Ch 18 Neurology Quiz: Brain Injuries & Multiple Sclerosis

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Questions and Answers

Which of the following is NOT a common location for contusions in the brain?

  • Temporal lobes
  • Frontotemporal junction
  • Frontal lobes
  • Parietal lobes (correct)

What is the most common cause of extradural hematomas?

  • Gunshot wounds
  • Falls
  • Motor Vehicle Accidents (correct)
  • Sports injuries

Which of the following is a characteristic of a closed head injury?

  • The dura mater is torn.
  • Brain tissue is exposed to the environment.
  • The brain is not exposed to the environment. (correct)
  • Always results in a coma.

Subdural hematomas are most commonly associated with which of the following?

<p>Both B and C (D)</p> Signup and view all the answers

Which of the following is NOT a symptom of a subdural hematoma?

<p>Seizures (C)</p> Signup and view all the answers

Intracerebral hematomas are most commonly located in which lobes of the brain?

<p>Frontal and temporal (D)</p> Signup and view all the answers

Which of the following is a common sign of an intracerebral hematoma?

<p>Decreasing level of consciousness (A)</p> Signup and view all the answers

What is a concussion?

<p>A mild brain injury that may or may not involve loss of consciousness (A)</p> Signup and view all the answers

What are the possible consequences of the autoimmune response in multiple sclerosis?

<p>Destruction of myelin sheaths leading to loss of nerve conductivity (B)</p> Signup and view all the answers

Which of the following is a risk factor for developing multiple sclerosis?

<p>Smoking (B)</p> Signup and view all the answers

Which clinical manifestation is considered the first sign of multiple sclerosis?

<p>Clinically isolated syndrome (CIS) (C)</p> Signup and view all the answers

Which of the following is a characteristic of a clinically isolated syndrome (CIS) manifestation?

<p>Symptoms caused by inflammation and demyelination in the CNS (C)</p> Signup and view all the answers

What is the typical age range for the onset of multiple sclerosis?

<p>20-40 years old (D)</p> Signup and view all the answers

Which of the following is NOT a typical clinical manifestation of multiple sclerosis?

<p>Muscle hypertrophy (A)</p> Signup and view all the answers

What is the defining characteristic of multiple sclerosis in terms of its impact on the nervous system?

<p>Degeneration of myelin sheaths (C)</p> Signup and view all the answers

What is the primary reason for the development of multiple sclerosis, as currently understood?

<p>A combination of genetic and environmental factors (B)</p> Signup and view all the answers

Which of the following is a characteristic of mild TBI (mild concussion)?

<p>Immediate, but transitory clinical manifestations without loss of consciousness (B)</p> Signup and view all the answers

Which of the following is a potential diagnostic tool for mild TBI that is currently being studied?

<p>Biomarkers like GFAP and UCH-L1 (D)</p> Signup and view all the answers

Which of the following statements about the Glasgow Coma Scale (GCS) score is accurate in relation to mild TBI?

<p>A GCS score of 13-15 is consistent with mild TBI. (C)</p> Signup and view all the answers

Which of the following is NOT a symptom of a mild concussion?

<p>Seizures (C)</p> Signup and view all the answers

What is the main cause of mild TBI?

<p>Most blunt trauma injuries (D)</p> Signup and view all the answers

Which of the following explains the physiological effects of a mild concussion?

<p>Damage to the delicate axonal fibers and white matter tracts (A)</p> Signup and view all the answers

Which biomarker is known to peak approximately 20 hours after a TBI and declines over 72 hours?

<p>Glial fibrillary acidic protein (GFAP) (D)</p> Signup and view all the answers

What is the key difference between Grade I and Grade II concussions?

<p>Presence of retrograde amnesia (A)</p> Signup and view all the answers

What is the most common cause of a primary hemorrhagic stroke?

<p>Hypertension (A)</p> Signup and view all the answers

Which of the following arteries, if affected, can lead to contralateral hemiparesis or hemiplegia?

<p>All of the above (D)</p> Signup and view all the answers

What is a common symptom associated with a lacunar stroke?

<p>Pure motor or sensory deficits (C)</p> Signup and view all the answers

Which of the following is NOT a common site for a hemorrhagic stroke?

<p>Hippocampus (A)</p> Signup and view all the answers

Which of the following arteries, if affected, can lead to expressive aphasia (nonfluent aphasia) in the dominant hemisphere and dyarthria in the nondominant hemisphere?

<p>Middle Cerebral Artery (B)</p> Signup and view all the answers

What is the term for a type of speech disorder characterized by difficulty in articulating words but with intact comprehension?

<p>Dysarthria (D)</p> Signup and view all the answers

Which of the following conditions is associated with an increased risk of embolic stroke?

<p>Patent Foramen Ovale (C)</p> Signup and view all the answers

What term describes the syndrome characterized by contralateral hemiparesis, ipsilateral lower motor neuron facial palsy, and the inability to move voluntarily, with preserved consciousness?

<p>Locked-in Syndrome (D)</p> Signup and view all the answers

Which of the following is NOT a common risk factor for lacunar stroke?

<p>Mitral Valve Prolapse (B)</p> Signup and view all the answers

What is the term for a condition that involves focal neurologic deficits in 80% of people experiencing hemorrhagic stroke?

<p>Hemiparesis (A)</p> Signup and view all the answers

What is the primary challenge facing chemotherapeutic treatment for gliomas?

<p>The blood-brain barrier prevents effective delivery of chemotherapeutic drugs (B)</p> Signup and view all the answers

Which of the following is NOT a clinical manifestation of gliomas?

<p>Loss of consciousness (C)</p> Signup and view all the answers

Which of the following is a type of primary extracerebral brain tumor?

<p>Meningioma (C)</p> Signup and view all the answers

What is the most common type of primary central nervous system (CNS) tumor?

<p>Astrocytoma (A)</p> Signup and view all the answers

Which of the following is a common early symptom of an astrocytoma?

<p>Headache (D)</p> Signup and view all the answers

What is the primary mechanism by which Landry-Guillain-Barré syndrome (GBS) develops?

<p>An autoimmune response targeting peripheral nerve components (C)</p> Signup and view all the answers

Which of the following is a common clinical manifestation of GBS?

<p>Progressive weakness, often starting in the legs and moving upwards (A)</p> Signup and view all the answers

What is the underlying cause of myasthenia gravis?

<p>Destruction of acetylcholine receptors at the neuromuscular junction (D)</p> Signup and view all the answers

Which of the following is a characteristic symptom of myasthenia gravis?

<p>Weakness that worsens with activity and improves with rest (D)</p> Signup and view all the answers

What is the primary target of autoantibodies in myasthenia gravis?

<p>Acetylcholine receptors at the neuromuscular junction (C)</p> Signup and view all the answers

What is a key difference between the pathophysiology of GBS and myasthenia gravis?

<p>GBS involves demyelination, while myasthenia gravis targets acetylcholine receptors (B)</p> Signup and view all the answers

Which of the following is a potential trigger for GBS?

<p>A recent bacterial or viral infection (B)</p> Signup and view all the answers

In myasthenia gravis, the autoantibodies that contribute to the disease are predominantly of which immunoglobulin class?

<p>IgG (C)</p> Signup and view all the answers

Flashcards

What causes mild TBI?

Damage to axonal fibers and white matter tracts affecting the cerebral cortex.

GCS range for mild TBI

The Glasgow Coma Scale (GCS) for mild TBI is 13 to 15.

What are GFAP and UCH-L1?

Biomarkers used to diagnose TBI and mild concussions.

Peak time for GFAP after TBI

GFAP levels peak around 20 hours post-injury.

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Grade I concussion

Transient confusion, no loss of consciousness, resolves in 15 min.

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Symptoms of mild TBI

Includes headaches, nausea, confusion, and attention deficits.

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Post-Traumatic Amnesia

Memory loss after trauma, can last less than 24 hours.

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Grade IV concussion

Loss of consciousness up to 6 hours, includes amnesia.

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Closed Head Injury

Injury where the dura mater remains intact and no brain tissue is exposed.

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Focal Brain Injury

Specific observable lesions in a precise brain location caused by trauma.

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Contusion

Blood leaking from injured vessels in specific brain areas, especially frontal and temporal lobes.

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Epidural Hematoma

Bleeding between the dura mater and the skull, often due to arterial bleeding.

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Subdural Hematoma

Accumulation of blood between the dura mater and brain, often from falls or MVAs.

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Intracerebral Hematoma

Bleeding within the brain tissue itself, associated with contusions.

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Concussion

A set of symptoms resulting from head trauma that may include loss of consciousness.

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Graded Concussions

Different levels of concussion severity ranging from mild to severe.

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Myasthenia Gravis Symptoms

Muscle weakness affecting eyes, face, mouth, throat, and neck, leading to ptosis, diplopia, and facial droop.

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Primary Intracerebral Tumors

Tumors that originate from brain tissue itself, including neuroglia and neurons.

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Metastatic Carcinoma

Brain tumors that spread from other body areas, including astrocytomas and glioblastomas.

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Glial Tumors

Tumors that arise from glial cells, causing seizures, visual disturbances, and loss of balance.

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Astrocytoma

A common type of brain tumor that develops from astrocytes, often causing headaches and seizures.

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Multiple Sclerosis (MS)

A chronic inflammatory disease causing CNS myelin degeneration and plaque formation.

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Etiology of MS

An autoimmune response in genetically susceptible individuals, with unknown cause; influenced by genetic and environmental factors.

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Embolic stroke

A type of stroke caused by a clot that travels to the brain from elsewhere in the body.

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Lacunar stroke

A small stroke occurring in small perforating arteries, typically affecting the basal ganglia and pons.

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Clinical Isolated Syndrome (CIS)

First neurologic episode lasting over 24 hours; may lead to MS.

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Paresthesia

A symptom of MS involving tingling or numbness, especially in limbs and face.

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Main causes of lacunar stroke

Common causes include hyperlipidemia, smoking, hypertension, and diabetes mellitus.

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Optic Neuritis

A type of MS symptom with blurring vision and eye pain due to inflammation.

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Hemorrhagic stroke

A type of stroke caused by spontaneous bleeding into the brain, often due to high blood pressure.

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Cerebellar Syndromes

Symptoms like tremor and gait instability due to cerebellum lesions in MS.

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Affected artery in MCA stroke

The middle cerebral artery, affecting speech and motor function, particularly in the dominant hemisphere.

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Contralateral paralysis in ACA stroke

Paralysis or weakness on the side opposite to the affected artery, mainly affecting lower limbs.

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Cognitive Deficits in MS

Memory and attention problems that may develop as MS progresses; includes depression and dementia.

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Relapsing-Remitting MS

Characterized by episodes of neurological symptoms followed by periods of remission.

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Basilar artery stroke

Stroke affecting the basilar artery, leading to motor and sensory deficits, including 'locked-in syndrome'.

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Symptoms of hemorrhagic stroke

Focal neurological deficits in 80% of patients, often including severe headache and loss of consciousness.

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Pure motor and sensory deficits

Deficits resulting from lacunar strokes, often due to small areas of infarction.

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Data processing deficits

Cognitive deficits caused by specific artery occlusions, leading to issues like aphasia or apraxia.

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Guillain-Barré Syndrome (GBS)

A rare autoimmune disorder causing peripheral nerve demyelination.

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Pathophysiology of GBS

Involves molecular mimicry leading to immune injury of peripheral nerves.

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Molecular mimicry

Immune response triggered by pathogens mimicking self-components.

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Clinical manifestations of GBS

Symptoms include numbness, pain, weakness, and progressive paralysis.

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Myasthenia Gravis (MG)

A chronic autoimmune disease affecting neuromuscular transmission.

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Pathophysiology of MG

Autoantibodies block Ach receptors, impairing nerve impulse transmission.

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Hallmark symptom of MG

Exertional fatigue and muscle weakness that improves with rest.

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Study Notes

Closed Head Injury

  • Involves head striking a hard surface or a rapidly moving object hitting the head.
  • Dura mater remains intact; brain tissue is not exposed.
  • Most are mild (75-90%); causes mild concussion.
  • Brief periods of bradycardia and decreased blood pressure, lasting 30 seconds or less, are possible.
  • Vital signs stabilize rapidly.
  • Can result from blunt or open trauma.
  • Associated with skull fractures sometimes.
  • Focal brain injuries occur precisely (e.g., cortical contusions, epidural hemorrhage, subdural hemorrhage, intracerebral hematoma).
  • Coup or contrecoup injuries are possible.

Contusions

  • Bleeding from injured vessels
  • Most common areas:
    • Frontal lobes (particularly at poles and along inferior orbital surfaces)
    • Temporal lobes
    • Frontotemporal junction
  • Extradural hematomas:
    • Bleeding between dura mater and skull
    • Often caused by MVAs (85% of cases)
  • Subdural hematomas:
    • Often caused by MVAs, or falls, especially in older adults or those with alcohol abuse.
    • Acute forms develop rapidly (within 48 hours), often located at the top of the skull.
    • 10-20% of TBIs.
    • Symptoms include headache, drowsiness, restlessness, and agitation (80% of people).
  • Intracerebral hematomas:
    • Common in MVAs and falls
    • Often located in frontal and temporal lobes
    • 2-3% of TBIs
    • Symptoms include decreasing LOC, contralateral hemiplegia, and a positive Babinski reflex.

Mild TBI (Mild Concussion)

  • Immediate, transitory clinical manifestations.
  • Loss of consciousness (LOC) is momentary or less than 30 minutes.
  • Post-traumatic anterograde amnesia is possible (transient, less than 24 hours).
  • GCS: 13-15
  • Often no findings on CT/MRI (lesions may show up with advanced MRI).
  • Symptoms include headaches, nausea/vomiting, confusion, disorientation, attention deficits, dizziness.
  • May require increased vigilance for a period after injury due to risk of diffuse axonal injury, metabolic impairment, altered neural activation and cerebral blood flow issues.

Moderate TBI

  • LOC lasting more than 30 minutes.
  • Post-traumatic anterograde amnesia lasting 24 hours or more.
  • GCS: 8-13.

Severe TBI

  • LOC lasting more than 24 hours.
  • Immediate autonomic dysfunction.
  • Increased intracranial pressure (ICP) 4-6 days post injury.
  • GCS: less than 8, with brainstem signs (pupillary reaction, cardiac/respiratory symptoms).
  • Severe sensorimotor and cognitive deficits.
  • Up to 14% vegetative state and 20-40% mortality.

Concussion Grades

  • Grade I: Transient confusion/disorientation, no LOC, amnesia resolving within 15 minutes.
  • Grade II: Transient confusion/retrograde amnesia, lasting no more than 15 minutes, and possible LOC (5-10 minutes).
  • Grade III: Any LOC, confusion, and amnesia persisting longer than several minutes after impact, often from the moment of the injury.
  • Grade IV: LOC lasting up to 6 hours, with retrograde and anterograde amnesia.

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