Intro to CNS Disorders Flashcards
what does the CNS control
behavior, thought, motor function
changes in ____ in the nucleus of the cell body alters gene expression resulting in abnormal production of harmful proteins that make the CNS more vulnerable to disease
DNA
give examples of how DNA can be altered, causing CNS disease
- genetic predisposition
- toxicity due to drug/alcohol abuse
- environmental triggers
tissue death that occurs with severe injury or disease
necrosis
sets off cascade of inflammatory actions; leads to excitoxicity and release or free radicals; contributes to damage of surrounding tissues; cell is destroyed (membranes and structures)
necrosis
genetically programmed degradation of DNA
apoptosis
seen in development as neuronal pruning; does not lead to inflammatory action; may be triggered by free radicals resulting in cell death; may be pathologic (cancer cells); cell membranes generally intact
apoptosis
what are the two types of glial cell
macroglia and microglia
give examples of macroglia cells
astrocytes, oligodendrocytes, schwann cells
the connective tissue of CNS; support and maintain neuronal plasticity; most populous in CNS
macroglia cells
most numerous on all CNS cells (supporting cells)
astrocytes
associated with CNS deymylemination and what is a disease example
olgiodendrocytes
MS
associated with PNS demyelination and what is a disease example
schwann cells
diabetic peripheral neuropathy
the immune system of the CNS; 10% of glial population; respond when CNS tissue is damaged; act as phagocytes and can trigger astrocytes
microglia cells
when microglia are triggered, what s/s do they produce
fever, sleep, decreased appetite, lethargy, swelling
are usually transient, but aging cells are not deactivated by apoptosis and may contribute to pathogenesis of neurologic disease
microglia
made of epithelial cells that form a tight matrix that block diffusion between cells
blood brain barrier
how does glucose and amino acids cross the blood brain barrier
protein transport
give some examples of pathogens that are able to penetrate the blood brain barrier and lead to disease
meningitis
encephalitis
some metabolic disorders
cells that line the ventricles and spinal canal; produce CSF
ependymal cells
what can ependymal cells be implicated by
infectious diseases
stroke
TBI
shunt that drains CSF from the ventricles to the perineum (gut) to decrease ICP
ventriculoperitoneal shunt
what are the 3 main ways axons can be injured
shearing, compression, traction
damage to axons that occurs in TBI due to shearing forces during coup-countercoup injury (due to increased velocity)
diffuse axonal injury (DAI)
traction on a peripheral N that causes degeneration of the distal end of axon
wallerian degeneration
amines
serotonin, dopamine, acetycholine, norepinephrine
amino acids
GABA, glycine, glutamate
neuroactive peptides
enkephalins, endorphins, substance P
gaseous neurotransmitters
nitrous oxide, carbon monoxide
how can pathology develop due to neurotransmitters
- changes in the synthesis/availability of neurotransmitters
- changes in target cells can cause abnormal responses to normal levels of transmitters
nerve growth factor, BDNF, and other _______ contribute to maintenance and survival functions of neurons known as ______
neurotrophic factors
neuroprotective
best way to increase neurotrophic factors
aerobic exercise
aging
senescene
nerve conduction velocity decreases by 15% in myelinated fibers by
8th decade (80 y/o)
what can develop in the brain with aging
neurotic plaques, glial scar tissue, neurofibrillary tangles
by how much does blood supply decrease to brain with aging and what does this mean
10-15%
decreased glucose and decreased brain metabolism
changes in PNS associated with age
diminished vestibular, vision, and somatosensation
changes in ANS due to age
decreased ANS reactivity
alterations in BP, RR, HR, blood flow, organ function
by 60 y/o, we lose what percent of hair cells in vestibular system
40%
neurological disorders associated with age
muscular dystrophy
down syndrome
parkinson’s
alzheimer’s
neurological disorders associated with race/ethnicity
tay-sachs
neural tube defects
neurological disorders associated with genetic history
duchenne’s muscular dystrophy
huntington’s chorea
spinal muscle atrophy
neurological disorders associated with familial history
DM
charcot marie tooth
CT markers placed for tracking dopamine uptake
DaTScan
used to identify disruption of white matter
diffusion tensor imaging
evaluates function of CN 8 - auditory component and integrity of brainstem in coma
brainstem auditory evoked potentials (BAEP)
determines O2 saturation in brain tissue
near-infrared spectroscopy
how/where is CSF analysis taken
- via percutaneous puncture in subarachnoid space
- between L3-4 or L4-5
why would a CSF analysis be performed
- evaluate inflammatory diseases of CSF
- rule out CNS infection
- confirm otherwise undiagnosed CNS conditions
what does pink/clear/yellow/cloudy CSF each indicate
clear = normal
yellow = old RBC
pink = active bleeding
cloudy = infection
example of diseases for evaluation of CSF
meningitis, encephalitis, MS, parasitic/fungal infections, rabies, syphyilis
when is CSF analysis contraindicated
ICP is elevated or presence of focal neurologic signs –> brain would leak into back
evaluates changes in glucose, proteins, WBC, or identified bacteria in blood samples which may indicated infectious pathologies
CBC and diff, cytology, bacteriology
most common ordered lab test; provides info on size, availability, # of blood cells in peripheral circulation; ratio of RBC, WBC, plasma
CBC
measures relative volume of RBC’s; quick screen of anemia/polycythemia
hematocrit
normal hematocrit values for M and F
M 42-52%
F 37-47%
measures oxygen carrying capacity of RBC
hemaglobin
normal hemoglobin levels for M and F
M: 14-18
F: 12-16
____ level changes cause brain/nerve tissue to shrink/swell which may alter consciousness, induce coma, or intracranial hemorrhage
sodium
must have ____ and ____ levels WNL for neuromuscular transmission of action potentials
potassium and calcium
high or low levels of _____ may result in diabetic ketoacidosis, insulin shock, or diabetic coma
glucose
normal adult values and critical values for sodium, potassium, calcium, fasting glucose
- Sodium: 134-142; 110
- Potassium: 3.7-5.1; <3.2 or >5.1
- Calcium: 8.6-10.3; <7 = tetany; >12 = coma
- Fasting Glucose: 70-100; over 60 y/o 90-130
sedative-hypnotic drugs and side effects they can cause
barbituates, benzodiazepines
- drowsiness, changes in motor performance the next day, antegrade anmesia, physical dependance, sleeping while driving, GI discomfort
anti-anxiety, anti-depressant, affective disorder drugs and side effects they can cause
xanax, buspar, ativan, klonopin, elavil, cymbalta, prozac
- dizziness, HA, nausea, drowsiness, addiction, abuse, orthostatic hypotension, cardiac arrhythmias, seizures
anti-epiletic drugs and aide effects they can cause
pehnobartial, valium, ativan, tegretol, neurontin (gabapentin)
- usually take across the lifespan - withdrawal has to be gradual and controlled by physician
anti-coagulation medications (stoke) and side effects
coumadin, herparin, asprin (ASA)
- hemorrhage most common negative effect, easily bruised
drugs to tx:
parkinsons
seizures/spasticity
spasticity
and side effects
- PD: levadopa/sinemet
- Seizures/spasticity: neurontin/gabapentin
- Spasticity: balcofen
sedation, dizziness, nausea, ataxia, fatigue
initial period of neural shock and disruption of neural connectivity in undamaged areas of brain due to connection to damaged portions of brain
diaschisis
cortical reorganization via collateral sprouting; regenerative synaptogenesis via pharmacological, novel tasks, and aerobic activity
neuroplasticity
3 main interventions to help improve neuroprotection
exercise
diet
sleep
