CNS Flashcards
Consequence of cerebral autoregulation failure
failure at mean arterial pressure of around 180 mmHg -> cerebral edema and increased ICP
Etiology of vasogenic edema
BBB breakdown
increased vascular permeability
etiology of cytotoxic edema
increase in intracellular fluid because of neuronal, glial or endothelial cell membrane injury
Global symptoms of elevated ICP
Headache
Decreased consciousness
Vomiting
3 common clinical settings associated with
herniation (a focal symptoms of elevated ICP)
cerebral edema
increased CSF volume (hydrocephalus)
mass lesions
pathophysiology of NPH
Cerebrovascular disease
Hypertension
Congenital
Decreased CSF absorption
Clinical triad of NPH
Gait difficulty
Cognitive deficits
Psychomotor slowing
Decreased attention and concentration
Impaired executive function
Urinary incontinence
Causes of hypoxic-ischemic brain injury
Causes of hypoxic-ischemic brain injury
etiology of SDH
tearing of the
bridging veins
TBI Glasgow Coma Scale (GCS) score
13 to 15 mild traumatic brain injury
9 to 12 moderate
8 or less severe
TBI Primary brain Injury
diffuse axonal injury
focal cerebral contusions
Hematomas
TBI secondary brain Injury
inflammatory responses
apoptosis
ischemias
CTE and its pathophys
develops after repeated concussion
tau-immuno-reactive degenerative
pathophys of myelomeningocele
Chiari II malformation
Brain stem dysfunction
Hydrocephalus
CP pathophys
Periventricular leukomalacia (PVL)
pathophys of meningitis
Cytokines
increased BBB permeability
increased ROS
increased ICP
etiology of fever in meningitis
reset the hypothalamic thermal set point by pyrogens
etiology of headache in meningitis
↑ ICP stimulate nociceptors
etiology of changed mental status in meningitis
↑ICP → brain herniation → damage to ARAS
PD pathophys
Dopamine depletion in basal ganglia
Disruptions in the connections to the thalamus and motor cortex
Compensatory mechanisms in PD
Increasing dopamine synthesis
Increasing dopaminergic neurons
Increasing the proliferation of dopamine receptors
Clinical features of PD
Tremor
Bradykinesia
Rigidity
Postural instability
pathophys of vascular dementia
brain ischemia or loss of vascular integrity with hemorrhage disrupts normal brain function and causes cognitive impairment
mechanism for HAND
HIV-1, through infected monocytes, can cross the BBB -> neuroinflammation
-> cytokines release
HIV+patients have high cortisol levels indicative of HPA axis deregulation
etiology of Alzheimer’s Disease is linked to HAND
HIV-1 induces synaptic deficits and neurodegeneration
MS pathophys
begins as an inflammatory immune-mediated disorder
microglia form a complex with the activated T cells
-> destruction of the myelin and oligodendrocytes
Clinically isolated syndromes (CIS) pattern of MS
first attack of a disease with inflammatory demyelination but has yet to fulfill MS diagnostic criteria
MS Relapsing-remitting (RR)
clearly defined relapses/exacerbation with partial or full recovery
MS Secondary progressive (SP)
initial RR disease course followed by gradual worsening
MS Primary progressive (PP)
steady progression from onset
etiology and pathophys of ALS
Excessive glutamate resulting in death of motor neurons (excitotoxicity)
Inflammatory responses
motor neuron degeneration and death
Spinal cord becomes atrophic
Clinical features of ALS
upper: weakness with slowness, hyperreflexia and spasticity
lower: weakness, atrophy and fasciculations
pathophys of GBM
mutation in isocitrate dehydrogenase (IDH) accumulation of the onco-metabolite 2-hydroxyglutarate (2-HG)
clinical symptoms of GBM
headache increased ICP nausea and vomiting cognitive impairment Seizures
etiology and clinical features of meningiomas
abnormal chromosome 22
headache and weakness in an arm or leg are the most common symptoms
most common tumor that metastasizes to the brain
lung
