Disease, Cognition, Aging Flashcards
1
Q
Non-Inflicted Brain Injury
A
- Seizure Activity
- Infection – Viral, Bacterial, Parasitic
- Inflammatory – Auto-immune
- Neoplasms - Cancer
- damage can lead to lasting impairment b/c brain regenerates VERY slowly if at all
2
Q
Seizures and cause
A
=Uncontrolled extra electrical activity in the brain causing a paroxysm (sudden attack)
be caused by any brain insult
- most seizure/epileptic disorders are Idiopathic – Cause is unknown
- rest are a combo of:
Genetic (though unknown mechanism)
Hypoxia
Infection
TBI
Neoplasms
3
Q
Types of Seizures
A
-
Generalized Seizure
* electrical activity in deep cortical structures (thalamus)–> spreads throughout the brain. - Simple-Partial
- start in cortical area, don’t spread through brain (Localized). 2/3 of seizures
- no Alteration of Consciousness
-
Complex-Partial
* Alteration of Consciousness (Usually either losing consciousness, or losing responsiveness) 2/3
Seizure activity=ictal activity
4
Q
Absence (petit mal)
A
- 5-30 seconds of unresponsiveness,
- secession of activity
- loss of awareness
- generalized
5
Q
Tonic-Clonic (grand mal)
A
- Stiffening of body followed by clonic muscle jerks.
- associated with incontinence and followed by post-ictal sleep.
- “Classic” seizure, not necessarily dangerous if rare and individual is cared for during seizure
- bad prognosis if repetitive and long (>5 minutes)
- generalized
6
Q
Simple Partial
A
- no loss or alteration of consciousness (aware of seizure)
- Tactile hallucinations (sensory symptom)
- Olfactory hallucinations (usually unpleasant)
- Intense feelings – fear, euphoria, deja or jamais vu (psychic symptom)
- Myclonus (usually unilateral bc localized)
- Dysphasia or schizophasia (psychic)
Sweating, horripilation, hyperventilation (autonomic)
7
Q
Complex Partial
A
- loss of awareness/consciousness
- Similar symptoms:
- Automatisms – random, purposeless movements
- Individual usually does not remember the seizure, and is tired afterwards
8
Q
Aura
A
If a Partial seizure (esp simple one) turns into Generalized seizure, the partial symptoms are called the Aura, much like the aura before a migraine
9
Q
Temporal Lobe Epilepsy
A
- Most common form of epilepsy
- most resistant to meds (surgery)
- simple-to-complex partial seizure,
- olfactory hallucinations, intense psychic sensations (religious hallucinations and delusions), then period of altered consciousness, occasionally with tonic-clonic seizure
- Seizure starts in (and is usually limited to) either the hippocampus or the temporal cortex
10
Q
Seizure Sequelae
A
- TLE associated with increasing memory and attention deficits
- Seizure while doing attention required activity (driving)
- Inc freq + severity of seizures predict inc neural damage and impairment, more seizures
11
Q
Status Epilepticus
A
- seizure activity lasting >30 minutes.
- medical emergency with a 20% mortality rate.
- Associated with epilepsy, stroke, TBI, drug withdrawal or overdose, high fever, or poor compliance with seizure medication
12
Q
Seizure Dx
A
- MRI and CT particularly for TLE, bc possibility of identifying hippocampal atrophy
- observation and EEG.
- Types of seizures have specific look.
- EEGs used to Dx area of brain seizure activity, type of seizure, and differentially diagnose absence seizures from things like daydreaming or ADHD.
13
Q
Seizure Tx
A
Acute
- injection of a CNS depressant, typically benzodiazepine (Valium) or barbituate (phenobarbital), + anti-convulsant
Long-term/prophylactic treatment
anti-convulsants
- lots of neurological side effects
- Easy to OD
- Dosage carefully monitored
- Avoiding Seizure triggers
- Nerve Stimulation – under trial (vagus and DBS)
14
Q
Surgery for Seizure & Prog
A
Partial:
- Attempt to locate area of seizure activity using CT, MRI, Angio, and EEG
- Do Wada test to make sure you won’t affect dominant brain hemisphere
- Cut it out (often the hippocampus in TLE)
General:
- Cut corp cal – seizure cannot generalize to other half of the brain
- Lobectomy/Hemispherectomy – very rare, but still used if no other recourse danger of mortality
Prog good esp if young (flexibility)
15
Q
Multiple Sclerosis (MS)
A
- Neurodegenerative disease
- demyelinating autoimmune disorder,
- inflammation of the brain cause immune functions to kill oligodentrocytes (the cells that make myelin)
- Females more likely
- Symptoms include weakness and incontinence.
- “flare-up,” then remit (each flare-up getting worse)
- Etiology is unknown
16
Q
MS Dx Tx & Prog
A
Dx
- differential disorder=usually diagnosed when any other possibilities ruled-out.
Tx
-
corticosteroids to
reduce inflammation & experimental tx for
prophylaxis.
Prog
-
no cure for MS but slow progression, and symptoms
are the issue - mortality average 10
years less than a non-MS individual
17
Q
Amyotrophic Lateral Sclerosis (ALS aka Lou Gehrigs)
& Symptoms
A
- Progressive degrading of motor neurons, from upper motor (cortical & white matter) to lower motor (brainstem & spinal cord to muscles).
- middle age onset ~40-60 yr
- Symptoms: inc muscle weakness, from limbs to trunk to viscera (such as bladder) to facial muscles to (finally) the diaphragm.
18
Q
Dx Tx of AMS
A
Dx
- involves upper and lower motor neuron signs
- Confirm via electromyography nerve conduction tests, which measure electrical activity of muscles & speed of nerve transmission
- disease progresses, becomes evident on CT/MRI
- Cause unknown but maybe environmental factor (cause protein build-up in motor
neurons)
Tx
- only supportive,
- such as PT and OT for muscle weakness
- Mortality is currently 90% within 5 years
19
Q
Encephalitis
A
– brain infection caused by bacteria, virus, fungus, or parasite
20
Q
Meningitis
Symptoms, Prog, Dx, Tx
A
=infection of the meninges, by bacteria, fungus or virus
- Symptoms – fever, phonophobia, photophobia, nausea, vomiting, rigidity, rash, muscle spasms, AMS. Fever cause overheating + inflammation of brain–>cell death –>hearing loss.
- Prognosis & mortality assoc w/ age, higher mortality among children and elderly, + how fast it is treated.
Dx
- lumbar puncture
Tx
- antibiotics, antiviral agents, antifungals
- much higher mortality than other types of infection.
21
Q
HIV & brain disfunction
A
- slip past the blood-brain barrier relatively easily, due to “trojan horse” method of infection.
- found in CSF within 14 days of viral transmission
- “hide” in the CNS even when it is undetectable in blood tests
22
Q
Toxoplasmosis
A
- parasite living in cats and multiplies in rats.
- in humans/mammals, forms cysts (Bradyzoites!) that hide in muscles or brain causing no damage, UNLESS you are a baby or have bad immune
- Symptoms – swollen lymph nodes, eye damage, encephalitis.
23
Q
AIDS Dementia Complex
A
- Late-stage AIDS patients can suffer from severe loss of neurocognitive function, in memory, concentration, SoP, and executive functioning.
- Some HIV-infected individuals only develop Mild Neurocognitive Disorder
- many changes in brain cells: damaged glial cells and astrocytes, (believed result of micro-infection).
- like premature aging
24
Q
Aging and Cognition
A
- no significant decline in cog func
- Mostly in SoP and Motor Speed
25
Q
Causes for Age-Related Cognitive Impairment
A
- Brain cells do not replace themselves at the rate that others do. When brain cells die, many are never replaced. Result is evident as enhanced sulci.
- Normal” Brain Injury – cognitive decline is gradual/continuous from ~25 on. Alcohol, drugs, environmental toxins, brain injury, fevers, infections, all slowly affecting brain functioning, (particularly gray matter)
- Result: cortical enhancement
26
Q
Dx of MCI (Mild Cognitive Impairment)
A
- Standard neurocog battery – IQ tests, Memory tests (visual and auditory), SoP, Visuospatial, Motor Speed, Attention, Executive Functioning
- CT/MRI scan to rule out organic cause:
Differential Diagnosis –
- Silent stroke
- Korsakoff’s – Alcohol-related memory impairment; easily seen on a CT scan by atrophied hippocampus
Rule out dementia -
- No sudden onset
- No loss in ability to function normally at work, home, and hobbies
- No visible neural correlate
- No personality change
- Not apparent upon multiple testings with Mini Mental Stat Exam over a year.
- individuals who display MCI are significantly more likely to develop Dementia
27
Q
Tx of MCI
A
- Supportive therapy like adding memory aids.
- monitor with Mini Mental Stat Exams regularly to determine if the patient is heading towards dementia
