Test 3 Flashcards
(405 cards)
1
Q
Exotropia
A
Deviation of one eye outward
Less common strabismus (lazy eye)
2
Q
LGMD: Limb-girdle Muscular Dystrophy
A
Variation of muscular dystrophy
Pelvic and/or shoulder girdles are predominately involved
3
Q
Awareness of the environment or responsiveness to a stimulus or task without being distracted by other stimuli
A
Attention
4
Q
Goal directed behavior
A
Deciding on a goal
Planning how to reach a goal
Executing a plan
Monitoring execution of plan
5
Q
Vegetative state
Arousal vs awareness
A
Have arousal
No awareness
6
Q
Conduction aphasia
A
Understands language
Language output unintelligible
7
Q
“Your brain is lying to you, it’s telling you that you are off balance and falling towards your weaker side. I want you to use your eyes for finding your balance.”
A
Lateropulsion “Pushers syndrome”
8
Q
2 types of long term memory
A
Explicit/Declarative
Implicit/Nondeclarative
9
Q
Refractive error
A
Indistinct vision improved by corrective lenses
10
Q
Determinants of severity of stroke
A
Location of lesion Size/extent of lesion Early acute management Amount of collateral blood flow Amount of brain swelling
11
Q
Anterograde amnesia
A
Memory problems from brain injury forward
12
Q
Chronic psychologic stress
Sympathetic nerve endings response
A
In adrenal gland ->
release epinephrine ->
Inhibit lymphocyte and cytokine production
In thymus, lymph nodes, spleen, and bone marrow->
Release norepinephrine and peptides->
Suppress natural killer cells and proliferation of lymphocytes;
Increased number of WBC
13
Q
Presentation of primary brain tumor:
Parietal lobe
A
Receptive aphasia
Sensory loss
Hemianopia
Spatial disorientation
14
Q
Blood supply to thalamus
A
PCA
15
Q
Majority of people with visual impairments are ___; half the blind population is ___.
Every ___ someone in US becomes permanently blind or partially sighted/low vision
Nearly ___ in every ___ children in US has low vision or is legally blind.
A
Elderly
Over 65 years old
Every 7 minutes
Nearly 1 in every 1000 children in US have low vision or is legally blind
16
Q
Visual spatial neglect
A
Ignoring one side or stimuli coming from one side of ones own body
Damage to right parietal area
Sensory extinction
17
Q
Consciousness
A
Arousal
Attention
Selection of object of attention
Motivation of initiation of motor activity and consciousness
Neuromodulators produced by brainstem neurons, transmitted to cerebrum by reticular activating system
18
Q
Astereognosis
A
Inability to identify objects by touch and manipulation despite intact discriminative somatosensation
Lesion to secondary somatosensory area
19
Q
Central vestibular disorders
A
Damage to vestibular nuclei or their connection to brain
Symptoms milder than peripheral disorders
Often affect structures other than vestibular nuclei
May produce brainstem signs like sensory/motor loss, double vision, dysarthria
3+ days of continuous severe vertigo with nausea/vomiting indicates CNS lesions
20
Q
Signs/symptoms of brain tumors
A
- Focal damage
- Headache
- Signs of ICP
- Seizures
- Personality changes
- Neurological dysfunction
- Secondary effects: ischemia/hypoxia, herniation, hydrocephalus, post traumatic epilepsy
21
Q
Ampulla
A
Swelling at end of semicircular canals that contain crista
22
Q
Contralateral inferior quadrantanopia
Possible visual pathway lesion location?
A
Optic radiations
Upper bank of calcarine fissure
23
Q
Areas of brain?
Working memory
A
Lateral prefrontal cortex
Tempoparietal association cortex
24
Q
Positive visual changes
A
Simple or formed
Lights, colors, geometric shapes
Retinal detachment -> light flashes
Acute glaucoma-> rainbow halos around objects
Migraine -> blurred vision and scotomas
25
Vestibular nuclei contribute to...
1. Head movement
2. Head position relative to gravity
3. Eye movement control when head moves (gaze stabilization)
4. Postural adjustments
5. Autonomic functions
26
Left neglect
Loss of navigation skills
Unable to recognize faces
Lesion in which hemisphere?
Right hemisphere
27
Cardiovascular
| TBI
1. Severe deconditioning
2. VO2 peak significantly decreased in all neuro diagnosis
3. No reserve
4. Most with neuro diagnosis don’t have the VO2 peak to meet the demands for daily living of older adult
5. Growth hormone insufficiency
6. Most with neuro diagnosis, VO2 requirements increase 2ndary to gross motor insufficiencies
28
Membranous labyrinth
Cochlear duct, utricle, saccule, semicircular canals
Filled with endolymph
Hair cell receptors: bend and send signal frequencies to CN8
29
Procedural memory
Knowledge of how to perform actions and skills
Implicit memory produces changes in performance WITHOUT conscious awareness
PRACTICE REQUIRED
Perceptual skills- recognition of object, pattern, face
Cognitive skills- reasoning and logic
30
Right hemisphere lesion
| ____ neglect
Severe left neglect
31
Loss of holistic processing (intuitive and pictorial)
Tend to only focus on details
Because language intact, other people may think the person is much more capable than he/she is
Lesion in which hemisphere?
Right hemisphere
32
Declarative memory- organization and categorization of information
Structure?
Lateral prefrontal cortex
33
Implicit (nondeclarative)
Procedural (skills and habits)
Structure?
Striatum
34
Visual acuity
Tested by eye chart
Snellen fraction = test distance/letter size
Visual field defects do not typically affect visual acuity
35
Otolithic organs
Utricle in horizontal plane
Saccule in vertical plane
Membranous sacs located between cochlea and semicircular canals
Do NOT respond to rotation
Respond to:
Head position relative to gravity
Linear acceleration and deceleration
Each sac contains a macula
36
Declarative memory processing
| Structure?
Medial temporal lobe:
Medial temporal cortex
Hippocampus
37
Somatoform
Emotional distress is subconsciously converted into physical symptoms
Difficulty walking, paresis, Ataxia
Not malingering because no external gain
Subconscious, so truly unable to control behavior
38
Vertigo
Most common
False perception of movement of self or surroundings
Both central and peripheral causes
Due to imbalance of vestibular signals
39
Retinal cells other than rods/cones
Ganglion cells : fire APs and relay info to optic nerve
Horizontal and amacrine cells:
Interneurons
Laterally connect with adjacent bipolar and ganglion cells
Lateral connections result in center-surround receptive fields
40
Cerebral thrombus
| Clot leads to...
Hypoxia
Ischemia
Infarction
Tissue death
41
Bony labyrinth
Compact bone
| Contains perilymph that suspends membranous labyrinth
42
Primary visual cortex supplied by ____ Artery
PCA: Posterior Cerebral Artery
43
Dysarthria structures involved
Motor neurons
Or
Corticobrainstem neurons
44
Homonymous defect
Indistinct vision improved by corrective lenses
45
Chronic psychologic stress
| Blood reactions
Blood platelets secrete more ATP ->
Blood vessel changes->
May lead to heart attack and strokes
46
Muscular dystrophy
| Cardiac complications
DCM: dilated cardiomyopathy
In up to 90% of DMD => 28 years old
Originally responsible for 20% of DMD deaths but expected to increase as NIV prevents respiratory related mortality
Generally treated with ACE inhibitors, beta blockers, diuretics in early cardiomyopathy
47
Cerebral cortex disorder-
| Motor planning areas
Apraxia
48
Conduction aphasia structures involved
Neurons connecting Wernicke’s area with Broca’s area
49
Unable to comprehend and produce emotional content of speech
Lesion in which hemisphere?
Right hemisphere
50
Herniation - secondary
Secondary hypoxia or ischemia: Can be from stroke or TBI
Herniation:
1. Cingulate
2. Transtentorial
3. Uncal
4. Tonsillar
51
Episodic
Declarative memory
Collection of personal events
52
Nonfluent Aphasia
Expressive function-communication exam
Broca’s aphasia
Speech awkward, restricted, interrupted, and produced with effort
Lesion involving 3rd frontal convolution of left hemisphere (Broca’s area)
53
Vestibular nuclei reside
Reside in brainstem at pontomedullary junction
54
Intellect impaired,
Loss of linear processing (logic/analytical)
Tends to neglect details
Lesion in which hemisphere?
Left hemisphere
55
Unilateral lack of awareness of sensory stimuli, lack of personal hygiene and grooming, lack of movements of limbs
Personal neglect
56
Brain area for...
Understanding communication
Directing attention
Comprehending space
Tempoparietal association area
57
Vision after stroke
```
Brainstem stroke:
Ocular motility issues
Diplopia
Oscillopsia
Visual distortions
Paralysis of conjugate gaze
```
Visual field defects:
Homonymous hemianopsia common
Need to differentiate from neglect
58
Right portion of visual space ->
Left hemi-retina if each eye
59
Presentation of primary brain tumor:
| Temporal lobe
Complex partial or generalized seizures
Quadrantanopia
Behavioral alterations
60
Goal-directed behavior and divergent thinking
| Area of brain?
Lateral prefrontal cortex
61
The process of knowing and includes both awareness and judgment
Cognition
62
Neglect
Behave as if one side of body/space does not exist
Usually affects left side
2 types: personal and spatial
63
DM: Myotonic Dystrophy
Variation of muscular dystrophy
Adult onset
Multi-systemic disorder which affects many organs, brain, peripheral nerves, immune system
64
Utricular macula
Resides in floor of macula when head is upright
Oriented horizontally
Maximal response: head upright and leaning forward
Also responds to linear acceleration and deceleration
65
Some optic tract fibers bypass the ___ to enter ____.
| These fibers form ___.
Some optic tract fibers Lateral geniculate nucleus to enter the brachium of superior collicus
These fibers form extrageniculate visual pathways
66
DMD: Duchenne’s muscular dystrophy
| Pathology
Caused by mutation on Dystrophin gene on X chromosome
Leads to either severe reduction or complete absence of Dystrophin in skeletal and cardiac muscles
Dystrophin- large but low abundance protein;
disrupts link between intracellular cytoskeleton and extracellular matrix, leading to sarcolemma instability;
Essential for force transduction between contracting muscle fibers
Several isoforms in brain and responsible for mental retardation in 1/3 DMD cases
67
Working memory
Temporary storage and manipulation
| Where we keep our goal relevant for a short time
68
Formed visual hallucinations
People, animals, complex scenes
Arise from inferior temporo-occipital visual association cortex
```
Causes:
Toxic/metabolic disturbances
Hallucinogens, anticholinergics, cyclosporin
Alcohol/sedative withdrawal
Focal seizures
Complex migraine
Neurodegenerative conditions
```
69
Temporal lobe lesions affect _____ optic radiations.
| Result in ____.
Temporal lobe lesions affect inferior optic radiations/Meyers loop
Result in contralateral homonymous superior quadrantanopia
“Pie in the sky”
70
Concussion signs
1. Appears dazed
2. Confused
3. Moves clumsily
4. Answers questions slowly
5. Personality changes
6. Retrograde amnesia
7. Anterograde amnesia
8. LOC
71
Subcortical white matter lesions
Most common with damage to arteries of internal capsule
Extreme effects due to bundling of high concentration of axons and tracts
72
Cortex for sensory integration, understanding communication, spatial comprehension, verbal and spatial intelligence
Tempoparietal cortex
73
Vestibular gaze stabilization
Face tilts down
```
Canal stimulated?
1st synapse in vestibular nucleus?
2nd synapse in vestibular nucleus?
Muscles activated?
Movement of eyes?
```
Face tilts down
Anterior canal stimulated
1st synapse: superior vestibular nucleus
2nd synapse: CN3
muscles activated:
Ipsilateral superior rectus
Contralateral inferior oblique
Eyes move up
74
Vestibulocolic pathways
To the nucleus of the spinal accessory nerve (CN11) influencing head position
75
Info from upper visual space ->
| Info from lower visual space ->
Upper visual space -> lower retina
| Lower visual space -> upper retina
76
4 focus areas
| Concussion management
1. Neuropsychiatric
2. Migraine and somatic symptoms
3. Cognitive slowing
4. Sleep disturbances
77
Primary visual cortex lesions
Upper bank->
Contralateral inferior quadrant defects
Lower bank->
Contralateral superior quadrant defects
78
Lesion of medial prefrontal cortex causes
```
Apathy
Loss of ability to feel emotions
Lack of self-awareness
Lack of understanding social cues
Impulsiveness
```
79
Nystagmus
| Location of lesion
Vestibular nuclei or
| Vestibular nerve
80
Arousal: 8 items
1. Alert
2. Lethargic
3. Obtunded
4. Stupor (semi-coma)
5. Coma
6. Unresponsive (vegetative) state
7. Persistent vegetative state
8. Minimally conscious state (MCS)
81
Area where light results in excitation or inhibition of the cell
Neuron receptive field
82
Monocular scotoma
Visual field defects
Lesion of retina
Very large lesions may affect entire retina
```
Causes:
Increased ICP
Anterior ischemic optic neuropathy
Glaucoma
Optic neuritis
Optic glioma
Meningioma
Trauma
```
83
Stroke responsible for most deaths
Hemorrhage
| More than 40% of deaths
84
Thalamic injury
Involve the relay nuclei which interrupt ascending pathways
Comprise contralateral sensation
Proprioception greatest
Common with Parkinson’s, Thalamic stroke, TBI
85
Broca’s aphasia
Grammatical omissions and errors
Short phrases
Effortful speech
86
Blood vessels that supply lateral geniculate nucleus
Anterior choroidal Artery
Thalamogeniculate artery
Posterior choroidal artery
87
Lesions proximal to optic chiasm
Produce homonymous visual field defects
| Defect occurs in same portion of visual field for each eye (right half of both eyes of left half of both eyes)
88
“FAST” stroke
Face drooping:
ask person to smile - does 1 side droop?
Arm weakness:
ask person to raise both arms- does 1 drift downward?
Speech difficulty:
Ask person to repeat simple phrase- slurred or strange speech?
Time to call 911: immediately call if any of these signs
89
Structures in goal-directed behavior loop
Lateral prefrontal cortex
Head of caudate
Part of globus pallidus
VA nucleus of thalamus (VA)
90
Optic chiasm
Ventral surface of brain beneath frontal lobes and rostral to pituitary gland
Susceptible to compression by pituitary gland tumors
Partial crossing of fibers
91
Medial vestibular nucleus and small portion of inferior vestibular nucleus gives rise to ____ tract.
Extends ____ and controls ____.
Medial vestibulospinal tract
Extends into cervical region and controls head and neck position
92
Broca’s aphasia structures involved
Broca’s area- usually in left hemisphere
93
Vibration direction of ossicles to tympanic membrane to oval window...
Malleus -> incus -> stapes
94
FSHD: Facioscapulohumeral Muscular Dystrophy
Variation of muscular dystrophy
One of most common inherited myopathies
95
Anopsia
Lack of vision in an eye due to interruption of an optic nerve.
96
Axons leaving lateral geniculate nucleus enter___ ___ to form ___.
Which the project to ____.
Axons leaving LGN enter white matter and fan out over wide areas to form optic radiations.
Optic radiations then project to primary visual cortex in occipital lobe.
97
Examination of LOC - 4
| level of consciousness
1. Cognition
2. Arousal
3. Attention
4. Orientation
98
Hemorrhagic conversion
Complication of acute stroke
Common after administration of tPA or other thrombolytic
(Worsening of symptoms)
2 types:
Hemorrhagic infarction
Parenchymal hematoma
99
Optic neuritis
Inflammatory demyelinating disorder of optic nerve
Many cases associated with MS
Often an early sign of MS
Signs/symptoms:
Eye pain (esp with eye movement)
Monocular visual problems
Acute or slowly progressive
100
The physiological readiness of the human system for activity
Arousal
101
Consciousness system
Attention (direction of consciousness)
Neuromodulator?
Origin of neuromodulator?
Norepinephrine
Locus coeruleus and medial reticular zone
102
Motor perservation
Uncontrollable repetition of a movement
| Apraxia
103
Cerebral edema/increased ICP
| Signs/symptoms
1. Behavior changes
2. Decreased consciousness
3. Ha (headache)
4. Lethargy
5. Decline in neuro status
6. Vomiting
7. Seizures
104
Vestibular gaze stabilization
Face turns right or left
```
Canal stimulated?
1st synapse in vestibular nucleus?
2nd synapse in vestibular nucleus?
Muscles activated?
Movement of eyes?
```
Horizontal canal
1st synapse: medial vestibular nucleus
2nd synapse: CN 3 and 6
Muscles:
Ipsilateral medial rectus
Contralateral lateral rectus
Eyes move horizontal
105
Which lobe? Which hemisphere?
| Spatial perception
Parietal association
| Right hemisphere
106
Nystagmus
Involving oscillations of eyes
Often present at birth or soon after
Unknown cause but can also indicate neurological damage
Movements may be jerky or slow
May have decreased acuity due to inability to maintain steady fixation
107
Refractive errors
Tend to be inherited, but there is no pattern of inheritance
Size of eyeball, shape of cornea, shape of lens...etc are all variables in refractive error
Eye exercises are of no benefit in improving refractive errors
108
TIA
Transient ischemic attack
Deficit lasting < 24 hours
15% all stroke preceded by TIA
109
Vestibular system disorders
Vertigo
Nystagmus
Disequilibrium
110
Explicit (declarative) memory
| Structure?
Medial temporal lobe
| Hippocampus
111
Retrograde amnesia
```
Lost memory (past) prior to brain injury
May not be complete
```
112
Short term subjective experience
Emotion
113
Subarachnoid stroke
Hemorrhage
Vessels on surface of brain hemorrhage
Typically ruptured aneurysm
AVM - arteriovenous malformation
114
TBI:
| Mortality and outcomes
Overall mortality rate in severe TBI not decreasing
Increased risk of death increased x7
Increased risk of Alzheimer’s
```
57.8% moderate/severe disability
55% unemployed
38.8% declined from earlier status to 5 yr outcome
32.3% need assistance
29.1% dissatisfied with life
21.7% dead
```
115
Cardiovascular TBI:
Decrease in ___ ->
Decrease in ___ ->
Decrease in ___
Decrease in available motor units->
Decrease in metabolically active tissue->
Decrease in oxidative potential
116
Crista
In ampulla
Supporting hair cells
Sensory hair cells
Embedded in gelatinous mass called cupula
Movement of cupula causes hair cells to move and detect movement
117
Strabismus
Deviation in position of one or both eyes due to macular imbalance
“Lazy eye”
May occur only at certain distances or times (tired)
Can be corrected with surgery, visual training or injecting paralyzing drugs into muscles involved
Best if treated before age 2- will not “outgrow” and ability to correct decreases with age
118
Parasol cells
P-alpha or A cells
Retinal ganglion
Large cell bodies
Large receptive and dendritic fields
Respond best to gross stimulus features and movements
Larger diameter fibers
Project to magnocellular layers of lateral geniculate nucleus of thalamus
119
Retina - outer layer
Photoreceptors = outermost layer farthest from lens
120
Cerebral cortex-
| Ventral and Medial Dorsal Prefrontal Association Cortex
Personality and emotion
121
Global (total) aphasia structures involved
Wernicke’s area, Broca’s area, and the intervening cortical and subcortical areas
122
Caudate/Ventral striatum disorders
Primarily lead to behavioral disorders- apathy
Rarely noted motor disorders
Excessive activity here leads to OCD as
123
What location determines importance of stimuli and decides focus of attention?
Right tempoparietal association area
124
Macular sparing
Occurs because fovea represents a large area of primary visual cortex (~50%)
MCA or PCA provide collateral flow in area of macula of occipital pole- area contains fovea
External compression of optic nerve can result in concentric visual loss
125
Most common type of stroke?
Ischemic- Cerebral thrombus
Usually slow in development- narrowing that eventually becomes occluded
126
Amaurosis fugax
“Browning out”
TIA of retina
Monocular vision loss ~10 min
Ipsilateral internal carotid artery stenosis
127
Presentation of primary brain tumor:
| Cerebellum
Ataxia
Dysmetria
Nystagmus
128
Cerebral cortex disorder-
| Secondary sensory areas
Agnosia
129
Lesions that are distal from optic chiasm...
| Lesions that are proximal...
Distal one eye
| Proximal both eyes
130
Encephalopathy
| 13 Signs and symptoms
1. Progressive memory loss
2. Progressive cognitive dysfunction
3. Personality changes
4. Problems with concentration, attention
5. Lethargy
6. LOC
7. Myclonus
8. Seizure
9. Tremor
10. Muscle atrophy
11. Nystagmus
12. Dementia
13. Swallowing and speech impairments
131
Diabetic retinopathy
Proliferation of blood vessels may cause hemorrhaging into vitreous or scar formation of retina
Blurred vision or total loss
Usually develop problems ~20 years after onset of diabetes
Incidence/severity increase with duration of diabetes and may be worse if diabetes poorly controlled
Accounts for ~25% of people with vision impairment in western world
132
Autonomic dysfunction
| TBI
1. Temperature elevation/excessive sweating
2. HTN
3. Tachycardia/Tachypnea
4. Pupillary dilation
5. Extensor posturing
6. Paroxysmal autonomic instability with dystonia (PAID) and Paroxysmal Sympathetic hyperactivity
7. Management of systems pharmacologically
133
Interlaminar neurons located between layers of lateral geniculate nucleus participate in ____
Color vision
134
Cones
Less numerous
Highly represented in fovea
High spatial and temporal resolution
Detect colors
135
Retinal ganglion cell types
Parasol Cells
| Midget cells
136
Bilateral vestibular loss
Loss of internal sense of gravity
Spatial orientation requires visual and Proprioceptive cues
Difficulty walking on uneven surfaces or in dark/eyes closed
No vertigo
No asymmetric vestibular info coming in
137
Key motivation areas ___ and ___.
| Neurotransmitter required for motivation?
Medial prefrontal cortex and ventral striatum
Dopamine
138
Consciousness system
Motivation, motor activity, and cognition
Neuromodulator?
Origin of neuromodulator?
Dopamine
Substantia nigra and ventral tegmental area
139
Cerebral cortex-
| Parietotemporal association areas
Communication
140
Presentation of primary brain tumor:
| Frontal lobe
```
Dementia
Personality changes
Gait disturbances
Generalized or focal seizures
Expressive aphasia
```
141
Autodestructive cellular phenomena associated with diffuse axonal damage or degeneration of white matter
Diffuse axonal injury (DAI)
142
Most common primary brain tumors
Meningioma (33.4%)
Glioblastoma (17.6%) - most common malignant; more commonly older adults
143
Agnosia
Inability to recognize familiar objects with one sensory modality while retaining ability to recognize same object with another sensory modality
Damage to secondary sensory areas
144
TBI mechanisms of injury
Direct impact
Severe acceleration/deceleration
Blast injury
Penetrating object
145
TBI Secondary damage
```
Secondary:
ICP
Hypoxia or ischemia
Seizures
ICH (intracranial hemorrhage)
Electrolyte and acid-base imbalance
```
146
Dystrophinopathies
Severe DMD: Duchenne’s muscular dystrophy
And
BMD: Becker’s Muscular Dystrophy
Absence of dystrophin (DMD) or partially functioning forms of dystrophin (BMD)
147
Cerebral embolus
Traveling blockage:
Thrombus, fat, air, or bacteria
Medical management:
Anticoagulants for those at risk
DVT prophylaxis
148
Impulsive behavior, unaware of deficits, overestimate own abilities
May drive with devastating results
May walk without necessary cane or brace
Unintentional fabrication of information caused by deficits in recognizing errors and memory and by disinhibition
Lesion in which hemisphere?
Right hemisphere
149
3 types of memory
Working
Declarative
Procedural
150
Medical/Legal definition of partially sighted/low vision
Visual acuity better than 20/200 but < 20/70 in better eye with best correction
151
Working memory is critical for...
1. Language
2. Problem solving
3. Mental navigation
4. Reasoning
5. Multitasking
152
Apraxia caused by ...
Secondary damage to the
Premotor or supplementary motor areas,
OR
Inferior parietal lobe
153
Medical/legal definition of blind
Central visual acuity of 20/200 or < in better eye with best correction, or field of vision limited to < 20 degrees.
154
Risk factors for stroke
1. HTN
2. DM
3. Disorders of heart rhythm
A-fib increases risk x5
Frequently asympomatic/undetected
4. High cholesterol and other lipids
5. Smoking/tobacco use
6. Physical inactivity
7. Nutrition
8. Family history/genetics
9. Chronic kidney disease
155
Medial vestibular nucleus and small portion of inferior vestibular nucleus fibers ascend into ____, and then to ___ to mediate ____.
MLF: medial longitudinal fasciculus
And then to
Oculomotor, trochlear, abducens nuclei, superior colliculus and CN 11 to mediate the
VOR: vestibulo-ocular reflex
156
Most input to primary visual cortex arrives at cortical layer __
Primary visual cortex AKA ___.
4 which is thick and subdivided
Layer 4beta contains many myelinated axons (pale appearing stria of Gennari)
Due to distinction- Primary visual cortex AKA striate cortex
157
Autism spectrum disorders
Autism, Asperger’s, Pervasive developmental disorder
Leads to: impaired social skills, restricted interests, and repetitive behaviors
Abnormal connectivity of limbic system and striatal social brain systems
Can develop from:
Pattern of brain development after birth
Immune system attacking brain proteins
Genetic factors
158
Vestibulospinal tracts
Both medial and lateral, to lower motor neurons that influence posture
159
Encephalopathy prognosis
Treatment of underlying cause may improve outcome
Often irreversible damage
Can be fatal
160
Declarative memory
Stuff you can declare..,facts, events, locations, concepts
Recollection that can be easily verbalized
Requires attention
161
Encephalopathy
| Infectious disorders
1. Bacterial
Infectious meningitis; brain abscess; tuberculos meningitis
2. Spirochetes
Neurosyphilis; Lyme
3. Viral
Herpes zoster; HIV associated; viral meningitis
4. Parasitic
Cysticercosis; toxoplasmosis; malaria; African sleeping sickness
5. Fungal
Aspergillosis; candidiasis; histoplasmosis
6. Prion related
Creutzfeldt-Jakob disease
162
Examining cognitive function-
| Attention
```
Attention span
Sustained attention
Divided attention
Focused attention
Ability to follow directions
```
163
Central fixation point for each eye falls onto
Fovea
164
10 effects of TBI
1. NM/ somatosensory
2. Autonomic dysfunction
3. Cognitive
4. Psychological
5. Behavioral
6. Communication
7. Visual/Perceptual
8. Dysphagia
9. Vision/Vestibular
10. Cardiovascular
165
Cochlear nerve symptoms
| PNS vs CNS signs/symptoms
PNS:
May have tinnitus
Decreased hearing
CNS:
Uncommon
166
Cerebral cortex-
| Primary motor cortex
Fractionation of movement
167
4 types of attention
1. Orienting
2. Divided
3. Selective
4. Sustained
168
Hallucinations
Perception of something that is not present
169
Sound transmission
External auditory meatus->
Tympanic membrane->
Sound amplification in middle ear (malleus, incus, stapes) and
Sound dampening (tensor tympani - malleus, stapesius- stapes)->
Oval window->
Fluid movement in cochlea ->
Hair cells send signals to cochlear nerve->
Pressure dissipated at round window
170
Vestibular neuritis
Vestibular nerve inflammation
2nd most common cause of vertigo
Cause:
reactivation of latent herpes simplex Type 1 virus
Virus damages vestibular ganglion and interrupts signals to brain
Symptoms:
Disequilibrium, spontaneous nystagmus, nausea, hearing unaffected
Duration: severe vertigo up to 3 days, gradual improvement over 2 weeks
Prognosis: typically resolves over 2 weeks viral clearing
Treatment: Meclizine for nausea, vomiting and vertigo
171
___ area- instructions for language output
Broca’s area
172
Emotional lability
Abnormal, uncontrolled expression of emotions
1. Abrupt mood shifts, usually to anger, depression, anxiety
2. Involuntary, inappropriate emotional expression in absence of subjective emotion (pathologic laughter or crying)
3. Emotion triggered by nonspecific stimuli unrelated to emotion expressed
173
Infarcts to blood supply of lateral geniculate nucleus
Contralateral homonymous hemianopia (vision loss same side left/right both eyes)
Blood supply:
Anterior choroidal artery
Thalamogeniculate Artery
Posterior choroidal artery
174
3 stages of declarative memory
Encoding
Consolidation
Retrieval
175
Monocular visual loss
| Lesion possibly ____ in optic pathway?
Optic nerve
176
Causes of encephalopathy
1. Infectious agents
2. Metabolic or mitochondrial dysfunction
3. Brain tumor or increased ICP
4. Prolonged toxin exposure
5. Chronic progressive trauma
6. Poor nutrition
7. Lack of oxygen or blood flow
177
2 broad categories of brain tumor
1. Primary CNS tumors
Abnormal proliferation of cells originating in nervous system
2. Metastatic tumors
From neoplasms elsewhere in body that spread to brain
5-10x more common than all primary CNS tumors combined
25-45% of all cancer patients eventually have brain metastasis
178
Ipsilateral eye deviated medially
| Lesion location
Abducens nerve
179
Hair cells
# Translate mechanical force into nerve impulses
Consist of:
Sensory neuron
Multiple small stereocilia
Single large kinocilium
Movement toward kinocilium = excitatory
Movement away from kinocilium = inhibitory
180
Lesions of tempoparietal cortex cause
Inability to handle new information effectively
Difficulty with concrete thinking
Difficulty generalizing information
Personal and spatial neglect
Inability to navigate
Tendency to become upset with even minor changes in routine
181
Inflammatory demyelinating disorder of optic nerve
Many cases associated with MS
Often an early sign of MS
Signs/symptoms:
Eye pain (esp with eye movement)
Monocular visual problems
Acute or slowly progressive
Optic neuritis
182
Infarct of entire primary visual cortex on one side results in
Contralateral home hemianopia
183
Etiology of stroke
87% ischemic
Cerebral thrombus or embolus
13% hemorrhage
Most intracranial/intracerebral
Subarachnoid least common (3%)
184
Brain area might be damaged in person who has difficulty reading/interpreting body language/facial expressions?
Anterior temporal lobe
185
Brain tumor rehabilitation
Requires understanding nature of tumor and prognosis
Assessment/intervention needs to address pain and emotional impact
Functional status may be variable and change depending treatment and/or tumor progression
Focus may shift in preparation for functional/mental decline and improving quality of life
186
Alien hand syndrome
Involuntary, uncontrollable movement of UE
Moves without intention
Grasps unintentionally
Damage due to variety of cortical and subcortical structures
Leads to frustration, annoyance, anger
Treated with visual feedback and sensory stimulation for affected limb
187
Optic disc
~ 15* medial to fovea
Axons exiting retina gather to form optic nerve
No photo receptors
“Blind spot” - 15* lateral and inferior to central fixation point (no functional defect when using both eyes; blind spot for 2 eyes not superimposed)
Central retinal artery
188
Presentation of primary brain tumor:
| Occipital lobe
Contralateral hemiplegia
189
Scotoma
Circumscribed region of visual loss
190
PT concussion rehab
| Symptoms addressed
1. Balance
2. Dizziness
3. Headache
4. Neck pain
5. TMJ dysfunction
6. Activity intolerance
7. Oculomotor dysfunction
8. Cognitive
191
Neuropsych
| TBI
```
1. Memory impairment
PTA; short-term memory
2. Emotional changes
Ranging from obtundity to hyperactivity
3. Communication
Aphasias; dysarthria
4. Cognitive impairment
Attention/concentration deficits
Executive function loss
Loss of reasoning and/or abstract thinking
Poor problem solving
```
192
Coup Contra Coup
Like bad racetrack wreck injury...
Front and back of brain get bruised
Brainstem swelling and tearing
193
__% brain tumors benign
Median age diagnosis
Most common cancer in ___
Average survival rate (malignant)
Nearly ___ in US with primary brain and CNZ tumor
____ new cases of primary brain tumor per year
80% brain tumors benign
Median diagnosis age 59
Most common cancer in 0-14 year olds, leading cause of cancer-related deaths in children
Average survival rate (malignant) 34.7%
700,000 in US with primary brain and CNS cancer
Nearly 80,000 new cases of primary brain tumor annually
194
Nystagmus
| PNS vs CNS signs/symptoms
PNS:
Almost always present
Typically unidirectional , NOT vertical
CNS:
Frequently present
May be vertical, unidirectional, or multidirectional
195
Cerebral edema/increased ICP
| Treatment
Osmotherapy
Corticosteroid
Surgical decompression
196
Hemiparesis/Hemiplegia and hemisensory loss affecting left side of body and face and left visual field
Lesion in which hemisphere?
Right hemisphere
197
Auditory agnosia
Can perceive sound but not recognize it
Left secondary auditory cortex- inability to understand speech
Right auditory complex- interferes with interpretation of environmental sounds
198
Intracerebral stroke
Hemorrhage
Vessel in brain bursts
High BP and aging blood vessels often cause
199
Somatognosia
Body scheme disorder
Damage to dominant parietal lobe
200
Damage related to BI (Brain injury)
DAI (diffuse axonal injury)
Cerebral contusion/concussion (mild, moderate, severe)
201
Each year ___ people have stroke
| ____ first strokes, ___ recurrent
795,000 strokes
610,000 first time
185,000 recurrent
202
Signs and symptoms of ICP
1 headache
2. Altered mental state
3. Nausea and vomiting
4. Papilledema
5. Visual loss
6. Diplopia
7. Cushing triad: HTN, bradycardia, irregular respiration’s
203
TBI statistics (gender/age)
Males 1.5 x greater risk
0-4 yrs old
15-19 yrs old
>= 65 yrs old
Adults >= 75 have highest rates of TBI related hospitalizations and death
Males 0-4 have highest rate of TBI ER visits, hospitalizations and death
204
Examining cognitive function-
| Memory
```
Immediate recall
Recent memory (short term)
Remote memory (long term)
```
205
Dysarthria
Communication exam- expressive function
Impairment of speech production from damage to CNS or PNS
Causes weakness, paralysis, or uncoordination of the motor-speech system
206
Monocular scotoma
| Possible Visual pathway lesion location?
Retina
207
```
Goal directed behavior, emotions, decision making, social behavior, personality
Brain region(s)?
```
Association cortex:
Medial, lateral and ventral prefrontal areas
Anterior temporal
208
Structures in social behavior loop
Ventral prefrontal cortex
Head of caudate nucleus
Substantia nigra reticularis
MG (medial group) of thalamic nuclei
209
Global (Total) Aphasia
| Characteristics
Cannot speak fluently
Cannot communicate verbally
Cannot understand language
210
Consciousness is mediated by neuromodulators produced by brainstem neurons are transmitted to cerebrum via ____
Reticular formation
211
Vestibulocerebellar pathways
To the vestibulocerebellum, which controls the magnitude of muscle responses to vestibular information (including the gain of the vestibulo-ocular reflex)
212
Wernicke’s aphasia
Cannot comprehend language
| Speaks fluently but unintelligently
213
Lesions affecting tempoparietal junction in left hemisphere
Wernicke’s aphasia
214
Cuneus
“Wedge”
| Portion of primary visual cortex above calcarine fissure was
215
Inability to perform voluntary, learned movements in the absence of loss of sensation, strength, coordination, attention or comprehension
Apraxia
216
Associative learning
Type of memory?
Structures?
procedural aka Implicit (nondeclarative) long term memory
Emotional: amygdala
Skeletal musculature: cerebellum
217
Bitemporal hemianopia
| Possible location of lesion in visual pathway?
Optic chiasm
218
Almost ___ x risk of first strokes in African Americans vs Caucasians
2x higher risk African Americans
219
Higher order visual processing- dorsal pathways
Dorsal pathways-
Project to parieto-occipital association cortex
Answers “where?”
Analyze motion and spatial relationships between objects
220
Ability to form concepts
| Ability to reason
Intellect
221
Primary visual cortex resides ___
Resides on banks of calcarine fissure
Upper optic -> superior bank
Inferior optic (Meyers loop) -> inferior bank
222
VOR
Vestibulo-ocular reflex
Eye movements adjust for
changes in head position
Stabilizes images during head movement
Head turns right = increase signal from right horizontal canal and decrease signal from left horizontal canal
Info -> vestibular nuclei-> CN regulating eye movements
223
Bilateral lesion
| ____ neglect
Severe right neglect
224
Peripheral vestibular disorders
Recurrent vertigo
Severe nausea
Nystagmus always present with peripheral vertigo
Frequent tinnitus and diminished hearing
```
Types:
BPPV: benign paroxysmal positional vertigo
Vestibular neuritis
Meniere’s disease
Traumatic injury
Perilymph fistula
```
225
Neuromuscular/Somatosensory
| TBI
1. Paralysis/paresis
2. Altered muscle tone and/or abnormal reflexes
3. Poor coordination/ataxia
4. Cranial nerve dysfunction
5. Impaired balance
6. Poor selective motor control
7. Bowel and bladder dysfunction
8. Dysphagia
9. Loss of sensory function or hypersensitivity
226
Cautious behavior
Hesitant to try new tasks
Anxiety, depression, catastrophic reactions, easily frustrated and angered
Lesion in which hemisphere?
Left lesion
227
Photopsias
Bright, unformed flashes, streaks, or balls of light
228
Neglect
Tendency to behave as if one side of body and/or one side of space does not exist
Damage to right parietal area
Increased hyperactivity of left brain attention
229
Hallpike/positional testing
Central vs peripheral vestibular lesion
Peripheral (inner ear) results
Onset of nystagmus: delayed
Adaptation/Habituation: yes
Characteristics of nystagmus and vertigo:
Horizontal or rotary, NOT vertical
Does not change directions
Prominent nystagmus only if vertigo also present
230
2 types of declarative memory
Episodic
| Semantic
231
Muscular dystrophy
| Non-motor presentation
Global development delay
Severe learning difficulties/Autism
Failure to thrive
“Liver disease” -often noted incidentally during investigation of other illnesses
Serum creatine kinase (CK) is elevated since birth (10-100x normal)
232
Examining for ICP
| 8 items
1. Altered level of consciousness
2. Altered vital signs
3. Headache
4. Vomiting
5. Pupillary changes
6. Papilledema at entrance to eye
7. Progressive impairment of motor function
8. Seizure activity
233
2 cortical areas critical for working memory
Lateral prefrontal cortex
| Tempoparietal association cortex
234
Hallpike/positional testing
Central vs peripheral vestibular lesion
Central results
Onset of nystagmus: immediate or delayed
Adaptation/Habituation: no
Characteristics of nystagmus and vertigo:
Horizontal, rotary, or vertical
May change directions
Prominent nystagmus may occur in absence of vertigo
235
Anosognosia
Severe denial, neglect or lack of awareness of condition
Damage to right anterior insula
236
Unilateral vestibular loss
Problems with posture, eye movement control, nausea
Imbalance of signals from damaged side with intact side
Vestibulospinal system affected
Fall/lean TOWARD side of lesion
237
Retinitis pigmentosa
Often hereditary
Progressive retinal deterioration
Slow progressive field loss.
Peripheral to total blindness or tunnel vision
Symptoms is night blindness since affects rods first
Problems with mobility and adjusting to light change
No effective treatment
238
Esotropia
Deviation of 1 eye toward the nose
Most common firm of strabismus (lazy eye)
239
Lingula
Resides on banks of calcarine fissure
Upper optic -> superior bank
Inferior optic (Meyers loop) -> inferior bank
240
Hypertropia
Deviation of one eye up
Least common strabismus (lazy eye)
Deviations may occur with either eye, alternately, or alway be the same
241
Semicircular canals activated by rapid rotation may trigger
Loss of postural control (leaning and falling)
Head orientation adjustment
Eye movement reflexes
Autonomic changes (nausea/vomiting)
Altered consciousness (lightheadedness)
Conscious awareness of head orientation and movement
242
Disconnection aphasia
Communication exam- conduction aphasia
Understands language but output unintelligible
Damage to neurons connecting Wernicke’s and Broca’s areas
243
Emotions, motivation and self-awareness
| Area of brain?
Medial prefrontal cortex
244
Cortical blindness results from damage to ____.
Eye usually shows ____ but ____.
Visual cortex
Eye usually shows no signs of pathology but neurological damage hinders stimulation from reaching brain and/or hinders organization/decoding of info once it reaches brain
May be able to regain some degree of functional vision if vision stimulation provided (brain plasticity)
245
In adults 70% brain tumors are ___,
In kids 70% brain tumors are ____.
(Above/below...)
Adults
70% tumors above tentorium
Kids
70% below
246
Muscular dystrophy- NIV (non-invasive ventilation)
Night breathing is augmented by breaths of portible ventilation over facial/nose mask
Can e tend average survival into the mid 20s and 30s
Forced vital capacity <50% is a good indicator for NIV
247
Disequilibrium
Perception of imbalance
248
Lateropulsion
“Pushers syndrome”
Pushing away from less paretic side in sitting, during transfers, in standing and with walking
Push towards hemiparetic side
Damage to right posterior thalamus
17-19* midline shift towards stroke side (affected side of body)
249
Vestibuloreticular pathways
To the reticular formation, influencing the Reticulospinal tracts and autonomic centers for nausea and vomiting
250
Muscular dystrophy
| Pharmacology
1. Glucocorticoid corticosteroids
Most effective
Weight gain - short-term use
Vertebral fractures- long term use
2. Prednisone
Can stabilize function/strength for 6 mo-2 yrs
Most widely used medication
Prolonged walking ability, preserves respiratory function, decreased incidence of scoliosis/cardiomyopathy
3. Often alternating corticosteroids and prednisone every 6 months
4. Supplements: calcium and vitamin D
251
Glaucoma
Often caused by increased pressure in eye; may be due to faulty drainage system of eye
If pressure continues, decreased blood supply so peripheral retinal cells may die and eventually can damage optic nerve
Gradual onset, can be controlled by medications or surgery.
Can result in total blindness if not treated
Exacerbated by fatigue or stress
252
Cupula movement
Head moves one way- cupula moves opposite direction
Head stationary: baseline rate of hair cell firing
Head moves: fluid lag causes cupula to bend and move hair cells
Constant movement: endolymph moves at same speed so hair cells fire at constant rate
Head movement slowing or stopping: cupula bends in opposite direction
Orientation of semicircular canals at 90* to each other relays movement from correct plane of motion
253
Medial longitudinal fasciculus
Bilateral connections with the extraocular nuclei (CN 3,4,6) and superior colliculus, influencing eye and head movements
254
Lack of understanding of spatial relationships
Spatial neglect
255
Contralateral superior quadrantanopia
| Possible visual pathway lesion location?
Meyers loop,
| Lower bank of calcarine fissure
256
Unilateral bs Bilateral vestibular disorders
Unilateral: dysfunction with posture, eye movement control and nausea
Bilateral: eliminates internal sense of gravity
Reliance on visual and somatosensory
NO DIZZINESS PRESENT
257
Optic tract lesion- visual field defect
Uncommon
Contralateral Homonymous hemianopia (loss of visual field one half of each eye- like both left or right halves)
Causes:
Tumor
Infarct
Demyelination
258
___ area- auditory comprehension and vocabulary
Wernicke’s area
259
Lateral vestibular nucleus gives rise to ___ tract.
Extends ___.
Maintains ___.
Regulates ___.
Lateral vestibular nucleus gives rise to lateral vestibulospinal tract.
Extends entire length of spinal cord
Maintains balance and extensor tone
Regulates LMN to postural muscles in limb and trunk
260
Lateral vestibulospinal tract
Originates in lateral vestibular nucleus
261
AIDS and vision loss
35-75% of people with AIDS (PWA) develop visual problems ranging up to total blindness
As earlier diagnosis and improved treatment prolong life- more PWA are surviving to stage of vision loss
Vision loss appears to be a late complication of AIDS
Causes: AIDS retinitis, AIDS CNS infections, AIDS toxoplasmosis retinitis, AIDS Kaposi’s sarcoma
262
Axons in retinal ganglion cells in optic tracts form synapses on ____, which then projects to _____.
Axons of retinal ganglion cells in optic tracts form synapses in Lateral geniculate nucleus (LGN)
LGN then projects to primary visual cortex
263
Classes of center-surround cells
On-Center:
Cells excited by light in center of receptive field and inhibited by light in surrounding area
Off-Center:
Cells inhibited by light in center of receptive field and excited by light in surrounding area
264
TBI Primary damage
```
Primary:
Contusions
Hematomas
Diffuse axonal injuries
Penetrating injuries
Blast injuries
```
265
Lesions of eye, retina and optic nerve
Results in monocular visual field defects
Monocular visual loss (loss of one eye)
Monocular scotoma- visual loss in one spot of one eye
266
Consciousness system
Generalized arousal level
Neuromodulator?
Origin of neuromodulator?
Serotonin
Raphe nuclei
267
Dysarthria
Lacks motor control of speech muscles
268
muscular dystrophy - Variations
DMD: Duchenne’s muscular dystrophy
BMD: Becker’s Muscular dystrophy
LGMD: Limb-girdle Muscular dystrophy
FGMD: Facioscapulohumeral muscular dystrophy
DM: Myotonic dystrophy
WDM: Welander Distal myopathy
269
8 Disorders affecting cerebral function
1. Loss of consciousness
2. Impaired attention
3. Epilepsy
4. TBI and stroke
5. ADHD
6. Autism spectrum
7. Alien hand syndrome
8. Psychological disorders
270
Retrieval
Declarative memory stage 3
Cues generated by lateral prefrontal cortex used to search encoded memories
271
Considerations for Pusher syndrome
Right sided stroke 59%
Neglect 62%
Severe hemiparesis 82%
Subsides by 6 weeks: 62%
Subsided by 3 months : 79%
272
Central lesion- vestibular pathology
Vestibular nuclei, brainstem, cerebellum
Connections within brain
Brain cannot process incoming information
Milder symptoms than peripheral lesion
273
Traumatic injury- vestibular disorders
Fracture of temporal bone
Inner ear damage
Pressure changes in the inner ear
274
Optic chiasm- visual field defect
Bitemporal hemianopia (loss of lateral half vision of each eye)
Located near pituitary gland
Compressed by lesions in this area
Common causes:
Pituitary adenoma
Meningioma
Hypothalamic glioma
275
Astigmatism
Irregular curvature of cornea
May cause visual fatigue, headaches, growing and squinting
In middle age, lens becomes less flexible and less able to accommodate for near point viewing: PRESBYOPIA
276
Hallpike positional testing
Central vs peripheral vestibular lesions
Patient rotates head 45* right/left
Quick passive movement from sitting to supine with head turned
Stimulates nystagmus and vertigo
277
Constructional apraxia
Unable to comprehend the relationship of parts to the whole
278
Myopic
Nearsighted eye
Eyeball too long, light rays come to focus before they reach fovea of retina
Symptoms: squinting and frowning
279
Classifications of TBI
Most commonly determined by GCS (Glasgow coma scale)
3 domains: eye, verbal and motor responses
Mild: 13-15
Moderate: 9-12
Severe: 3-8
280
Nausea and/or Vomiting
| PNS vs CNS signs/symptoms
PNS:
Moderate to severe
CNS:
Mild
281
Hyperopic
Farsighted eye
Eyeball too short, light rays focus behind fovea of retina
Symptoms: lack of interest in reading, rubbing eyes, or headaches, dizziness or nausea
282
Lateral geniculate nucleus layers
6 layers
```
Magnocellular layers:
layers 1 and 2
Relay info from parasol cells to retina
Motion and spatial awareness
M pathway
```
```
Parvocellular layers:
Layers 3-6
P pathway
Relay info from midget cells
Detailed form and color
```
283
Optic radiations lesions typically result in...
Homonymous defects affecting contralateral visual fields
Contralateral homonymous hemianopia (half of eye - same side of both eyes left or right)
Contralateral Superior quadrantanopia
Contralateral inferior quadrantanopia
(Quarter of eye- again both eyes effected same side)
284
Inferior optic radiations _____, form _____.
| Convey information from ___.
Inferior optic radiations arc into temporal lobe
Form Meyer’s Loop
Convey information from inferior retina, superior visual field
285
Verbal apraxia
Communication exam: expressive function
Impairment of volitional articulatory control secondary to a cortical, dominant hemisphere lesion
286
Common causes of central vestibular disorders
```
Vertebrobasilar ischemia
Brainstem or cerebellar tumor
Cerebellar degeneration
MS
Arnold-Chiari malformation
Migraine
```
287
Nystagmus
Involuntary rapid and repetitive eye movements
More severe in peripheral than central disorders
Peripheral- habituation, central - no change
Unbalanced inputs to vestibulo-ocular reflex (VOR) circuits
288
___ is leading cause of TBI
Falls
289
Minimally conscious state
| Arousal vs awareness
Have arousal
| Varied awareness
290
Ideomotor apraxia
Patient cannot perform task on command, but can do task when left on own
291
consciousness system pathologies
LOC: loss of consciousness
Impaired attention
ADHD: attention deficit hyperactivity disorder
292
WDM: Welander distal myopathy
Variation of muscular dystrophy
Progressive, beginning in hands or feet
Late adult onset
293
The superior colliculus is important in ____ (visual)
Important in directing visual attention and eye movements towards visual stimuli
(Extrageniculate visual pathways)
294
Glaucoma symptoms
```
Adults:
Poor night vision
Halos around light
Photophobia (light sensitivity)
Subtle loss of contrast
```
Kids:
Tearing, photophobia and spasms of eyelids
295
Type of stroke associated with A-fib
ischemic- Cerebral embolus
A-fib strokes tend to be more disabling/severe
296
Amnesia
Loss of declarative memory
Retrograde or Anterograde
297
Contralateral homonymous hemianopia
| Possible visual pathway lesion location?
Optic tract,
Optic radiations,
Lower or upper banks of calcarine fissure
298
Right/left discrimination disorder
Difficulty determining right and left side of ones own body
Damage to right parietal-occipital area
299
Examination of level of consciousness
CRS-R
Score ranges 0-23
6 subscales:
1. Auditory
2. Visual
3. Motor
4. Oromotor/ verbal function
5. Communication
6. Arousal
Lower scores = reflex activity
Higher scores = cognitively mediated activity
300
Vestibular gaze stabilization
Face tilts up
```
Canal stimulated?
1st synapse in vestibular nucleus?
2nd synapse in vestibular nucleus?
Muscles activated?
Movement of eyes?
```
Posterior canal
1st synapse: medial vestibular nucleus
2nd synapse: CN 3 and 4
Muscles:
Ipsilateral superior oblique
Contralateral inferior rectus
Eyes move down
301
Age/ratios of stroke
```
30% over 75
25% 65-75
18% 56-64
22% 40-55
5% < 40
```
There has been an increase in younger people having strokes from the 1990s
302
Site of auditory receptors of the ear?
Cochlear duct
303
Macula
Hair cells in gelatinous membrane with calcium carbonate crystals on top (otoconia)
Changes in head position tilt macula
Hairs bend due to otoconia displacing the gelatinous mass
Bending of hairs stimulates neuronal firing frequency in CN 8
304
Optic tract wraps around the midbrain ___ to reach ___
Optic tract wraps around midbrain laterally to reach Lateral Geniculate Nucleus of thalamus
305
Left hemisphere lesion
| ____ neglect
Minimal right neglect
306
Cerebral cortex-
| Dorsolateral prefrontal association cortex
Executive function
307
Lesions to lateral prefrontal cortex
Loss of:
Goal directed behavior
Ability to generate alternative possibilities
Conscientiousness
308
Optic chiasm
Fibers from left hemisphere-retinas of both eyes end up in ____
(____ visual field)
Medial fibers of each eye are responsible for ___.
Fibers from left hemisphere-retinas of both eyes ends up in left optic tract (right visual field)
Medial fibers of each eye are responsible for lateral hemi-fields
309
Saccular macula
Oriented vertically
Maximal response: from laterally flexed position
Side-lying -> Standing
310
Visual agnosia
Inability to visually recognize objects despite having intact vision
Lesions in secondary visual area
Prosopagnosia
311
Cerebral cortex-
| Primary sensory areas
Discriminative sensory information
312
Ménière’s disease
Associated with abnormal fluid pressure in inner ear
Unknown cause
More prevalent in females
Symptoms:
Sensation of fullness in ear, tinnitus, severe acute vertigo, nausea, vomiting, hearing loss
Duration: 30 min - 24 hours
Prognosis: disease lifespan ~7 years
Some have mild hearing loss and few episodes; most have multiple episodes and progressive hearing loss
Treatment: diuretics, low sodium diet, gentamicin injection to damage labyrinth to control nausea/Vomiting
Surgically sever vestibular nerve
313
Phosphenes
Photopsias produced by retinal shear or optic nerve disease
314
Ideational apraxia
Patient cannot perform task at all, either on command or on own and
315
The dangerous subdural
“Walk and die”
Blow to head...initially seems fine, imaging may even be fine
But subdural hematoma is forming/building
Often by the time symptoms appear, is too late
Bridging veins may tear
316
In hemianopia, ___ field is blanked out in ____ eye(s)
The most common defect, _____, occurs in ___ field of vision.
Can also occur...
Half field blanked out on both eyes
Most common: right homonymous hemianopia
Occurs in corresponding halves of right field of vision
Can also occur in corresponding halves of left field of vision, upper half (superior hemianopia), lower half (inferior hemianopia), or both outer halves of field (bitemporal hemianopia)
317
____ fill in hole from blind spot
Visual analysis pathways fill in holes of blind spot even when looking through one eye
318
Rods
More than cones 20:1
Don’t detect colors
Poor spatial and temporal resolution
Function mainly in low-level lighting conditions
Response of most rods saturated in normal daylight
319
Language processing path
1. Primary auditory cortex
2. Secondary auditory cortex
3. Wernicke’s area
4. Subcortical connections
5. Broca’s area
6. Oral and throat region of sensorimotor cortex
320
Both eyes deviated Ipsilaterally
| Location of lesion
Frontal eye fields
321
Optic nerve
Retinal ganglion cells send axons to optic nerve
Optic nerve exits through orbital apex via optic canal of sphenoid bone
Distal to optic chiasm
322
Peripheral regions of ipsilateral ____ and contralateral ____ are more anterior along ____.
Peripheral region of Ipsilateral retinas and contralateral visual fields are more anterior along calcarine fissure
323
Presentation of primary brain tumor:
| Thalamus
Contralateral sensory loss
Behavioral changes
Language disorders
324
Cognitive scale: Rancho Los Amigos Levels of Cognitive Function (LOCF)
10 levels of cognitive function
```
No response ( I)
Decreased response (II, III)
Confused (IV, V, VI)
Automatic (VII)
Purposeful (VIII, IX, X)
```
Describes emerging behaviors where patients may plateau at any level
325
Concussion symptoms
1. Headache
2. Nausea
3. Balance problems
4. Double vision
6. Photosensitive
7. Feel sluggish
8. Change in sleep patterns
9. Cognitive changes
326
Predictors for hemorrhagic conversion
Large infarct
A-fib and cerebral embolism
Hyperglycemia
Thrombolysis
327
Brainstem region signs
| PNS vs CNS signs/symptoms
PNS: none
```
CNS:
May have motor or sensory deficits
Babinski’s sign
Dysarthria
Limb ataxia
Or hyperreflexia
```
328
Semicircular canals
3 hollow rings perpendicular to each other: anterior (superior), lateral (horizontal), posterior
Receptors detect motion via movement of endolymph
Only sensitive to rotational acceleration and deceleration
Canals open into utricle (otolythic organ)
At end of each canal is swelling (Ampulla) that contains a crista
329
Difficulty understanding and producing language; dysarthria
Lesion in which hemisphere?
Left
330
Divergent thinking
Ability to conceive variety of possibilities
331
Entropic phenomena
Seeing structures in ones own eye
332
Awareness of time, person and place
Orientation
333
Examining cognitive function
| 6 items
1. Memory
2. Attention
3. Emotional responses and behaviors
4. Higher-level cognitive abilities
5. MMSE: mini-mental state exam
6. cognitive scale: rancho los amigos levels of cognitive function (LOCF)
334
Posttraumatic amnesia
Mild: 0-1 day
Moderate: >1 to 7 days
Severe: > 7 days
335
CDC - mild TBI or concussion
1. Thinking/remembering
Difficulty thinking clearly, concentrating, remembering new information; feel slowed down
2. Physical
Headache, fuzzy/blurred vision, nausea/vomiting (early on), dizziness, sensitivity to noise/light, balance problems, tired/no energy
3. Emotion/Mood
Irritability, sadness, nervous, anxiety, more emotional
4. Sleep
Sleeping more, less or trouble falling asleep
336
Common metastasis to brain
| Primary tumor sites...
```
Lung 48%
Breast 15%
Genitourinary 11%
Osteosarcoma 10%
Melanoma 9%
```
337
As light passes through lens of eye, it
Forms an image in retina that is inverted and reversed
338
Cerebral edema/increased ICP
| Causes
Bleeding into brain
Fluid around brain
Swelling within brain (caused by ischemia)
339
Hemiparesis/Hemiplegia and hemisensory loss affecting right side of body and face and right visual field
Lesion in which hemisphere?
Left hemisphere
340
Muscular dystrophy
| Motor presentation
Abnormal gait, toe walking, waddling gait, frequent falls
Calf hypertrophy, foot posture abnormalities/deformities
Difficulty running and rising from floor
Ages 2-5
Average loss of ambulation and wheelchair dependence - 9.5 years
341
GCS (Glasgow coma scale)
| Prognostic value in brain injury
Only valid at day 15
Verbal and motor correlate with better FIM scores
Inverse relationship with GCS and mortality
In children > 5 GCS and LOC < 11 days
342
Optic chiasm lesions
Medial fibers for each eye are responsible for lateral visual fields
Lesions produce bilateral field defects
Bitemporal hemianopua :
Lateral (outer half of each eye) visual field loss
343
ROP: retinopathy of prematurity
Occurs mainly in premature babies that get high/prolonged oxygen
Proliferation of blood vessels and fibrous tissue through retina and vitreous stretches retina and causes retinal detachment
Visual damage moderate to total; can have scattered areas of intact retina, so may have scattered vision
344
Vestibulothalamocortical pathway
Provides conscious awareness of head position and movement and input to the corticospinal tracts
345
Lesions affecting tempoparietal junction in right hemisphere
Spatial neglect
And/or
Difficulty understanding non-verbal communication
346
VORs move ____ to direction of ____ to maintain visual stability
Move eyes opposite to direction of head movement
347
Examining for CNS infection
| 8 items
1. Global signs
2. Neck mobility
3. Kernig’s sign
4. Brudzinski’s sign
5. Irritability
6. Slowed mental function
7. Altered vital signs
8. Generalized weakness
348
Encoding
declarative memory stage 1
Process information into memory representation
349
Wernicke’s aphasia structures involved
Wernicke’s area- usually in left hemisphere
350
GCS (Glasgow coma scale)
| Prognostic value in stroke
Verbal is better than eye or motor
Verbal and eye are greatest predictor
Cognition is key
351
Callosotomy
Corpus callosum: huge fiber bundle connecting hemispheres
Surgical separation with cases of excessive neuronal activity- limits activity to 1 hemisphere
Does lead to poor communication between hemispheres and sides of the body can perform alternating tasks
Learn to compensate fast- so rarely seen in therapy
352
Hemianopia
AKA homonymous hemianopsia
Interruption of an optic tract
Results in lack of vision on 1 side of the visual field in both eyes.
Images from only 1/2 of each eye reach the brain
More commonly seen in CVA
353
In ___ there is direct access to photoreceptors without distortion
Fovea
354
Examining cognitive function-
| Higher-level cognitive abilities
Judgement, problem solving, abstract reasoning
Fund of general knowledge
Calculations and sequencing
355
Mild TBI or concussion
Injury to head from blunt trauma or acceleration/deceleration forces
Results in 1 or more of following:
1. Confusion, disorientation, or impaired consciousness
2. Dysfunction of memory around time of injury
3. LOC < 30 minutes
4. Onset of observed signs or symptoms of neurological or neuropsychological dysfunction
CDC
356
Peripheral lesion- vestibular pathology
Inner ear
CN 8 vestibular portion
Diminishes sensory information coming into brain
357
Sustained, subjective, ongoing emotional experience
Mood
358
What is a stroke?
Damage from ischemic or hemorrhagic lesion
Symptoms must last 24 hours or is considered TIA
Primary pathology: reduced arterial blood flow, cell death due to ischemia
Secondary pathology: (ischemic penumbra)
Cell death -> edema -> increased ICP -> more cell death
Or edema leads to herniation
359
Negative visual changes
Scotoma (circumscribed region of visual loss)
Or
Homonymous visual field defect
May see dark brown, purple or white regions where they can’t see
Regions of absent vision are results of lesions of central visual pathways
Retinal lesions result in black, dark brown or purple scotomas
360
Parietal lobe lesions affect ____ optic radiations.
| Result in ____.
Parietal lobe lesions affecting upper optic radiations
Result in contralateral homonymous inferior quadrantanopia
“Pie on the floor”
361
Labyrinth
Inner ear
| Cochlea, vestibule, semicircular canals
362
4 Sites of cerebral damage
1. Thalamic injury
2. Subcortical white matter lesions
3. Callosotomy
4. Caudate/Ventral striatum disorders
363
The loss of half the visual field in each eye, contralateral to side of cerebral hemisphere lesion?
What area?
Homonymous hemianopsia
| Primary visual cortex
364
Upper optic radiations arc into ___.
| Convey information from ____.
Upper optic radiations arc into parietal lobe
| Convey information from superior retina, inferior visual field
365
Perilymph fistula
Perilymph is fluid between bony and membranous labyrinths
Fluid leak between inner and middle ear
Causes abrupt hearing loss, tinnitus and vertigo
Most cases secondary to trauma
366
Semantic
Declarative memory
Acquired common knowledge
NOT BASED ON PERSONAL EXPERIENCE
367
Stroke signs/symptoms
1. Sudden numbness or weakness- face, arm or leg
2. Sudden confusion or difficulty speaking or understanding others
3. Sudden difficulty with vision in 1 or both eyes
4. Sudden dizziness, difficulty walking, loss of balance or coordination
5. Sudden severe headache with no known cause
368
ADHD
Developmentally inappropriate inattention and impulsiveness
Abnormal circuits from
Prefrontal cortex to striatum, parietal cortex, and cerebellum
And from
Parietal cortex to temporal cortex
Deficits in extreme function, working memory, and the dopamine reward pathway lead to difficulty maintaining attention with disinterest in tasks
369
Consolidation
Declarative memory stage 2
Stabilizing memory
Synaptic: long term potentiation; minutes to hours
Systems: reorganizes memory info across large neuronal networks; minutes to decades
370
Visual, vestibular, perceptual
| TBI
1. CN impairments that affect vision
2. Visual field changes
3. Visuospatial abnormalities
4. Vestibular: peripheral or central
5. Vestibulo-ocular: dizziness, vertigo, blurred/unstable vision, nausea, difficulty with busy environments
6. Agnosia
7. Apraxia
371
Personality disorders
Inflexible, maladaptive patterns of inner experience and behavior
Types: Eccentric, Acting out, Behavioral
Prone to rapid mood swings, excessive sensitivity, passive resistance, ambiguous complaints
372
Fovea region near ___.
| Occupies about ___% of ____.
Fovea region near occipital pole
| Occupies ~50% primary visual cortex
373
Declarative memory- perceptual integration
| Brain structure?
Tempoparietal association cortex
374
Photoreceptors
Respond to light-> excitatory or inhibitory response on bipolar cell layer -> synapse onto ganglion cells -> axons to optic nerve
375
Represents a breakdown in the conceptual system or motor production system or both
Apraxia
376
Fluent aphasia
Communication exam- receptive function
Wernicke’s aphasia
Fluent word salad
Auditory comprehension impaired
Lesion in posterior 1st temporal gyrus of the LEFT hemisphere (Wernicke’s area)
377
Entire optic radiation lesion- visual field defects
Affects both upper and inferior optic radiations
Contralateral homonymous hemianopia (visual field of same half of both eyes lost- like right or left halves)
378
Muscular dystrophy
| Respiratory complications
Through teen years, decrease in respiratory reserve and sleep hypoventilation
Respiratory muscle weakness, REM sleep, hypoxic dips, obstructive apnea
Leads to drowsiness, decrease appetite, headaches, nausea, fatigue, poor concentration in school, failure to thrive, decreased coughing ability
If untreated patients that become hypercapnic, survival rate is less than 1 year
379
Examining cognitive function-
| Emotional responses and behaviors
Safety, judgement
Affect, mood
Frustration tolerance, self-centeredness, insight into disability
Ability to follow rules of social conduct
Ability to tolerate criticism
380
BPPV: benign paroxysmal positional vertigo
```
Inner ear disorder
Most common cause of vertigo
Acute onset of vertigo and nystagmus
Provoked by changes in head position (getting in/out bed, bending over, tossing/turning in bed)
Subsided in less than 2 minutes
```
Cause: otoconia displaced from macula and inside semicircular canal
Most often posterior canal
Hallpike maneuver stimulates movement of otoconia;
Subsided when endolymph stops moving
381
Potential causes of hemorrhage
Aneurysm
AVM: arteriovenous malformation
HTN
382
Visual processing in neocortex
Magnocellular layers of LGN- analyze motion- movement and gross spatial features
Project mainly to 4C-alpha
Parvocellular layers of LGN-
Analyzing relay - fine spatial info
Terminate in 4C-beta
Parvocellular and interlaminar zones-
Analyze color
Special region: layers 2-3 “blobs”
383
Cerebral thrombus
| Medical management
Increase circulation
HOB down
Normalize BP
Thrombolytics
Manage cerebral edema
384
___ and ____ interpret stimuli as threat. They send info to ____
Amygdala and prefrontal cortex
Send info to hypothalamus
385
Men vs women
| Strokes
Younger ages Men > Women
Older ages women> men
More women have a stroke each year than men
386
DMD: Duchenne’s muscular dystrophy
| Background and demographics
If untreated: severe disability and death in early teens
Treated: survival into adulthood possible
1 in 3500 male births
1/3 do not have family history (new mutations)
Leading cause of death is respiratory insufficiency in late teens-early 20s; also DCM dilated cardiac myopathy
387
Chronic psychologic stress
| Pituitary response
```
Pituitary activates adrenal glands ->
Releases cortisol ->
Increase plasma triglyceride levels
And
(Immune) inhibit lymphocyte and cytokine production
```
388
Stroke is the ___ leading cause of death
Every ___, someone has a stroke, every ____ someone dies from a stroke
Leading cause of ____ in US
3rd leading cause of death
Every 40 seconds someone has a stroke,
every 3-4 minutes someone dies from stroke
Leading cause of long term disability in US
389
Fovea
Subdivision of macula
Pigmented area near center of retina
Region of retina with highest visual acuity
Info from fovea represents ~50% fibers in optic nerve and 50% cells in primary visual cortex
390
Illusions
Distortion or misinterpretation of visual perception
391
The knowledge of how to perform skilled movement is lost
Apraxia
392
Lesions in ventral prefrontal and anterior temporal lobe cause
Social misconduct (aggression, sexual promiscuity)
Lack of awareness of others needs and feelings
Poor judgement
Defective decision making
393
Midget cells
P-beta or B cells
Retinal ganglion
Small cell bodies
Small receptive and dendritic fields
More numerous
Sensitive to fine detail and order
Smaller diameter fibers
Project to parvovellular layers of lateral geniculate nucleus
394
Procedural memory
Nonassociative learning: habituation and sensitization
Structure?
Reflex pathways
395
Photoreceptors and bipolar cells ___ AP
| Information conveyed ___
Photoreceptors and bipolar cells do NOT fire APs
Info conveyed via passive electrical conduction
Neurotransmitter released in graded fashion depending on membrane potential
396
Examining communication- 5 items
1. Expressive function
2. Receptive function
3. Conduction aphasia
4. Global aphasia
5. Non-verbal communication
397
Presentation of primary brain tumor:
| Brainstem
```
CN dysfunction
Ataxia
Papillary abnormalities
Nystagmus
Hemiparesis
Autonomic dysfunction
```
398
MMSE: Mini-Mental State Exam
Screening items for orientation, registration, attention and calculation, recall and language
Scored up to 30
21-24 mild impairment
16-20 moderate impairment
15 or less indicates severe impairment
399
Consciousness system
Selection of object of attention, based upon goals
Neuromodulator?
Origin of neuromodulator?
Acetylcholine
Pedunculopontine nucleus
400
Social behavior and decision making
| Area of brain?
Ventral prefrontal
| Anterior temporal lobe
401
Higher order visual processing- ventral pathways
Project to occipito-temporal association cortex
Answers “what?”
Analyzes form
Specific regions identify colors, faces, letters and other stimuli
402
Oscillopsia
| PNS vs CNS signs/symptoms
PNS:
Mild unless lesion is bilateral
CNS:
Severe
403
Structures in emotion loop
Medial prefrontal cortex
Ventral striatum
Ventral palladium
MG (medial group) of thalamic nuclei
404
Global aphasia
Most severe form of aphasia
Marked impairments in comprehension, production, and fluency of language
Cannot read or write
Damage to Wernicke’s, Broca’s, cortical/subcortical areas
405
Both eyes deviated contralaterally
| Lesion location
Pontine paramedian reticular formation
