Neuroanatomy
What does this visual represent?
Homunculus: head, arm, leg, (aka body) mapped on the cortex
What is the comprehensive criteria of MCI? What are the risk factors for converting from MCI to dementia?
1. Identify multiple subtypes if MCI ≥ 2 scores w/in domain fall below 1 SD. Normal is performance on 1 measure w/in 1 or 2 cog. domains fell >1 SD below
2. Presence of more severe memory deficits and/or executive dysfunction
What part of the brain is most impacted by Alzheimer’s? What are the pathologies in Alzheimer’s? What are the pathologies in FTD?
1) Hippocampus
2) Plaque deposits of beta-amyloid and neurofibrillary tangles of tau
3) TDP 43, FUS, & tau
What is a disorder? Etiology? Syndrome? Pathology?
Disorder: A group of symptoms involving abnormal behaviors or physiological conditions, persistent or intense distress, or a disruption of physiological
functioning.
Etiology: The causes of a disease/disorder.
Syndrome: A set of symptoms and signs that are usually due to a single cause (or set of related causes) and together indicate a particular physical or mental disease or disorder.
Pathology: The scientific study of functional and structural changes involved in physical and mental disorders and diseases
What is the definition of a stroke? What is the difference between ischemic and hemorrhagic? How might their presentation on NP tests look?
1) “Rapidly developing clinical signs of focal (or global) disturbance of cerebral function, with symptoms lasting 24 hours or longer or leading to death, with no apparent cause other than of vascular origin”
2) Ischemic: Blockage of a vessel by thrombus (stationary blood clot) or embolus (floating blood clot) results in loss of blood supply to downstream neural tissue
Hemorrhage: Rupture of a vessel results in loss of blood supply to downstream neural tissue. Blood accumulates and puts pressure on surrounding brain tissue. Primary cause: hypertension!
3) Ischemic Strokes: deficits will follow the cerebral vascular neuroanatomic territory affected by the occlusion
Hemorrhagic strokes: more diffuse dysfunction involving areas of several different cerebral vascular territories. NP outcomes vary more widely
Does white or gray matter enable connectivity between all brain areas?
White
If a patient has MCI, will they for sure go on to develop dementia later in life?
No
REM sleep behavior disorder, fluctuations in cognitive functioning, visual hallucinations, and extrapyramidal symptoms points to what diagnosis?
Dementia with lewy bodies
What is apraxia? Anosagnosia?
1) Difficulty making certain motor movements on command
2) Pt is unaware of deficits or in denial
A tumor in the left frontal lobe or infarct in the left MCA SUPERIOR division is associated with ___ aphasia, while an infarct in the left MCA INFERIOR division or lesions nearby Wernicke’s area is associated with ___ aphasia. What symptoms would Broca’s aphasia present with?
1) Broca’s, Wernicke’s
2) Agrammatism, paraphasic errors, & poor repetition
Functions of the parietal lobe:
Tactile sensation; Visuospatial function (right); Spatial attention (right); Reading (left); Calculation (left)
What is delirium? What does the symptom presentation look like? What could cause this?
1) A disturbance in awareness and attention
2) Impaired attention, impaired memory, disorientation, rambling or nonsense speech, aggression, hallucinations, etc.
3) Infections, dehydration, kidney/liver failure, reaction to new medications, etc.
Dietary changes, behavioral disinhibition, apathy/inertia, loss of empathy, deficits in executive functioning but relative sparing of memory and visuospatial skills, etc. are symptoms of what?
bvFTD
What is dysarthric speech? Apraxic? Dystonic?
1) Dysarthric: difficulty controlling tongue or voice box causing slurred speech
2) Apraxic: difficulty moving mouth/tongue to say sounds or speak at all
3) Dystonic: strained or breathy speech
A stroke in the left PCA can cause the following symptoms:
Alexia without agraphia, transcortical sensory aphasia, memory impairment, etc.
Functions of the temporal lobe:
Audition; Language comprehension (left); Sensory prosody (right); Memory; Emotion
What are the three main symptoms of normal pressure hydrocephalus?
Cognitive impairment, gait problems, urinary incontinence
What are the variants of FTD? What is the cognitive profile of bvFTD? What are pick bodies? Is there treatment for FTD?
1) Motor, language, and behavior
2) Executive dysfunction, memory & visuospatial ok
3) Argyrophilic circular inclusions
4) No
What does the NP profile look like for chronic pain?
Reduced attentional capacity, processing speed, psychomotor speed, learning, & problem solving
What symptoms are found in Gerstmanns syndrome?
Agraphia, acalculia, right-left disorientation, finger agnosia
(1) The posterior cerebral artery provides blood supply to: (2) the middle cerebral artery provides blood supply to:
1) the Inferior and medial temporal lobe (including the hippocampus), occipital lobes, the thalamus, and the splenium of the corpus callosum
2) Most of dorsolateral convexity of the brain including the lateral/inferior frontal lobe and lateral superior temporal lobe
When assessing for Wernicke-korsakoff syndrome, what symptoms are you looking for?
Disorientation, confusion, indifference, inattentiveness, ataxic gait, nystagmus, and opthalmoplegia
What is the cognitive profile for posterior cortical atrophy, svPPA, lvPPA, and nonfluent variant PPA?
PCA: Primarily visual deficits
svPPA: Decreased word comprehension & naming
lvPPA: Impaired single-word retrieval & repetition of sentences/phrases
nonfluent variant PPA: Agrammatism (grammar errors), halting speech, short phrases, apraxia of speech
Does a patient HAVE to have hallucinations to meet criteria for DLB?
No
What is global aphasia often caused by? Conduction aphasia will have ___ speech, ___ repetition, & ___ comprehension. Mixed transcortical aphasia will have ___ fluency, ___ repetition, & ____ comprehension.
1. A large stroke in the stem of the left middle cerebral artery (MCA) that impacts both superior and inferior branches
2. fluent speech, poor repetition, and intact comprehension
3. impaired, intact, and impaired