Neurological System Disorders

Front 1

What is a TIA?
What are its symptoms?

Back 1

- Transitory stroke that can last a few minutes up to 24 hrs. (typically short duration)
- Numbness/weakness in face/arm/leg; confusion; difficulty speaking/understanding speech; trouble seeing in one/both eyes; difficulty walking; dizziness; loss of balance and/or coordination

Front 2

What can a TIA lead to?

Back 2

Can lead to a serious/debilitating stroke. 1/3 of those that have a TIA will have an acute stroke in the future.

Front 3

Risk Factors for CVA

Back 3

Hypertension
Cardiac disease
Atrial fibrillationDiabetes mellitus
smoking
alcohol abuse
hyperlipidema
age (risk increases with age)
Gender (males at higher risk)
Race (African American & Latino @ higher risk)
Heredity

Front 4

Symptoms of Middle Cerebral Artery (MCA) stroke

Back 4

Contralateral hemiplegia
Hemianesthesia
Homonymous hemianopsia
aphasia
Apraxia

Front 5

Contralateral hemiplegia

Back 5

Paralysis occurring on the side of the body opposite to the side of the brain in which the causal lesion occurs.

Front 6

Hemianesthesia

Back 6

Loss of tactile sensibility on one side of the body. Also called unilateral anesthesia.

Front 7

Homonymous Hemianopsia

Back 7

Hemianopsia (Loss of vision in one half of the visual field of one or both eyes) of the right or left halves of the visual field of both eyes.

Front 8

Aphasia

Back 8

Partial or total loss of the ability to communicate verbally or using written words

Front 9

Apraxia

Back 9

Neurological condition characterized by loss of the ability to perform activities that a person is physically able and willing to do.

Front 10

Internal Carotid Artery (ICA) Stroke

Back 10

see MCA CVA

Front 11

Anterior cerebral artery (ACA) Stroke

Back 11

Stroke results in contralateral hemiplegia
Grasp Reflex
Incontinence
Confusion
Apathy and/or Mutism

Front 12

Grasp Reflex

Back 12

Flexion or clenching of the fingers or toes on stimulation of the palm or sole, normal only in infancy.

Front 13

Apathy

Back 13

Lack of interest, concern, or emotion; indifference.

Front 14

Posterior Cerebral Artery (PCA) stroke

Back 14

Results in homonymous hemianopsia
Thalamic pain
Hemi-sensory loss
Alexia

Front 15

Thalamic pain

Back 15

or Central Post Stroke Pain (CPSP) is a type of chronic nerve pain that starts when part of the central nervous system has been injured. The pain has been described as burning, aching, or pricking in nature, although the character of the pain can be widely variable. It's usually constant and unrelenting, with a tendency to increase in intensity over time. Movement, changes in temperature, or other unrelated stimuli may aggravate the symptoms. It is often accompanied by abnormal sensation in the affected body part.

For more info: http://www.painclinic.org/nervepain-centralpoststrokepain.htm

Front 16

Alexia

Back 16

aphasia characterized by loss of ability to read

Front 17

(L) Hemispheric specialization

Back 17

Movement of (R) side of body
Processing of sensory info from (R) side of body
Visual reception from (R) field
Visual verbal processing
Bilateral motor praxis
Verbal memory
Bilateral auditory reception
Speech
Processing of verbal auditory information

Front 18

Symptoms of L CVA

Back 18

apraxia
difficulty starting and sequencing tasks
perseveration
easily frustrated
high anxiety levels
inability to communicate verbally
cautious and slow
hesitant and insecure

Front 19

(R) Hemispheric specialization

Back 19

movement of (L) side of body
processing of sensory information from (L) side of body
visual reception from (L) field
visual spatial processing
Left motor praxis
nonverbal memory
attention to icoming stimuli
emotion
processing of nonverbal auditory information
interpretation of abstractiformation
interpretation of tonal inflections

Front 20

Symptoms of R CVA

Back 20

Spatial relationship problem
hand-eye coordination
irritability
short attention span
cannot retain info
difficulty learning individual steps
poor judgement in personal safety
diminished body image
(L) sided neglect
quick & impulsive
indifferent

Front 21

What type of immediate care is necessary for an individual with a CVA?

Back 21

-airway maintenance
-adequate oxygenation
-nutritional intervention (IV fluids, alternaive feeding routs
-decubiti prevention
-treatment of underlying cardiac dysfunction

Front 22

What pharmacologic therapies are used with CVA?

Back 22

- Antithrombotic therapy (aspirin/heparin).
- Thrombolytic therapy - oppen occluded cerebral vessels and restore blood flow to ischemic areas

Front 23

What is a Traumatic Brain Injury (TBI)

Back 23

Damage as a result from skull penetration or rapid acceleration/deceleration of brain.
- Risk groups include males from ages 15-29.

Front 24

Symptoms of TBI

Back 24

Loss of consciousness
cerebral contusion/laceration/edema from surface wounds/skull fractures
Hemiplegia/Monoplegia
Abnormal reflexes
Decorticate/decerebrate rigidity
Fixed pupils
coma
Changes in vital signs

Front 25

Decorticate Rigidity

Decerebrate Rigidity

Back 25

See image: http://www.wrongdiagnosis.com/bookimages/13/4923.png

Decerebrate: damage to upper brain stem Arms adducted and extended, wrists pronated, fingers flexed. Legs stiffly extended w/ plantar flexion

Decorticate: Result to damage from (one or both) corticospinal tracts. Arms are adducted and flexed, wrist/fingers flexed on chest, legs stiffly extended and internally rotated. feet- plantar flexion

Front 26

What is used measure consciousness in an individual with TBI? What does it assess?

Back 26

Glascow Coma Scale (GCS). Scale contains a range of points for eye, verbal, and motor responses.

Front 27

What are the ranges for GCS?

Back 27

-Highest total = 15 (i.e., fully conscious)
-Lowest is 3 (i.e., deep coma or death).
- ≤ 8 = severe.
- 9 through 12 = moderate
- ≥ 13 = minor

Front 28

TBI Medical Management

Back 28

Resuscitation
Mgmt of respiratory dysfunction
Cardiovascular monitoring
Surgical/pharm/mech. means to decrease intracranial pressure
Neurosurgery to manage lacerated vessels and depressed skull fractures
Antibiotics
Anticonvulsants
Sedatives
Antidepressants

Front 29

Give examples of traumatic and non-traumatic spinal cord injuries

Back 29

Traumatic: Injury as a result of compression, shearing force, contusion secondary to motor vehicle accident, diving accident, penetration wound (gun/knife), sports injury, or fall

Nontraumatic: injuries from tumor or progressive degenerative disease

Front 30

American Spinal Injury Association Classification of spinal cord injury
or
ASIA Impairment Scale

Back 30

Degree of impairment and severity of injury.

A = Complete: No motor or sensory function is preserved in the sacral segments S4-S5.

B = Incomplete: Sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5.

C = Incomplete: Motor function is preserved below the neurological level, and more than half of key muscles below the neurological level have a muscle grade less than 3.

Hint 30

D = Incomplete: Motor function is preserved below the neurological level, and at least half of key muscles below the neurological level have a muscle grade of 3 or more.

E = Normal: motor and sensory function are normal.

Front 31

Symptoms of SCI (9)

Back 31

1-Spinal shock (4-8 wks): all reflex activity is obliterated 2below level of injury. Presents as flaccid paralysis.
3- Partial/complete sensory deficits
4-Loss of bowl/bladder control
5-Loss of temperature control BELOW the lesion

Hint 31

6-decreased respiratory function
7-Sexual dysfunction
8-Changes in muscle tone; spasticity in upper motor neuron lesions, flaccidity in lesions below L1
9-Loss of motor function resulting in tetraplegia or paraplegia; may be complete of incomplete

Front 32

Central Cord Syndrome

Back 32

Resulting from hyperextension injuries and presenting as more upper extremity deficits vs lower extremities.

http://4.bp.blogspot.com/_PC3aIMjVWm8/SSFoC-qxdMI/AAAAAAAABHs/hGyjLfIG_AQ/s400/Figure11.jpg

Front 33

Brown Sequard

Back 33

Hemi-section of the cord resulting in ipsilateral (same side) spastic paralysis and loss of position sense and contralateral loss of pain and thermal sense.

http://4.bp.blogspot.com/_ACMP_K_Nvzc/RxldY_L1j5I/AAAAAAAAAcg/XP9t-Cm_iiQ/s400/BROWN+SEQUARD+1.JPG

Front 34

Anterior cord

Back 34

Resulting from flexion injuries;motor function, pain, and temperature sensation are lost bilaterally below the lesion.

Front 35

Conus Medullaris

Back 35

Injury of sacral cord and lumbar nerve roots resulting in lower extremity motor and sensory loss and a reflexic bowel and bladder.

Front 36

Cauda Equina syndrome

Back 36

Injury at L1 and below resuting in lower motor neuron lesion; flaccid paralysis with no spinal reflex activity.

Front 37

Complications with SCI (7)

Back 37

1-Respiratory complications (pneunomia, decreased vital capacity)
2-Decubitis ulcer formation
3-Orthostatic hypotension
4-Deep vein thrombosis (DVT)
5-Autonomic dysreflexia
6-Urinary tract infection
7-Heterotopic ossification

Front 38

Pneunomia

Back 38

http://www.mayoclinic.com/health/pneumonia/DS00135

Inflammation of lungs

Front 39

Decubitis Ulcer Formation

Back 39

http://img.medscape.com/pi/emed/ckb/rehabilitation/305143-317514-319284-1714348.jpg

Pressure Ulcer

Front 40

Orthostatic Hypotension

Back 40

Excessive fall in blood pressure upon assuming an upright position.

Front 41

Autonomic dysreflexia

Back 41

An abnormal response to a noxious stimulus such as catheter blockage or sitting on a sharp objects. This results in extreme rise in bloood pressure, pounding headache, and profuse sweating. It is deemed a medical emergency if the stimulus is not eliminated quickly.

Front 42

Heterotopic ossification

Back 42

Formation of bone in abnormal anatomical locations

Front 43

Medical Mgmt of SCI (9)

Back 43

1-Stabilization to prevent further cord damage
2-Traction and rest for unstable injuries
3-Surgery with internal fixation
4-Diruetic prescription to decrease inflammation
5-Bladdar care
6-Decubiti prevention
7-Control fo autonomic dysreflexia and orthostatic hypotension
8-prevention of thrombus formation
9-treatment for heterotopic ossification

Front 44

Cerebral Palsy (CP)

Back 44

Caused by injury/disease prior to/during/after birth resulting in brain damage and secondary neurological and muscular deficits.

Can be detected by 12 months of age. See page 159 (5th edition therapy ed) for symptoms.

Front 45

CP: Lesion of the motor cortex

Back 45

Spasticity with flexor/extensor imbalance

Front 46

CP: Lesion in basal ganglia

Back 46

Fluctuating muscle tone causing dyskinesia, dystonia, or athetosis.Characterized by choreoathetosis more proximal than distal; or writhing movements more distal than proximal.

Front 47

Dyskinesia

Back 47

Difficulty or distortion in performing voluntary movements, as in tic, chorea, spasm, or myoclonus.

he word dyskinesia (dis-ki-ne�ze-a) is logically derived from two Greek roots: dys-, trouble + kinesis, movement = trouble moving.

http://www.medterms.com/script/main/art.asp?articlekey=11214

Front 48

Dystonia

Back 48

A movement disorder in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures. The movements, which are involuntary and sometimes painful, may affect a single muscle; a group of muscles such as those in the arms, legs, or neck; or the entire body.

http://www.medicinenet.com/dystonia/article.htm

Front 49

Athetosis

Back 49

Involuntary writhing movements particularly of the arms and hands.

http://www.medterms.com/script/main/art.asp?articlekey=2379

Writhing:
writhe (r)
v. writhed, writh·ing, writhes
v.intr.
1. To twist, as in pain, struggle, or embarrassment.
2. To move with a twisting or contorted motion.
3. To suffer acutely.
v.tr.
To cause to twist or squirm; contort.
n.
The act or an instance of writhing; a contortion.
http://www.thefreedictionary.com/writhing

Front 50

CP: Lesion in cerebellum

Back 50

Results in ataxic movements characterized by lack of stability so coactivation is difficult resulting in primitive total patterns of movement.

Front 51

What are the different types of CP?

Back 51

Spastic
Athetoid
Flaccid
Ataxic

Front 52

Complications of CP in children

Back 52

50-75& Language and intellectual deficits
50% Seizures
40-50% Visual Impairments
Feeding disturbances

Front 53

Medical Mgmt of CP

Back 53

Antispasticity drugs
Orthopedic to address scoliosis and joint contractures
Surgery to decrease contractures to improvem functional movement
Dietary itnerventions/special feeding techniques for regularity in elimination

Front 54

Chorea

Back 54

Brief, purposeless, involuntary movements of distal extremeties and face.

Front 55

Myoclonus

Back 55

Brief/rapid contraction of muscle or group of muscles

Front 56

Tics

Back 56

Brief, rapid, involuntary movements often resembling fragments of normal motor behavior.

Front 57

Tremor

Back 57

Rythmic, alternating, oscillatory movements produced by repetitive patterns of muscle contraction and relaxation. (resting, action/intention tremor)

Front 58

Parkinsons Disease (PD)

Back 58

Slowly progressive/degenerative CNS disorder. Onset after age 40.

Front 59

PD Symptoms

Back 59

Begins with "pill-rolling"
Tremor
Rigidity
Akinesia
Postural istability
Festinating gait
Retropulsion (falling backwards)
Propulsion (falling fowards)
Mask Face
Micrographia

Front 60

Hoehn & Yahr 5 Stage Scale of PD

Stage 1

Back 60

Unilateral tremor
Rigidity or Akinesia
Min-No functional impairment

Front 61

Hoehn & Yahr 5 Stage Scale of PD

Stage 2

Back 61

bilateral tremor
Rigidity or Akinesia
(I) with ADL
No balance impairment

Front 62

Hoehn & Yahr 5 Stage Scale of PD

Stage 3

Back 62

Worsening of symptoms
First signs of impaired righting reflex
Onset of disability in ADL
Can lead (I) life

Front 63

Hoehn & Yahr 5 Stage Scale of PD

Stage 4

Back 63

Requires help with some/all ADLS
Unable to live alone w/out some assistance
Able to walk/stand unaided