CNS-II Flashcards

1
Q

Def. of early onset dementia

A

o Cases of dementia in adults ranging from 18 to 65 years of age
 Learning and memory
 Can’t be independent anymore

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the most common cause of dementia in adults

A

alzheimers disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the neuropathologic changes that occur in the brain in Alzheimers disease

A

• Essential neuropathologic changes”
o Neuritic plaques
o Extracellular deposits of amyloid beta peptides
o Neurofibrillary tangles (tau proteins)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pathogenesis of AD

A
  • Amyloid precursor protein (APP) cleaved by beta-secretase and gamma-secretase
  • Mutations in presenilin 1 (PSEN1) or presenilin 2 (PSEN2)  production of amyloid beta plaques
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what do the tau proteins cause in the brain

A

• Tau:

o hyperphosphorylated and aggregates → Causes an inflammatory response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Genetic risk factors for early-onset AD

A

o Early-onset Alzheimer’s
 Younger than age 65 (40s and 50s)
 Mutations in APP, PSEN1, and PSEN2
 ANY OF THESE THREE MUTATE AND THERE WILL BE A 100% CHANCE OF AD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Genetic risk factors for late-onset AD

A

 People age 65 and older

 Carries of APOE e4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pre-symptomatic period occurs due to ?

A

genetic mutations in APP1, PSEN1 or PSEN2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Cardinal Clinical symptoms of AD

A

o Memory impairment

o Executive function and judgement/problem solving behavioral and psychological symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pathogenesis of Parkinson’s

A

– Interplay of genes and the environment
o Basal ganglia circuits
 Dopamine depletion in the substania nigra ultimately results in:
 Increased inhibition (GABA) of the thalamus
 Reduced excitatory input (glutamate) into the motor cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

hallmark pathology of Parkinsons disease

A

lewy body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

The brain compensates for the dopamine depletion by?

A

o Increasing the synthesis of dopamine in surviving neurons
o Proliferation of dopamine receptors
o Gap junctions allowing rapid communications between neurons increase dramatically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Clinical Features of PD

A

o Tremor
 “rest tremor” and intermittent
o Bradykinesia
 Generalized slowness of movement
o Rigidity
 Increased resistance to passive movement about a joint
 Pts feel like it’s taking them forever to do something
o Postural Instability
 An impairment of postural reflexes that cause a feeling of imbalance and a tendency to fall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Amyotrophic Lateral Sclerosis (ALS) is defined by?

A

• Definition: persistently progressive neurodegenerative disorder that causes:
o Muscle weakness (motor neuron degeneration)
o Disability
o Eventually death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Amyotrophic Lateral Sclerosis (ALS) established risk factors and environmental factors ?

A
•	Sporadic: 90 to 95%→ Sporadic and familial ALS. Approximately 90% cases of ALS are called “sporadic,” meaning the cause or causes of the disease are unknown. 
•	Established risk factors 
o	Age 
o	Family history 
•	Environmental factors 
o	Smoking 
o	Environmental toxin exposure 
o	Military Service
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Etiology of ALS

A
•	Etiology (unknown, but they’re hypothesis)
o	Abnormalities in RNA metabolism 
o	Excitotoxicity 
o	Viral Infections 
o	Inflammatory Responses
17
Q

Pathology of ALS

A

o Intracellular inclusions in degenerating neurons and glia
→ Characterized by motor neuron degeneration and death with gliosis
→ Spinal cord becomes atrophic
→ The affected muscles show denervation atrophy

18
Q

Clinical Features of ALS

A

o Upper motor neuron:
 findings of weakness with slowness, hyperreflexia, and spasticity
 Due to degeneration of Frontal Motor Neurons
o Lower motor neurons:
 Findings of weakness, atrophy, and fasciculations (muscle twitch)
 Due to degermation of lower motor neurons in the brainstem and spinal cord

19
Q

pathogenesis of multiple sclerosis and alternate theories

A

o Immunopathology:
 Begins as an inflammatory immune-mediated disorder
 Microglia forms a complex with the activated T-cells leads to destruction of myelin and oligodendrocytes
 Areas of CNS affected are referred to as “lesions” or “plaques”
o Alternate Theories:
 A possible immune (but not autoimmune) etiology
 Genetically determined

20
Q

Main Disease Patterns of multiple sclerosis?

A

o Clinically isolated syndrome
 First attack of a disease with inflammatory demyelination, but has yet to fulfill MS diagnostic criteria
 With no previous evidence of MS: newly diagnosed
o Relapsing-Remitting (RR)
 Clearly defined relapses with fully recovery
o Secondary Progressive (SP)
 Initial RR disease course followed by gradual worsening (transitional)
o Primary progressive (PP)
 Progressive accumulation of disability (w/ or w/o remission)

21
Q

Symptoms of multiple sclerosis

A

• Symptoms: (polysymptomatic onset)
o Sensory in limbs
o Visual loss
o Motor (subacute)

22
Q

What are gliomas

A

o Gliomas are primary brain tumors that show histologic features of glial cells
 Glial cells are the cells that support the nerve cells (astrocytes, oligodendrocytes, ependymal cells)

23
Q

what type of brain tumors are diffuse gliomas?

A
o	Astrocytomas 
	Diffuse Gliomas
o	Oligodendrogliomas 
	Diffuse Gliomas 
o	Ependymomas 
o	Mixed Gliomas
24
Q

Gliomas can be classified into three categories they are?

A

• Classifications of diffuse gliomas
o Mutation of the IDH -OR- IDH Wildtype (stays normal) astrocytomas
 Enzyme in kreb’s cycle
o Mutation of IDH -AND- Co-Chromosomal deletion of chromosome 1 and 19( causes loss of tumor suppressor gene)oligodendrogliomas
o IDH-mutant -OR- IDH- wild type glioblastoma
• Systemic symptoms

25
Systemic symptoms of diffuse gliomas
• Systemic symptoms o Headache ICP o Seizures  ICP o N/V  ICP o Depressed level of consciousness   perfusion to brain o Neurocognitive dysfunction   perfusion to brain
26
Focal symptoms of diffuse gliomas
• Focal Symptoms o Weakness o Sensory loss
27
Astrocytoma | • Formation of astrocytoma: grade II astrocytoma is associated with:
o Mutations in IDH1 o Inactivation of the TP53 o Mutations in the chromatin regulator gene
28
• IDH and its link to gliomas:
o Acquiring a somatic mutation in either IDH-1 or IDH-1  accumulation of the oncometabolite 2-hydroxyglutarate (2-HG) o Elevated levels in 2-HG can cause  Changes in DNA and histone methylation (epigenetic)  Abnormalities in cellular differentiation  Tumorigenesis (oncogenic)
29
The transition from low-grade to high grade (malignant) glioma is associated with?
o Cell cycle checkpoint inactivation o Tumor suppressor gene inactivation o Angiogenesis
30
what brain tumors are considered High-grade gliomas?
o Anaplastic gliomas | o Glioblastoma
31
what is a meningioma
• Definition: | o Predominantly benign tumors of adults arising from the meninges
32
What are risk factors for a Meningioma
o Prior radiation therapy (ionizing radiation) to the head and neck, typically decades earlier  Therapeutic -cancer  Atomic bomb survivors
33
What is the etiology of a meningioma and what are the clinical features?
• Etiology: o Abnormal chromosome 22 • Clinical Features o Usually slow-growing tumors o Headache and weakness in an arm or leg are the most common symptoms o Often express progesterone receptors  Tumor will grow faster in pregnant women ( due to high progesterone levels)
34
The most common brain tumor in adults is? What are the common most primary sites of this tumor
``` o Lung ** o Skin (melanoma) o Kidney o Breast o GI tract ```
35
How do metastatic tumors come to be?
o Circulating tumor cells use the bloodstream or lymph system initially migrate and enter the lungs, then move on to the brain
36
What are the clinical features of metastatic brain tumors
o Headache o Focal neurologic dysfunction: Hemiparesis o Cognitive dysfunction