PT 711: Brain Fart

Mr. Willis

100

Which are the two major arteries entering the skull?

Internal Carotid Artery

Vertebral Artery

200

Which blood vessels contribute to the blood supply of the anterior brain?

Anterior Cerebral Artery (ACA)

Middle Cerebral Artery (MCA)

300

What is the blood supply of the corpus callosum and what is the approximate proportion?

Anterior Cerebral Artery (4/5th)

Posterior Cerebral Artery (1/5th)

400

While the cortical branches of the PCA supply blood to some of the temporal lobe and the occipital lobe; where do the DEEP branches off the PCA supply blood to?

Parts of Thalamus

Parts of Basal Ganglia

500

Other than the MCA and the ACA, name at least one more branch of the ICA

Posterior Communicating Artery

Anterior Choroidal Artery

Opthalamic Artery

600

Which two blood supplies contribute to internal capsule?

Deep branches of ACA

Deep branches of MCA

700

What is this?

Middle Cerebral Artery

800

Anterior and Posterior spinal arteries provide direct blood flow to the entire spinal cord while radicular arteries (which feed supply mostly the meninges) are most prominent in what two areas of the spine?

Thoracic

Lumbar

Is your brain functioning?

100

What are the general functions of the Frontal Lobe?

Motor Control (premotor cortex)

Problem Solving (prefrontal area)

Speech Production (Broca's Area)

(Also acceptable: changes in mood and personality, challenges in sequencing of events, loss in flexibility of thinking)

200

Which part of the brain is responsible for involuntary responses?

Brainstem

300

Your patient comes in and strangely complains of auditory processing, language comprehension, and memory/info retrieval...what area of their brain may be affected?

Temporal Lobe

400

If a patient's chart determines they have a lesion in the cerebellum, how might they present?

Impaired Balance and Coordination

500

This lobe of the brain contains the somatosensory cortex

Parietal Lobe

- touch perception

- body orientation

- sensory discrimination

600

Nearly all the pathways that project to the cortex must first synapse in this structure

Thalamus

700

These structures modulate the output of the corticospinal tract and other descending motor systems

Cerebellum

Basal Ganglia

800

This structure describes a region deep in the brain that functions as a communication pathway; it allows communication between areas of the cerebral cortex and areas of the brainstem

Internal Capsule

cereBRUH

100

Where are the two potential spaces in the brain?

Epidural: between outermost dura and skull

Subdural: between innermost dura and arachnoid

200

Your patient has suffered an epidural hematoma, what structure is critically involved given the location of the bleed?

Middle Meningeal Artery

300

Bridging veins are found where in the brain (that we know of)?

Subdural Space

400

The subarachnoid space is an actual space due to the adherence of arachnoid mater to the dura and the pia mater to the brain; it contains major arteries and CSF. What is another important structural component to the subarachnoid space?

Creates Cisterns

500

These are the main sites for absorption of CSF into the sinuses using villi as one-way valves allowing flow of CSF to venous blood. They project into the sinuses, particularly the sagittal sinus.

Arachnoid Granulations

600

What are the three functions of CSF?

- Bathes external and internal surfaces of the brain and spinal Cord

- Serves as a cushion btwn CNS and surrounding bones

- Involved in nourishment of nervous tissue

700

Your patient's chart states that they have increased intracranial pressure, immediately the three causes of increased ICP come to mind. What are they?

Bleed

Failure of to reabsorb CSF into venous system

Mass

800

Your CI is super into neuro and wants to talk about hydrocephalus. Unfortunately, she's quizzing you about the 3 most common causes of hydrocephalus...and they are?

Excess CSF production

Obstruction of CSF circulation (in ventricles/subarachnoid space)

Decreased reabsorption of CSF (via arachnoid granulations)

Are you paying attention?

100

This highly complex cognitive function resides in the non-dominant side of the brain and refers to the ability to initiate and maintain concentration/alertness on a particular stimulus/set of stimuli

Attention

200

Your neuro patient wants to go grocery shopping after their session and ask for written directions to the closest one; the next session they come back and admit that they couldn't make sense of the written directions.

Your directions are definitely impeccable so it has to be their neuro injury. Which side can you infer the injury is on?

Dominant/L Side

300

You bring your patient out to the gym in order to work on an exercise requiring the parallel bars, as you are explaining the exercise you see the patient glancing around at other patients and getting distracted by colorful equipment. What type of attention is impaired in this patient?

Selective Attention

400

What are the two types of spatial neglect?

Peripersonal: within reach

Extrapersonal: far space

500

Lesions of the non-dominant parietal association cortex may result in UNL, name at least ONE other way it would present

Difficulties w Visual Spatial Analysis

Personality/Emotional Changes

Difficulty Comprehending/Expressing Emotion in Speech

600

This term refers to the inattention to the contralesional 1/2 of mental pics

Representational Neglect

700

Name at least 2 types of motor neglect

Akinesia: absence of movement (even w motor ability)

Hypokinesia: delayed initiation of movement

Motor Impersistence: inability to sustain movement/posture

Hypometria: decreased movement amplitude

Bradykinesia: slow execution of movement

Motor Extinction: pt has difficulty moving both limbs @ the same time

Hemispatial/Directional

800

What are the 3 possible subtypes of sensory neglect?

Auditory

Somatosensory

Visual

Double A's

100

Aphasia and apraxia are most associated with damage to which side of the brain?

L Hemisphere

200

Which two areas in the brain are responsible for speech production and speech comprehension?

Broca's Area (frontal lobe) - speech production

Wernicke's Area (temporal lobe) - speech comprehension

300

Your patient presents to PT s/p stroke with aphasia, throughout of the course of the treatment they are able to provide short, non-fluent sentences and often struggle to find the appropriate word. At one point, they try to repeat a word you have said but struggle and are unable to do so. What blood supply was likely impacted to result in this aphasia?

Superior Division of MCA (Broca's Aphasia)

400

Name at least 2 characteristics of Wernicke's Aphasia, oftentimes a result of a stroke involving the inferior division of the MCA

- Severely impaired comprehension

- Fluent, quick speech

- "Empty" speech (verbose verbal output/paraphasia)

- Normal prosody

- Uses word substitutions

- Neologism

- Impaired repetition

- Impaired naming

- Unawareness of communication impairment

 

500

This type of speech disorder refers to a problem with motor programming of speech unrelated to muscle weakness/paralysis and presenting as groping/mouthing, inconsistent/variable errors, speech sound/substitutions, sequencing errors, and awareness of errors

Speech Apraxia

600

You instruct your patient to demonstrate to you how to put on a seatbelt, they reach for their seatbelt but do not grasp or pull it across their body. What type of limb apraxia could this be?

Ideational Apraxia - inability to perform a sequence of actions/multistep tasks

700

This refers to a disturbance in motor control of speech resulting in problems w speech execution due to muscle weakness/paralysis. There are various types including flaccid/spastic, ataxic, hypo/hyperkinetic, and mixed

Dysarthria

800

Name at least 1 complication that may result from dysphagia

Aspiration

PNA

Malnutrition

Dehydration

Different Strokes 4 Different Folks

100

Your stroke patient presents to PT with sequencing difficulties, catastrophic reactions, and impaired logic; which side of the brain is affected?

L Side

200

Name at least two appropriate Stroke Outcome Measures

FIM

Fugl-Meyer Assessment (motor performance)

Postural Assessment Scale for Stroke Patients

Stroke Impact Scale

Trunk Impairment Scale

300

In terms of the National Institute of Health Stroke Scale, a good prognosis is indicated with a higher/lower score

Lower

400

Which type of stroke has a higher mortality rate?

Intracerebral Hemorrhage

500

Name at least one of the predictors of mortality and poor outcome following an intracerebral hemorrhage

Older Age

Low Glasgow Coma Scale Score and Level of Consciousness

Increased Intracerebral Hemorrhage Volume

Presence of Intraventricular Hemorrhage

Deep/Infratentorial Intracerebral Hemorrhage location

Preceding Anti-Thrombotic Therapy

600

Can you identify the 5 most common types of Lacunar Syndromes?

Pure Sensory: d/t infarct in thalamus + may have chronic pain

Pure Motor: d/t infarct in post limb of internal capsule

Dysarthria-Clumsy Hand Syndrome: d/t lesion in genu of internal capsule/base of pons + motor speech disorder (no language deficit) 

Ataxic Hemiparesis: d/t lesion in genu of internal capsule/base of pons

Sensorimotor Stroke: d/t lesion in thalamus/adjacent post limb of internal capsule

700

This occurs within minutes of an infarction and can increase intracranial pressure - it is a major problem w large infarcts and is frequently the cause of death in acute strokes

Signs of this may include:

- decreased consciousness/coma

- decreased HR

- irregular respirations

- unreacting pupils

- vomiting

Cerebral Edema

800

Match the appropriate etiology to  Intracerebral Hemorrhage or a Subarachnoid Hemorrhage

- caused by high blood pressure, burst aneurysm, and illicit drugs

- head injuries, burst aneurysm, and AVM

Intracerebral Hemorrhage: high BP, burst aneurysm, illicit drugs

Subarachnoid Hemorrhage: head injuries (not really considered a stroke if head trauma), burst aneurysm, AVM

Bruised Brain Syndrome

100

Your patient presents to PT s/p TBI, your CI reads their presentation as follows:

"Difficulty with identification and categorization of objects, increased aggression, and memory deficits especially in recognizing faces"

Your CI then asks you what lobe you think is likely affected

Temporal Lobe

200

Name at least 3 TBI prognostic factors

- Age

- Gender

- Presence if Prior Brain Injury

- Injury Severity

- Length of Coma

- Initial GCS

- Injury Etiology

- Rehab Length of Stay

- Duration of Post-Traumatic Amnesia

- Timing of Rehab

- Intensity of Rehab

- Nature of Injury (TBI vs NTBI)

- Presence of Comorbidities

300

The primary impairments of the TBI are grossly dependent on location/severity of injury; name at least 3 primary impairments that your patient may present with.

Motor Control

Tone

Sensory Deficits/Perception

Visual

Pain

Postural Control

Speech/Language/Swallowing

Cognition

Behavioral

400

You walk into your patient's room in the IRF to introduce yourself, your patient interrupts and starts talking about wanting to stand up. They don't listen to any of your reasoning and are unable to self-identify obstacles to return to ambulating. When you assist them in sitting up, they lurch forward to the RW repeatedly and attempt to stand up despite multiple verbal cues to slow down.

Which side of the brain is likely impaired?

Right Side - decreased insight/awareness of deficits/lack of safety awareness, impulsivity

500

You are conducting an examine of your alert and oriented TBI patient, there are no contraindications; what tests and measures would you conduct. (Name two tests and measures)

Motor Control

Postural Control

Reflex Integrity

Muscle Tone

Functional Mobility

Cranial Nerve Integrity

Joint Integrity/ROM

Sensation/Sensory Integration

Integument Integrity

Pain

600

Your patient is distressed at the start of your session, they say that their doctor mentioned secondary impairments and they have no idea what they are talking about. What are the secondary impairments for TBI that your patient may experience?

Musculoskeletal Impairments

Cardiopulmonary/Cardiovascular Impairments

Integumentary Impairments

700

There are several mechanisms that may cause damage in the hours-to-days following injury, these are called secondary mechanisms. Name at least one.

Excitotoxicity: toxic actions of excitatory neurotransmitters (glutamate) leading to loss of neuronal function + cell death

Apoptosis: nerve cell death d/t necrosis and inappropriate apoptosis

Edema: leakage of water from blood vessels to brain tissue via damaged BBB - leads to expansion of brain volume + increased ICP

Secondary Ischemia: results from impairment/decline in cerebral blood flow from local edema/space occupying hematomas/herniation of brain tissue/increased ICP

800

What is the danger of CSF mixing with blood?

Clots forming in the CSF

That's Pretty Palsy

100

What are some typical tests and measures for individuals with CP related to body structure/function (name at least 2)

Tone

Muscle Strength

ROM

Selective Motor Control

Posture

Joint Contractures

Balance

(other acceptable: CN integrity, ventilation, respiration, aerobic capacity)

200

Name at least one cause of CP

Hypoxia/Hypoxia-Ischemia

Periventricular White Matter Injury (in sensorimotor pathways - more common in premature infants)

Germinal Matrix Hemorrhage

Diffuse Encephalopathy

Brain Malformation

Perinatal Stroke

Intrauterine Infection

Genetic Factors

300

When is a prenatal infant at most risk of developing a Germinal Matrix Hemorrhage and Periventricular Leukomalacia

GMH: most common before 32 wks (GMH is matured by 34 wks)

PVL: most common after 30 wks

400

Please state which part of the CNS is associated with the following forms of CP:

- Spastic

- Athetoid (Dyskinetic)

- Ataxic

Spastic: motor cortex or pyramidal tracts

Athetoid/Dyskinetic: basal ganglia and/or cerebellum

Ataxic: cerebellum

500

In one sentence, describe the GMFCS levels

Level 1: child walks (home/outdoors/community), climbs stairs without railing, and runs/jumps - speed, balance, and coordination are limited

Level 2: child walks in most settings (may use AD), climbs stairs w railing - difficulty in open/uneven environments ad minimal running/jumping

Level 3: child walks using handheld AD in most indoor settings, climb stairs w railing - use wheeled mobility for long distances/self-proper for short distances

Level 4: child's method of mobility requires physical assist/powered mobility in most settings - walks short distances at home w A and is otherwise transported in manual w/c or powered mobility

Level 5: child is transported in manual w/c in all settings - limited in ability to maintain antigravity head/trunk postures and control leg/arm mvmts

600

What are some standardized motor tests used for CP? (Name at least 2)

GMFM-66 or -88: gross motor function measure specific for CP, used for prognosis

Movement-Assessment Battery for Children (M-ABC): manual dexterity/ball skills/static and dynamic balance for school aged kids

Tests for Gross Motor Development (TGMD-2)

Alberta Infant Motor Scale (AIMS): general infant measure for gross motor - only before diagnosis of CP

Peabody Development Motor Scale (PDMS-2): general development measure

Bruininks Oseretsky Test of Motor Proficiency (BOT-2): general gross and fine motor for higher level/older children

700

Which type of CP presents with reduced muscle tone and abnormal gait w a wide BOS?

Ataxic CP

800

Your teenage CP patient presents to PT with slow and uncontrollable writhing/jerky movements of the hands, feet, arms, and legs usually due to damage to the basal ganglia and/or cerebellum. What type of CP is this?

Athetoid CP