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48 Cards in this Set
- Front
- Back
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% Diagnoses attained by:
history physical exam diagnostic testing imaging |
History: 80%
Phys. Exam: 10% Diagn. Testing: 5% Imaging: <5% |
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Why Localization is Awesome
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-Allows for more rapid diagnosis and treatment
-Identifying site of lesion allows improved differential diagnosis -Improves diagnostic evaluation -Helps eliminate incidental findings on testing |
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Levels of Localization
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Cerebrum
Cerebellum Brainstem Spinal Cord Peripheral Nerve Junction and Muscle |
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Polyneuropathy
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Symmetric involvement
Distal ends affected first Decreased reflexes Distal weakness |
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Mononeuropathy
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Individual nerve with both motor and sensation involved
Focal weakness Ex: Carpal tunnel syndrome |
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Median Nerve
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Commonly affected by wrist compression (carpal tunnel syndrome)
Controls wrist, thumb and index fingers |
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Ulnar Nerve
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Frequently injured at elbow
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Radial Nerve
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Controls fingers besides thumb/index
Injured by pressure on axilla and upper arm |
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Carpal Tunnel Syndrome Symptoms
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Numbness/tingling in hand/wrist thumb, index finger, dropping objects, symptoms mostly at night
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Ulnar Neuropathy Symptoms
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Weak hand, difficulty turning keys/doorknobs, numbness/tingling in 4th and 5th fingers, occasional elbow soreness
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Radial Neuropathy
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Wrist drop, Patient unable to extend wrist or fingers up, no associated pain, occasional numbness, no night/day preference
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Essential Tremor
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Most common movement disorder
Tremor present during action, absent at rest. Has been correlated to activity in the sensorimotor area and the cerebellum Family history positive in 1/2 of patients. Symmetric No rigidity or bradykinesia No significant response to Parkinson's meds Often involves upper extremities, head, voice |
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Parkinsonism
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Non-specific term used to describe a constellation of signs on physical examination similar to those seen in PD:
tremor bradykinesia (slowness of movement) rigidity (increased resistance to passive movement that is uniform throughout the range of motion) postural instability and gait abnormality Parkinsonism is a clinical diagnosis |
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Parkinson's Disease
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Parkinsonism with no known cause
Characterized by most of the 4 cardinal features Responsive to anti-parkinson medications Mean survival after onset: 20+ years Decreased dopamine |
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4 Cardinal features of Parkinson's Disease
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Tremor
Rigidity Bradykinesia Postural instability |
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Non-Cardinal Features of Parkinson's Disease
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Fatigue, depression, dementia, insomnia
Bladder symptoms, sexual dysfunction Restless legs Drooling, reduced facial expression |
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Corticobasal Degeneration
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Parkinson plus syndrome
Asymmetric onset Apraxia can transition to Alien Hand Syndrome No good response to PD meds CT and MRI may reveal contralateral atrophy |
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Progressive Supranuclear Palsy
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Parkinson plus syndrome
Gait disturbance with frequent falls Personality change Rapid progression Poor response to PD meds |
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Multiple System Atrophy
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Parkinson plus syndrome
Rapid progression Poor response to PD meds MRI may show brainstem degeneration |
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Lewy Body Dementia
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Progressive parkinsonism and dementia
Minimal or no resting tremor Early cognitive/psychiatric features noted, w/ depression Hallucinations, made worse by PD meds Dramatic changes in a day |
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Wilson's Disease
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Defect in copper metabolism causing buildup in liver, brain, eye
Wing-beating tremor, dystonia, ataxia, dysarthria Kayser-Fleischer Rings present in eye Presents in early adulthood |
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Huntington's Disease
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Manifests in 3rd or 4th decades with movement disorders and cognitive decline
With each generation, disease manifests earlier in life |
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Dystonia
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Muscle contractions cause twisting/repetitive movements or abnormal postures
Symptom that may be seen as a part of a variety of disorders May be task-specific and worsened by stress |
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Ataxia
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Lack of coordination while performing voluntary movements
Usually caused by damage to the cerebellum Can have many causes |
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Migraine definition
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Moderate to severe, recurrent, unilateral or bi-lateral, throbbing headache lasting hours to days, which is usually accompanied by nausea, photophobia, phonophobia and worsened by routine physical activity
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Migraine Pathophysiology
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Likely stems from an overly sensitive trigeminocervical pain system (head protective)
Aura is caused by a spreading wave of depolarization, “cortical spreading depression” |
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Common Migraine Triggers
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Fasting, alcohol, caffeine withdrawal, stress, too much/little sleep, menstruation, fatigue, bright lights/loud noises, acute head injury, certain foods
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Dementia definition
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A clinical syndrome characterized by an acquired loss of cognitive and emotional abilities, severe enough to interfere with work or usual social activities, including family obligations.
Insidious onset, persistent, progressive |
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Possible new name for Dementia
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Major Neurocognitive Disorder
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Mild Cognitive Impairment
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Mild acquired decline in cognitive abilities
Noted subjectively and/or with objectively documented decline Not affecting function Mild Person is compensating Up to 15% of persons with MCI may develop dementia within a year |
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Pathophysiology of Alzheimer's Disease
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Amyloid plaques
Tau tangles Chaperone protein changes Neuron and synapse loss Altered chemical transmission |
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Classification of Dementia Severity
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Mild: Some impairment, can function independently
Moderate: Dependent in many areas, not in self-care Severe: Needs help for basic adult daily life |
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Alzheimer's Neurotransmitter Abnormalities
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Decreased Acetylcholine
Increased glutamate |
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Vascular Dementia
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Dementia following a stroke
A syndrome of behavioral and cognitive impairment due to vascular factors affecting the brain |
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Vascular Dementia Presentation
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Executive dysfunction worse than memory loss
Recognition better than spontaneous recall Depression, Involuntary emotional expression disorder Focal neurological deficits (speech, limb) Increased tone, psychomotor slowing, gait Bladder control problems |
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Frontotemporal Dementia
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3rd commonest degenerative dementia
~10% of all cases Younger age of onset and shorter life span Social and dietary changes are early Neurological signs are more frequent (PD, ALS) |
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Frontotemporal Dementia Clinical Presentation
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Prominent and severe language impairment
Prominent behavioral (frontal) deficits Early affective symptoms Relatively preserved visuospatial skills May have ALS, PD like symptoms |
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Intelligence
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The ability to reason, to understand and profit from experience
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Brain characteristics and Intelligence
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Brain size
Neural conduction speed and processing speed Processing efficiency |
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Ideas for why Males have larger brains than Females
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1. Female brains are more efficient due to density of neurons and higher ratio of gray to white matter
2. Males have superior spatial intelligence and this requires greater brain capacity |
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Significance of higher white matter to grey matter ratio
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Higher average IQ--ratio higher in humans than any other animal
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Do brains of people with lower IQs use more or less energy than brains of people with higher IQs?
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More energy
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How much does IQ change with each generation?
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5-25 points increasing per generation
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Neurotechnology
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Any technology that has a fundamental influence on how people understand the brain and various aspects of consciousness
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David Marr's 3 levels of explanation for computational neuroscience
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1. Computational: what does the mind do?
2. Algorithmic: what information is used and how? 3. Implementation: how is the algorithm performed by the physical elements of the brain? |
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Exploratory Procedures
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We choose how to touch based in part on what we want to feel
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A way to measure when interfacing with the brain
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Internal electric fields (microelectrodes)
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A way to stimulate when interfacing with the brain
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Internal electric (intracortical microstimulation)
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