1
Q
What are the goals for pts with brain tumors?
A
Goals are quality of life and to return home; Centered around functional limitations but allowing for changes in patient status
- limited survival
2
Q
What are the most common primary brain tumors (40-45%)?
A
Gliomas:
- Astrocytoma (4 grades) – includes glioblastoma (worst)
- Oligodendroglioma
- Ependymoma
3
Q
What are the types of brain tumor?
A
- Glioma
- Meningioma
- Medulloblastoma
- Metastatic brain tumor (can be primary or secondary)
4
Q
What are the signs and symptoms of a brain tumor?
A
- Headache
- Visual changes*
- Nausea/vomiting
- Lethargy
- Seizures*
- Syncope
- Weakness*
- Cognitive changes*
- Behavioral changes
5
Q
What are the behavioral changes seen with a brain tumor?
A
- Irritability
- Flat affect
- Emotional lability
- Lack of initiative
6
Q
What are symptoms of a brain tumor headache?
A
- 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 - different than usual headaches
- Become more frequent and severe over time
7
Q
What is the key to differentiate between a CVA and TIA?
A
TIA (transient ischemic attack aka mini stroke) symptoms resolve completely within 24 hours
8
Q
What are the types of stroke?
A
- Ischemic - blood clots and blocks blood flow - embolus (traveled to stroke area) and thrombus (stays where it strokes)
- Hemorrhagic - Intracerebral (within cerebrum) and Subarachnoid (in subarachnoid space)
9
Q
What is the most common artery to have stroke?
A
Middle cerebral artery
10
Q
The following are all risk factors for:
- Age over 65
- Men > women
- Hypertension
- High cholesterol
- Adult onset diabetes (type II)
- Cigarette smoking
- Heavy consumption of alcohol/drugs
- Obesity
A
Stroke
11
Q
Velocity dependent increase in muscle tone; Resistance to stretch/passive movement
A
spasticity
- passive movement increases spasticity as speed increases
12
Q
What causes spasticity?
A
injury to descending motor tracts producing hyperactive stretch reflexes (UMN loss)
13
Q
What are the clinical findings in stroke patients?
A
- Depends on location
- Sensory, motor, and cognitive dysfunction
- Initial flaccidity then spasticity
14
Q
- Difficulties with communication (Aphasia – receptive, expressive, global)
- Negative, anxious, depressed, slower, cautious, uncertain, insecure
- More realistic about their problems, very aware of impairments
are behavioral differences seen in patients with stroke involvement of the ____ side of the brain
A
Left (left hemiparesis)
- patients are fearful and need to be pushed by PTs to do more
15
Q
- Unilateral neglect - completely ignoring/ not paying attention to affected side of the body and environment
- Indifferent, quick, impulsive, euphoric, poor judgment
- Overestimate their abilities, often unaware of impairments
are behavioral differences seen in patients with stroke involvement of the ____ side of the brain
A
Right (right hemiparesis)
16
Q
What is the main issue for patients with a right sided injury of the brain?
A
safety
17
Q
What behaviors are affected during stroke that occur with either side?
A
- Short attention span
- Emotional lability
- Irritability, confusion, restlessness
- Psychosis, delusions, or hallucinations
18
Q
What age groups are most likely to have a TBI?
A
- 0-4 = big falls, shaken baby syndrome
- 15-24 = motor vehicle accidents
- 65+ = falls
- incidence greater in males in all age groups
19
Q
Why are TBIs the most difficult to treat?
A
Behavioral difficulties make it challenging
20
Q
What are primary issues with head trauma?
A
- Skull fractures
- Contusions of gray matter
- Diffuse white matter damage
21
Q
What are the secondary issues with head trauma?
A
- Anoxia
- Ischemia
- Swelling/Increased intracranial pressure (ICP)
- Hematoma
22
Q
What is an open head injury? closed head injury?
A
Open: Penetrating injury, Dura compromised
Closed: Nonpenetrating injury, Dura uncompromised
23
Q
Tear in the meningeal artery between skull and dura; Fast bleed, and will show up right away; Usually from a focused blow to the head
A
Acute epidural hematoma
24
Q
Venous rupture between dura and the arachnoid; Slower bleed, but continues to bleed over time; High mortality rate
A
Acute subdural hematoma
25
What are the types of hematoma?
1. Acute epidural hematoma
2. Acute subdural hematoma
- these are emergencies; surgery is typically needed
26
What is used to prognose the severity and duration of a coma from a head injury?
Glasgow coma scale
27
What is used to score a glasgow coma scale? what do the scores indicate?
```
EVM:
- Eye opening
- Verbal response
- Best motor response (in upper limbs)
Scores:
- 3-8 = Severe head injury (coma, poor prognosis)
- 9-12 = Moderate head injury
- 13-15 = mild head injury
```
28
What is used to prognose the cognitive and behavioral changes from a head injury?
Rancho Los Amigos Scale for cognitive functioning
29
Chronic inflammatory demyelinating [autoimmune] disease of the CNS white matter in the cerebrum, cerebellum, brainstem, and spinal cord; Severing of axons in acute plaques; Results in conduction block and loss of function; Multifocal disease
Multiple Sclerosis
- nerves fatigue quickly due to demyelination
- one of the most common debilitating neurological diseases of YOUNG people
- Caucasians, Females (2-3:1), Young adults
- possibly trigger by virus or infection, linked to genes, linked to environment (geographical pattern)
30
What are the types of MS? what is the most common?
1. Relapsing Remitting – most common (85%); symptoms almost completely resolve after an attack (pts often become secondary progressive after many years)
2. Secondary Progressive
3. Primary Progressive (worst prognosis)
4. Progressive Relapsing
31
What are clinical characteristics of MS?
1. Motor - Paresis, spasticity, fatigue, impaired balance and gait
2. Sensory
3. Paresthesias, numbness (one of the first symptoms
4. Pain
5. Vision (most often first symptom)
6. Speech (dysarthria) and Swallowing (dysphagia)
7. Cognitive
8. Depression
9. Bladder, Bowel, and Sexual Dysfunction
32
How is MS diagnosed?
```
Made by a neurologist
Based on:
- History (family, geographical)
- Clinical findings
- Clinical tests
- MRI, CT – 2 or more distinct lesions
- CSF – elevated immunoglobulin
- Evoked potentials – slowed or abnormal conduction
```
33
Disease that affects the basal ganglia; Very common neurodegenerative disorder; 2% of the population older than 65; Incidence increases dramatically with age; Average age of onset is 60 years; Occurs 1.5 times more frequently in men
Parkinson's disease
34
What is the pathophysiology of parkinson's disease?
Cells in the substantia nigra stop producing dopamine
| - Brain doesn’t receive messages about how and when to move
35
What is the role of basal ganglia?
1. Planning and programming of movement
2. Willed movements, muscle tone, and muscle force
3. Cognitive processes – awareness of body in space, ability to adapt behavior, and motivation
36
What are the 4 cardinal features of parkinson's disease?
1. Rigidity
2. Bradykinesia - slowness and difficulty continuing movement (along with akinesia freezing episode)
3. Tremor - resting; disappears with sleep and dissipates voluntary movement (pill-rolling)
4. Postural instability - narrow base of support, stooped posture; frequent falls
37
What are the atypical gait patterns seen in parkinson's
1. Reduced stride length
2. Reduced speed
3. Shuffling steps
4. Insufficient heel strike
5. Reduced trunk rotation
6. Decreased arm swing
7. Festinating gait (small quick steps)
8. Freezing of gait
9. Difficulty turning
10. Difficulty with dual tasking (micrographia,
38
Where are the most common sites of spinal cord injury?
C5-C7;
T12-L2
- transitional vertebrae give up stability for increased mobility
39
What is the percentage of men to women with SCI? what is the percentage of SCIs are traumatic
Male = 80%
female = 20%
- 90% traumatic (10% non traumatic)
40
When documenting neurological level of a SCI, you document sensory level and motor level, on each side. Where would you document those levels? How do you classify it into a single neurological level?
Sensory level = last normal dermatome
Motor level = last normal myotome with a 3/5
- lowest segment where motor and sensory function is normal on both sides
41
Where is the injury if it follows a dermatome/ myotome pattern? where is the injury if it follows a body region? where is the injury if it follows a nerve distribution?
SC or nerve root;
Stroke;
Peripheral nerve
42
What are the types of incomplete SCIs?
1. Brown-sequard syndrome (hemisection) - usually caused by violence
2. Anterior cord syndrome - hyeperflexion injury (fall or diving)
3. Central cord syndrome - hyperextension injury, edema/hemorrage around the cord squeezes in (sever spinal stenosis)
4. Cauda equina
43
Pathological autonomic reflex occurring in SCI in lesions above T6 (but can be as low as T8); A sudden increase in blood pressure in response to a noxious stimuli (most commonly precipitated by bladder distension); No vasodilation below the level of the lesion so above the level of lesion BP gets very high
Autonomic dysreflexia
| - rate of this is higher right after SCI occurs
44
What are the symptoms of autonomic dysreflexia?
1. Hypertension
2. Bradycardia - vagus nerve is trying to bring HR down to lower BP
3. Severe, pounding headache
4. Increased spasticity
5. Flushing and sweating above the level of lesion
45
What should you do in case of autonomic dysreflexia?
- MEDICAL EMERGENCY
1. SIT PATIENT UP!!!
2. Check catheter and other irritants
3. If symptoms don’t subside get help
46
Upper AND Lower Motor Neuron Disease:
LMN – anterior horn cells of spinal cord
UMN - degeneration of corticospinal tracts, neurons in motor cortex and brainstem
Amyotrophic Lateral Sclerosis (ALS)
AKA Lou Gehrig's Disease
- death in 2-5 years
47
What are the S and S of ALS?
1. Relentlessly progressive** (quickly) asymmetrical weakness leading to muscle atrophy/wasting
2. Hyperreflexia and spasticity
3. Fasciculations
4. Eventual respiratory failure
5. EMG findings - decrease in muscle electrical activity
48
Involuntary movement disorder; Results in twisting/writhing repetitive movements and abnormal postures; Increased muscle tone; Thought to be caused by altered nerve cell communication in several regions of the brain commonly the basal ganglia; Common symptoms are pain and fatigue due to the constant muscle contractions
Dystonia
49
Hereditary disease that causes progressive degeneration of nerve cells in the brain; Results in movement, cognitive, and psychiatric impairments (impulsive, inflexible, inappropriate behavior; depression); Common symptoms – dystonia (see previous slide), impaired gait and balance
Huntington's Disease
| Avg age = 30-50
50
Progressive dementia characterized by slow decline in memory, thinking and reasoning, making judgments and decisions, planning and performing familiar tasks, and hanges in personality and behavior; Most common form of dementia; Nonreversible; 20% of people over 85, 5% of people over 65; Higher incidence in women
Alzheimer's disease
| - see plaques and tangles
51
Collection of protein on the outside of brain cells
Plaques
52
Protein twists into abnormal tangles inside brain cells
Tangles
Systems Screening II
flashcards
Decks in class (27)
# Cards
-
Bones92
-
Muscle30
-
Muscle relaxants25
-
Random Reading11
-
Joints24
-
Special topics47
-
CNS Pathology52
-
PNS Pathology12
-
Mental status37
-
Neurological Screening13
-
Balance reflexes sensation15
-
Pathology of the Eye22
-
Stroke37
-
CNS Injury22
-
Vestibular23
-
Cranial Nerves12
-
Parkinson's Disease38
-
Affective disorders26
-
Alzheimer's Disease11
-
Schizophrenia20
-
Sedative and Hypnotic Drugs16
-
ADHD19
-
Migraines17
-
MS18
-
Drug videos35
-
Seizures14
-
Neurological Disorder Pharmacology12
