the affected body part

Question 46

What medical treatments are done for CRPS?

Answer 46

1. Psychotherapy 2. Sympathetic nerve block 3. Medications 4. Spinal cord stimulation 5. Intrathecal drug pumps 6. Acupuncture

Question 47

What PT treatments are used for systemic pathology of CRPS?

Answer 47

1. Modalities for pain control 2. ROM exercises 3. Compression/elevation/massage 4. Mobilizations 5. Exercise program/Graded Motor Imagery/Aquatic - Worst thing a patient can do is immobilize the extremity