Midterm COPY Flashcards
What is Necrosis?
Premature cell death where cells rupture, spilling their contents into the exracellular space
Which type of cell death results in an inflammatory response, which can lead to further distress?
Necrosis
What is Apoptosis?
Programmed cell death, cells are dismantled into membrane-bound vesicles
‘Cell Suicide’
What is Acquired Brain Injury (ABI)?
Any brain injury that occurs after birth and is not hereditary, congenital, or degenerative
What are three possible causes of ABI?
- Lack of Oxygen
- Drug toxicity
- Poisoning
What is Tramautic Brain Injury (TBI)?
A sub-category of ABI which includes only damage to brain caused by an external mechanical force
What are three possible causes of TBI?
- Concussion (blow to head)
- Blast Injury
- Penetrating Trauma
What is a major cause of death and disability across the world and the number one cause of death in children in youth?
Traumatic Brain Injury
How does a TBI occur?
When a blow to the head is sufficiently forceful the CSF is unable to protect the brain resulting in a collision of the brain with the skull
What is a Contrecoup TBI?
When the brain collides with the skull on the opposite side of impact
What is a Coup TBI?
When the brain collides with the skull on the same side of impact
TBI severity depends mostly on degree of _______ force.
How does this occur and what can result from it?
Rotational Force
Skull rotates and brain is too slow to catch up
Can result in sheared corpus callosum or torn bridging veins
What happens at the site of contact with skull in a TBI? (The Primary Phase)
Swelling (Edema) and Bleeding (Hematoma) which can lead to Inceased Intracranial Pressure (ICP)
Necrotic Death - result of direct impact leading to rupturing of cells
What is Generalized Damage in TBI?
Diffuse injury throughout the brain as a result of white and grey matter having different densities and shifting during impact
How does Diffuse Axonal Injury (DAI) occur?
Twisting and shearing forces cause axons to be torn from cell bodies (axotomy)
What is the Energy Crisis faced in TBI?
Disrupted blood flow leads to:
Lack of Oxygen (Hypoxia)
Lack of Glucose (Hypoglicemia)
What is Excitotoxicity and how does it happen in TBI?
Excess Glutamate Release due to rupturing cells (necrosis)
How does Excitotoxicty effect neurons?
Glu continously binds to and activates post-synaptic receptors which causes neurons to depolarize and fire leading to influx of Ca2+ and K+
Ca2+ (Calcium) ends up sequestered in mitochondira which disrupts production of ATP and increased production of Reactive Oxygen Species (ROS)
ATP is required to make and use _______
_______ is required to make ATP
Glucose
Glucose
In TBI there is a lack of glucose as a result of decreased _______ flow and _______ production
Blood
ATP
Hypoglycemia in TBI leads to _______ deficits as neuronal activity _______ after over-excitation
Cognitive
Decreases
Lack of Oxygen (Hypoxia) in TBI as a result of decreased blood flow causes a switch to _______ glucose metabolism which can lead to overproduction of _______ _______ (acidosis) which damages BBB
Anaerobic
Lactic Acid
What type of cytokines do microglial secrete?
Pro-inflammatory Cytokines
What is ROS and what causes it?
Reactive Oxygen Species which can lead to DNA damage, protein admage and lipid abnormalities
ROS levels increase during times of environmental stress
What is Oxidative Stress?
The result of an imbalance of ROS and antiOX
What are the effects of TBI in the Frontal Lobe?
Lack of Focus
Irritability
Language difficulty
What are the effects of TBI in the Parietal Lobe?
Difficulty with reading
Spatial Misperception
What are the effects of TBI in the Occipital Lobe?
Blind Spot
Blurred Vision
What are the effects of TBI in the Temporal Lobe?
Problems with short and long-term memory
What the results of TBI in the Cerebellum?
Difficulty walking
Slurred speech
What are the results of TBI in the brainstem?
Changes in breath
Difficulty swallowing
What is Immune Privilege?
Sites of the body are able to tolerate introduction of foreign substance without eliciting inflammatory response
Brain is not immune privileged due to interaction with peripheral immune system
How do the innate and adaptive immune systems communicate?
Chemical communication via Cytokines
What are Cytokines?
Small signalling proteins which act via specific receptors to coordinate the immune system and elicit either pro or anti-inflammatory effects
What is the Vagus Nerve?
The 10th cranial nerve which contain most of the afferent connection between the CNS and bodily organs
What are Paraganglia?
Cells located along the vagus nerve which release Neurotransmitters upon cytokine bonding and send signals to the brain
What is a concussion?
A Mild TBI which results in a temporary loss of brain function
A concussion resulting in alterations of consciousness most likely affected which brain regions?
Upper Brainstem
Reticular Activating System
A concussion resulting in altered neurological function most likely affected which brain regions?
Corpus Callosum
Anterior Commissure
A concussion resulting in headache, dizziness, and fatigue most likely affected which brain region?
Vascular Injury
A concussion resulting in impairments in short-term memory, attention, and concentration most likely affected which brain regions?
Hippocampus
Frontal Lobe
A concussion resulting in changes in mood and emotional function most likely affected which brain regions?
Amygdala
Basal Forebrain
Prior Concussion _______ likelihood of a second concussion and causes greater _______
Increases
Deficits
Repeated concussions have _______ effects, even if separated by years
Significant
What are some long-term complications which are more likely to occur with multiple concussions?
Loss of long-term memory
Depression
Neurodegenerative Disoders
What is Chronic Traumatic Encephalopathy (CTE)?
A progressive degenerative disease found in individuals with a history of multiple concussions
What brain changes are seen in a patient with CTE?
Decreased brain weight and enlarged ventricles
Widespread neuronal death
Tau aggregates (tangles of protein) and beta-amyloid plaques
What are common symptoms of CTE?
Memory impairments
Erratic behaviors and impulsivity
Depression and suicidal thoughts/behaviour
How can we detect CTE?
MRI, EEG
Symptoms inventory, injury evaluation, cognitive tests
What arteries do the Brain’s blood supply come from?
Common Carotid and Vertebral Arteries
What is the Circle of Willis
A communication circle at the base of the brain formed by the common carotid and vertebral arteries
What main arteries of the brain arise from the Circle of Willis?
Anterior Cerebral Artery (ACA)
Middle Cerebral Artery (MCA)
Posterior Cerebral Artery (PCA)
What is a stroke?
Interruption of blood flow to the brain
What is an Ischemic Stroke?
Blockage in blood vessels which leads to Ischemia (lack of blood flow to tissue or organ)
80% of strokes
What is a hemorrhagic stroke?
Rupture in blood vessel
20% of strokes but accounts for 40% of all stroke deaths
Symptoms and prognosis depend on where stroked occured, _______ and _______ - deficits observed will be specific to affected region
Duration and Severity
What is Ataxia?
The result of a Cerebellar stroke
Motor impairments and difficulty with walking, balance and coordination
Why is blood flow to the brain essential?
The brain relies on blood supply to get its glucose and oxygen (energy supply)
Four minutes without perfusion can result in permanent cellular damage and functional deficits
Deposits of _______ in the arteries (Atherosclerosis), which forms plaques, can lead to what? (which can cause a stroke)
Chloresterol
Narrowing of the arteries in the neck or brain
A stroke can be caused by certain genetic mutations which can…?
Increase risk of hypercholesterolemia
Damage blood vessel walls
Cause clotting disorders
What are some environmental/experiental factors which can cause a stroke?
What are the common link between all of them?
High BP, smoking, obesity, inactivity, trauma, or alcoholism
Increased inflammation of vessel walls
What is an Intracerebral Hemorrhagic Stroke and what does it lead to?
When blood vessels rupture and blood leaks into surrounding brain tissue which creates swelling (edema) and increased pressure (ICP)
Leads to cell death
What are the most common causes of a hemorrhagic stroke and what is the mortality rate?
High blood pressure and aging blood vessels
35% mortality rate
What is a subarachnoid hemorrhage? What is the most common cause and the mortality rate?
Bleeding in subarachnoid space
Brain Aneurysm (blood-filled bulge in weakened blood vessel wall)
40-50% mortality rate
What is a Transient Ischemic Stroke?
A mini-stroke (mild ischemic stroke)
Causes and symptoms are the same as a stroke but only last minutes to hours
A TIA leads to a more severe ischemic stroke in _______% of patients
15-30%
Why could TIAs potentially be adaptive?
The brain can adapt to things if they occur slowly including lack of oxygen (hypoxia) as a result of lack of blood flow
What are the benefits of Ischemic Preconditioning in someone who suffers a global ischemic stroke following a TIA?
Improved neuronal survival
What is the treatment for a TIA?
Anti-coagulants (blood thinners) to help prevent blood clotting and larger stroke
What is infarction?
Ischemia-induced cell death
What is the core of a stroke and how is it affected?
Area directly fed by occluded vessel
Receives less than 20% of normal blood vessel
Results in Necrosis and Apoptosis
What is the penumbra of a stroke and how is it affected?
Outskirts of lesion, receive blood flow from other vessels
Receives between 20-40% of normal blood flow
Results in Apoptosis due to Ripple Effect (toxic signalling cascades spilling over from core)
In a stroke how does Apoptosis occur?
Lack of glucose → no fuel for Na/K pumps → resting potential of neurons can’t be maintained → cells depolarize → flooding of Glu → cells initiate self-destruct
In a stroke how does Necrosis occur?
Lack of oxygen → switch to anaerobic glucose metabolism → Acid build-up (acidosis) → decreased membrane permeability → Ions and water rush in → cell swells and ruptures
How does the Blood Brain Barrier get damaged in a stroke, and how does this effect the immune response?
Ischemia → epithelial cells weakened (due to hypoxia and resulting acidosis) → reperfusion, peripheral immune cells leak through → exacerbate immune response and inflammation
How do Micoglia effect the inflammatory response in a stroke?
They release pro-inflammatory cytokines
What is reperfusion?
When blood flow resumes after a stroke
How do leukocytes (white blood cells) infilitrate the BBB and what effects do they have on the brain? (Stroke)
Due to the weakened BBB → reperfusion brings leukocytes with it
They release even more inflamamtory molecules, futher compromising stability and impeding recovery
How does Ca2+ effect the brain after a stroke?
Excess Ca2+ (Calcium), as a result of neuronal depolarization, results in production of ROS - in turn Mitochondria can’t deal with this stress and release signals to induce apoptosis
What is Collateral Ciruclation?
Blood flow through secondary pathways after the obstruction to the principle pathway occurs