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Clinical Neuropsychology
N/A
61
Psychology
Graduate
04/19/2009

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Cards

Term

cerebral vascular accident

Definition

aka "stroke" -- the sudden appearence of of neurological Sx as a result of the interuption of blood flow

The most common cause of death worldwide

Term

Infarct

Definition

an area of dead or dying tissue resulting from an obstruction of the blood vessels normally supplying the area; often caused by a stroke

Term

What is the main predictor of prognosis after a cerebral vascular accident?

Definition

If a stroke occurs in a small area (such as a capillary) the prognosis is usually good. However, if a major (i.e. large) vessel is blocked, devastating damage can occur, resulting in serious disability or death.

Term

Name 5 of the most common vasular disorders that affect the CNS.

Definition

Ischemia

Migraine stroke

Cerebral hemorage

Angiomas

Artiovenous aneurysms

Term

Ischemia

Definition

any of a group of disorders in which the Sx are caused by a vessel bloackage preventing a sufficient blood supply to the brain

Term

Thrombosis

Definition

a type of ischemia where some of the blood vessel has coagulated to form a plug or clot that has remained at the place of its formation

Term

Embolism

Definition

a type of ischemia where a clot or other plug brought through the blood from a larger vessel is forced into a smaller one, creating an obstruction

 

can be a blood clot, bubble of air, deposit of oil or fat, or a small mass of cells detached from a tumor

 

usually affect the middle cerebral artery of the left hemisphere

Term

cerebral artiosclerosis

Definition

a thickening and hardening of the arteries

 

often results in an ischemia due to blood flow constriction

Term

cerebral vascular insufficiency (transient ischemia)

Definition

a temporary ischemia that is usually not harmful (e.g. "blood-choke")

Term

What is a migraine stroke (definition and Sx)?

Definition

an ischemia resulting from a migraine attack which is a common source of stroke in ppl under 40, eps. women

 

an immeditate constriction of the blood vessels (i.e. a vasopasm) is thought to be responsible, but the cause of the vasopasm is unknown; commonly affected area is the posterior (rear) cerebral artery

 

Sxs include impaired sensory function (esp. vision), numbness of skin (esp. arms), difficulties in moving, and aphasia

Term

What is cerebral hemorrhage? What is the most common cause? Is it deadly or relatively benign?

Definition

Massive bleeding into the brain; most commonly caused by hypertension

 

Often fatal, esp. when patient is unconscious more than 48 hrs

Term

What is an angioma? What can happen when they form in the brain?

Definition

Angiomas are lesions formed by malgnant collections of blood vessels in some stage of hemorraging. Thus, they have a dark red or blue color like mulberries. Often referred to as "spider viens", they are often removed using cosmetic procedures, esp. in the legs.

In the brain, angiomas can be deadly because they can result in ischemia. They can also rupture, resulting in dead as a result of cerebral hemorrhaging (although this is rare).

Term

Aneurysm

Definition

A problem within the blood vessel due to deficits in vessel elasticity.

 

Basically the vessel swells up like a balloon. Aneurysm "balloons" are weak and are likely to burst.

 

They often cause intense pain in the head because the swelling pushes against the dura matter (outer covering of brain) which contains many pain receptors.

Term

Edema

Definition

the accumulation of fluid in and around damaged tissue

Term

What are the main treatments for vascular disorders?

Definition

No specific Tx, but surgery and psychotherapies can help if delivered within 3 hrs after a vascular emergency

 

Rx can be given to dissolve clots, dialate vessels, and/or reduce cerebral edema

 

Surgeries can be performed but are not always practical (e.g. an aneurysm in the middle of the brain could not be removed do to its location)

 

Term

What are the two most important factors in the incidence of head injury?

Definition

age and sex

 

Children and the elderly are likely to occur TBIs from falls

 

Males ages 15-30 are likely to occur TBIs through automobile and motorcycle accidents (although sports also account for about 20% of TBIs)

Term

Two types of head trauma

Definition

Open-head injuries, where the skull is penetrated

 

Sx tend to be specific and often undergo rapid and spontaneous recovery, thus these ppl make good research participants

 

Closed-head injuries, where the skull isn't penetrated -- result from a blow to the head

 

Closed-head injuries from traffic accidents are particuarly bad b/c the head is often moving forward when the blow is struck

Term

What is a coup? A countercoup? A hematoma?

Definition

A coup is a bruise (contusion) at the site of the blow when the skull is pushed into the brain.

 

A countercoup is contusion where the brain is pushed against the opposite side of the skull from where the blow occurs.

 

A hematoma is a collection of blood outside the blood vessels, usually resulting from damage to the blood vessel -- in the brain, hematomas can cause serious problems because there is no where for the blood to go and pressure increases inside the skull

Term

Name two types of injuries that result from closed-head injuries.

 

Definition

1) Discrete impairment of the specific functions mediated by the cortex at the site of the coup or countercoup lesion

 

2) More generalized impairments from widepsread trauma throughout the brain -- commonly associated with damage to the frontal and temporal lobes (these areas are most susceptible to damage)

Term

In our textbook author's opinion, who seems to be affected most by closed-head injuries: smart ppl or dumb ppl?

 

Smart ppl because they are more aware of cogntive deficits

Definition

 

Term

What are the 2 primary brain injuries that result from closed-head injuries?

Definition

1) Macroscopic lesions

Coup, coutercoup (usually in the frontal and temporal lobes), and lacerations (tearing wounds) of the brain resulting from depressed skull fracture

 

2) Microscopic lesions

widespread tearing of fibers in the brain resulting from the stress of the TBI

Term

Name 6 secondary consequences of closed-head brain injuries ("HE PISS")

Definition

1) Intracranial Hemorrhaging (bleeding)

 

2) Edema (fluid build-up) in white matter (mylinated axons) adjacent to lesion

 

3) Raised intracrannial Pressure

4) Ischemic (blood-flow restriction) brain damage

 

5)Diffuse brain Swelling  -- hyperemia

 

6) Brain Shift and herniation

 

"HE PISS"

Term

Are closed-head injuries always accompanied by visible neurological Sxs?

 

Definition

No; Sxs may not appear, and this makes assessment very important.

 

However, ppl with head injuries are more suscrpitble to subsequent head injuries b/c they continue doing things that result in damage. Further, damage is cumulative (as in the "punch-drunk syndrome" documented with boxers)

Term

What is the purpose of the Glasgow Coma Scale (GCS)? What are the three domains therein?

Definition

To objectively measure the degree of unconsciousness and of recovery from unconsciousness.

 

The three domains are eye opening (E), motor response (M), and verbal response (V)

Term

Despite the objectivity of the GCS, it has been criticized for missing up to 50% of ppl with brain injuries. What is an alternative way to measure the severity of head trauma?

Definition

The length of posttraumatic amnesia (PTA). The length of PTA is correlated (unperfectly) with subsequent memory disturbance.

 

This method has been criticized because there is no consensus on how to measure the length of an individual's PTA.

Term

How long does recovery from head trauma usually take? When does the bulk of cognitive recovery take place? Which areas tend to have the best overall prognosis? The worst?

Definition

Recovery may continue for 2-3 years, but most cognitive improvements occur within 6-9 months.

 

Prognosis for the recovery of cognitive functioning is generally good.

 

There is less optimism about recovery concerning social skills and personality. Thus, the quality of life for ppl with closed-head injuries is significantly reduced and the reduction is chronic.

Term

What are the characteristics of epilepsy? What are symptomatic seizures? What are idiopathic seizures?

Definition

Epilepsy is charactersized by seizures of various types that register on an EEG and are asscoaited with disturbances of consciousness.

 

Symptomatic seizures can be identified with a specific cause.

 

Idiopathic seizures appear spontaneously and in the absence of other diseases in the CNS

Term

What is the most remarkable clinical feature of epileptic disorders? Name three Sx found in many types of epilepsy.

Definition

The varying length of time between attacks -- from minutes to years.

 

1) An aura, or warning of impending seizure

2) Loss of consciousness

3) Movement

Term

How is Dx confirmed for epilepsy? What are the limitations of this method?

Definition

Dx is made by EEG scans of the brain. This method is inexact b/c some ppl have abnormal EEGs and do not have seizures.

Term

Name and characterize four types of seizures

Definition

1) Focal seizures -- begin in one place ("focus") and then spreads. Jacksonian focal seizures begin in the part of cortex representing the region of the body where the movement first began.

 

2) Generalized seizures -- bilaterally symtremical without a focal onset (include grand mal seizures and petit mal seizures)

 

3) Akinetic seizures are ordinarliy only seen in children; they usually result in falling down for a brief period of time (football helmet recommended)

 

4) Myoclonic spasms are massive seizures that consists of a sudden extension of the body and often begin with a cry

Term

What are the two methods used to treat epilepsy?

Definition

Anticonvulsant drugs are the treatment of choice; these drugs inhibi the discharge of abnormal neurons by stabilizing the neronal membrane.

 

If Rx fail, focal seizures can be alleviated by surgery.

Term

Tumor

Definition

A mass of cells that grows independent of surrounding cells and has no physiological use.

 

Brain tumors grow from glia or other support cells, not neurons.

 

Benign tumors are not likely to regrow after removal.

 

Malignant tumors are likely to regrow.

 

The type of tumor may not be as important as how accessible it is to surgery.

Term

Differentiate between encapsulating and infiltrating tumors

Definition

Encapsulating tumors develop as a distinct entity in the brain; some are cystic, which means they offer the bonus of a fluid-filled cavity in the brain.

 

Infiltrating tumors are not distinct from the brain; they get in and destroy normal cells (including neurons) and cause general disruption.

Term

Name some Sxs of brain tumors

Definition

1) Increased intracranial pressure

2) Headache

3) Vomiting

4) Swelling of the optic disk (called papilledema)

5) Slowing of the heart rate (called bradycardia)

6) Mental dullness

7) Double visions (called diplopia)

8) Convulsions

9) Other functional impariments as result of location

Term

What are three type of brain tumors?

Definition

Distinguished based on where they originate:

1) Gliomas (45%) arise from glial cells and inflitrate the brain -- severity and response varies

 

2) Meningiomas are growths attached to the meninges (the outer covering of the brain) and are the most benign because they are encapsulated outside the brain

 

3) Metastic tumors (from the word metastasis, which is the transfer of a disease from one part of the body to another) are tumors from other organs of the body, usually the lungs or breasts.

 

Metastic tumors usually travel in packs, making removal difficult and the prognosis poor.

Term

Where are headaches produced (specifically)?

Definition

1) dura matter

2) large arteries of the brain

3) the venous sinuses (venous channels between layers of dura matter)

4) Branches of the 5th (trigeminal -- chewing, face and mouth touch and pain), 9th (glossopharyngeal -- taste, senses carotid pressure) , and 10th (vagus -- senses aortic pressure, slows heart rate, stimulates digestive organs, and taste) cranial nerves and the 1st (olfactory -- sniffer) and 3rd (occulormotor -- eyelid and eyeball movement) cranial nerves


The point is there is a lot of stuff that can cause a headache@

Term

 

Definition

 

Term
Frontal lobes are all tissue anterior to _____.
Definition
central sulcus
Term
The frontal lobes constitute _____% of the neocortex.
Definition
20
Term
How is the PFC defined (i.e. what brain region)?
Definition
the region receiving projections from the dorsomedial nucleus of thalamus
Term
The _____ is responsible for executing movements.
Definition
motor
Term
The motor cortex projects directly to _____ _____ _____ to directly control body movements.
Definition
spinal motor neurons
Term
What structure is responsible for selecting movements to be executed?
Definition
Premotor cortex
Term
The premotor cortex is subdivided into four areas. The _____ responds to internal cues, and the _____ and _____ to external cues.
Definition
supplementary motor area; premotor area; frontal eye field
Term
All areas of the premotor cortex receive projections from the _____ PFC. What does this result in?
Definition
dorsolateral; the dorsolateral PFC has a role in the control of limb and eye movements
Term
Name three regions of the PFC.
Definition
dorsolateral, orbital (aka inferior), medial
Term
Which area of the PFC is the end point for the dorsal ("where") visual stream?
Definition
dorsolateral
Term
Which area is the endpoint for the ventral ("what") pathway? This area is also connected to the amygdala and hypothalamus.
Definition
inferior (orbital)
Term
Which area of the PFC may be key in learning associations between environmental cues and rewards?
Definition
orbital
Term
Damage to which area is associated of the PFC is associated with inappropriate social Bx?
Definition
orbital
Term
Damage to which area is associated of the PFC is associated with inappropriate social Bx?
Definition
orbital
Term
Damage to which area of the PFC is associated with deficits in self-regulation related to poor autonoetic awareness.
Definition
orbital
Term
Damage to the PFC is associated with loss of divergent thinking. What does this mean?
Definition
Thinking of a thing in multiple ways (e.g. "How many ways can you use a coat hanger?")
Term
What is referred to as the "classic executive circuit"?
Definition
dorsolateral circuit
Term
What functions are attributed to the dorsolateral circuit?
Definition
executive Fx such as working memory, cog. flexibility, selective and sustained attention, verbal and nonverbal fluency, planning/organization, inhibition control, abstract reasoning, temporal-spatial tagging in episodic memory, self-monitoring, insight, and judgment
Term
The _____ circuit is associated with the regulation of emotional and social Bx.
Definition
orbitofrontal
Term
Damages to what area of the PFC results in personality changes?
Definition
orbitofrontal
Term
The _____ circuit is implicated in cognitive and emotional/motivational processing. It plays an important role in Bx inhibition.
Definition
anterior cingulate
Term
Explain how the anterior singulate circuit is selectively activated.
Definition
Activated in response to willed (i.e. voluntary) actions, in contrast with actions that are determined by external stimuli
Term
What is akinetic mutism? What area does it affect?
Definition
syndrome resulting in profound apathy, reduced/absent verbal/motor Bx, a sense of psychological emptiness, reduced response to pain, hunger, or thirst; affect the anterior cingulate circuit of the PFC
Term
What is a less severe form of akinetic mutism?
Definition
abulia
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