Chapter 28: Nervous System Part 2 Flashcards
stroke: clinical symptoms and diagnosis
-signs and symptoms: Facial ______, ______,
inability/difficulty ______, weakness on ______,
______ on one side, numbness, disturbance in fine movements, ______ (unable to control urination). ______ patients mimic stroke symptoms
DIAGNOSIS:
-It is possible to distinguish a cerebral infarct from a cerebral hemorrhage by a ______
-______ provides similar information and is equally effective
-Manifestations of all these conditions related to strokes, depend on ______ and ______
Drooping headache speaking one side paralysis Incontinence Hypoglycemic computed tomography CT scan Magnetic resonance imaging (MRI) location size
Stroke- theres a treatment if you act FAST F- A- S- T-
face- look uneven
arm- one arm hanging down
speech- slurred speech
time- call 911 now
stroke treatment:
- ______: Considered the gold standard, ______ (or Alteplase IV r-tPA) is the only FDA-approved treatment for ischemic strokes. TPA needs to be used within ______ hours of having a stroke or up to ______ hours in certain eligible patients. The goal is less damage to ______ (area of the brain which receives low oxygen due to the stroke).
- Physical removal (within 6 to 7 hours of onset only after a patient receives ______) of a large blood clot, called an ______ or a ______, is another strongly recommended treatment option.
- ______: A small tube called a catheter can sometimes be threaded up through a ______ in an ______ or ______ and guided into the brain tissue, allowing the surgeon to use camera technology to help fix the problem.
- Once the catheter is guided to the source of the bleeding, it deposits a ______, such as a coil, to prevent further rupture.
- This type of procedure is ______, meaning that the surgeon gains access via the vascular system, making it less invasive than conventional surgical treatment.
- Sometimes ______ is required to secure a blood vessel at the base of the ______.
Ischemic Stroke tissue plasminogen activator three 4.5 penumbra TPA endovascular procedure mechanical thrombectomy Hemorrhagic stroke major artery arm leg mechanical agent endovascular surgery aneurysm
-Inflammation of the leptomeninges. Meninges consist of three layers (______, ______, and ______) that lie between the ______ and the ______
-______ and ______ together are known as leptomeninges.
-Pyogenic meningitis: ______, ______, and ______ (neonates) ______ (children and teenagers), ______ (adults and elderly), and ______ (non-vaccinated infants).
-Viral meningitis: ______ virus, ______ (children; fecal-oral transmission), ______ & fungal (immunocompromised individuals)
SYMPTOMS, PATHOGENESIS, and TREATMENT
-Presents with classic triad of ______, ______ (neck stiffness) & ______; ______, vomiting, and altered mental status (sometimes). Complications are usually seen with ______. Death: _____ meningitis secondary to ______. Hydrocephalus, hearing loss, and seizures
-Spinal tap (between __ & __): sampling of CSF
-______: Purulent exudate w/in leptomeninges, dilated ______. Lab findings: ____ CSF with ______, ↑ ______ & ↓ ______. ______ for identifying the bacteria.
-______: lymphocytes with normal CSF glucose.
-______: lymphocytes with ↓ CSF glucose
-Treatment: Pyogenic (______ & ______ as needed), Viral (self limiting & ______) & fungal (______ & ______)
meningitis dura, arachnoid, and pia brain skull Pia arachnoid Group B streptococci Ecoli Listeria monocytogenes Neisseria meningitis Streptococcus pneumoniae H influenza HSV Coxsackievirus echovirus headache nuchal rigidity fever photophobia bacterial herniation cerebral edema L4 L5 Pyogenic meningeal vessels neutrophils protein CSF glucose Gram stain Viral Fungal antibiotic steroid anti-viral anti-fungal steroid
- Follows viral (EBV,HSV&CMV) infection (demyelination of ______ via ______ mediated immune reaction)
- ______ and ______ in legs & ______ muscle weakness. Rapidly progressive ______
- May cause ______
- Reversible disease & Spinal injury may affect ______ or ______ properties.
- Diagnosis; ______: CSF with large ______ count with mild ______ count increased.
- treatment: supportive/resuscitative interventions & IV ______
Guillain-Barre Syndrome demyelination neurons T-cell Weakness tingling ascending paralysis respiratory failure/arrest CNS cognitive Lumber puncture/spinal tap protein cell IgG
- Caused by small protein particle produced and resistant to ______. Only inactivated by ______ for __ hour.
- The normal form of protein is the “good prion” designated ______. The abnormal form of protein is the “bad prion” designated ______. Transmission is thought to be by exposure to (most commonly by ingestion of) ______ (or human) tissue, particularly, but not exclusively, brain.
- These disorders are anatomically defined by the finding of ______ (spongiosis), which is characterized by clusters of ______ in CNS ______ matter, along with a striking absence of inflammatory response.
Creutzfeldt-Jakob/mad cow Disease heat/sterilization 1M NaOH 1 PrPc PrPsc prion-containing animal spongiform encephalopathy small cysts gray
Multiple sclerosis: (Autoimmune disease)
PATHOGENESIS:
-______ within the ______ of CNS (scattered in the brain and spinal cord). Gross examination shows ______ in the ______ matter. Helper ______ and cytotoxic ______ T lymphocytes and macrophages infiltrate plaques.
-women affected ______ as often as men
-associated with HLA-______
-characteristics also include depletion of ______-producing ______.
-Presents with relapsing ______ with periods of remission (multiple ______ in time and space).
-remission of neurologic symptoms: Charcot’s triad: ______, ______, & ______
-sensory abnormalities: Loss of sensitization of ______
-motor abnormalities: ______ weakness, ______, ______, and ______ dysfunction (______ nervous system)
-
Demyelinatinon white matter gray-appearing plaques white CD4+ CD8+ twice DR2 myelin oligodendrocytes neurologic deficits lesions nystagmus, scanning speech & tremor touch Muscle bowel bladder sexual autonomic
multiple sclerosis diagnosis and treatment
-Diagnosis: ______ and ______.
MRI reveals plaques (areas of _____ matter demyelination) Lumbar puncture shows increased ______, increased immunoglobulins with ______ bands on high resolution electrophoresis, and myelin basic protein.
-______: The most common treatment for multiple sclerosis, corticosteroids reduce the inflammation that spikes during a relapse. Examples include ______ and ______.
-______ (such as Betaseron, Avonex and Rebif) appear to slow the rate at which multiple sclerosis symptoms worsen over time. Side effects are ______ damage.
MRI lumbar puncture white lymphocytes oligoclonal IgG Corticosteroids oral prednisone intravenous methylprednisolone Interferons liver
The mechanism by which dimethyl fumarate (DMF) exerts its therapeutic effect in multiple sclerosis is unknown. DMF and the metabolite, ______, have been shown to activate the Nuclear factor ______ pathway in vitro and in vivo in animals and humans. The Nrf2 pathway is involved in the cellular response to ______. MMF has been identified as a ______ in vitro.
TECFIDERA monomethyl fumarate (MMF) (erythroid-derived 2)-like 2 (Nrf2) oxidative stress nicotinic acid receptor agonist
Metabolic disorder of the Nervous System
- inborn errors of metabolism:
- ______: Can’t degrade the amino acid phenylalanine
- ______: Deficiency of HGPRT enzyme (hypoxanthine-guanine phosphoribosyl transferase): self mutilation & involuntary movements.
Phenylketonuria
Lesch-Nyhan Syndrome
chronic alcoholism
- ______: Characteristics include loss of memory & ______ associated with chronic alcoholism and deficiency of ______(vitamin B1). Reversible.
- ______: Characterized by disorientation, ______, delusion. Patient often complain of painful ______ with ______ pains. May be irreversible.
- ______: Characterized by rapid onset of disorganized thought process.
wernicke's syndrome disorientation thiamine korsakoff syndrome insomnia extremities nerve Delirium
Neurodegenerative Diseases
- ______ disease
- ______ disease
- ______ disease
- ______ (Lou Gehrig’s disease): ALS
alzheimers
parkinsons
huntingtons
amyotrophic lateral sclerosis
Most important cause of dementia. This disease was formerly viewed as ______ occurring in middle-aged persons (pre-senile dementia); the entity now includes dementia at any age if it is associated with characteristic clinical and pathologic findings.
-______ of the cortical parts of the ______ and ______ parts of the brain
-Disease of older people (>70 years). Patients become ______ and ______; ______ is a common cause of death.
-______—progressive loss of cognitive functions
and a functional decline (loss of memory
predominates)
PATHOGENESIS
-The brain appears atrophic and shows narrowing of
the ______ and a widening of the ______
-Neuritic (senile) plaques: cluster with ______). Aβ amyloid is derived from ______, which is coded on chromosome ___. APP normally undergoes ______ (breaks) and ______ results in Aβ amyloid. Amyloid may also deposit around vessels, increasing the risk of ______.
-Neurofibrillary tangles: ______ (Defective)
-Genetic risk: E4 allele of apolipoprotein E (APOE) is associated with ______ risk, E2 allele with ______ risk.
-______: AD occurs by 40 years of age
-Diagnosis: ______ scan for early diagnosis.
-Treatment: ______ to slow progression. Progressive disease with no cure.
alzheimers disease premature senility atrophy frontal temporal mute bedridden infection Dementia gyri sulci Aβ amyloid amyloid precursor protein (APP) 21 alpha cleavage beta cleavage hemorrhage TAU proteins increased decreased Down syndrome PET/MRI Acetylcholinesterase inhibitors
- Cause dementia, affects more women. It is characterized by cortical _____ and accumulation of ______ (cytoplasmic inclusion bodies made of ______).
- Treatment: Treat the ______ and ______ symptoms arise early.
- ______ disease with no cure
pick disease atrophy Pick bodies neuro filaments Behavioral language progressive
parkinson disease
- subcortical neurodegenerative disorder
- Decreased number of ______ in the substantia nigra of the ______.
- Histologic manifestations include ________ of the substantia ganglia and damaged cells contain highly characteristic eosinophiliic intracytoplasmic inclusions ( _____bodies).
- Idiopathic Parkinson disease damages neuronal pathways from the ______ to the ______, resulting in ______.
- Clinical features (______): Tremor-pill rolling tremor at rest & disappears with ______
- Rigidity: ______ rigidity in the extremities
- ______: slowing of voluntary movement & expressionless face
- Postural instability
- Treatment: ______, ______ and Deep brain stimulation.
- Causes: Idiopathic, ______, ______ such as MPTP (methyl-phenyl-tetrahydropyridine), a contaminant in illicit street drugs.
- ______, parkinsonism with autonomic dysfunction and orthostatic hypotension.
dopaminergic neurons basa ganglia depigmentation Lewy bodies substantia nigra corpus striatum dopamine depletion 'TRAP' movement cogwheel Akinesia/bradykinesia L-DOPA Dopamine agonist trauma dopamine antagonists Shy-Drager syndrome
