Final Lecture Flashcards
Tumors
a mass of cells whose growth is uncontrolled and that serves no useful function
Can be malignant (cancerous) or benign –> Depends on whether the tumor is encapsulated
Is an encapsulated tumor benign or malignant
Benign
Who is benign and malignant most common in
Benign more common in women; malignant more
common in men
Tumors damage brain tissue by
Compression and Infiltration
* Malignant can compress and infiltrate
* Benign tend to only compress
Primary and secondary brain tumors
Primary = start in CNS, Most commonly seen in those under 15 and above 65 y/o
Secondary = Metastasize to brain, Most common brain metastases are from lung and breast cancer.
Grading of CNS Tumors: grade 1 and grade 4
Grade 1:
* low proliferative potential (cells not dividing a lot)
* possibility of cure after surgical resection
Grade 4:
* histological evidence of malignancy (looking at tissue under microscope)
* mitotically active (cells are dividing/proliferating)
* prone to necrosis
* associate with rapid preoperative and postoperative disease progression and fatal outcomes
Gliomas
Most common primary brain tumoors (33%)
Tumor of the glial cells (astrocytes, oliog., etc.)
Types:
- Astrocytoma
- Meningioma
Astrocytoma
tumor of the astrocytes
Can be low grade or high grade
Type to know: Grade 4 Astrocytoma = Glioblastoma Multiforme
Glioblastoma Multiforme
Grade 4 Astrocytoma
- Most aggressive tumor form (grows in 1-2 months)
- Average survival rate from diagnosis approx. 2 years
- Higher Incidence in white individuals
Meningioma
tumor of the meninges, usually benign and slow growing
–> Encapsulated
Main Treatments for Gliomas
Surgical resection (remove tumour)
* partial resection (debulking)
* total gross resection
Radiation
* whole brain (damages hippocampus)
* Hippocampus sparing (new technique, keeps hippocampus in tact)
Chemotherapy
* Must cross blood-brain barrier
* Gliadel Wafters (chemo-therapy impregnanted wafer)
Seizure
a period of sudden, excessive activity of cerebral
neurons (glutamate, gaba, etc.)
Facts:
* Epilepsy chronic d/o of recurrent seizures
* can be partial/focal or generalized
Partial/focal types of seizures
Partial/Focal Types:
- simple partial = no major change in consciousness (can be aware or not aware of it happening)
- Complex partial = cause of loss of conciousness
Generalized types of seizures
- Tonic-Clonic (aka Grand mal)
- Absence (aka petit-mal)
- Atonic
Tonic-Clonic/Grand Mal Seizures
most severe form of seizure
include conclusions (violent uncontrollable muscle movements)
* tonic phase: stiffening of muscles
* clonic phase: jerking or twitching (frothy, eye blinking)
Typical stages
Can one person have different types of seizures?
Yes!
Absence “petit mal” seizures
Sudden lapse in consciousness
* Staring blankly into space
* Eyelid fluttering
* Lip smacking
* Involuntary hand movements
Last less than 15 seconds
Atonic seizures
Aka “drop seizures”
Sudden loss of muscle control = collapse or fall
Different to Cataplexy in Narcolepsy due to loss of consciousness (in atonic, they don’t know whats happening)
Challenges of seizures
50% of those with seizure d.o show damage to the hippocampus
falling/drowning
Car accidents (unable to drive for 1 year post)
Pregnancy complications (seizure meds hard on babies)
Emotional issues
Challenges of seizures
50% of those with seizure d.o show damage to the hippocampus
falling/drowning
Car accidents (unable to drive for 1 year post)
Pregnancy complications (seizure meds hard on babies)
Emotional issues (see next slide)
Emotional issues with epilepsy
Most common = ADHD, anxiety, aggression
6-10% experience post-ictal psychosis
Epilepsy increases risk of schizophrenia by 2.5x (think because of the synaptic pruning that happens during seizure)
Seizure first aid
Prion diseaes
Type of neurodegenerative disease
occur when prion protein, found throughout the body, begins folding into an
abnormal three-dimensional shape.
damaged prion protein destroys brain cells, leading to a rapid decline in thinking
and reasoning. aka Transmissible Spongiform Encephalopathies (looks like sponge)
Creutzfeldt-Jakob disease
Type of neurodegenerative disease
Most common between Kuru and Prion
- “Mad cow disease” epidemic of the 1980’s to 1990’s (People ate cows whose feed was contaminated with meat from ill sheep)
- Can be sporadic or familial
- Causes severe mental deterioration and dementia – 8 month avg.
Kuru Disease
Type of neurodegenerative disease
From eating contaminated human brain tissue
Traditional practice of Fore people of Papa New Guinea
* Cannabilism of deceased loved ones
10-50 year incubation period of disease
Kuru = “trembling” aka Laughing Sickness – leads to total loss of muscle control and dysphagia (difficulty swallowing)
Parkinson’s Disease: General
Caused by the degeneration of dopamine-secreting neurons in the substantia nigra that send axon to the basal ganglia = a deficiency of automatic, habitual motor responses
- 95% of cases are sporadic
Parkinson’s Disease: Symptoms
Dystonia = rigidity (cog wheel test: see lack of smooth movement when moving arm)
- Bradyskinesia & Slowed reaction times = falls
- Shuffling gait
- Face Masking (mask like expression)
- Tremors (75% have pill rolling tremor)
Parkinson’s Disease: Treatments
L-Dopa - time-limited, side effects of hallucinations and delusions (trying to give your body more dopamine)
Deprenyl – slows Parkinson’s progression
Intentional lesioning of the pathway
Deep Brain Stimulation
* 75% relief of symptoms
* Contraindicated (aka not used) in those with cognitive or memory impairments**
Huntington’s Disease: General
Inherited disease resulting in degeneration of
the basal ganglia
* Chromosome 4 mutation = defect causes the
building blocks of DNA called cytosine, adenine, and
guanine (CAG) to repeat many more times than they
normally do.
Huntington’s Disease: Symptoms
Chorea – involuntary jerking movements
Dystonia (neurological movement disorder characterized by involuntary (unintended) muscle contractions that cause slow repetitive movements or abnormal postures that can sometimes be painful)
Slurred speech and swallow difficulties
Amyotrophic Lateral Sclerosis (ALS): General
degenerative disorder that attacks spinal cord and cranial nerve motor neurons, causes brain and muscle connection loss (die from respiratory failure)
90% sporadic, 10% inherited
Inherited: In inherited forms – mutation on chromosome 21 (gene that produces the enzyme superoxide dismutase (mutation leads to protein misfolding)
Amyotrophic Lateral Sclerosis (ALS): Symptoms
Progressive weakness and muscular atrophy - eventual loss of speech, swallow w/ paralysis
Eye movements spared
Death typically caused by respiratory failure – typically within 24 months
* Only current pharmacological treatment is Riluzole (extends life by approx. 2 months)
Multiple Sclerosis (MS): General
= an autoimmune demyelinating disease.
At scattered locations within the CNS, the person’s immune system attacks myelin sheaths, leaving behind hard patches of debris called sclerotic plaques.
Damage occurs in white matter (think demyelinating disease)
Multiple Sclerosis (MS): Risk Factors
Females > Males
Living far from the equator (think environment, not genetic)
Black or white race
Smoking
Multiple Sclerosis (MS): Symptoms
- Fatigue
- Vision problems
- Bladder/bowel dysfunction
- Spasms
- Slowed Processing Speeds*
Types of multiple sclerosis
Note: besides primary progressive, they all go up and down (set backs). Easily exploited by pharmaceutical companies (will wait to give medications to time with this cycle)
Meningitis: general and caused by
= Inflammation of the meninges caused by viruses or bacteria.
- Virus
- Bacteria
- Fungus
- Parasite
Etiology:
* Spread of middle-ear infection to the brain
* Head injury
* Embolus that has dislodged from bacterial infection in the heart (IV drug use - dirty needles = increased risk)
Meningitis: Symptoms
- Stiff neck**
- Headache
- AMS (altered mental status)
- Fever
- Photophobia (sensitive to light)
- Sometimes – convulsions, LOC, death
Brudzinski and Kernig
KNOW
Use to see if meningitis
Flexion of the hips and knees in response to neck flexion
Resistant to extension of leg while the hip is flexed
Dementia as an umbrella term
Umbrella term for memory loss and other thinking abilities severe enough to interfere with daily life
KNOW: Alzheimer is the most common
5 common types of dementia
Alzheimer’s Disease: Causes
Neuritic plaques (B Amyloid) & neurofibrillary tangles (tau)
estrogen lowers risk of Alz. –> less common in women
B Amyloid
* Abnormal in Alzheimer’s and Trisomy 21
Immune system research: possibly due to bad immune system
Tx with anti-inflammatory drugs results in lower risk
Exposure to toxins, TBI, infections may trigger abnormal B amyloid formation (estrogen lowers risk)
APOE gene is involved in making a protein that helps carry cholesterol and other types of fat in the bloodstream
Vaccine research
* Sensitize immune system against Amyloid
Alzheimer’s Disease: Impact on brain
Alzheimer’s Disease: Differential
Occurs later in life (70+)
memory loss
Getting lost in familiar places
Vascular Dementia
Associate with brain damage due to ischemic injury, anoxia
Risk factors same as stroke risk factors
Experience “mini strokes” called Lacunar Infarcts
*causes microvascular changes
* accumulation over time –> dementia symptoms
Typical age of onset: 65
Vascular vs Alzheimer’s disease testing
KNOW
Vascular dementia impairments:
* semantic memory
* visuo-spatial/perceptual skills
* slowed processing speed
* with cuing/recognition paradigm, can recall information (memory is okay, but retrieval is not okay)
Alzheimer’s impairments:
* Episodic Memory
* Language
* Cuing/Recognition does not help
IN BOTH:
* executive/attentional functioning
* lack of awareness that they have it
Mild cognitive impairment vs dementia
Not all people with mild cognitive impairment go on to have dementia, but when it does go to dementia the decline happens rapidly
Dementia with Lewy Body Disease
Characterized by the abnormal build up of alpha-synuclein proteins into masses i.e., lewy bodies (which effects the chemicals in the brain which causes symptoms)
Symptoms:
* Visual hallucinations - 80% of individuals early on in condition (are aware they are hallucinations)
* falls and dysautonomia (autonomic functions are off like bad temp regulation)
* movement issues
* Sleep problems (REM sleep disorder)
* fluctuating cognition
* mood and behavior change
Fronto-Temporal Dementia
Umbrella term for group of brain diseases known as frontotemporal lobar degeneration (accumulation of Tau protein, overwhelms the brain and causes tissue death)
3 types:
* behavioral variant (most common, changes in personality and behaviors)
* Primary progressive aphasia (communication progressively worsens)
* movement disorders
FTD: Behavioral variant
most common, changes in personality and behaviors
- Lack of empathy and interest
- Increasing inappropriate social bx
- Changes in eating bx, desire to eat inedible foods
Schizophrenia: Risk and development
- 46% concordance rate (chance of heritability)
- 10x risk of African and Caribbean migrants
- Men>Women
- Mutation in 21 of the 23 chromosomes
- Older Paternal Age
- Atypical prenatal development (influenza, prematurity, preclampsia, gestational diabetes
- Poor social adjustment and academic performance
- Deficient psychomotor functioning
Schizophrenia: Minor physical anomalies
- High-steepled palate
- Partial webbing of two middle toes
- Especially wide or narrow-set eyes
Schizophrenia: Disease burden
- 20% reduction in life expectancy
- 40% of deaths attributable to suicide
Schizophrenia: age of onset
Schizophrenia: birth month
Akathisia
Subjective unpleasant feeling of restlessness
Bradyskinesia
Bradykinesia means slowness of movement and is one of the cardinal manifestations of Parkinson’s disease. Weakness, tremor and rigidity may contribute to but do not fully explain bradykinesia.
Tardive Dyskinesia
condition where your face, body or both make sudden, irregular movements which you cannot control (tounge darting)
symptoms irreversible but Vitamin E can prevent further deterioration
Antipsychotic side effects: Extrapyramidal
Extrapyramidal – impairment in motor functions NOT related to the pyramids
- Tardive Dyskinesia – symptoms irreversible but Vitamin E can prevent further deterioration
- Akathisia – subjective unpleasant feeling of restlessness
- Pseudo-Parkinsonism (slow)
- Acute Dystonia (lack of movement)
Antipsychotic side effects: Anti-cholinergic
dry mouth, urinary retention, blurred vision, constpiation
Antipsychotic side effects: Treatment resistance medication
Failing of at least 2 antipsychotic medication trials (resistant to medications), have to use Clozapine
- Requires blood test every 18 weeks d/t high risk of
neutropenia (low neutrophil levels – these fight
infection)
Depression: Heritability
Families of persons with affective disorders are 10x more likely to develop MDD or BMD
Depression: neuropathology
KNOW
Hedonic tone/responsiveness: trait or genetic predisposition underlying one’s baseline range and lifelong ability to feel pleasure
* see dysfunction in mesolimbic and mesocortical pathways
* los of 40-90% of glial cells
* LOW Hedonic Tone = Increase risk of anhedonia, depression, and dysthymia (Seen in MDD and ADHD) –> MAYBE SNRIS BETTER THAN SSRIS BECAUSE ISSUE ISN”T NEEDING MORE SERITONIN
Also: see hippocampus neurogenesis
- explains 3-6 week lag in tx response time (brain needs to get used to SSRIS)
Brain differences: Generalized anxiety DO
- Reduced connections between amygdala and PFC
- Activation of the vmPFC does not result in reduction of amygdala activation
- Lowered GABA presence in amygdala
Brain differences: Social Anxiety
Disproportionate activation of amygdala when viewing negative expressions and neutral ones
Brain differences: During panic attack
- Increase activation of amygdala & periaqueductal grey (pain)
- Can be induced by the breathing of CO2 and injection of lactic acid
Brain differences: “Anxious Apprehension” vs. “Anxious Arousal”
KNOW
- Anxious App = ↑ activation in left frontal lobe i.e., Broca’s (over activated speech area)
- Anxious Arousal = ↑ activation in right temporal lobe i.e., increased sensitivity to environmental sounds and noises.
