Diseases And Disorders Flashcards
Syringomyelia
- a fluid filled cyst in the spinal cord (central canal)
- from lifting heavy objects or automobile accidents
- loss of pain and temperature on both sides of the body at the sight of the cyst since this is the crossing point of the STT
- continual expansion can cause brainstem trouble if not drained
Treponema pallidum
- syphilis
- spirochete will slowly invade myelinated neurons and most likely travel to the posterior columns causing demyelination of the neurons (neurosyphilis)
- loss of touch and proprioception known as tabes dorsalis (syphilitic myelopathy) —-> blindness, paralysis and dementia
Arthrogryposis, Gordon’s Syndrome
- PIEZO2, a molecular ion channel that responds to stretch and proprioception, critical for mechotransduction
- genetic variant leads to congenital joint contracture in two or more areas of the body, mechanosensory deficiencies
Acute Inflammatory Demyelinating Polyradiculopathy
- autoimmune disorder in which the immune system attacks the peripheral nerves, often damaging the Schwann cells
- weakness, pain, autonomic dysfunction, including respiratory failure
- recovery possible
- Guillaume Barre Syndrome
- Chronic IDP (CIDP) is similar, but waxes and wanes more, chronic immune attack on the peripheral myelin
- treatment involves plasmapheresis to help remove antibodies, administration of immunoglobulins to neutralise harmful antibodies
- corticosteroids or immunosuppressants can be used but less effective, especially in GBS
Charcot Marie Tooth
- hereditary demyelinating peripheral neuropathy that affects both motor and sensory neurons due to the defect in a number of proteins/lipids and the lack of proper myelin
- PT and moderate activity
Krabbe Disease
- hereditary lysosomal storage disease (deficient in galactocerebrosidase) in which there is a dysfunctional metabolism of sphingolipids resulting in the destruction of proper myelin that can occur in the PNS and CNS
- diagnosed 3-6 months after birth and results in death but can also occur later in life as a more mild form
- no known cure
- bone marrow transplant can be an optional therapy
Metachromatic leukodystrophy
- hereditary lysosomal storage disease that affects both PNS and CNS
- accumulation of sulfatides that destroy myelin (deficient in the enzyme arylsulfatase-A)
- no known cure
- bone marrow transplant can be an optional therapy
Brown Sequard Syndrome
- loss of touch/proprioception on one side of the body and loss of pain/temperature from the other side of the brain due to damage to one side of the spinal cord - the signals can’t get to the brain
- often a loss of muscle activity and increased deep tendon reflexes on the side of the damage, Babinski sign
Depression
- linked to low levels of serotonin, norepinephrine
- selective serotonin reuptake inhibitors (SSRIs -sertraline, fluoxetine, paroxetine)
- monoamine oxidase inhibitors (MAOis - phenyelzine), tricyclic antidepressants (TCAs - imipramine, amitriptyline), serotonin and NE reuptakeinhibitors (SNRIs - venlafaxine, duloxetine)
ADHD
- linked to low levels of NE
* methylphenidate, dextroamphetamine, amphetamine, atomoxetine
PTSD
- linked to high levels of NE
* beta receptor antagonist (propranolol) and alpha2 receptor agonist (clonidine)
Schizophrenia
- linked to unbalanced levels of dopamine
* drugs that block dopamine (haloperidol, risperidone)
Parkinson’s
•linked to low levels of dopamine
Huntington’s
•hereditary genetic disorder dealt with by inhibiting dopamine
Cluster headaches
- unilateral
- men > women
- periorbital presentation of lacrimation and rhinorrhea at times
- repetitive, 15 min- 3hours and can have bouts that last for weeks to months
- often occur at night when sleeping
- triptans, prophylaxis Ca++ channel antagonists [verapamil], Fremanezumab
Tension headaches
- bilateral
- steady, mid to moderate pain that typically lasts 30 min to 6 hrs
- due to muscle contractions in the neck and head region or may be due to other causes
- OTC pain relievers first, prescription meds include higher doses of naproxen; indomethacin, ketorolac, triptans (if patient has tension headaches + migraines)
Migraines
- unilateral and pulsating
- nausea/vomiting, photophobia, photophobia, auras (visual or olfactory or auditory)
- 4-72 hrs
- higher doses of naproxen; indomethacin, ketorolac, triptans
- prophylaxis include beta blockers - propranolol, timolol) and Ca++ channel antagonists - verapamil; topiramate, valproate
- Erenumab - inhibit CGRP receptors
Medications used for pain (some not on Exam 1 list)
•opioids:
-hydromorphone (mu agonist, 8-10 x more potent than morphine)
-meperidine (mu agonist, neurotoxic at high doses)
-pentazocine (k and mu agonist, lower abuse potential)
•NSAIDs
-diclofenac 9reversibel COX inhibition)
-sulindac (reversible COX inhibition)
•glucocorticoid steroids
-methylprednisolone (oral)
-prednisolone (oral)
-budesonide (oral and inhaled)
-triamcimilone (inhaled and topical)
-mometasone (inhaled and topical)
-betamethasone (topical)
•gabapentinoids:
-gabapentin and pregabalin (inhibition of VGCC by binding to the alpha 2 delta protein that delivers VGCC to the membrane surface of the presynaptic cell, decrease their trafficking to the membrane) side effects include somnolence and memory problems
•NE and/ or dual reuptake inhibitors:
-duloxetine and amitriptyline (block reuptake of NE and/or serotonin, work via and increase in descending inhibition, increasing the NE and 5HT to the dorsal horn of the SC)
-Tramadol has a similar mechanism as well as weak mu opioid agonist activity
•VGSC blockers:
-lidocaine
•triptans:
-sumatripan, naratriptan, zolmitriptan, eletriptan, rizatriptan (agonists at the serotonin receptors 5-HT 1b/d, receptors found on blood vessels and on neurons —> vasoconstriction and decrease in peripheral neuronal activity)
•beta blockers:
-propranolol and timolol (block the beta-adrenergic receptors, reducing the ability of endogenous NE and epinephrine to act the the beta receptors resulting in a decrease in hypertension and widespread decrease in sympathetic activity, full mechanism as migraine prophylactic unknown
•CGRP inhibitors:
-erenumab (fully human monoclonal antibody of calcitonin gene related peptide receptor used to prevent migraines, targets CGRP receptor)
-fremanzumab (humanised monoclonal antibody directed against CGRP that is used for chronic cluster headaches
Dementia
- decreased levels of acetylcholine
* aceylcholinesterase inhibitors (done-evil, rivastigmine)
Multiple sclerosis
- demyelinating disease
- loss of myelin in CNS, irreversible
- between activebouts of the disease, the population of Na+ and K+ channels in demyelinated intermodal regions can increase to levels that can support propagation of regenerative APs (though slower)
- temperature - Na+ channels open and close more quickly in response to depolarizationas temperature rises - duration of AP is reduced
Myasthenia gravis
- weakness and rapid fatigue of muscles under voluntary control
- immune system produces antibodies to acetylcholine receptors or tyrosine kinase receptors at NMJ, thymus triggers or maintains production of antibodies
