4th Exam: Neurologic Disease

Question 1

Meningococcal Meningitis:

Answer 1

Carriers have nasopharyngeal bacteria, often in epidemics, outbreaks, young adults and kids, DIC = intravascular thrombosis (caps) (skin, adrenal lesions), can be fatal

Question 2

Meningitis with WFS:

Answer 2

Adrenal gland hemorrhage = insufficiency, meningitis assoc w inflammation, inflammation → leaky vessels→ edema, seizures, confusion, coma, WFS: numerous skin hemorrhages

Question 3

WFS sf:

Answer 3

Waterhouse-Friderichsen Syndrome

Question 4

Brain Abscess sources:

Answer 4

local or distant infection
o Endocarditis, tooth extraction
• Endocarditis: emboli on valves travel to brain

Question 5

Etiology of brain abscess:

Answer 5

usually bacterial, not a single species, but mixed flora

Question 6

Signs of brain abscess:

Answer 6

signs of mass lesion w fever, headache, sizures, elevated WBC

Question 7

Mortality, morbidity of brain abscesses:

Answer 7

10%, 50%

Question 8

Abscess:

Answer 8

necrosis of tissue + inflammation, PMNs

Question 9

What forms the capsule around an abscess?

Answer 9

collagen

Question 10

Why does a capsule form around an abscess?

Answer 10

Attempt to wall-off infection and prevent spread

Question 11

Myotonic Dystrophy:

Answer 11

Hatchet face with ptosis (droopy eyelids), dysphagia (be aware, may choke on saliva), muscle disease, dominant inheritance, progressive muscle weakness

Question 12

Mito Disorders esp effect:

Answer 12

cells in organs that don’t turn over quickly (heart, skeletal muscle, brain)

Question 13

Mito Myopathies:

Answer 13

Ptosis, dysphagia, too many mito, abnormal mitochondria

Question 14

Abnormal mitochondria:

Answer 14

Differing sizes & shapes, whorled appearance (whirling cristae), crystal-like inclusions

Question 15

Degenerative Diseases:

Answer 15

Selective vulnerability: distinct topography, often Idiopathic, hereditary/genetic/molecular basis, neurons primarily affected, atrophy + gliosis (astrocytes proliferate → scarring of the brain) + a unique change

Question 16

Dementia:

Answer 16

Loss of cognitive function, decline from a previous level of function, slowly progressive, modalities affected: memory, judgment, reasoning, calculation, language, lesions in cerebrum

Question 17

Causes of dementia:

Answer 17

Alzheimer’s & similar diseases, Huntington’s, Parkinson’s (movement disorders), vascular disease, infections, alcohol abuse, Vit deficiency

Question 18

Alzheimer’s:

Answer 18

• 50-75% of all dementia cases
• Incidence increases w age
  o 50% people > 85yo
• 5-10yr survival after dx
• Disease of cerebral cortex- cerebral cortical atrophy, diffuse
• Senile plaques in Alzheimer’s

Question 19

Alzheimers effects on cerebral cortex:

Answer 19

diffuse, sulci bw gyri are very wide, representing atrophy, ventricles dilated, loss of cortical neurons- almost 50%, neural connections to create memory, calculation and reasoning are lost, leads to dementia, senile plaques:

Question 20

What are senile plaques in Alzheimer’s made of?

Answer 20

Core: amyloid, surrounded by degenerating neurites (damaged neurons)

Question 21

Pathogenesis of Alzheimer’s – Amyloid

Answer 21

Several pws, all begin with Beta-amyloid deposits (plaques in brain), neurotoxic w loss of neurons (activates macs inducing inflammation, accelerates apoptosis of neurons)

Question 22

Amyloid Formation and Breakdown:

Answer 22

APP (Amyloid Precursor Protein) formation, may be increased (Ex. Down’s Syndrome), cleavage/degradation may be reduced

Question 23

APP:

Answer 23

normal membrane protein, 563-770 AAs

Question 24

May lead to the reduction of amyloid breakdown:

Answer 24

Secretase enzymes break down APP, failure of breakdown → amyloid deposits

Question 25

process of amyloid breakdown failure:

Answer 25

Alpha secretase cuts amyloid in half so that it becomes soluble and goes away, if alpha secretase doesn’t cleave, the amyloid is intact and insoluble, Beta and Gamma secretases then liberate the amyloid so that it floats free and deposits in the brain, may also have a mutation in alpha secretase that causes it to cleave the wrong area or not at all.

Question 26

Parkinsonism:

Answer 26

Syndrome, not a single disease, 50-70yo, tremor at rest, rigidity, bradykinesia (slow movements), disorder of involuntary nervous system (normally modulates motor activity), gradually results in disability

Question 27

Causes of parkinsonism:

Answer 27

Idiopathic: classical Parkinson’s disease, hereditary: alpha-synuclein gene, post-encephalitic: viral encephalitis, toxic: MPTP, cycad beans, pesticides?, head trauma

Question 28

Loss of neuromelanin =

Answer 28

loss of neurons containing melanin

Question 29

Parkinson’s Disease:

Answer 29

Cytoplasmic Lewy Bodies (dense center, lighter halo around), composed of filaments, contain alpha-synuclein, neurons with Lewy bodies are damaged and will die

Question 30

Trigeminal Neuralgia is aka:

Answer 30

Tic douloureux

Question 31

Trigeminal Neuralgia:

Answer 31

Sudden, severe, stabbing pain, many small attacks, lasting < 2m each (episodic), triggered by: touching face, brushing teeth, but mostly nothing

Question 32

Causes of Trigeminal Neuralgia:

Answer 32

Usually idiopathic, vascular compression?, MS, tumors

Question 33

Trigeminal Neuralgia presents similarly to:

Answer 33

neuralgia inducing osteonecrosis of jaw

Question 34

pain is least common in the branch of CNV in Trigeminal neuralgia:

Answer 34

Division 1

Question 35

Pathogenesis of Trigeminal neuralgia:

Answer 35

Nerve root compressed by vascular structure, irritation of nerve → hyperactive nerve nucleus, myelin begins to break down on CN V

Question 36

Causes of Bell’s Palsy:

Answer 36

Idiopathic, trauma: surgery of parotid gland, infections: herpes simplex, zoster, Lyme disease, tumors, demyelinating diseases (MS, Guillain-Barré)

Question 37

Bell’s Palsy:

Answer 37

Often subacute onset and course (Self-limited, 85% improve in 3wks), facial paralysis- usually unilateral (Eyelid can’t close, mouth droops), slurred speech, drooling, decreased lacrimation, taste