Final exam - Disorders

Question 1

Scales

Answer 1

• Glasgow Coma Scale (3-15)
• Mini Mental Assessment (0-30)
• ICD-10 = The International Statistical Classification of Diseases and Related Health Problems (WHO - neurological disorders like alzheimer’s)
• DSM-V = Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (go to for psychiatry)

Question 2

Parkinson’s Disease

Answer 2

• MPTP - drug induced Parkinson’s symptoms (ex. tremors, rigidity - depletion of substantia nigra DA)
• Nigrostriatal DA pathway = Substantia Nigra to Striatum (caudate/putamen and na)
• Post-mortems - < 100,000 nigral neurons = DA starved striatum
• Around 60% of nigral neurons have to be lost, with an 80% depletion of striatal DA, before the symptoms of PD develop

Question 3

Treatments for Parkinson’s

Answer 3

• MAO inhibitor (ex. Eldepryl) slows down breakdown of DA (leaving dopamine in synapse so it has longer time to work)
• L-DOPA can lead to eventual dyskinesia so use of DA agonists delay use of L-DOPA, reduce eventual dose of L-DOPA and reduce motor problems (ex. Requip & Mirapex)
• Ex. Rascol study = DA agonist for as long as possible and then add L-DOPA

Question 4

Stem Cells

Answer 4

1. Capable of dividing and renewing themselves for long periods through cell division
2. Unspecialized
3. Can give rise to specialized cell types
4. Can get them not only from embryonic tissue but from adult bone marrow, umbilical cord tissue, adult skin cells
   Ex. Cut finger, stem cells will help with restoration of the skin

Question 5

Epilepsy - Alternate Treatment

Answer 5

• Vagus nerve stimulation (VNS) designed to prevent seizures by sending regular, mild pulses of electrical energy to brain via vagus nerve
• Pulses supplied by device (like pacemaker) placed under skin on chest wall with wire to the vagus nerve in neck (activate GABA-ergic system & activate parasympathetic nerve)
• Vagus nerve is part of autonomic nervous system, controls functions of body that are not under voluntary control (heart rate)
• Epilepsy linked to increased glutamate activity

Question 6

Excitotoxicity & Stroke

Answer 6

• When brain is injured it releases abnormally large amounts of glutamate, over-stimulating gluatamate receptors on surface membranes of postsynaptic neurons (causes unusually large amounts of calcium to enter nerve cells)
• Excess calcium disrupts biochemical processes within neuron & activates enzymes that produce free radicals
• Free radicals = structurally unbalanced chemicals capable of destroying other compounds that form internal structure of neurons
• Excitotoxicity occurs = neuronal cell death as a results of this increase in glutamate & influx of calcium that results in increased free radicals

Question 7

Stroke Treatment

Answer 7

• Hemorrhagic stroke & ischemic stoke (hemorrhagic = blood, harder to treat, can’t tell which one from symptoms)
• Thrombolytic drugs = drugs that immediately dissolve the blood clots that cause many strokes, drastically reducing amount of damage strokes produce (ex. tissue plasminogen activator - tPA)
• Only work if delivered directly into bloodstream, either through vein or artery (intra-arterial) and only administered within a few hours of stroke before oxygen-deprived nerve cells suffer permanent damage
• Time window for getting best results from thrombolytic drugs is 3h from first signs of stroke
• “Time is brain” (FAST acronym : Face : ask to smile, droopy?, Arm : ask to raise arms, both arms or one arm?, Speech : ask person repeat simple phrase, speech slurred or confusing?, Time : critical, call 911