DMD 5248 > Bikman: Nervous Path > Flashcards

Bikman: Nervous Path Flashcards

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1
Q

Neurons: Function, Rxn to injury

A

Transmit impulses

Become red and degnerate

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2
Q

Astrocytes: Function, Rxn to injury

A

Part of BBB

Hypertrophy, hyperplasia

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3
Q

Oligodendrocytes: Function, Rxn to injury

A

Produce myelin

Proliferate

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4
Q

Microglia: Function, Rxn to injury

A

Phagocytose invaders

Little change

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5
Q

Ependymal cells: Function, Rxn to injury

A

Line ventricles

Little change

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6
Q

Causes of increased cranial pressure

A
  1. Cerebral edema
  2. Increased CSF volume (hydrocephalus)
  3. Expanding mass lesions
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7
Q

What are the different types of cerebral edema?

A
  • Focal - around a focal lesion
    • Acute infarcts
    • Contusions
    • Penetrating injuries
  • Generalized - diffuse insult
    • Hypoxia
    • Toxin exposure
    • Encephalitis
    • Trauma
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8
Q

Types of Hydrocephalus

A
  1. Noncommunicating - block in ventricular system
    Only part of the ventricular system accumulates fluid
  2. Communicating - block in subarachnoid space
    Entire ventricular system accrues fluid
  3. Ex Vacuo - ventricular system is dilated because of brain atrophy
    Increase in CSF due to brain atrophy
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9
Q

What does hydrocephalus increase our risk of?

A

Herniation

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10
Q

What is herniation?

A

One part of the brain gets pushed into another compartment

Often fatal

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11
Q

What are symptoms of herniation?

A
  • Headache
  • Vomiting
  • Decreased consciousness
  • Ocular defects
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12
Q

What ocular defects may be observed in someone with hernation?

A
  • Ptosis
  • Impaired adduction
  • Limited elevation and depression of eye
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13
Q

What is a cerebrovascular disorder? What are the two types?

A

Any abnormalities in the brain caused by a pathologic process in the BVs

  • Cerebral infarction - loss of blood flow to brain area
  • Cerebral hemorrhage - bleeding within the brain
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14
Q

What is TIA?

A

Transient Ischemic Attacks (TIA)

  • Confusion
  • Difficulty communicating
  • Usually no long-term dysfunction (<24hr)

WARNING SIGN OF THROMBOTIC* OR *EMBOLIC STROKE!!!!!

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15
Q

What are the different types of cerebrovascular accidents (CVA)?

A
  • Hemorrhagic stroke
    • Intercranial/cerebral hemorrhage - from aneurysm
    • Hypertension is most common cause
  • Thrombotic stroke
    • Arterial occlusions caused by thrombi formed in arteries supplying the brain or in the intracranial vessels
  • Embolic stroke
    • Thrombus formed outside the brain
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16
Q

What is FAST?

A
  • Face
  • Arms
  • Speech
  • Time
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17
Q

What are the different types of intracranial aneurysm?

A
  • Saccular (berry) aneurysms
    • Exacerbated by hypertension
    • Increases risk of hemorrhage/hemorrhagic stroke
  • Fusiform (giant) aneurysms
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18
Q

What is the most common type of aneurysm and where is its location most likely?

A

Saccular

At bifurcations

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19
Q

Vascular malformation types

A
  • Cavernous angioma
    • Dilated BVs with no other brain tissue forming a tumor
  • Capillary telangiectasis
    • Small abnormally dilated capillaries
  • Venous angioma
    • Abnormal cluster of veins draining a region of brain tissue forms a tumor
  • Arteriovenous malformation (AVM) - MOST LETHAL
    • Arteries > veins in a tangle of malformed vessels
    • Higher risk of hemorrhage
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20
Q

Types of Trauma

A
  • Closed (blunt)
    • Head hits hard surface or rapid object hits the head
    • Dura is intact and no brain tissue exposure to envt
    • Causes focal** or **diffuse brain injury
  • Open (penetrating)
    • Injury breaks the dura and brain tissue is exposed to envt
    • Focal injury
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21
Q

What are the two types of closed trauma?

A
  • Coup - injury directly at point of impact
  • Contrecoup - injury on polar opposite of impact site
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22
Q

What is a focal brain inury?

A
  • Observable brain lesion
  • Impact force produces contusion
    • Extradural (epidural) hematoma
    • Subdural hematoma
    • Intracerebral hematoma
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23
Q

What is an extradural hematoma?

A
  • Blood above dura
  • Caused by tear in middle meningeal artery
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24
Q

What is a subdural hematoma?

A
  • Blood between dura and arachnoid
  • Caused by shearing of bridging veins
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25
What is an **intracerebral hematoma**?
* Blood in subarachnoid space * Caused by contusions, ruptured **berry aneurysms**
26
What are the categories of concussion?
Mild Classic
27
What is a mild concussion?
* Temporary axonal disturbance causing attention and memory deficits but **_no loss of consciousness_**
28
What are the different type of mild concussion?
* **_Grade I_** * Confusion, disorientation, **momentary** amnesia * **_Grade II_** * Momentary confusion and **retrograde** amnesia of prior minutes * **_Grade III_** * Confusion with **retrograde** and **anterograde** amnesia
29
What are the different types of **classic** concussion?
* **_Grade IV_** **- COMA** * **Loss of consciousness (\<6hr)** * ***Disconnection of cerebral systems from brain stem and reticular activating system*** * **Physiologic and neurologic dysfunction** without substantial anatomic disruption * **Anterograde** and **retrograde** amnesia
30
What is **diffuse axonal injury**?
* **Diffuse axonal injury (DAI)** * Axonal damage * **Shearing, tearing, or stretching of nerve fibers** * **Severity corresponds to amount of shearing force applied** to brain and brainstem * Shaking, inertial effect * Acceleration/deceleration * Shaken baby syndrome
31
Effects of DAI?
* **Traumatic coma** lasting more than 6hr because of axonal disruption * **Severity corresponds to the amount of shearing force applied to brain and brainstem** * Mild * Moderate * Severeb * **Most patients with DAI rarely regain consciousness again, but those who wake are imparied**
32
Nervous System Infections
* Meningitis * Encephalitis * Abscess * Prion disease
33
Meningitis
* **Inflammation** of **protective membranes** (spinal cord and brain) * Infection caused by * Bacteria * Viruses
34
Which bacteria strains can bring on meningitis in different age populations?
* ***_E.coli_ -*** **Newborns** * ***_H. influenza_* - Infants/Children** * ***_N. meningitidis_*- Young Adults** * ***_S. pneumoniae/L. monocytogenes_* - Elderly**
35
What might you observe in the CSF of a **spinal tap** of someone infected with **_bacterial_** meningitis?
* Cloudy * Increased pressure * Increased protein * Decreased glucose
36
Which types of viruses can bring on meningitis?
* EBV * HSV * VZV
37
What might you observe in the CSF of a **spinal tap** done on someone infected with **_viral_** meningitis?
* Cloudy * Increased protein * **Normal** glucose
38
General manifestations of meningitis?
* **Neck stiffness** * **Brudzinki's sign** - flex neck and person reflexively flexes at the hips too if the patient has meningitis
39
What is **encephalitis**?
* Inflammation of brain substance * Often **viral**
40
Manifestations of **encephalitis**?
* Seizures, confusion, delirium, coma * Reflex asymmetry, **altered ocular responses** * Altered mood, memory, behavior * Histological marker: **perivascular leukocyte accrual**
41
What oculomotor response may be observed in somone affected with encephalitis?
"Doll's eyes"
42
What may the **caloric reflex test** be used to detect?
**Encephalitis** ## Footnote Eyes start twitching towards the side of cold water infusion (any reaction OTHER than this one is considered abnormal)
43
What is an abscess?
Focal infectious lesion
44
What are routes of infection of abscesses?
1. **Direct implantation** (i.e. trauma) 2. **Local extension** 3. **Hematogenous spread** (i.e. blood) 4. **Peripheral nerves** (i.e. rabies)
45
What bacteria typically cause abscesses?
***Strep viridans*** ***Staph aureus***
46
What is **Prion Disease**?
* **Prion** = abnormal form of cellular protein * **Creutzfeldt-Jakob disease** * **Interacts with other proteins to cause "spongiform change" which can then lead to progressive dementia**
47
Tumors in the nervous system
* Glioma * Medulloblastoma * Meningioma * Nerve sheath tumors
48
Gliomas
* Arise from * Astrocytes = **astrocytoma** * Oligodendrocytes = **oligodendroglioma** * Ependymal cells = **ependymoma** * **​**Histological marker: **_Perivascular rosettes_** * Often **fatal**
49
Medulloblastoma
* **Cerebrum** * Usually in childreen * **_Very radiosensitive_**
50
Meningioma
* Encapsulated, *benign* tumor * **Surface** of brain (no invasion) * **Symptoms** are caused by **compression** * **Cured by resection** * Histological marker: **_Whorls of polyhedral cells_**
51
Nerve Sheath Tumor
* Arise from **cranial** and **spinal nerve roots** and **peripheral nerves** * Benign but compresses
52
What are the different types of **nerve sheath tumors**?
* **Schwannoma** * Histological marker: **_Verocay body_** * **Neurofibroma** * von Recklinghaus(sp?); like elephant man
53
Demyelinating diseases
* Multiple sclerosis * Guillain-Barre Syndrome
54
Multiple Sclerosis
* _Destruction of CNS_ due to _**inflammation** of vessels_ in the CNS and _**demyelination** of nerve cells_ * **Scarring** throughout the CNS * Caused by _interaction_ b/w _**autoimmune genetic** predisposition_ and _**viral** infections_ of the brain (HSV and EBV) * Age: 20-50yo * Females are more likely to have it 2:1
55
Manifestations of MS
* **_Motor_**, **_sensory_**, **_cognitive_**, or **_autonomic system_ dysfunction** * Histological marker: **Plaques around ventricles** * Motor responses * **Snout reflex** - lip pursing when touched lightly * **Palmomental reflex** - cheek/chin twitching when stroking palm
56
MS Dx
* **High IgG in CSF** * MRI detects **multiple lesions** throughout **CNS**
57
Guillain-Barre Syndrome
* **Acute peripheral neuropathy** * **Progressive, ascending weakness** * **Begins in lower** extremities * **Autoimmune attack** on **peripheral nerve** resulting in **demyelination** and **conduction block** * Infection can also trigger it (i.e. Zika virus)
58
Different types of degenerative diseases
* Alzheimer * Parkinson's * Huntington's * Amyotropic lateral sclerosis
59
What are degenerative diseases?
**Progressive failure of cerebral functions not caused by impaired level of consciousness** Classifications: * **Cortical** * **Alzheimer's _*\*\*MOST COMMON\*\**_** * **Subcortical** * **Parkinson's** and **Huntington's**
60
Alzheimer Disease
* **Most common neurodegenerative disease _worldwide_** * Caused by degeneration of the brain, manifested by * _Morphological_ and _biochemical_ changes * You have **_decreased surface area_** of the brain due to a **_decrease in the size of the folds_** (late change detectable on MRIs)
61
What are morphological/histological changes observed in Alzheimer's?
* **Neurofibrillary Tangles** * Intracellular tangles of microtubules and microfilaments * **_Tau hyperphosphorylation_** * **Senile Plaques** * Areas of degenerated cells that coalesce around a fibrous core (detected upon autopsy) formed from **_Amyloid beta protein_** * Can have autosomal dominant mutation in BA * **Decreased blood flow** to brain
62
What is AD typified by? What does ApoE mutation have to do with AD?
* AD is typified by _amyloid plaques_ * ApoE breaks amyloid plaques down; so if you have **ApoE mutation**, plaques are not getting broken down and you have an accumulation of these amyloid plaques * **ApoE4 genotype** carriers are _10-30x's more likely to develop AD_
63
Clinical Manifestations of AD
* Slow and progressive change in **memory** (recent goes first) * **Mood** changes * **Motor function** changes (late) * Disease appears to be **related to genetic factors** and also poorly ID'd **environmental factors**
64
Bikman pushing keto diet: how is this related to AD risk factors?
**Higher glucose levels may be a risk factor for dementia, even in people w/o diabetes** Risk factors: * Abnormal glucose toelrance * ApoE4 phenotype * Fasting plasma glucose * 2hr plasma glucose * Fasting insulin * 2hr insulin **Ketones improve cognitive function**
65
AD Dx, Prevention, Tx
* Currently _no approved tests_ for early AD dx * **Dx is made by ruling out other diseases and following its course** * Prevention * **Folate rich diet** * **Reduce refined carbs** * **Insulin-sensitizing meds (i.e. metformin)** * **Increase essential FAs** * **Physical activity** * **Mental exercise** * Tx: **No cure**
66
Parkinson Disease
**Destruction of brain *dopaminergic neurons*** (striatum and nigra) * Destruction is related to **genetic** and **environmental** factors
67
Function of DA
* **Coordinate brain centers** that monitor _body position_ * Involved in neuronal circuits that permit _pre-programed movements_ (you don't think about it) * **_Inhibits Ach_** **neurons** that cause _muscle movement_ * Reduces spontaneous, involuntary movements **DA IS RELATED TO MOTOR FUNCTION**
68
Clinical Manifestations of PD
* Resting tremor * Rigidity * Akinesia - pill rolling hand movement * Dementia, slow thought process, or depression * Shuffling gait * Frozen face * Postural abnormalities * Disorders of righting and equilibrium
69
PD Dx
* Case history * Course of disease * Brain scans
70
What environmental factosr are linked to PD?
* Head trauma * Anesthetic exposure * Hydrocarbon exposure (solvents) * Pesticide exposure * Living in agricultural area or being involved in agriculture * Drinking well water (pesticides and herbicides?) * Working with wood or wood products (wood preservative?) * Working in janitorial services (cleaning supplies?)
71
PD Tx
* **_Levodopa (L-dopa)_** * **DA precursor that can enter remaining DA neurons and increase DA release** * DA agonists * MAOIs * Monoamine oxidase is an enzyme that degrades DA * Electrode placed into basal ganglia of brain
72
Huntington Disease
* **Degeneration of _basal ganglia_ and _cerebral cortex_** * **Early** symptoms: **motor deficiencies** * **Later** symptoms: **dementia** * *_Autosomal dominant_* mutation
73
Amyotrophic Lateral Sclerosis (ALS)
* **Degeneration of motor control neurons** * **Rapidly progressing weakness and spasticity** * _Sensory and cognitive function is unaffected_ * M \> W * 40+yo
DMD 5248
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