brain disease 2

Question 1

epilepsy means

Answer 1

‘to seize’ having repeated seizures

Question 2

seizure

Answer 2

abnormal, transient highly synchronous brain activity

Question 3

types

Answer 3

partial/focal (simple and complex)

generalised

Question 4

incidence

Answer 4

prevalence of active epilepsy about 0.5-1%

5% will expereince a non febrile seizure

Question 5

childhood absence epilepsy

Answer 5

4-12 years

absence of seizures/ petit mal (10-30 sec episodes of unresponsivity sometimes eye rolling, lip smacking, hand shaking, several hundred per day)
characteristics 3 Hz spike-wave discharge
mutations in low threshold voltage-dependent Ca channels
resolves with pathology during puberty

Question 6

temporal lobe epilepsy

Answer 6

late childhood and adolescence
most common epilepsy of adults
epileptogenic focus in hippocampus and or amygdala and or parahippocampal gyrus (recurrent excitatory circuits)
complex partial seizures often preceded by aura
may develop into secondary generalised tonic-clonic /grand mal seizure

Question 7

causes of epilepsy

Answer 7

• over 2/3 idiopathic in nature
• reflex seizures, precipitated by a trigger e.g. flashing light…
• genetic - mutations in Na channels
• cerebrovascular disease
• tumours
• alcohol/drugs
• trauma/hypoxia
• infection
• metabolic disorder
• developmental disorders
• degenerative disorder
• pathological synaptic plasticity (kindling)

PRODUCING AN IMBALANCE IN EXCITATION AND INHIBITION IN THE NERVOUS SYSTEM

Question 8

treatments acute

Answer 8

• generalised or complex partial - recovery position
• simple partial- reassurance, maintain safe environment
• benzodizepenes

Question 9

treatment for chronic

Answer 9

• pharmacological e.g. ethosuximide (blocks/modulate Ca and Na channels) and carbamazepine (modulates Na channels potentiates GABA receptors)
• surgical e.g. remove tumour, arteriovenous malformation or epileptogenic tissue (temporal lobe, hippocampus)
• electrical e.g. vagal, depp brain stimulation
• avoidance of seizure triggers

Question 10

Sz incidnence

Answer 10

about 0.6% population worldwide

peak onset early 20s

Question 11

Sz pathology

Answer 11

increased levels of dopamine in the mesolimbic pathway

Question 12

negative symptoms of Sz

Answer 12

flat affect, alogia, anhedonia, asociality, avolition

Question 13

causes of Sz

Answer 13

genetics: 50% concordence in mono zy twins - DISC-1
env: 50% in mono az twins
developmental: infection in utero, poor diet, asphyxia
social facotrs: env, stressful relationship
drug abuse: cannabis/cocaine cause or effecT?
dopamine hypothesis excessive D2R stimulation
redcued NMDAR function

Question 14

mice with reduced expression of NMDARs exhibit

Answer 14

excessive motor activity
stereotypy
deficits in social and sexual interactions
symptoms that are ameliorated by typical and atypical antipsychotics

Question 15

pathology depression

Answer 15

reduced hippocampal volume
vascular lesions
reduced BDNF

Question 16

incidence of depression

Answer 16

3% japan
18% USA
average 10%
women 2x men

Question 17

stroke definition

Answer 17

neurological deficit of cerebrovascular cause that persists

beyond 24 hours or is interrupted by death within 24 hours”

Question 18

difference between stroke and transient ischameic attach

Answer 18

the latter is a syndrome with of stroke like symptoms that resolve within 24 hours

Question 19

crucial points- brain function ceases…

Answer 19

brain function ceases 60-90 seconds of an ischaemic event

irreversible brain damage if ischaemic event > 3 hours duration

Question 20

2 types of stroke

Answer 20

ischaemic

haemorrhagic

Question 21

ischaemic strokes

Answer 21

embolus (wandering clot)
thrombus (locally-formed clot)
systemic hypoperfusion e.g. heart attack

Question 22

haemorrhagic strokes

Answer 22

entry of blood into CNS via rupture of a blood vessel/sinus or an aneurysm

Question 23

types of haematomas in the brain

Answer 23

epidural
subdural
subarachoid
intracerebral

Question 24

epidural haematoma

Answer 24

traumatic damage to the meningeal artery or dural venous sinus (e.g. blow to the head)

Question 25

subdural haematoma

Answer 25

caused by rapid movement of head causing tearing of the cerebral being as it enters a dural venous sinus

Question 26

subarachnoid haemotoma

Answer 26

caused by damage (e.g. aneurysm) to a cerebral artery or vein subsequent bleeding into the subarachnoid space

Question 27

intracerebral haemotomas

Answer 27

cause by damage of a blood vessel within the brain

Question 28

incidence of stroke

Answer 28

10% deaths worldwide
2nd leading cause of death
95% occur>45 years

Question 29

risk factors for stroke

Answer 29

• high blood pressure (?)
• high cholesterol
• diet
• physical inactivity
• drugs of abuse (alcohol, cigarettes, cocaine, amphetamine)

Question 30

treatment for stroke preventative

Answer 30

anticoagulaants ; carotid angioplasty/endarterectomy; diet/lifestyle

Question 31

treatment for acute ischamic stroke

Answer 31

thromoblysis- tissue plasminogen activators (within 3 hours); thromobectomy; angioplasty; stenting

Question 32

treatment for acute hemorrhagic stroke

Answer 32

surgery

Question 33

treatment for chronic post stroke

Answer 33

control of hypertensions; aspirin; physical and occupational therapy

Question 34

alzheimer’s disease 1907 alois alzheimer pathology

Answer 34

profound loss of neurones
plaques (amyloid)
neurofibrillary tangles (hyperphosphorlyated tau)

Question 35

incidince of alzheimers

Answer 35

1.5%-2% worldwide

Question 36

causes of alzheimers

Answer 36

• age, 10% over 65, 50% >85
•genetics but predominantly for early onset e.g. ApoE4 gene
variant
•trauma
• high blood pressure/hypercholesteremia (but statins
ineffective),
•environmental factors?

Question 37

Alzhiemrs treatmetn

Answer 37

• symptoms - acetyl cholinesterase inhibitors, NMDA
receptor antagonists e.g. memantine
• risk - NSAIDs and caffeine, intellectual stimulation, diet and
exercise