Disorders of the CNS Flashcards
what is the cost of mental health in europe
close to 800billion
what are the common mechanistic aspects of pathogenesis that are common to several brain disorders
1) molecular modulators : mutations, altered gene expression, abnormal protein-protein interactions, othe molecular mediators of neuronal dysfunction
2) environmental modulators (can impact gene expression etc)
3) pharmacological modulators
what is the role of the cerebral cortex
- Planning and execution of motor activity
- Perception and conscious awareness of sensory information
- Learning, cognition, comprehension, memory, conceptual thinking, awareness of emotions
- Most common cause of neurological problems are damage to the cerebral cortex:–trauma, tumour, stroke, neurodegeneration
what is the role of the basal ganglia
where is it
- Deep cerebral nuclei (ncl)
- Caudate nucleus, Putamen, Ncl. Accumbens, Globus pallidus
- Substantia nigra, Subthalamic nuclei
- Motor function: initiation, coordination of movement, posture, tone
- Cognition, perception and emotional behaviours(including reward system)
- Dysfunction of basal ganglia leads to akinesia, involuntary movements–Parkinson’s disease, Huntington’s disease
what is the role of the hypothalamus
- Homeostatic functions of the body: integrate endocrine (pituitary gland functions), autonomic (visceral motor), somatic motor and limbic systems
- control of appetite, fluid intake, metabolism
- Body temperature
- Sleep-wake cycle
- Sexual behaviour
- Emotions, aggression
- Memory
what is the role of the thalamus
- Relay sensory and motor signals from the periphery and/or brain regions to the cortex
⇒Processing & integration of sensory & motor information; Main entrance for information to the cortex
what is the role of the limbic system
several components:
- Cortex: limbic lobe, hippocampus
- Amygdaloid body, Septum
- Some thalamic nuclei, some hypothalamic nuclei
limbic system is unique to mammals:
- species preservation (reproduction, instinctive behaviours) / self-preservation (feeding behaviour, aggression), expression of fear, motivation, emotions, learning & memory
- Dysfunction: dementia, anxiety, affective disorders, psychosis
what is the role of the brainstem
what does it consist of
- Midbrain, Pons, Medulla oblongata
- Motor control, pain, blood pressure, respiration and other autonomic functions–Postural, whole-limb, cardiovascular and respiratory control
what is the role of the cerebellum
- Coordination of movements
- Maintenance of posture, balance (equilibrium) and muscle tone
- Learning of motor tasks
- Processes memory of skilled motor activity
what is the role of neurons
- Process information
- Sense environmental changes
- Communicate changes to other neurons
- Command body response
what is the role of glial cells
(astrocytes; microglia; oligodendrocytes)
- Insulates, supports, and nourishes neurons
- Sense environmental changes
- Process information
- Communicate changes to neuron
how many neurological disorders are there
more than 600
what is the most prevalent neurological condition
headaches/migranes
describe migraine
symptoms
causes
treatment
- Intense pulsing or throbbing pain in one head area
- Three times more common in women than in men
SYMPTOMS: “Aura,” visual disturbances = flashing lights, zig-zag lines or a temporary loss of vision - Triggering factors: bright or flashing lights, lack of food or sleep, or exposure to light
CAUSES: link with dilation and constriction of blood vessels? Inherited abnormalities in genes that control the activities of certain neuronal populations?
TREATMENT: triptan drugs (acting at serotonin receptors- 5HT3)
describe the prevalent diagnosis condition: anxiety,
SYMPTOMS:
- can interfere with daily activities
- excessive anxiety or worry, most days for at least 6 months, about a number of things such as personal health, work, social interactions, and everyday routine life circumstances
- Difficulty controlling feelings of worry
- Feeling restless, wound-up, or on-edge
- Easily fatigued
- Difficulty concentrating
- Being irritable
- Muscle tension
- Having sleep problems
CATEGORIES:
generalized anxiety disorder, panic disorder, various phobia-related disorders
CAUSES:
combination of genetic and environmental factors
TREATMENT:
psychotherapy, medication
describe depression
symptoms
causes
treatment
- Depressive disorder interferes with daily life, normal functioning
CATEGORIES:
Major depressive disorder, Psychotic depression, Postpartum depression, Seasonal affective disorder
SYMPTOMS:
- Persistent sad, anxious or “empty” feelings; Feelings of hopelessness, pessimism, guilt, worthlessness, helplessness; Irritability, restlessness; Loss of interest in activities/hobbies; Thoughts of suicide, suicide attempts
- Difficulty concentrating, remembering details and making decisions
- Insomnia, early-morning wakefulness, or excessive sleeping
- Overeating, or appetite loss
- Fatigue; Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment
CAUSES:
- combination of genetic, biochemical, environmental and psychological factors
TREATMENT:
- antidepressant medications (acting at serotonin and dopamine receptors), psychotherapies
describe psychoses and schizophrenia
symptoms
causes
treatment
PSYCHOSIS: generic psychiatric term for a mental state characterized by a “loss of contact with reality”, incl. false beliefs (delusions) and hallucinations
EPISODE OF PSYCHOSIS VS PSYCHOTIC ILLNESS:
schizophrenia (skhizein= to split; phren= mind), schizoaffective disorders, affective psychosis incl. mania, psychotic depression, mixed affective psychosis
SYMPTOMS: perceptual disturbances (e.g. illusions, hallucinations), delusions, thought disorder, disorder of emotion, lack of insight into the unusual nature of one’s experience and behavior
CAUSES:
a number of substances and medical conditions can cause psychosis, incl=:
- Alcohol and certain illegal drugs
- Brain tumours
- Dementia, neurodegenerative diseases, CNS infections
TREATMENT: antipsychotic drugs (acting at serotonin and dopamine receptors), hospitalisation
describe Tourette syndrome
symptoms
causes
treatment
CHRONIC NEUROLOGICAL
SYMPTOMS:
- repetitive, stereotyped, involuntary movements and vocalizations called tics
- neurobehavioral problems e.g., inattention, hyperactivity and impulsivity, obsessive-compulsive symptoms (e.g., intrusive thoughts)
CAUSE: unknown
TREATMENT: some medications to alleviate symptoms interfering with functioning
describe traumatic brian injury
categories
symptoms
treatment
- Sudden trauma causes damage to the brain
CATEGORIES:
mild, moderate, severe
SYMPTOMS: - loss of consciousness, headache, confusion, light headedness, dizziness, blurred vision, behavioural / mood changes, fatigue / lethargy, changes in sleep patterns, trouble with memory, concentration, attention
- Nausea, vomiting, convulsions, seizures, slurred speech, loss of coordination, confusion, agitation
TREATMENT:
- Seek medical attention
Prevent further injury:
- Monitor oxygen supply
- Maintain fluid flow
- Control blood pressure–½ patients surgery to remove haematoma
- Disabilities: cognition, sensory processing, communication, mental health
Rehabilitation:
- Therapy (physical, speech/language, psychiatry…)
describe CNS (brain and spinal) tumours
- abnormal growths of tissue (benign or malignant)
- can place pressure on tissue and impair function
SYMPTOMS:
- Brain tumour: headaches, seizures, nausea, vomiting, vision or hearing problems, behavioural, cognitive, motor and/or balance problems
- Spinal cord tumour: pain, sensory alterations, motor problems
describe the case study of Phineas Gage
- iron went throigh his skull
- through pre frontal cortex
- had aggression, epilepsy due to this
what is the treatment for CNS tumours
- surgery, radiation, chemotherapy
- steroids (reduce swelling)
describe spinal cord injury/compression
- Sudden, traumatic blow to the spine that fractures or dislocates vertebrae (displaced bone fragments, disc material, or ligaments bruise or tear into spinal cord tissue)
- Cause fractures and compression of the vertebrae, crushing and destruction of axons
- Disruption of the communication down the spinal cord between the brain and the rest of the body
- Complete recovery versus paralysis
describe spinal cord injuries cause classfication complications treatment
CAUSES:
often road traffic accidents
CLASSIFICATION:
incomplete versuscomplete (total lack of sensory and motor function below the level of injury)
COMPLICATIONS:
chronic pain, bladder and bowel dysfunction, increased susceptibility to respiratory and heart problems
TREATMENT:
Rehabilitation programs combine physical therapies with skill-building activities and counselling to provide social and emotional support
describe epilepsy cause symptoms diagnosis treatment
- Clusters of neurons sometimes signal abnormally
- Alterations of the normal pattern of neuronal activity
CAUSES:
- illness, brain trauma, abnormality in brain wiring, imbalance of neurotransmitters
SYMPTOMS:
- Alterations of sensations, emotions, and behaviour–Convulsions, muscle spasms, loss of consciousness
DIAGNOSIS:
EEG, brain scan
TREATMENT:
for 80 % epilepsies, seizures can be controlled with antiepileptic drugs and/or surgical techniques
what is hydrocephalus
- Excessive accumulation of cerebrospinal fluid
- Potential detrimental pressure on brain tissue
CAUSES:
- abnormal dilations of ventricles
- Congenital versus acquired (stroke, trauma)
SYMPTOMS:
- vomiting, problems with balance, coordination, sleepiness/lethargy, drowsiness, changes in personality, cognition
describe MS multiple sclerosis
- Demyelinating condition (disrupted communication btw the brain and the body). Symptoms range from relatively benign to disabling / devastating
CAUSES: Unknown. Autoimmune disease? Environmental trigger? Virus?
SYMPTOMS: blurred or double vision, red-green colour distortion, blindness in one eye; Muscle weakness in their extremities, difficulty with coordination and balance; Abnormal sensory feelings (numbness, prickling, or “pins and needles” sensations); Speech impediments, tremors, dizziness; Cognitive impairments: concentration difficulties, attention, memory, poor judgment; Depression
what is narcolepsy-cataplexy
- neurological disorder
SYMPTOMS: - excessive daytime sleepiness, cataplexy (sudden onset of muscle atonia) direct transition from wakefulness to REM sleep
CAUSE: loss of hypocretins/orexins neurotransmission
TREATMENT: wake-promoting drugs
describe dementia
causes
symptoms
Significant impairment of intellectual functioning that interferes with normal activities and relationships. Collection of symptoms
CAUSES:
- number of disorders that affect the brain
- reactions to medications, metabolic problems and endocrine abnormalities, nutritional deficiencies, infections, poisoning, brain tumours, anoxia or hypoxia, heart and lung problems
- Commonly observed in very elderly individuals
- However, dementia is NOT a normal part of the ageing process
SYMPTOMS:
- loss of ability to solve problems and maintain emotional control, alterations of language skills, personality changes, behavioural problems such as agitation, delusions, and hallucinations.Memory loss is a common symptom of dementia
which CNS disorders hav symptoms of dementia
- Alzheimer’s disease –vascular dementia –Lewy body dementia –frontotemporal dementia, Pick’s disease –Huntington’s disease –Creutzfeldt-Jakob disease
others also
describe Alzheimer’s disease
- Most common form of dementia. Heterogeneous syndrome:Onset, duration, clinical signs
SYMPTOMS:
Progressive cogntive impairment
- memory and attention deficits
- reduced language skills (aphasia), orientation (apraxia)
- reduced executive functions (abstract thinking & judgement)
Hallucinations
Alterations of personality, delusions, psychosocial incompetence
CAUSES:
- familial forms: mutations in different genes
- sporadic forms:2 risk factors: age, ε4 allele of apolipoprotein E
TREATMENT:
- None to slow the progression of AD
- Cholinesterase inhibitors to improve memory, alertness, motivation
what happens in Alzheimer’s disease to the brain
- brain atrophy
- Massive loss of neurons and synapses in the hippocampus & cortex (area-specific)
- Extracellular deposition of β-amyloid peptide forms SENILE PLAQUES
- Intracellular aggregation of tau protein FORMS Neurofibrillary tangles
- Astrocytes activation
- Microglial activation
- Complement activation
- Cytokines/chemokines
what are the gene environment interactions in Alzheimer’s disease
1) environmental factors:
mental stimulation, physical activity, diet
(can affect alpha beta-degrading proteases eg neprilysin)
2) genetic factors:
APP, PS1, PS2, APOepsilon4 mutations
(can affect and cause altered APP processing)
alters Abeta plaques
alters NFTs
altered neuronal plasticity –> neuronal and synaptic dysfunction and cognitive decline and dementia
what is Pick’s disease
FRONTOTEMPORAL DEMENTIA
- Rare dementia syndrome associated with shrinking of the frontal and temporal anterior lobes of the brain
CAUSES:
- Pick bodies containing an abnormal form of the tau protein inside nerve cells
SYMPTOMS:
1) changes in behaviour: disinhibited or apathetic, inc inappropriate social behaviour; distracted; loss of insight into the behaviours of oneself and others; changes in food preferences; agitation or, conversely, blunted emotions; repetitive or compulsive behaviour OR
2) language disturbance: inc difficulty making or understanding speech
- Spatial skills and memory remain intact
TREATMENT:
No treatment to slow the development of dementia. Medications required to control aggressive, agitated, dangerous behaviours
what is multi infarct dementia
- common cause of memory loss in elderly
CAUSE: - multiple strokes (disruption of blood flow to the brain) causes Damaged brain tissue
SYMPTOMS: - confusion, problems with short-term memory; wandering, getting lost in familiar places; losing bladder or bowel control; having difficulty following instructions
TREATMENT: - no treatment to reverse brain damage. Prevention of future strokes (e.g., high blood pressure, diabetes, high cholesterol, cardiovascular disease)
describe Parkinson’s
Motor system disorder
Cause: loss of dopamine-producing brain cells (neurons) in the substantia nigra
Symptoms: Tremor, or trembling in hands, arms, legs, jaw, and face; Rigidity, or stiffness of the limbs and trunk; Bradykinesia, or slowness of movement; Postural instability, or impaired balance and coordination
Treatment: no cure but pharmacology provides relief from symptoms
describe huntingtons disease
Motor system disorder
Cause: genetically programmed degeneration of brain cells (i.e., neurons) in certain areas of the brain (striatum, cortex) loss of 25% of brain weight!Familial hereditary disease: autosomal dominant; Huntingtin gene mutation, expansion of CAG repeats encoding glutamine causes toxicity
Symptoms: uncontrolled movements, loss of intellectual faculties, emotional disturbance (personality changes).
Advanced symptoms: Uncontrolled jerking (“Huntington’s Chorea”), slurred speech, severe psychiatric conditions
Treatment: no cure but pharmacology to reduce behavioural and movement symptoms
what is thepathophysiology of huntington’s
Neurodegeneration in specific brain areas (striatum, cortex) leads to loss of 25% of brain weight
what gene-environment interactions occur for Huntington’s
- environmental factors: mental stimulation, physical activity
- mutant huntintin –> abnormal folding –> abnormal protein interactions –> aggregation and abnormal gene expression and protein trafficking –> altered neuromodulators –> altered neurogenesis –> neuronal and synaptic dysfunction –> motor, cognitive and psychiatric symptoms
mutli infarct dementia and cerebral aneurysm are examples of what
cerebrovascular accidents
describe vascular dementia
- Common cause of memory loss in the elderly
Causes: multiple strokes (disruption of blood flow to the brain) causes damaged brain tissue
Symptoms: confusion, problems with short-term memory; wandering, getting lost in familiar places; losing bladder or bowel control; having difficulty following instructions
Treatment: no treatment to reverse brain damage. Prevention of future strokes (e.g., high blood pressure, diabetes, high cholesterol, cardiovascular disease)
describe cerebral aneurysm
- Dilation, bulging, or ballooning-out of part of the wall of an artery in the brain
- Can occur at any age, although more common in adults
Symptoms: unrupturedcerebral aneurysm depend on its size and rate of growth. Loss of feeling in the face or eyes problems. After rupture, severe headache, nausea, vision impairment, vomiting, and loss of consciousness
Treatment:
Emergency treatment following a ruptured cerebral aneurysm to restore deteriorating respiration and reduce abnormally high pressure within the brain
Surgery to prevent repeat aneurysm rupture
describe leptomeningitis and encephalitis
- Inflammatory diseases of the membranes that surround the brain and spinal cord
Causes: bacterial or viral infections
Symptoms of meningitis: high fever, severe & persistent headache, stiff neck, nausea and vomiting. Confusion, sleepiness, and difficulty waking up may occur. In infants: irritability or fatigue, lack of appetite, fever.
Symptoms of encephalitis: sudden fever, headache, vomiting, increased sensitivity to light, stiff neck, confusion and impaired judgment, drowsiness, weak muscles, unsteady gait, irritability. Severe: loss of consciousness, seizures, muscle weakness, or sudden severe dementia
Treatment:
- Treatment for bacterialinfection: antibiotics
- Treatment for viralinfection: antiviral medications prescribed for herpes (simplex virus) encephalitis or other severe viral infections.
- Anticonvulsants to prevent or treat seizures
- Corticosteroids to reduce brain swelling & inflammation
- Sedatives may be needed for irritability or restlessness
- Medications for fever and headache.
- Individuals with encephalitis or bacterial meningitis are usually hospitalized for treatment
describe Creutzfeldt-Jakob Disease (CJD)
- Rare, degenerative, invariably fatal brain disorder Spongiform encephalopathy
Cause: protein called prion (harmless versusinfectious form)
- Onset of symptoms occurs at about age 60
- Major categories: sporadic, hereditary, acquired
- Diagnostic: no diagnostic test. Rule out treatable forms of dementia such as encephalitis or chronic meningitis. The only way to confirm a diagnosis of CJD is by brain biopsy or autopsy
Treatment: none available
what is Kuru
- Rare and fatal brain disorder that occurred at epidemic levels during the 1950s-60s among the Fore people in the highlands of New Guinea. Transmissible spongiform encephalopathy (prion protein)
Cause: ritualistic cannibalism
Symptoms: cerebellum affected causing unsteady gait, tremors, and slurred speech. Kuru = “shiver”. Behavioural changes present but dementia minimal or absent. Mood changes were often present
describe autism
- complex neurodevelopmental disorders
- spectrum: wide range of symptoms and skills an in level of functioning
- Asperger’s syndrome: childhood disintegrative disorder, oervasive developmental disorders not otherwise specified
- symptom onset: EARLY CHILDHOOD
SYMPTOMS:
- repetitive and characteritistic behaviours
- alterations in social communication and interaction [engangement]
CAUSE:
- genes that control brain development, regulaiton of brain cell communication
TREATMENT: behavioural interventions (social and language skills) , sometimes medications
