Term
|
Definition
| Open/closed brain injury, most common |
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Term
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Definition
| Occlusions, aneurysms, bleeds, AVMs, 2nd most common |
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Term
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Definition
| Tumors, infilrative vs. displacing, 3rd most common |
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Term
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Definition
| Anoxia, liver/kidney, nutritional |
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Term
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Definition
| Meningitis/encephalitis, vasculitis (causes fevers; avoid sustained fever >105) |
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Term
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Definition
| Environmental, Prescription, OTC, poison |
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Term
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Definition
| Anoxia, iatrogenic, fever, anesthesia |
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Term
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Definition
| Anoxia, post-ictal secondary trauma (This is almost always a symptom of trauma, vascular, neoplatic, metabolic, infectious, toxic, or surgical issues. This is especially the case when bleeding in the brain is present). |
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Term
| Traumatic Brain Injury (Three types) |
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Definition
| Mild traumatic brain injury (mTBI), Closed brain (head) injury (CHI), Open brain (head) injury (OHI) |
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Term
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Definition
| Tissue Loss, Tissue Swelling or Edema, Hydrocephalus, Epilepsy |
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Term
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Definition
| Irreparable damage in CNS. (Can recover but it occurs via reorganization, will be different than before). |
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Term
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Definition
| With occlusion of blood, vascular diffusion, or fluid build-up for various reasons. Can produce herniation and compression. Edema is the more medical term, but edema shows "pitting" without pain when pressed. Edema is different than swelling. Swelling (hard and hot) edema (indents and not hot - more concerning). |
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Term
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Definition
| Build up of CSF, causes expansion of ventricles and tissue swelling/edema. |
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Term
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Definition
| Disrupts ongoing activity and cause severe metabolic damage. |
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Term
| Mild Brain Injury Statistics |
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Definition
AKA - the miserable minority (does not produce obvious impairment, however something has changed, the person is less than before).
MVAs - 60%, Falls 16%, Sports 14%, Violence of other forms 10%.
Males > Females
Single > Married > Divorced > Widowed |
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Term
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Definition
| May or may not produce obvious neurological deficits, often however, leads to interpersonal, job related, and "self" conflicts. Often undetected until after problems begin and first seen as emotional changes, notably, depression, anxiety, or irritability. |
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Term
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Definition
| A violent jarring or shaking that results in a disturbance of brain function. There is no bleeding, but function at the point of impact is disrupted. |
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Term
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Definition
| Concussion, Acceleration/Deceleration, Shearing/Diffuse Axonal Injury, Secondary Swelling, Metabolic Changes. |
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Term
| Acceleration/Deceleration |
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Definition
| Sudden change in momentum. |
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Term
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Definition
| With increased intercranial pressure (ICP) and reduced blood flow (anoxia). |
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Term
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Definition
| Increased glucose and oxygen need with reduced availability. Glutamate toxicity (biggest problem). This accounts for headache, nausea, and fatigability that occurs after a concussion. |
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Term
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Definition
| Headache, Dizziness, Memory Problems, Poor Attention, Slowed Thinking, Fatiguability, Easily Frustrated, Poor Stress Tolerance, Apathy, Depression, Poor Abstraction, Poor Reasoning, Impaired Learning, Confusion, Sleep Problems, Nausea, Vomiting. This is usually temporary but can become permanent. |
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Term
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Definition
| Occurs in athletes with prior concussion following a relatively minor impact (can occur up to four days post injury). Catastrophic increase in intracranial pressure due to dysfunction of autoregulation of cerebral circulation (bloodflow is altered). Most often occurs in athletes < 24 years old. Possible predisposed because of exposure to viral encephalitis and infections like mono. |
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Term
|
Definition
Glasgow Coma Scale > 12
Loss of consciousness < 20 min.
Hospitalization < 48 hours (without collateral injury)
No structural damage on neuroimaging (does not show white matter damage which occurs most often in mTBI). |
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Term
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Definition
Three components:
Eye opening (5 points)
Verbalization (5 points)
Response to Commands (5 points)
Total of 15 points (fully alert) |
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Term
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Definition
| High speed injury with stretching or shearing of brain tissue - specifically axons. Radiographically shows pin-point (petechial) bleeding in white matter pathways. Frequently associated with immediate, deep coma (but not always). Even mild forms can be very disruptive. |
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Term
| Results of Diffuse Axonal Injury |
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Definition
Cerebral swelling and elevations in intracranial pressure are common. Mortality = 30-40% Good outcome = 20-30%
In less severe cases, recovery can appear to be good for the first few days, and then declines over the course of two weeks due to damaged axons dying off. |
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Term
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Definition
| Impact concussions produce some damage at the site of impact. The brain rebounds (fluid dynamics) and the pressure of the impact is broadcast to the opposite side of the brain. Assessed damage often greater at the contre-coup than at the coup. |
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Term
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Definition
| Point of impact compresses tissue. |
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Term
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Definition
| Brain rebounding after coup damages opposite pole and suffers "cavitation" (bubbles or cavities). |
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Term
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Definition
| Involves rapid displacement of tissue producing injury either through compression displacement or through an induced vacuum. |
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Term
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Definition
| Account for 20% of 1.54 million injuries reported annually in US (estimated only 1/3 of injuries are reported). 9% of sports-related brain injuries require hospitalization. For children under 15, sports-related injuries are more than twice as frequent as MVAs. |
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Term
| Mechanism of Injury for mTBI in athletes |
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Definition
1 - Rotational acceleration
2 - Linear acceleration
3 - Carotid (neck) injuries (Circle of Willis)
4 - Deceleration on impact
Cervical collars reduce these, mouth guards merely protect teeth. |
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Term
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Definition
| Effects of repeated concussions are cumulative (never resolve 100%). 50% of professional boxers show brain atrophy. 87% of professional boxers show neurological signs. Impacts can be sub-concussive and still produce these signs. All sports are similarly affected. Girl's field hockey, basketball, and soccer (especially goalies) are notably more prone to concussion than other sports. |
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Term
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Definition
| Sudden occlusion of vessel by some blood borne "cork". Usually occur without warning, can result from blood clots, bacterial rafts, or fat globules - usually at bifurcations. Associated with other diseases or poor cardio-vascular health. Onset of cognitive signs very rapid onset, must be treated quickly or can produce permanent damage. "Roto-rooter" can be used. |
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Term
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Definition
| Gradual occlusion of vessel by cholesterol plaque or inflammation (mostly a lifestyle issue). These develop over long periods restricting blood flow through reduced-diameter vessels. Associated with high cholesterolemia - but can result from arterial inflammation. Often manifest at periods of low blood pressure - often in the early morning. Can produce Transient Ischemic Attack (TIA) that serves as a warning of full-blown CVA. Treated by roto-rooter, enzymes, or thinners. |
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Term
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Definition
| A combination of embolic and thrombotic, can block larger vessels which makes it more dangerous than embolic and thrombotic. Thrombus reduces diameter of artery making it more likely for otherwise benign embolism to cork vessel. TIA do not accompany these. Need to be treated as embolism. |
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Term
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Definition
| A "ballooning" of a weakened vessel with systolic blood pressure spike. Frequently occur in chronically hypertensive people in poor cardiovascular shape (African-American males account for 50%). Sudden and usually intensely painful onset. Weakened vessel can rupture - extremely urgent situation. Can be "girdled" (with silk) back into shape - but probability of recurrence is high. |
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Term
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Definition
| A "bleed" due to puncture or rupture of a vessel. One of the worst of the cerebrovascular accidents because blood and brain do not mix. Can occur because of rupture with high blood pressure, penetration, impact trauma. Become more common with aging and reduced elasticity of vessels. Site and degree of rupture determines prognosis. Blood on brain extremely dangerous, control of bleed has to be fast. Seizures/convulsions often indicate bleed. |
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Term
| Arteriovenous Malformation (AVM) |
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Definition
| An abnormal connection between an artery and a vein. Some genetic component, usually postnatal like with forcep delivery, the arteries and veins get squashed together and grow that way, mixes bloods. Inefficient and often "leaky" these can cause gradual damage to cortical surface. Prone to rupture, especially after periods of stress or head impact, even if asymptomatic prior to episode. Surgically removed when detected. |
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Term
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Definition
| Many are preventable with life-style changes (away from sedentary, high-fat diets) family history also an issue (mostly due to modeled lifestyle). Many are asymptomatic until it is "too late". Correction is possible, but it must be fast. Recovery is very slow and requires extensive rehab. Are increasing. |
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Term
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Definition
| Sudden numbness or weakness of the face, arm/leg, especially unilaterally. Sudden confusion, trouble speaking, or understanding speech. Sudden trouble seeing in one or both eyes. Sudden trouble walking, dizziness, loss of balance or coordination. Sudden, severe headache without obvious cause. |
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Term
| Transient Ischemic Attack (TIA) |
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Definition
| Under normal, waking pressure, a mildly occluded artery can still function normally. Under low blood pressure, for whatever reason, pressure is insufficient to push enough blood past occlusion. Brain distal to thrombus shuts down prophylactically (metabolically shuts down) which produces a "mini stroke". Once BP restored, stroke signs abate. Usually after several minutes, but can take longer. This is a masked blessing to get treatment before full CVA. |
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Term
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Definition
| The brain is fodder for a host of tumors. Tumors reflect rampant, non-regulated growth of various brain tissues. The type, speed, and quality of growth relates to danger of these growths. Tumors are increasing in frequency. Many people, however, have tumors that remain benign and sub-clinical. Create their own vascular supply that is often unstable and leaky. Damage can occur from the leaks alone. |
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Term
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Definition
| Take years (or decades) to produce clinical effects (meningiomas are the most common). |
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Term
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Definition
| These can take only a few months (or weeks) such as Glioblastoma Multiforme |
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Term
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Definition
| These are encapsulated and push brain out of the way (most common). |
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Term
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Definition
| These consume brains tissue as they grow. |
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Term
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Definition
| The brain can compensate for slow growing displacers until they reach critical mass (brain can no longer compensate). Stolen vascular supply or leaks can produce stroke-like symptoms. Bleeding can provoke seizures (sometimes the first clinical sign of a tumor). Altered neural functioning can look very psychiatric with hallucinations/delusions, etc. tumors are also notorious for changing personality. Displacement can produce herniation or other forms of neural distortion. |
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Term
| Tumor Classification - Grade I |
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Definition
| Relatively harmless, will probably not be a problem - and easy to treat. |
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Term
| Tumor Classification - Grade II |
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Definition
| Could become a problem if left alone. Easy to treat and should be treated. |
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Term
| Tumor Classification - Grade III |
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Definition
| Dangerous and require treatment. Treatment often complex and aggressive. Often given a 5 - year prognosis. |
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Term
| Tumor Classification - Grade IV |
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Definition
| Deadly and resistant to treatment. Prognosis can be a few months. Often getting affairs in order is recommended. |
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Term
|
Definition
| Relatively rare and usually developmental. Usually PNS, hereditary, and require surgery if problematic. |
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Term
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Definition
| 50% of clinical cases. Arise from glial cells. Very troublesome and require treatment. |
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Term
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Definition
| 20% of clinical cases. Usually displacing slow growers relatively easy to reduce. |
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Term
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Definition
| 10% of clinical cases. Arise from tumors elsewhere in the body. Almost always Grade IVs. |
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Term
| Evolving Clinical Signs of a Tumor |
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Definition
| Slow growers can develop for years before clinical signs appear. Most often unnoticed until dramatic. Compensation often occurs ans is seen in subtle changes in the way the person does things. Attention/concentration deficits usually appear first. Eventually level of arousal compromised with greater difficulty staying alert/focused. Focal signs can appear with localized tumors. Eventual obtundation - person ends in coma. |
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Term
| Acute Clinical Signs of a Tumor |
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Definition
| Headaches (intense, "core", exacerbated by postural changes). Nausea and Vomiting (not related to food consumption, projectile vomiting is a very bad sign). Mental Clouding/Fatigueability. Focal Signs (Loss of specific neurological functions that localize the tumor, these can be sensory, perceptual, motor, reasoning, memory, or more abstract losses). Seizures and/or Convulsions. |
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Term
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Definition
| A general term for global reduction in cognitive process. Not all are age-related, but aging increases risk of development. Multiple forms of dementing process: Cortical, subcortical, demyelinating, metabolic, toxic, vascular, traumatic, infectious, neoplastic, hydrocephalic. |
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Term
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Definition
| Memory Impairment (long-term preserved but short-term, working memory, and learning notably impaired). Cognitive Dysfunctions (Aphasias, apraxias, agnosias, etc.), Global Intellectual Deterioration (sufficient to interfere with occupational, social, or personal performance). |
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Term
| Most Common Causes of Dementias |
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Definition
Alzheimer Pathology - 55%
Stroke - 15%
Multiple causes - 12%
Parkinson's Pathology - 8%
Traumatic Brain Injury - 4%
Non-specific causes - 6%
Multiple causes often reflect general physical deterioration including cardio-vascular, liver, kidney, nutritional, etc. all working toward cascade. |
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Term
| Cortical Dementing Syndromes |
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Definition
| A constellation of cognitive, behavioral, and functional deficits arising from brain damage that primarily affects the cerebral cortex. |
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Term
| Subcortical dementing syndromes |
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Definition
| A constellation of cognitive, behavioral, and functional deficits arising from brain damage that primarily affects subcortical nuclear or white matter structures (basal ganglia, internal capsule). |
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Term
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Definition
| Cortical atrophy, neuron loss, synaptic loss; especially in pre-frontal and anterior temporal cortex. Neuritic plaques and neurofibrillary tangles. Cholinergic loss (from Nucleus Basalis of Meynert) and noradrenergic loss (from Locus Coeruleus). Progressive, erratic cognitive loss. This progression can be slowed with medications, but cannot be halted. |
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Term
| Functional Markers of Alzheimer Disease |
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Definition
| Anosmia (Loss of the sense of smell can precede cognitive loss by years). Learning and Memory (Hallmarks of cortical dementias appear next). Visualspatial Loss (Often appears first as disorientation to place). Executive Loss (Judgement, decision making, and flexibility disappear). Language (Anomias, word approximations, and related expressive dysfunctions). |
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Term
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Definition
| Fronto-Temporal dementia (Pick's disease), Lewy-Body dementia, Cortico-basal dementia, Fronto-Parietal dementia, Anoxic and metabolic dementias (expressed primarily through cortical damage). |
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Term
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Definition
| Huntington's disease, Parkinson's disease, Progressive supranuclear palsy, Vascular dementia. Each of these is heralded by dysfunctions in the areas of the brain they affect; e.g. the cognitive signs of Parkinson's dementia are often preceded by depression with movement disorders and tremor at rest. |
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Term
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Definition
| Genetic disorder that programs the Basal Ganglia to self destruct - especially the Caudate Nucleus. Uncontrolled, involuntary movement; especially Chorea (rapid, purposeless, stereotyped movement). Behavior problems relating to apathy and noncooperation. Failure to anticipate or plan ahead. Global dementia. |
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Term
| Functional Markers of Huntington's Disease |
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Definition
| Attention and concentration reduced. Executive functioning, especially anticipation, planning, and impulse control. Psychomotor speed reduced. Visuospatial abilities decline. Learning and memory decline; with episodic (learn across trials, retain over delay), remote (recognize famous faces, old public events), and semantic memory (general knowledge, language based information), more affected than explicit memory. Priming and skills learning also worse. |
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Term
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Definition
| Severe amnesia with poor consolidation. Severe temporally graded, retrograde amnesia. Information never gets in. |
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Term
| Memory Summary Subcortical |
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Definition
| Mild memory deficit with inefficient retrieval. Mild, non-graded retrograde amnesia. Information gets in but getting it back is hard. |
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Term
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Definition
| A dementing syndrome from severe depression. Can occur in early middle age through senescence. Functionally similar to sub-cortical dementia, but with important differences. These differences, and the correct diagnosis are critical for appropriate treatment. Treatment can involve antidepressant medication and psychotherapy. This is becoming common, and is very important. |
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Term
| Differential Diagnosis Pseudodementia vs. Dementia |
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Definition
Pseudodementia - Family aware, can date onset of symptoms, seeks medical attention early, symptoms progress rapidly, history of psychiatric symptoms common, deficits detailed, emphasize disability, poor effort on tests, very concerned, poor social skills, AM/PM not much different, attention preserved, gives up on questions (IDK), memory loss for specific periods, task performance markedly varies (success improves).
Dementia - Family unaware, doesn't know onset, seeks medical attention late, symptoms insidious, history of psychiatric symptoms uncorrelated, deficits concealed, delights in success, struggles to perform, appears unconcerned, skills retained, PM gets worse, attention faulty, gives near misses but tries, loss of recent more than for remote, task performance consistently poor. |
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Term
| WMS-IV Norms and Applicable Populations |
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Definition
| 16-90 years old with special norms for 65-90 and is matched with regard to gender and a general ability factor (GAI). Ethnicity and Educations are also part of the WMS-IV norms. |
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Term
| WMS-IV Test-Retest Reliability |
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Definition
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Term
| Content Validity of WMS-IV |
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Definition
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Term
| Construct Validity of WMS-IV |
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Definition
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Term
| WMS-IV Brief Cognitive Status Exam |
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Definition
| Time Estimation, Confrontational Naming, Mental Control, Clock Drawing, Incidental Recall, Inhibition, Verbal Production. |
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Term
| WMS-IV Visual Reproduction |
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Definition
| Five designs shown one at a time for 10 seconds then the stimulus is removed and client must reproduce designs. Disturbances can reflect basic visual processing and visual construction dysfunctions. Difficulties in perceptual organizational skills, in frontal praxic functions, or in simple graphomotor or fine motor problems can impair performance. |
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Term
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Definition
| Recall of stories. Disturbances can reflect verbal information processing deficits, poor verbal memory, a lack of attention to detail, or poor verbal comprehension. |
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Term
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Definition
| A new test, client is shown grids with red or blue dots and client must mark in blank grid where blue dots overlapped. Disturbances in visual content retention and spatial organization are both tapped. Distractability (red dots), executive decision making, and motor placement issues can be seen. |
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Term
| WMS-IV Visual Reproduction II |
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Definition
| Client draws previous visual reproduction designs 20-30 minutes after first viewing. Disturbances: visual or verbal encoding dysfunction, gestalt recognition and processing, and graphomotor disturbances can be observed. The recognition phase allows determination of level of encoding difficulty. |
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Term
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Definition
| Again about 20-30 minutes after first logical memory subtest, client is asked to recall stories. Disturbances: verbal information processing deficits, poor verbal memory, a lack of attention to detail, poor verbal comprehension. |
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Term
| WMS-IV Verbal Paired Associates I |
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Definition
| Client is read slowly a series of paired words, then client is given the first word and asked to retrieve the second. Disturbances reflect problems with associative learning, level of the client's associative ability can be estimated by comparing the easy associations with the hard ones (prefrontal integrity), learning with feedback without serial cueing, and the learning curve of patients is estimated here. |
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Term
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Definition
| Client must recreate a design on a grid. Disturbances reflect problems with attention to detail, visual organization, verbal encoding, and spatial memory factor strongly in this subtest. |
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Term
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Definition
| Client has to identify the correct design from a grouping of several distractors. Disturbances are similar to spatial addition, requires non-verbal, sequential abilities, maintaining a mental image, or set of images in sequence requires considerable visual memory and executive control . |
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Term
| WMS-IV Verbal Paired Associates II |
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Definition
| The client is asked to remember the word that went with the first word from before and then asked to recognize the correct pair from a large number of pairs. Then asked to remember as many of the first words in the pair as they can (optional). |
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Term
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Definition
| Client is asked to place the correct designs in their correct position from before. |
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Term
| What neurotransmitter decreases in activity (back to levels similar to childhood) as a person ages and what does this effect? |
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Definition
| GABA decreases and it effects organization of thoughts, decision making, and executive functioning. |
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Term
| What type of hemorrhage is common in older populations and what is the cause? |
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Definition
| Subarachnoid hemorrhages and are usually caused by falls. |
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Term
| Describe Alzheimer Disease |
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Definition
| Onset can occur between 45 and 60, progression is erratic but typically fairly rapid, some pyramidal signs may be present, aphasia apraxia and agnosia are common, physical wasting occurs in terminal stages only, Kluver-Bucy syndrome may be present, memory disturbances appear very early, speech is not seriously affected until late, depression with irritability is common throughout, initial overactivity with restlessness is common, seizures become common in later stages, direct forward staring is noted early, and some extrapyramidal rigidity can also be seen. |
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Term
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Definition
| Onset after 65, progression is slow and less severe, extrapyramidal signs are rare, aphasia apraxia and agnosia are uncommon, physical wasting occurs with cognitive decline, Kluver-Bucy syndrome is rare, memory loss is idiosyncratic, speech is not seriously affected until very late, depression is common but irritability idiosyncratic, hypoactivity is more common than overactivity, no seizures are present, no changes in gaze or interpersonal relations until late. |
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Term
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Definition
| Onset age variable but correlates with Alzheimer's, can occur as early as 20's, more common in women than men, progression is variable, extrapyramidal signs are also variable but not common, aphasia apraxia and agnosia occur in later stages, physical wasting is not a common feature, Kluver-Bucy syndrome is common, memory loss is idiosyncratic, personality changes occur before the cognitive losses and include self-indulgence increased sexual interest and acting out tactlessness indiscreation steretypic behaviors are also common, seizures can occur but these usually reflect other or coincident processes. |
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Term
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Definition
| Approach to prefrontal issues must be comprehensive - whole brain contributes. Process observations must be incorporated - no hard signs. Lurian approach needed. |
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Term
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Definition
| Normative sample was free of any history of neurologic, psychiatric, or major medical issues. All assessed functions "mature" through childhood, peak around 20s stabilize in the 30s, and "decline" in normal older groups. All scores are age adjusted reflecting that which is "normal" for the cohort. Contrast and composite scores adjusted for "flier" scores by conversion to scale scores. Alternative form available but has a limited normative base. Both forms are basically fun. |
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Term
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Definition
| Initiation of problem-solving behaviors, fundamental sensory and motor integrity, verbal concept formation, non-verbal concept formation, transfer of concepts into action, abstract conceptualization and expression, flexibility of thinking, and flexibility of behavioral responses. |
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Term
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Definition
| Trail-Making, verbal fluency, design fluency, color-word interference, sorting test, twenty questions, word-context, towers test, proverb test. |
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Term
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Definition
| Expanded from HRB "Trails A & B" to balance distraction and consider visual scanning, motor speed, verbal and numerical proficiency. Five subtests: visual scanning, numerical and alphabetic sequencing, set switching, and motor speed. Reflects mental "flexibility", inhibition, set-shifting, scanning, and motor speed. |
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Term
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Definition
| Expanded version of COWAT. Three conditions: Letter fluency, category fluency, and category switching. Highly sensitive to any brain injury, but also reflects education and some gender differences. Reflects general info processing speed, rule adherence, inhibition, and set-shifting. |
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Term
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Definition
| An elaboration of Ruff's "Figural Fluency test" a complement to verbal fluency. Three conditions: Filled dots (undistracted), open dots (distracted with filled dots), and switching (both open and filled dots). Reflects non-verbal facility, response inhibition, cognitive flexibility, and general non-verbal processing speed. |
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Term
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Definition
| An elaboration of the Stroop test. Four conditions: Color-naming, word-reading, switching, and double switching. Provides baseline of color labeling and word reading skills. Reflects inhibition of over-learned responses, set-shifting, and higher level set-shifting. Last condition very sensitive to developing issues that may not yet be clinically obvious. |
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Term
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Definition
| A "new" test reflecting category formation, recognition, and verbalization (explanation). Two conditions: free sort and sort recognition. Reflects attention to detail, initiation of action, conceptualizing categories, and ability to identify existing categories. Abstraction and pattern skills needed. Useful in early detection of pre-frontal issues. |
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Term
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Definition
| An elaboration of the popular child's game. A single test with several scoring foci. Reflects hypothesis formation and testing, strategy formation, level of abstract and categorical thinking, flexibilty in response to feedback. Scoring reflects the nature of the dysfunction. |
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Term
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Definition
| Client has to determine the meaning of a "foreign" word on the basis of increasingly specific clues. A "new" test reflecting verbal concept formation from context; involves deductive reasoning, abstraction and verbal reasoning, concept formation and integration of information, and hypothesis formation, assessment, and set-shifting. Level of each of the above is reflected in the number of trials it takes to "get it". |
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Term
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Definition
| An elaboration of a really old game involving spatial foresight, planning, and reasoning skills. Incorporates numerous process observations. Reflects processes noted and mental flexibility, rule adherence, inhibition of impulses, establishing (learning) and maintaining set. Males tend to have an advantage with Towers, but nuances and complexity of the test make it very sensitive to early issues. Give good prognosis for rehab. |
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Term
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Definition
| An elaboration of another really old test of verbal abstraction - but one that is affected by education and cultural background. Two phases: free inquiry and recognition (multiple choice format creates distraction showing degree of impairment. Multiple levels of interpretation reflect abstraction and concept formation - internally generated vs. externally presented. |
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