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DMD 5248 > Bikman: Nervous Path > Flashcards

Bikman: Nervous Path Flashcards

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
Q

What is an intracerebral hematoma?

A
  • Blood in subarachnoid space
  • Caused by contusions, ruptured berry aneurysms
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26
Q

What are the categories of concussion?

A

Mild

Classic

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27
Q

What is a mild concussion?

A
  • Temporary axonal disturbance causing attention and memory deficits but no loss of consciousness
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28
Q

What are the different type of mild concussion?

A
  • Grade I
    • Confusion, disorientation, momentary amnesia
  • Grade II
    • Momentary confusion and retrograde amnesia of prior minutes
  • Grade III
    • Confusion with retrograde and anterograde amnesia
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29
Q

What are the different types of classic concussion?

A
  • 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
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30
Q

What is diffuse axonal injury?

A
  • 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
Q

Effects of DAI?

A
  • 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
Q

Nervous System Infections

A
  • Meningitis
  • Encephalitis
  • Abscess
  • Prion disease
33
Q

Meningitis

A
  • Inflammation of protective membranes (spinal cord and brain)
  • Infection caused by
    • Bacteria
    • Viruses
34
Q

Which bacteria strains can bring on meningitis in different age populations?

A
  • E.coli - Newborns
  • H. influenza - Infants/Children
  • N. meningitidis- Young Adults
  • S. pneumoniae/L. monocytogenes - Elderly
35
Q

What might you observe in the CSF of a spinal tap of someone infected with bacterial meningitis?

A
  • Cloudy
  • Increased pressure
  • Increased protein
  • Decreased glucose
36
Q

Which types of viruses can bring on meningitis?

A
  • EBV
  • HSV
  • VZV
37
Q

What might you observe in the CSF of a spinal tap done on someone infected with viral meningitis?

A
  • Cloudy
  • Increased protein
  • Normal glucose
38
Q

General manifestations of meningitis?

A
  • Neck stiffness
  • Brudzinki’s sign - flex neck and person reflexively flexes at the hips too if the patient has meningitis
39
Q

What is encephalitis?

A
  • Inflammation of brain substance
  • Often viral
40
Q

Manifestations of encephalitis?

A
  • Seizures, confusion, delirium, coma
  • Reflex asymmetry, altered ocular responses
  • Altered mood, memory, behavior
  • Histological marker: perivascular leukocyte accrual
41
Q

What oculomotor response may be observed in somone affected with encephalitis?

A

“Doll’s eyes”

42
Q

What may the caloric reflex test be used to detect?

A

Encephalitis

Eyes start twitching towards the side of cold water infusion (any reaction OTHER than this one is considered abnormal)

43
Q

What is an abscess?

A

Focal infectious lesion

44
Q

What are routes of infection of abscesses?

A
  1. Direct implantation (i.e. trauma)
  2. Local extension
  3. Hematogenous spread (i.e. blood)
  4. Peripheral nerves (i.e. rabies)
45
Q

What bacteria typically cause abscesses?

A

Strep viridans

Staph aureus

46
Q

What is Prion Disease?

A
  • 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
Q

Tumors in the nervous system

A
  • Glioma
  • Medulloblastoma
  • Meningioma
  • Nerve sheath tumors
48
Q

Gliomas

A
  • Arise from
    • Astrocytes = astrocytoma
    • Oligodendrocytes = oligodendroglioma
    • Ependymal cells = ependymoma
      • ​Histological marker: Perivascular rosettes
  • Often fatal
49
Q

Medulloblastoma

A
  • Cerebrum
  • Usually in childreen
  • Very radiosensitive
50
Q

Meningioma

A
  • Encapsulated, benign tumor
  • Surface of brain (no invasion)
  • Symptoms are caused by compression
  • Cured by resection
  • Histological marker: Whorls of polyhedral cells
51
Q

Nerve Sheath Tumor

A
  • Arise from cranial and spinal nerve roots and peripheral nerves
  • Benign but compresses
52
Q

What are the different types of nerve sheath tumors?

A
  • Schwannoma
    • Histological marker: Verocay body
  • Neurofibroma
    • von Recklinghaus(sp?); like elephant man
53
Q

Demyelinating diseases

A
  • Multiple sclerosis
  • Guillain-Barre Syndrome
54
Q

Multiple Sclerosis

A
  • 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
Q

Manifestations of MS

A
  • 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
Q

MS Dx

A
  • High IgG in CSF
  • MRI detects multiple lesions throughout CNS
57
Q

Guillain-Barre Syndrome

A
  • 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
Q

Different types of degenerative diseases

A
  • Alzheimer
  • Parkinson’s
  • Huntington’s
  • Amyotropic lateral sclerosis
59
Q

What are degenerative diseases?

A

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
Q

Alzheimer Disease

A
  • 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
Q

What are morphological/histological changes observed in Alzheimer’s?

A
  • 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
Q

What is AD typified by? What does ApoE mutation have to do with AD?

A
  • 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
Q

Clinical Manifestations of AD

A
  • 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
Q

Bikman pushing keto diet: how is this related to AD risk factors?

A

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
Q

AD Dx, Prevention, Tx

A
  • 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
Q

Parkinson Disease

A

Destruction of brain dopaminergic neurons (striatum and nigra)

  • Destruction is related to genetic and environmental factors
67
Q

Function of DA

A
  • 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
Q

Clinical Manifestations of PD

A
  • 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
Q

PD Dx

A
  • Case history
  • Course of disease
  • Brain scans
70
Q

What environmental factosr are linked to PD?

A
  • 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
Q

PD Tx

A
  • 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
Q

Huntington Disease

A
  • Degeneration of basal ganglia and cerebral cortex
  • Early symptoms: motor deficiencies
  • Later symptoms: dementia
  • Autosomal dominant mutation
73
Q

Amyotrophic Lateral Sclerosis (ALS)

A
  • Degeneration of motor control neurons
  • Rapidly progressing weakness and spasticity
  • Sensory and cognitive function is unaffected
    • M > W
    • 40+yo

DMD 5248 (6 decks)

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