Term
| where is the primary motor system? |
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Definition
| the primary motor system is in the pre-central gyrus, but there are other parts of the brain which have motor input - such as the supplemental motor area between the 2 hemispheres. |
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Term
| what is evidence of the brain's plasticity? |
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Definition
| if you have in injury to one part of the brain, you can reorganize the map completely - particularly w/the sensory function. |
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Term
| what information is provided by the cortical somatosensory system? |
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Definition
| fine *discriminative sensation such as 2 point discrimination, joint position and vibration sensation - the map for which is described in the homunculus (postcentral gyrus). |
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Term
| what characterizes the cortical visual system? |
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Definition
| the primary calcarine visual cortex is located in between the occipital lobes in areas 17, 18, 19 |
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Term
| what characterizes the cortical auditory system? |
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Definition
| this is located in the middle temporal (mesio-temporal) gyrus. |
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Term
| what characterizes the cortical olfactory system? |
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Definition
| this is the oldest part of the brain and is closely related to memory. the olfactory cortex has projections both medially and laterally into the limbic system. |
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Term
| where are the association areas? |
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Definition
| in between the primary areas - allows association of different information w/other information determined to be relevant (tiger = fear, etc) |
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Term
| is there an evolutionary benefit to having dominance of one side of the brain? |
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Definition
| yes, even though we are bilaterally symmetric. |
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Term
| what characterizes dominance in terms of motor control? |
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Definition
| 85% of people are right handed, 15 % are left handed |
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Term
| what characterizes dominance in terms of speech function? |
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Definition
| in R handers, language is in L hemisphere in the temporal and frontal lobes predominantly, as well as the parietal lobe. in L handers - half have full language dominance on the R side and the other half are codominant (a small number of L handers have language fully in the L hemisphere). |
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Term
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Definition
| injection of pentobarbital to carotid arteries of each hemisphere successively to determine hemispheric language dominance. |
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Term
| what is the orientation portion of the mini-mental status examination? |
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Definition
| assessing the pt's perception of *person (who is the pt? who else is in the room?), *place (5 questions on location: what city, state, county are we in etc.), and *time (5 questions on day, month, year, etc.) |
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Term
| what is the registration portion of the mini-mental status examination? |
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Definition
| telling a pt 3 things, for ex: ball, flag, and tree and then having them repeat them later. |
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Term
| what is the attention portion of the mini-mental status examination? |
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Definition
| have the pt either count backward by 7 from 100 (serial sevens) or have them spell world backwards. give the pt 1 pt for every correct answer. money-related questions work best for pts w/questionable educational level: "if i gave you a penny, nickel, dime, and quarter, then how much money do you have?" or "if i gave you $3.75 in quarters, how many quarters is that?" |
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Term
| what is the visuo-spatial portion of the mini-mental status examination? |
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Definition
| have the pt draw 2 pentagons which intersect at a point or draw a clock and put the hands at ten to eleven (good sign if they do cardinal numbers first). |
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Term
| what is the scoring for the mini-mental status (folstein bedside exam)? |
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Definition
| 10 pts for orientation (5 for time 5 for place). 3 pts for immediate memory (ball, flag, tree). 5 pts for world spelled backward/serial 7s. 3 pts for short term memory. 9 pts for language (3 for naming, 3 for "no ifs, ands, buts", 3 for 3 part command - folding paper etc), 3 pts for reading/writing tasks. this adds up to 30. over 26 is normal, 20-25 is mild cognitive impairment, 10-19 is moderate impairment, and <10 is severe. (if pt is blind, make total score less). |
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Term
| what is at the core of cortical localization? |
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Definition
| language function - b/c it totally resides w/in the cortex |
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Term
| how is spontaneous speech observed in terms of aphasia? |
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Definition
| does the pt speak naturally or do they have to work hard to get speech out? note normality of rhythm (*proseity) and pitch (*timber). |
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Term
| how is comprehension assessed in terms of aphasia? |
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Definition
| ask the pt to take their R hand and touch their L ear, close their eyes and stick out their tongue (do not give non-verbal clues). the right way for them to do it is for them to start performing it before you have even finished giving the command. |
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Term
| how is naming assessed in terms of aphasia? |
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Definition
| ask the pt to name simple body parts such as the different fingers, particularly the knuckles (really hard for aphasics). |
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Term
| how is repetition assessed in terms of aphasia? |
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Definition
| ask the pt to repeat a phrase like "no ifs, ands or buts". smaller words are harder. |
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Term
| how is reading/writing assessed in terms of aphasia? |
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Definition
| ask the pt to write a sentence then read a paragraph. |
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Term
| what characterizes broca's area? |
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Definition
| broca's area is located in the inferior frontal lobe and is associated w/coordination of the motor aspects of speech. if there is a problem here: slow, labored, choppy, or speech lacking in rhythm. |
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Term
| what characterizes wernike's area? |
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Definition
| wernike's area is located in the posterior third of the superior temporal gyrus and acts like the dictionary of the brain: where all the meanings of words are stored - allowing comprehension. if there is a problem in this area: transliteral substitution (being close, but not correct when naming things ex: chalk = shalk), word substitution (calling something by another name just to get any word out), and neologisms (inventing words) may occur. |
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Term
| what is the arcuate fasiculus? |
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Definition
| the white matter connecting broca's and wernike's areas |
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Term
| how are the different types of aphasia categorized? |
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Definition
| by fluency, comprehension and repetition |
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Term
| what characterizes wernicke's aphasia? |
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Definition
| pts w/this are fluent (good proseity and rhythm), but cannot comprehend language or repeat it |
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Term
| what characterizes broca's aphasia? |
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Definition
| these pts can comprehend, but are not fluent or able to repeat language. (opposite of wernike's) |
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Term
| what characterizes conduction aphasia? |
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Definition
| these pts are fluent and can comprehend, but cannot repeat - problem is between wernike's and broca's areas. |
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Term
| what characterizes global aphasia? |
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Definition
| this occurs w/severe injury to the dominant hemisphere, and pts w/it have no response to or production of speech. |
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Term
| what characterizes transcortical sensory aphasia (wernike's pt who can repeat)? |
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Definition
| pts w/this can repeat and are fluent, but cannot comprehend |
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Term
| what characterizes transcortical motor aphasia (broca's pt who can repeat)? |
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Definition
| pts w/this can comprehend and repeat, but are not fluent |
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Term
| what is isolation of the speech area aphasia? |
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Definition
| a rare condition where the pt can only repeat (parrot) |
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Term
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Definition
| similar to aphasia, but w/movement rather than language - lose the ability to put movement together in patterns to do things. |
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Term
| what is transitive apraxia? |
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Definition
| the inability to use objects as tools correctly |
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Term
| what is intransitive apraxia? |
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Definition
| problems w/use of gestures - such as waving goodbye |
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Term
| what is ideomotor apraxia? |
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Definition
| problems w/performing planned and learned tasks |
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Term
| what is ideational apraxia? |
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Definition
| problems w/using movement to do something |
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Term
| what is dressing apraxia? |
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Definition
| problems w/putting clothes on in the right order |
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Term
| what is constructional apraxia? |
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Definition
| problems w/understanding overlap of visual space (pentagon test etc) |
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Term
| what hemisphere does apraxia usually involve? |
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Definition
| the non-dominant hemisphere - often in the parietal lobe (where there is input into motor systems originates) |
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Term
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Definition
| lack of knowledge which localizes cortically |
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Term
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Definition
| lack of knowledge of illness. ex: pt w/a stroke who can't lift their arm denies that it is their arm (can be a psychiatric or neurological problem). |
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Term
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Definition
| the inability to recognize faces |
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Term
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Definition
| pts ignorance of one side - stroke pts may neglect their weak arm. this can be tested w/double simultaneous stimulation of both hands at the same time. |
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Term
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Definition
| loss of knowledge of body parts |
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Term
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Definition
| the inability of a pt to describe an overall concept derived from an image - but they can describe the smaller components which make up that image. |
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Term
| what is von-gerstmann syndrome (*know for exam*)? |
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Definition
| a type of agnosia which affects the inferior parietal lobe of the non-dominant hemisphere and consists of 4 parts: 1) acalculia: pt can't calculate. 2) finger agnosia: can't ID fingers correctly. 3) R-L confusion. 4) can't write. |
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Term
| what is characteristic behavior of pts w/temporal lobe damage? |
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Definition
| a "sticky" personality (won't leave their appointment after it is over), hypergraphic (many notebooks detailing their experiences), and hyperreligious. |
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Term
| what is characteristic behavior of pts w/frontal lobe damage? |
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Definition
| calm, happy, unconcerned about personal appearance |
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Term
| what is characteristic behavior of pts w/parietal lobe damage? |
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Definition
| these pts may be nasty/violent |
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Term
| what characterizes L brain dominant pts? |
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Definition
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Term
| what characterizes R brain dominant pts? |
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Definition
| holistic and artistic - see big picture |
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Term
| where is immediate memory stored? |
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Definition
| in the hippocampus and mesio-temporal structures. when there is global ischemia to the brain, these areas are affected first b/c they are more metabolically active. clinical test: have them say ball, flag, tree immediately after you. |
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Term
| what characterizes short term memory? |
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Definition
| the ability to remember things 2-3 min later |
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Term
| where is long term memory stored? |
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Definition
| diffusely over the brain - which is why alzheimer's pts who are bad w/short term memory can still remember things in long term memory. |
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Term
| what disease processes may affect cortical function? |
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Definition
| stroke/CVA (can be focal or diffuse), seizure (hyperfunction in one portion of the brain), tumors (focal in the brain), dementia/degenerative (such as alzheimer's), encephalitis (diffuse effect), and trauma (can be focal or global) |
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Term
| what does the bedside examination for higher cortical function consist of? |
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Definition
| orientation (place, time, etc), aphasia, motor (look for symmetry, do drift test), cortical sensory (2 point discrimination, vibration), and joint position sense |
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Term
| what are some specific cognitive tests? |
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Definition
| the mini-mental status/folstein exam, the clock draw+copy, word lists, boston naming test, verbal fluency (name all the animals you can think of), montreal cognitive assessment, praxis ("show me how you would hammer a nail" etc), and hand tasks. |
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Term
| what diagnostic studies can be used to look at cortical function? |
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Definition
| EEG and evoked potential (electrical function of the cortex), CT/MRI, MR spectroscopy (chemical composition of different parts of the brain), SPECT/PET, functional MRI, spinal fluid analysis, and bx |
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Term
| what are cerebral palsy, mental retardation, and minimal brain dysfunction? |
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Definition
| all are brain injury occurring between fertilization and infancy (not progressive disorders). cerebral palsy = mainly motor. mental retardation = mainly cognitive. minimal brain dysfunction = learning disorders, hyperactivity, epilepsy, etc. |
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Term
| what are the types of cerebral palsy? |
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Definition
| spastic hemiparesis (most common, ex: one side all folded up), spastic quadriparesis (bilateral hemiparesis), spastic diplegia (deficit in both legs), spastic mono and triparesis (may affect 1 arm or 3 out of 4), athetoid (if deficit is mainly in the basal ganglia: athetoid riding movements), ataxic (predominately cerebellar), and mixed. (plegia = paralysis, paresis = weakness) |
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Term
| what are the prenatal etiologies for cerebral palsy? |
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Definition
| abnormal ovum implantation, maternal diseases which affect fetal circulation, threatened miscarriage, external toxins (alcohol, cocaine), and metabolic disorders. |
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Term
| what are the natal etiologies for cerebral palsy? |
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Definition
| low birth weight (prematurity, multiple gestation, small for gestational age) and complications at childbirth (placental abruption, cord prolapse, and breech birth) |
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Term
| what are the postnatal etiologies for cerebral palsy? |
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Definition
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Term
| what is the pathology common to all etiologies leading to cerebral palsy? |
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Definition
| the fetal/neonatal brain suffers *significant hypoxia* which can then lead to intracerebral hemorrhage and brain damage (usually in the germinal matrix - can be subependymal or intraventricular). non-hemorrhagic causes: pre-term periventricular leukomalacia (affects white matter), ischemia after birth -> asphyxia (non-hemorrhagic stroke), infections, and trauma. |
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Term
| what problems are associated w/cerebral palsy? |
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Definition
| spasticity (causes joint deformity or contracture), excessive weight gain (can't exercise properly), epilepsy, hemiparesis, and opisthotonos (severe hyperextension). |
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Term
| what are treatments for cerebral palsy? |
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Definition
| seizure control and physical/occupational/speech therapy. spasticity rx control: baclofen, tizanidine, diazepam. spasticity surgical control: achilles tendon lengthening/transfer, neural sensory ablation, neural stimulation, and baclofen pump directly into the CSF. |
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