Alterations in Neurological Function Flashcards
____ ____ is the pressure within the skull
Intracranial pressure
Our average ICP is from 0-10, but we may have slight elevation from things like…
Sneezing, coughing
An ICP of ___-___ is moderate intracranial hypertension
20-40
An ICP of above ____ is severe intracranial hypertension (this happens in 50% of all TBIs)
40
____ ___ ____ is the mean arterial blood pressure
Cerebral perfusion pressure
Cerebral perfusion pressure is the force needed to overcome the pressure of the _____
Skull
Normal cerebral perfusion pressure is ___-___ mmHg
70-100
The Monro-Kellie Hypothesis explains ____ of CSF, brain tissue, and blood
Compliance
The Monro-Kellie Hypothesis states that an increase in either CSF, brain tissue, or blood would lead to ____ in the other two
Compensation (decrease)
We can monitor intracranial pressure using an ____ ____
Intraventricular catheter
What are some possible causes of increased intracranial pressure?
-Trauma
-Brain tumors
-Spinal tumors
-Spinal trauma
-Stroke
-Severe liver or heart failure
-Anything that increases cerebrospinal fluid production
-Anything that decreases cerebrospinal fluid removal
Manifestations of increased intracranial pressure:
-Deterioration in level of consciousness
-Restless and then lethargy
-Posturing (decorticate and then decerebrate)
-Headache
-Vomiting
-Visual abnormalities (diplopia, decreased visual acuity, disconjugate gaze)
-Deterioration of motor function
-Altered blood pressure and pulse (Cushing’s response)
-Pupillary dysfunction
-Gag and cough reflexes
-Distention of retinal veins
-Cranial nerve XI (shoulder shrugs)
-Altered respiration
-Altered temperature
-Loss of brain stem reflexes
-Papilledema (retinal inflammation)
What does Cushing’s Response cause?
-Decreased heart rate
-Increased blood pressure
-Decreased respiratory rate
-Widening pulse pressure
Cheyne strokes are periods of rapid breathing that may occur if there is damage at the ___ ___
Cerebral hemispheres
Central neurologic hyperventilation might occur if there is damage to the ____
Midbrain
Apneustic breathing might occur if there is damage to the ____
Pons
Ataxic breathing might occur if there is damage to the _____
Medulla
Decerebrate posturing results from severe damage to the top of the ____ ____
Brain stem
_____ posturing results from damage to one or both corticospinal tracts
Decorticate
Someone might have loss of corneal reflexes if they have damage to cranial nerve ____
VI
Someone might have loss of the oculocephalic reflex (dolls eyes) if they have damage to cranial nerve ____
VIII
Someone might have loss of the oculovestibular reflex (iced kalorics) if they have damage to cranial nerve ____
VIII
The ___ ___ ___ measures best response to pain
Glasgow Coma Score
____ herniation is caused by brain shifting above the tentorium
Supratentorial
____ herniations result from the brain moving away from the side of injury over the falx; nerves and arteries can get pulled over the midline which leads to ischemia to the frontal lobe and part of the parietal
Subfalcine
_____ herniations cause herniation across the tentorium (up or down); this usually occurs when there is a mass pushing the tissue up or down and is most commonly seen with a frontal lobe mass
Transterentorial
Symptoms of transtentorial herniations result from high ___ ___
Intracranial pressure
____ herniations are caused by lesions in the temporal or parietal lobe and cause someone to have lopsided pressure which pushes the uncus into the brain stem
Uncal
When the uncus gets pulled down, there is increased pressure on the brain that leads to ____ ____; you might see a blown pupil on the side of the injury and hemiparesis on the opposite side of the injury
Contralateral hemiparesis
_____ herniations push up or downward and are more rare than other types of herniations
Infratentorial
If an infratentorial herniation pushes up, it puts pressure on the ____
Midbrain
If an infratentorial herniation pushes down, it puts pressure on the ____
Medulla
Supratentorial herniation refers to the displacement of the _____ which is above the tentorium
Cerebrum
Infratentorial herniation refers to herniation of the ____ which is below the tentorium
Cerebellum
The ____ is the first line of defense for the brain
Skull
Head injury can cause ____ of the skull
Cracking
A ____ skull fracture is less likely to be a depressed fracture and is usually caused by getting hit by a large, flat object
Linear
A ____ fracture indicates that the bone has shattered into many pieces (egg shell)
Comminuted
A ____ fracture is when the bones gets pushed in a tears some of the brain tissue (can be caused by getting hit by something like a hammer)
Depressed
____ skull fractures are fractures of the base of the skull and are very concerning
Basal
Basal skull fractures may be an extension of a ___ fracture or an injury on its own
Linear
A concern with basal skull fractures is that they can tear the ____ and cause sinus fluid to get into the brain (this can cause high risk for infection)
Meninges
What are some signs that the meninges has been torn?
-Bitter taste of CSF in the back of the throat
-Might see CSF leaking out of the ear
-Preorbital edema
-Edema of the mastoid muscle
Facial fractures are concerning because if someone needs to be ____, it may cause difficult tube placement
Intubated
Brain injuries can result from things like…
-Falling
-Gun shots
-Violense
-Trauma
-Sports
____ injuries are broad injuries that effect the whole brain
Diffuse
One example of a diffuse injury is a ____
Concussion
What are common causes of concussions?
-Sports (hockey, football, boxing, soccer, lacrosse)
-Falls
-Car accidents
Symptoms of concussions include…
-Momentary loss of reflexes
-Arrest of respiration
-Amnesia before or after the event
-Headache
-Dizziness
-Confusion
-Visual disturbances
-Gait disturbances
Treatment for concussions includes ____ of the brain
Rest
___ ___ ___ is an aggregate of symptoms commonly presenting together after head injury
Post-concussion syndrome
What are some possible symptoms of post-concussion syndrome?
-Headache
-Dizziness
-Insomnia
-Decreased cognitive abilities
-Sleep
-Neuropsychiatric symptoms
-Neuroinflammation
____ ___ injuries result from the head and body suddenly stopping after moving at a high speed (common after car accidents)
Diffuse axonal
Diffuse axonal injuries damage ____
Axons
Usually, diffuse axonal injuries cause damage to the ____ ____ and cause high rates of mortality
Brain stem
With a ____ brain injury, there is not enough blood going to the brain
Hypoxic
Hypoxic brain injuries may be caused by…
Cardiac or respiratory arrest
Some hypoxic brain injuries may be mild but someone who is out for ~7.5 minutes might be ____ for life/have severe effects
Comatose
____ injuries are injuries to a more concentrated location of the brain
Focal
_____ ____ are bruises on the brain
Cerebral contusions
Cerebral contusions can also cause ____ in the days following the injury
Swelling
With cerebral contusions, a high amount of ____ moves into the cells which causes mitochondrial failure and energy failure
Calcium
Cerebral contusions cause changes in ___ __ after day 1 of injury
Blood flow
At first, there will be an ____ in blood flow to the injured area which leads to not enough blood in healthy tissues nearby
Increase
With a _____ injury, the brain and skull get hit hard by something
Compression
With a ____ injury, there is negative pressure on the brain tissue
Tension
A ____ injury is when axons are torn
Shearing
____ and ____ is a common pattern of contusions and is the same concept as the rebound effect that is caused by inertia
Coup and countercoup
____ ___ are tears in the brain tissue, usually caused by deep skull fractures or penetrating injuries
Cerebral lacerations
____ ____ are caused when a fractured skull tears the vessels between the skull and the dura; this tears the artery
Epidural hematomas
The torn artery causes blood to pump into the ___ ___
Epidural space
Epidural hematomas cause ____ herniations
Uncal
Epidural hematomas are caused by a rupture of arteries in the ___ ___
Epidural space
Manifestations of epidural hematomas:
-Loss of consciousness
-Coma
-Death (due to herniation)
_____ hematomas are below the dura, so veins instead of arteries will be affected
Subdural
___% of head injuries will cause a subdural hematoma
15
Subdural hematomas are caused by tearing of the vessels in the ___ ___
Subdural space
Subdural hematomas will also eventually lead to ____, but this takes much longer than epidural hematomas and they can be treated if caught early
Herniation
A ____ subdural hematoma is usually seen in older people and symptoms might not appear for days to weeks
Subacute
With an ____ subdural hematoma, symptoms show up within hours
Acute
With a ____ subdural hematoma, the hematoma comes back after treatment; the is commonly seen in elderly or people with alcohol use disorder
Chronic
Manifestations of subdural hematomas:
-Headache
-High ICP
-Progresses to coma (slowly) if untreated
Intracerebral hematomas are primarily caused by ____
Strokes
____ injuries are caused by something moving at a high velocity that moves all the way through the tissue
Missile
Missile injuries ____ tissue and cause immediate herniation and death within minutes
Displace
Lower velocity missiles will still cause herniation and edema, but will leave someone more time to get ____
Treatment
Brain stem injuries are somewhat rare as a primary injury because it is rare for someone to have trauma to the ____
Neck
Brain stem injuries are, however, common as a ___ injury
Secondary
Brain stem injuries are serious because the brain stem controls things like…
Breathing, heart rate
If someone has a brain stem injury, they would start _____ posturing and we would see a lot of autonomic brain stem dysfunction
Decerebrate
A ____ injury occurs at the point of impact, while a ____ injury is anything that occurs after that
Primary; secondary
Possible etiology of a secondary injury:
-Hypoxemia
-Hypotension
-Sustained increased ICP
-Respiratory complications
-Electrolyte imbalance
-Infections
Normally, cerebral blood flow is maintained over a wide range of cerebral perfusion pressures, but a stroke a cause loss of ____
Autoregulation
Cerebral edema leads to ____ intracranial pressure
High
____ is caused by dilation of the ventricles and a production of cerebrospinal fluid that exceeds reabsoprtion (high ICP)
Hydrocephalus
In the ____ form of hydrocephalus, a normal amount of the CSF is being made, but not enough is being reabsorbed; this leads to symptoms of high intracranial pressure
Communicating
In the _____ form of hydrocephalus, cerebrospinal fluid can’t freely flow
Noncommunicating
Usually, noncommunicating hydrocephalus is ____, but it may also be acquired from tumors or inflammation in or around the tubes that causes things to plug up
Congenital
Noncommincating hydrocephalus can also result from ____ ____
Hemorrhagic strokes
Symptoms of noncommunicating hydrocephalus develop very ____ because of the fast increase in intracranial pressure
Fast
A ____ is defined as an onset of new neurological deficits that fit a known vascular territory (symptoms very by location)
Stroke
Strokes are a leading cause of ___ and ___ in the United States
Death and disability
Are men or women more likely to have a stroke?
Women
What race is at highest risk for strokes?
African Americans
Symptoms of stokes are related to alterations in ___ ___
Blood flow
An _____ stroke is a “mini-stroke” and a warning sign for a full-blown stroke
Ischemic
____ ____ ____ is focal, reversible, and symptoms last for less than 24 hours
Transient ischemic attack
The pathology driving a TIA is the same for a full blow stroke, but blood blockage gets _____ before severe symptoms develop
Reversed
____% of people with TIA will go on to have a stroke within 3 months if not treated
30
_____% of people with TIA will go on to have a stroke within 6 months if not treated
60
____% of people with TIA will go on to have a stroke within 1 year if not treated
80
With a _____ stroke, the internal lumen is decreased due to atherosclerosis, leading to a thin vessel which allows less blood to get through (suddenly, not enough blood can get through)
Thrombotic
Thrombotic strokes are caused by decreased blood flow, usually due to atherosclerotic plaque which can be caused by things like ____ and ____
Diabetes and hypertension
Thrombotic strokes usually occur while at ____ when blood pressure drops (the lower blood pressure causes blood to move slower and not perfuse the brain enough (causes hypoxia)
Rest
____ strokes are still ischemic, but it is caused by something moving through the blood vessel and eventually becomes too big for the vessel and plugs it up
Embolic
____ ____ increases the risk of embolic stroke
Atrial fibrillation
Risk factors for embolic stroke:
-Atrial fibrilation
-Myocardial infarction
-Atherosclerotic plaque
Embolic strokes occur when someone is _____ because high blood pressure causes the clot to move and cause a blockage
Active
Symptoms of embolic stroke develop ____
Quickly
A ______ stroke is caused by an intracerebral hemorrhage in the brain tissue
Hemorrhagic
Half of the people who have a hemorrhagic stroke ____ instantly because intracranial pressure increases so rapidly because of so much blood rushing into the brain
Die
An _____ hemorrhage is commonly caused by hypertension
Intraparanchymal
With an _____ hemorrhage, vessels bleed into the ventricle side; so much blood fills up the cranial vault and this commonly leads to instant death
Intraventricular
Intraventricular hemorrhage can commonly be seen in ____ ____, but can also be caused by trauma
Premature babies
A ____ hemorrhage is underneath the arachnoid
Subarachnoid
With a subarachnoid hemorrhage, ruptured vessels in the circle of Willis cause an ____ and rupture into the subarachnoid space
Aneurysm
Subarachnoid hemorrhages can be caused by ____ vessels that could be caused by trauma and can cause a spike in intracranial pressure
Stretched
Subarachnoid hemorrhages commonly cause a quick ____
Death
Blood in the cerebrospinal fluid leads to massive ____ ____ in the brain and the whole body as well as a catecholamine response and cardiac arrhythmias
Inflammatory response
Manifestations of subarachnoid hemorrhage:
-Thunderclap headaches (rupturing blood dumping into the arachnoid space)
-Increase intracranial pressure
-Irritation of blood vessels leading to vasospasm
-May cause mini stroke
-Blurry or double vision
-Light sensitivity
-Severe neck rigidity
Signs and symptoms of a stroke in the middle cerebral artery:
-Hemiplegia/hemiparesis (face more than arms or legs)
-Aphasia
-Homonymous hemianopsia (loss of one field of vision)
Signs and symptoms of a stroke in the anterior cerebral artery:
-Paralysis of contralateral foot and leg
-Impaired gait
-Sensory loss
Signs and symptoms of a stroke in the posterior cerebral artery:
-Homonymous hemianopsia
-Visual deficits
General symptoms of a stroke include…
-Depression
-Dysfunction of CN III
____ ____ are caused by weakness of the muscularis wall of the blood vessels
Cerebral aneurysms
Cerebral aneurysms are slightly more common in ____ and may also have a familiar component
Females
___-___% of people who have cerebral aneurysms die at the scene due to high intracranial pressure from rupture
10-20
If cerebral aneurysms do not ____, they don’t cause any issues but we do not know which ones will
Rupture
Cerebral aneurysms are usually ____, but may also be caused by atherosclerosis, trauma, infection, or cocaine use
Congenital
Cerebral aneurysms are more common in ____ circulation than ____ circulation
Anterior; posterior
What are four classifications of aneurysms?
-Berry
-Fusiform
-Saccular
-Disecular
Aneurysms occur in places where blood vessels ____
Split
What are examples of locations of aneurysms?
-Internal carotid complex
-Anterior communicating artery
-First bifurcation of MCA
-Bifurcation of the basilar artery
Without rupture of an aneurysm, there is no _____
Mortality
Signs and symptoms of cerebral aneurysms:
-Cranial nerve deficits
-Meningeal irritation
What are two possible complications of aneurysms?
-Aneurysms rebleeding
-Cerebral vasospasm
Manifestation of cerebral vasospasm:
Gradual deterioration involving tissues perfused by affected vessels
____ ____ causes dilated vessels to shunt blood directly from the arterial system into the venous system
Arteriovenous Malformation
Arteriovenous malformation is a ____ malformation
Congenital
With arteriovenous malformation, a ___ ____ artery is connected to the veins, so this causes an outpouching of blood swirls and blood to be trapped and stolen from nearby tissues
High pressure
Arteriovenous malformation can cause the ____ side to become blown out because of such high pressure
Venous
Arteriovenous malformations are often ____ until they rupture
Undiagnosed
Sometimes, people may have symptoms from the “____ ____” where there is not enough blood in nearby tissues because the malformation is stealing it
Steal effect
Manifestation of the steal effect:
Headache
Most arteriovenous malformations rupture at around ____-___ years old, but they have low mortality since they are smaller than an aneurysm
20-30
____ is an infection that causes inflammation of the meninges around the brain
Meningitis
Risk factors for meningitis:
-Immune suppression
-Very young and very old people
-Kidney disease
-Cystic fibrosis
-Diabetes
The pathogen that causes meningitis common gets into the nervous system through the…
-Ears
-Sinuses
-Blood
-Mouth
If treated, meningitis has a low ____, but can be deadly without treatment
Mortality
What are four causes of bacterial/viral meningitis?
-Hemophilus influenza
-Neisseria meningitides
-Streptococcus pneumoniae
-E. coli
We have a vaccine for ____ ____, so rates of meningitis have come drastically down in the United States
Hemophilus influenza
____ ___ (meningococcus) is the most common form of meningitis in the United States, but a new vaccine was just developed
Neisseria meningitides
Streptococcus pneumonia is common in what populations?
-Small children
-Adults who had a skull fracture and surgery
E. coli can cause meningitis in what populations?
-People who are cognitively impaired
-Newborns
Signs and symptoms of meningitis:
-Fever
-Headache
-Stiff neck
-N/V
-Blurry vision
-Double vision
-Extremity pain
-Abdominal pain
-Reflex abnormality
-Swelling of the optic disc
-Blindness
-Vision field deficit
-Light sensitivity
-Facila paralysis
-Deafness
-Vertigo
Meningitis is diagnosed through a ____ ____
Lumbar puncture
What would the results of the lumbar puncture be if someone had bacterial meningitis?
-High protein level
-Low blood glucose
What would the results of the lumbar puncture be if someone had viral meningitis?
-Slightly increased protein level
-No change in glucose
-High lymphocytes
Spinal cord injuries are more common in ____
Men
What are some common causes of spinal cord injury?
-Car accidents
-Violence
-Gun shot
Average age of a spinal cord injury is ____
40
Spine ____ will often heal on their own
Fractures
_____ spine injuries can lead to difficulty breathing and death
Cervical
What are some classifications of spinal fractures?
-Simple fractures
-Compression (disc is squished in one side)
-Comminuted fracture (eggshell appearance)
-Odontoid fracture
-Thoracic and lumbar fracture
-Subluxation (partial dislocation)
-Dislocations
Mechanisms of spinal fracture:
-Hyperflexion
-Hyperextension
-Axial compression
-Rotation lateral flexion
-Penetrating
Hyperflexion is a wedge fracture of the ____ ____
Anterior side
Hyperextension is a contusion on the ___ ___
Posterior side
An axial compression is caused by something like a large beam that falls on the head and causes ___ and ___ damage
Brain and neck
What are types of injuries to the spinal cord?
-Concussion
-Contusions
-Laceration of the cord
-Transection (tearing of the cord)
-Hemorrhage
With a _____ spinal cord injury, the point above and below the injury can not communicate at all which causes a lack of motor and sensory impulses below the injury
Complete
___ ___ ___ is commonly seen with cervical cord injury; it causes damage to the nerve that innervates the arms so people feel like they are in a “barrel” which makes it impossible to move the arms
Ventral cord syndrome
With ___ ___ ____, symptoms are driven by what is below the injury
Anterior cord syndrome
If the injury is to the spinothalamic tract, it can cause defects in sensation of…
-Pain
-Temperature
-Light touch
With an injury to the spinothalamic tract, ____ is lost on the opposite side of injury
Pain
If there is damage to the corticospinal tract, it impacts ____ function
Motor
Posterior cord syndrome causes…
-Loss of position sense
-Proprioception
-Vibration sense
-Two-point sensation
____-____ ____ is caused by a hemi-cord injury, which commonly results from stabbing or missile injury; this causes weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side
Brown-Sequard Syndrome
What nerves allow us to raise and extend arms?
C5-C7
What nerves allow us to open and close our hands?
C6-C8
What nerves allow us to raise our legs?
L2-L4
What nerves allow us to wiggle our toes?
L3-S1
What nerves allow us to tighten our anus?
S3-S5
What nerve innervates the top of our shoulder?
C4
What nerve innervates the thumb?
C6
What nerve innervates the middle and ring finger?
C7
What nerve innervates the little finger?
C8
What nerve innervates the nipple line?
T7
What nerve innervates the umbilicus?
T10
What nerve innervates the big toe?
L4
What nerve innervates the little toe?
S1
_____ can be affected by injury to the cervical spine, the thoracic nerves, and the diaphragm
Ventilation
What nerves innervate the diaphragm?
C3-C5
____ ____ is a severe drop in blood pressure and heart rate that usually improves 3-5 days after injury
Neurogenic shock
___ ___ is a severe drop in blood pressure that usually lasts 1-3 weeks but can last up to 3 months
Spinal shock
Spinal shock causes a loss of ____
Reflexes
Spinal shock also causes ____ of the muscles because the lower motor neuron is still stimulated; when this develops, spinal shock is ending
Spasticity
____ ____ causes short-circuiting of autonomic nervous system after a transection of the spinal cord
Autonomic dysreflexia
Those with spinal cord injuries at ____ or above are at risk for dysreflexia
T6
Mechanism of autonomic dysreflexia:
-Vasodilation above injury
-Vasoconstriction below injury
Manifestations of autonomic dysreflexia:
-Decreased heart rate
-Bradycardia
-Hypertension
-Nausea
-Blurry vision
-If untreated, may lead to seizures, stroke, or death
If a women with autonomic dysreflexia becomes pregnant, she will have to have a _____
C-section
People with autonomic dysreflexia should have what preventative measures taken?
-Bladder and bowel evacuation
-Foot exams
People with autonomic dysreflexia have an inability to maintain ____ ____ and frequently experience pain and dysfunctional bowel and bladder
Body temperature
If a man have autonomic dysreflexia, they can still have an erection, but they can not ____
Ejaculate
What are some common long-term problems after spinal cord injury?
-Postural hypotension (T4-T6 injuries and above)
-Poikilothermia
-Deep vein thrombosis
-Skin integrity
-Pain
-Bowel and bladder dysfunction
-Sexual dysfunction
What populations are at higher risk for epilepsy?
-People younger than 15
-People older than 65
-Blacks
-More common in females than males
_____ epilepsy has no identifiable cause
Idiopathic
What can cause cerebral epilepsy?
-Meningitis increases risk
-Cerebral circulation issues
-Brain cancer
What can cause biochemical epilepsy?
-Drugs/alcohol (withdrawal, overdose, just the drug itself)
-Electrolyte disorders
-Micronutrient deficiencies
A ____ is a repetitive depolarization of action potentials
Seizure
Symptoms of epilepsy/seizures depend on the ____ of the brain that was involved
Area
A ____ ____ seizure starts in one place and stays in one place (usually colonic of rhythmic clinging of the face or arm in one area)
Simple partial
A ____ ____ seizure affects a bigger part of the brain but is only on one hemisphere
Complex partial
Symptoms of a complex partial seizure?
-Colonic activity
-Loss of consciousness
-Stiffness
_____ seizures involve both hemispheres
Generalized
_____ seizures usually occur in kids less than 5; they cause a blank stare and unresponsiveness and then they suddenly lose all muscle tone and drop to floor (last 10 seconds and then they are back to normal)
Absence
____ ____ seizures are Grand Mal
Major motor
An _____ may come before a seizure but is considered part of the seizure; it is a change in sensation before the muscle seizure occurs, some people may report changes in smells, taste, skin sensation, emotion, or sounds
Aura
Major motor seizures last from ___-___ minutes
2-5
Major motor seizures cause…
-Bowel and bladder incontinence
-Loss of consciousness
-Post-ictal phase causes muscle aches, tiredness, confusion, and memory loss
Major motor seizures affect both _____
Hemispheres
Major motor seizures are ___-___
Self-limiting
___ ____ is a Grand Mal seizure that doesn’t end in 5 minutes
Status Epilepticus
Status epilepticus has lots of ____ involvement
Neuronal
Status epilepticus may just be multiple ____ one after the other
Seizures
Status epilepticus is seen in people who…
-Abruptly stop taking anti-epileptics
-Take a drug that interferes with medication
Status epilepticus is not ___-___
Self-limiting
____ disorders are caused by a breakdown of the nervous system or part of the nervous system
Degenerative
_____ causes decreased cognitive function, memory, rational thinking, and executive function
Dementia
Possible etiologies of dementia:
-Destruction of brain tissue (trauma, tumor)
-Compression (chronic subdural hematoma)
-Inflammation (systemic inflammatory diseases)
-Biochemical imbalances
-Culminate in nerve cell degeneration and brain atrophy
____ is the most common type of dementia
Alzheimer’s
Alzheimer’s is more common in what gender?
Women
____ may be protective for Alzheimer’s, but once we lose it the protection is lost
Estrogen
Possible etiologies for Alzheimer’s:
-Autoimmune
-Slow virus
-Aluminum exposure
-High blood sugar
Alzheimer’s is caused by a problem with the metabolism of ____ that is normally broken down and cleared
Amyloid
Alzheimer’s causes an accumulation of amyloid plaques that slows the transmission of ____ ____
Neuronal impulses
As impulses with Alzheimer’s slow, ___ breaks free and microtubules break and cause the formation of neurofibrillary tangles
Tau
Tangles and plaques cause less impulses to get through and ____ to die off, leading to atrophy of the brain
Neurons
Early manifestations of Alzheimer’s:
-Forgetful
-Confusion
-Stubborn
-Memory loss
-Mood swings
-Loss of cognitive function
-Personality changes
Late manifestations of Alzheimer’s:
-Pronounced memory loss and cognitive dysfunction
-Aphasia
-Loss of bodily function control
-Indifference to food
-Infections
-Malnutrition
-Loss of muscle control
-Aspiration
-Death usually due to malnutrition or aspiration pneumonia
____ ____ ____ causes degeneration of the spine
Amyotrophic lateral sclerosis (ALS)
Etiology of ALS:
-Muscle wasting of the lateral part of the spine
-Degeneration of lateral horns (motor neurons) of the spinal cord
Life expectancy after ALS diagnosis is about ___ years
5
Possible mechanisms of ALS:
-About 10% of cases are familial
-Superoxide dismutase 1 is a gene that is related
-Possible relationship to viral infection
-Excess of oxidative stress
-Iron overload
-Too much glutamate
-Protein clumping in the neurons
ALS causes loss of ____ ____, but sensation is intact
Motor function
Manifestations of ALS:
-Mentation
-Sensory
-Hyperreflexia
-Bladder control usually spared
-Paralysis (usually more in the upper extremities)
-Dysphagia
-Breathing/airway protection problems
-Respiratory muscle movement
___ ___ is caused by a lack of dopamine in the basal ganglia
Parkinson’s Disease
Most people develop Parkinson’s around age ____
60
Most cases of Parkinson’s have an ____ cause, but possible viral
Unknown
What increases the risk of Parkinson’s?
-Brain trauma earlier in life
-Certain medication
Etiology of Parkinson’s:
Loss of dopaminergic neurons in the substantia nigra
Pathophysiology of Parkinson’s:
Once dopaminergic neurons die, there is no inhibitory impulses to stop excess movement; with Parkinson’s, there is no inhibition of extra impulses
What are some motor manifestations of Parkinson’s?
-Rhythmic tremor at rest
-Muscle rigidity and tenseness
-Difficult to initiate movement
-Slow movement
Secondary manifestations of Parkinson’s:
-Facet takes on a mask-like appearance
-Voice becomes monotone and slurred
-Cognitive changes in later stages
-Hallucinations and delusions
Autonomic symptoms of Parkinson’s:
-Orthostatic hypotension
-Urinary hesitation
-Uncontrolled sweating
____ is a disorder of the sense of self, it affects emotions but is different from mood disorders
Psychosis
Population characteristics for those affected by Schizophrenia:
-Older onset in females than males
-Potentially heritable
-If a sibling or parent has it, there is a 50% chance that you will have it too
Possible etiologies for Schizophrenia:
-Possible mutation that leads to overexpression of C4 (leads to abnormal pruning)
-Viral infection or nutritional deficiency in mother may lead to development in her baby later in life
-Excess dopamine and excess dopamine receptors in the brain
Manifestations of Schitzophrenia:
-Hallucinations
-Persecutory
-Feeling like someone else is controlling them
-Thoughts and speech are incoherent
-Loss of flow of normal speech
-Loss of emotional expression
-Absence of spontaneous speech
Mood disorders affect ____ ____
Emotional state
What are two mood disorders?
-Unipolar (Major Depression)
-Bipolar (Manic Depression Illness)
Unipolar causes periods of ____
Sadness
Bipolar causes periods of sadness broken up by period of ____
Mania
Unipolar and Bipolar are both much more common in what gender?
Female
Usually unipolar and bipolar are ____-onset disorders
Adult
There is a possible ____ predisposition for unipolar and bipolar
Genetic
Pathogenesis of depression:
-Serotonergic receptors: disconnection in the serotonergic neurons (as soon as serotonin is released, it is immediately taken back up)
-Nonadrengeric pathway: sending wakeup signal
Manifestations of depression:
-Blunted TSH response to TRH
-Elevated cortisol level during day and evening
-Circadian Rhythms
-Sleep alterations – decreased stage 3 and 4 (decreased deep sleep)
-Decreased REM latency
-Early awakening
-Depressed mood
-Loss of interests and pleasure
-Irritability
-Sadness
-Decrease or increase in appetite
-Insomnia
-Fatigue
-Excessive guilt
-Poor concentration
-Seasonal Affective Disorder: specific type of depression that occurs in late fall, early winter when we are not exposed to as much light
Average age of onset of bipolar is ___
25
Manifestations of the manic phase of bipolar:
-Sleep disturbances
-Insomnia
-Elevated mood
-Irritability
-Inflated self-esteem
-Decreased need for sleep
-Excessive talking
-Distractibility
-Increased physical activities
-Increased pleasurable activities
____ disorders are when someone has anxiety when there is no threat
Anxiety
With anxiety disorders, the _____ system is activated for no reason (all coming from the amygdala and low levels of GABA)
Limbic
Manifestations of anxiety disorders are usually driven by high _____
Catecholamines
Symptoms of anxiety disorders:
Increase heart rate
Increased BP
Light headedness
racing heart
difficult breathing
chest discomfort
generalized sweating
general weakness
Trembling
Abdominal stress
chills
hot flashes
