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Systems Path > Nervous System > Flashcards

Nervous System Flashcards

1
Q

What % of human genes are associated with the nervous system?

A

50% at least

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2
Q

What cells in the nervous system are the most sensitive to injury?

A

Neurons

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3
Q

What is selective vulnerability?

A

A group of neurons that are functionally related may be selectively injured by a particular type of insult

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4
Q

What part of the brain is most damaged by Alzheimers?

A

Hippocampus

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5
Q

Which cells are most vulnerable to the effects of mercury?

A

Cerebellar granular neurons

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6
Q

What cells are targeted by polio?

A

Anterior horn cells

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7
Q

Axon and dendrite repair is generally limited to what part of the nervous system?

A

PNS

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8
Q

Review: what is pyknosis?

A

Nuclear shrinkage in response to cell injury

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9
Q

Review: what is karyorrhexis?

A

Nuclear fragmentation or breakdown in response to cellular injury

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10
Q

Review: what is karyolysis?

A

Nuclear dissolution in response to cellular injury

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11
Q

What are red neurons? What are the causes?

What are the effects?

A

Acute neuronal injury
Causes: ischemia, overwhelming infection, toxicity
Effects: pyknosis then karyorrhexis

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12
Q

What is central chromatolysis?

A

The axonal reaction - reactions in the cell body appearing with axonal regeneration

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13
Q

What is Wallerian degeneration?

A

Changes in the distal axon of an injured neuron in the PNS.

  • degeneration of axon & myelin sheath
  • cellular responses leading to clearing of debris
  • activation of regeneration-associated genes (RAGs)
  • Schwann cell activity
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14
Q

Review: what is anteriograde degeneration?

A

Disintegration of the distal axon (usually following neuronal or axonal injury)

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15
Q

What are the cellular effects of atrophy and degeneration of nerve cells?

A
  • reduction in size
  • lipofuscin deposits
  • neuronal death
  • necrosis
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16
Q

Neurodegenerative disorders may result in what inside affected cells?

A

Inclusions / intra-neuronal deposits

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17
Q

Inclusion bodies: what are neurofibrillary tangles? What diseases produce them?

A

Twisted cytoskeletal fibers containing ubiquitin and other proteins.

Typical of:

  • Alzheimer’s
  • Parkinson-dementia complex
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18
Q

Inclusion bodies: what are Lewy bodies? What disease are they associated with? Where do they tend to be located in the brain?

A

Spheroids made of ubiquitin

Associated with Parkinson’s

Located in the substantia nigra

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19
Q

Inclusion bodies: what are Negri bodies? What disease are they associated with?

A

Virus inclusion bodies in infected cells

Associated with rabies

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20
Q

Inclusion bodies: what are lipofuscins? What conditions are they associated with?

A

“Wear and tear” pigments

Associated with aging, chronic hypoxia, and atrophy

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21
Q

Inclusion bodies: what metabolic storage disease leads to accumulation of gangliosides?

A

Tay-Sachs disorder

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22
Q

Inclusion bodies: what metabolic storage disease leads to accumulation of sphingomyelin?

A

Neimann-Pick’s disorder

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23
Q

What causes a cherry red spot in the fovea?

A

Degeneration of neurons of the retina —> leads to a thinning of the macula, allowing the vascularized choroid to show through

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24
Q

Rank the glial elements sensitivity to hypoxia

A

Oligodendrites
Ependymal cells
Astrocytes
Microglia

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25
Q

Review: what is the function of oligodendrites?

A

Secretion of myelin in the CNS

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26
Q

Review: what is the function of astrocytes?

A

Metabolic support
Formation of blood/brain barrier
Triparte synapse formation
Calcium wave communication between astrocytes across long distance

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27
Q

Review: what is the function of microglia?

A

CNS immune cells

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28
Q

Review: what is the function of ependymal cells?

A

Secretion of CSF

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29
Q

What are causes of increased intracranial pressure?

A
  1. Space occupying lesions (tumor, infection, etc)
  2. Edema or swelling
  3. Hydrocephaly
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30
Q

Review: what is swelling of the optic disc called?

A

Papilladema

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31
Q

What is hydrocephalus?

A

Increased volume of CSF
Dilated ventricles

Usually results in increased intracranial pressure

Usually related to imbalance between rates of production and absorption of CSF

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32
Q

Review: CSF

List the flow of CSF from production through reabsorption

A

Ependymal cells in the choroid plexus of the lateral ventricle —> lateral ventricles —> intraventricular foramina of Monro —> 3rd ventricle —> cerebral aqueduct of Silvius —> 4th ventricle —> lateral apertures (foramina of Luschka) OR median aperture (foramen of Megendie) —> subarachnoid space —> arachnoid granulations —> venous sinuses

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33
Q

What is obstructive or non-communicating hydrocephaly?

A

Blockage of CSF circulation, generally trapping CSF in the ventricles and preventing it from reaching the subarachnoid space

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34
Q

Review: what are foramen of Magendie? What are foramina of Luschka?

A

Magendie = central aperture of 4th ventricle, connecting to the cistern magna

Luschka: lateral aperture of 4th ventricle, connecting to the subarachnoid space

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35
Q

What is communicating hydrocephaly?

A

CSF enters the subarachnoid space but circulation or absorption is blocked

  • scarring in subarachnoid granulations or meninges
  • thrombi or other obstructions of dural sinuses
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36
Q

What kind of hydrocephaly does not include increased intracranial pressure? Why?

A

Hydrocephaly ex vacuo

Brain atrophy leaves space for ventricular swelling

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37
Q

What are early symptoms of hydrocephaly?

A

The symptoms of increased intracranial pressure in general:

  • headache
  • mental dullness
  • potential nausea and vomiting
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38
Q

What are advanced symptoms / clinical findings of hydrocephaly?

A
  • papilladema

- herniation of brain tissue, esp through foramen magnum

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39
Q

What is a concussion?

A

Closed head trauma —> indications of injury are typically absent. No bleeding, etc.

Associated with transient loss of consciousness, altered reflexes, etc.

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40
Q

What is contrecoup?

A

Head trauma where the damage is in parts off the brain opposite to the impact site. May be caused by brain tissue rebounding into the skull.

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41
Q

Brain trauma without injury to cranium (6):

A
  1. Contusion (interstitial bleeding, aka bruising)
  2. Laceration (tearing of brain surface with bleeding)
  3. Concussion
  4. Rotary motion with shearing
  5. Contrecoup
  6. Cord trauma
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42
Q

What are the two major classes of CNS infections?

A
  1. Meningitis
  2. Encephalitis

*progression from one to the other is possible

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43
Q

What are the 3 categories of meningitis?

A
  1. Acute pyogenic (bacterial)
  2. Acute lymphocytic (viral)
  3. Chronic
44
Q

What type of meningitis is more common?

A

Viral

45
Q

Bacterial causes of meningitis?

A 
N. Meningitidis 
E. Coli 
H. Influenzae b 
S. Pneumoniae 
S. Agalactiae
46
Q

CSF findings in acute pyogenic (bacterial) meningitis?

A
  1. Elevated polys (polynuclear cells - aka neutrophils)
  2. Reduced glucose
  3. Elevated proteins
    (Both due to bacterial metabolism)
  4. Bacteria present
47
Q

Common causes of viral meningitis?

A
  • mumps
  • ECHO viruses
  • Epstein-Barr
  • Herpes simplex
48
Q

CSF findings in acute lymphocytic (viral) meningitis?

A
  • elevated lymphocytes
  • moderately elevated proteins
  • normal glucose
49
Q

Common causes of chronic meningitis?

A
  • TB
  • fungi
  • brucellosis
50
Q

What are common causes of encephalitis?

A
  • viral
  • slow virus
  • prion diseases (unconventional agents)
51
Q

What is encephalitis?

A

Infection of brain parenchyma

52
Q

What is tropism (referring to encephalitis)?

A

Selectivity of damage inflicted by certain viruses - ie: polio is most likely to destroy anterior horn cells.

53
Q

What viruses are common causes of encephalitis?

A
  • arbor viruses (ie West Nile)
  • childhood infections including measles, rubella, chicken pox
  • herpes
  • polio
  • rabies
  • hiv
54
Q

What rare condition may follow childhood measles, eventually leading to dementia and motor disturbances?

A

Subacute sclerosing panencephalitis (SPPE)

55
Q

Prion diseases lead to what classic presentation of brain tissue?

A

Spongiform degeneration - microscopic vacuolization of brain tissue

56
Q

What 2 prion diseases lead to spongiform degeneration?

What are their causes?

A
  • Creutzfeldt Jacob disease: caused by spontaneous or hereditary mutations, or exposure to tissue containing these mutations through transplant or contact with infected tissue
  • Kuru: cannibalism in New Guinea
57
Q

What is a prion protein?

A

PrP (prion proteins) are mutated forms of normal membrane glycoproteins —> usually a conversion from alpha-helix folding to beta-sheet folding

58
Q

How do prion diseases propagate?

A

Mutated prions appear to induce the mutation in normal proteins when they come in contact, so the disease spreads without a live pathogen.

Mutations in prion regulatory genes are implicated in hereditary conditions.

59
Q

Review: what is Pott’s disease? What is the resulting deformity called?

A

Collapse of the vertebral column as a result of TB

The collapsed column is called a gibbous deformity

60
Q

What are granulomas?

A

Focal nodular infections consisting of macrophages, etc.

May give rise to expanding lesions

61
Q

What causes granulomas?

A
  • TB

- fungi

62
Q

What are common avenues for CNS infection?

A
  • sinus, eye, or ear infections
  • dental work
  • damage to the back of the throat, like a puncture wound
  • peripheral nerve infections (like rabies or herpes)
63
Q

What is a stroke?

A

Focal loss of neurological function of vascular origin which lasts more than 24 hours or leads to death

64
Q

What is a transient ischemic attack (TIA)?

A

Sudden, focal, reversible neurological disturbance due to disruption of blood supply lasting less than 24 hours

*A TIA is a short stroke!

65
Q

Focal ischemic infarct is the most common cause of stroke (75-90%). What is it?

A
  • atherosclerosis
  • thrombi or emboli related to atherosclerosis
  • aneurysms
  • inflammation
66
Q

What are other causes of stroke besides focal ischemic infarct?

A
  • ischemic encephalopathy —> generally ischemia of the entire brain, resulting from heart failure, shock, or another extreme hypotensive event
67
Q

What is the chief complaint for someone with a subarachnoid hematoma?

A

Worst headache they’ve ever had in their life

68
Q

What are the CSF findings for subarachnoid hematomas?

A

<24 hours = bloodstained

>24 hours = xanthocrhomia

69
Q

What is the most common cause of an epidural hematoma?

A

Rupture of the middle meningeal artery

70
Q

What is the “lucid interval”?

A

The early stage of a epidural hematoma, during which neurological symptoms are absent

71
Q

What vessels are associated with a subdural hematoma?

A

Communicating or bridging veins that connect the cortex to the venous sinuses

72
Q

Besides trauma, what is a cause of subdural hematoma?

A

Brain atrophy —> as the brain shrinks, the veins collapse down to the surface and are stretched too far

73
Q

What is the symptom onset for subdural hematomas?

A

Slow and progressive, usually starting 48 hours after trauma

74
Q

What are the classic signs are Parkinson’s?

A
  • stooped posture
  • festinating gait
  • cogwheel rigidity of limbs
  • sluggish voluntary movement
  • pill rolling tremor
  • rigid or expressionless face
  • mask like facies
75
Q

What part of the brain / which neurons are dominantly affected by Parkinsons?

A

Dopamine-producing pigmented neurons of the substantia nigra

76
Q

What deposits form in Parkinson’s, and what are they made of?

A

Lewy bodies - filamentous deposits of ubiquitin, parkin, and more

77
Q

Most Parkinson’s is idiopathic, but secondary Parkinson’s may be related to what conditions?

A
  • encephalitis
  • exposure to dopamine agonists (like contaminated street drugs)
  • repeated head trauma (boxers)
78
Q

Idiopathic dementia is also called what?

A

Alzheimer’s Dementia (AD)

May also be related to MS and Parkinson’s

79
Q

Effects of dementia include:

And what are the ABCs

A
  • memory loss
  • poor judgement
  • delusions of grandeur
  • disorientation

ABC’s
Activities of daily living
Behavior & personality changes
Cognition - thinking, reasoning, learning, memory

80
Q

Primary physical symptom or characteristic of dementia is…

A

Progressive brain atrophy, may be accompanied by hydrocephaly ex vacuo

81
Q

What collects in the brain in dementia? Where?

A

Neuritic plaques or neurofibrillary tangles of amyloid proteins (alpha-beta amyloids)

Dominantly collect in the hippocampus

82
Q

What is ALS? What is it’s common name?

A

Amyotrophic lateral sclerosis (ALS) or Lou Gehrig’s disease

83
Q

ALS is a common disorder of what?

A

Motor Neurons - both UMN and LMN

84
Q

Typically, where are the neurons affected by ALS located?

A
  • Anterior horn of cord
  • Cranial motor nuclei
  • UMN (Betz cells)
85
Q

Review: which are the bulbar nerves?

What areas or structures are part of the bulbar region?

A

Bulbar region = medulla and part of the brainstem (but NOT the midbrain) and the cerebellum

Cranial nerves 9-12 are the bulbar nerves

86
Q

What is the most common neurological disorder among young adults?

A

MS

87
Q

What kind of antigens are commonly seen in MS patients?

A

HLA Class D

88
Q

Neurosyphilis is part of which stage of the disease? What are the common neurological symptoms?

A

Tertiary syphilis

  • paresis due to progressive neuronal loss
  • tabes dorsalis (fibrosis of dorsal columns of spinal cord) leading to locomotor ataxia and muscular atrophy
89
Q

Review: what are syphilitic lesions called?

A

Gummas

90
Q

What percentage of bone cancer is from metastatic spread?

A

70%

91
Q

Review: What are the most common types of primary bone cancers?

A
  • osteosarcoma
  • Ewing’s sarcoma
  • Giant cell tumor (remember: soap bubble appearance)
92
Q

Describe most primary tumors of affecting the CNS

A

Extra-axial = they arise outside the CNS and cause some kind of compression, resulting in nervous system effects —> in the meninges, nerve sheaths, or pituitary or pineal gland

93
Q

What are intra-axial tumors?

A

Tumors that arise within the CNS itself

94
Q

In adults, where are most intra-axial tumors located? How is this location described?

A

70% are in the cerebral hemispheres

Supratentorial

95
Q

In children, where are the majority of intra-axial tumors located? What is this called?

A

70% are in the cerebellum, which is referred to as infratentorial

96
Q

What are the types of gliomas?

A
  • astrocytoma
  • glioblastoma
  • ependymoma
  • oligodendroglioma
97
Q

What is a pheochromocytoma?

What are their consequences?

A

Epinephrine-producing adenoma (tumor of a gland)

Lead to increased HR, BP, etc because of the excess epinephrine

98
Q

Review: what is a neurilemma?

A

The nerve sheath

99
Q

Review: what is Wallerian degeneration?

A

The degeneration that occurs in the distal segment of an injured axon —>

  • Typically a response to mechanical -injury (crushing or cutting)
  • debris is cleared by phages
  • swelling, chromatolysis, etc.
  • regeneration is dependent upon neuron survival, maintenance of the neurilemma, growth factors, and more
100
Q

What are the differences between polyneuropathy and mononeuropathy?

A

Poly

  • usually bilateral, affects multiple nerves in a wide pattern
  • Often caused by disease.
  • affects the longest nerves the most, therefore distal extremities

Mono

  • usually just one nerve, often follows a dermatomal pattern
  • Usually unilateral. Often caused by injury or isolated pathology
101
Q

Beriberi disease is caused by what deficiency?

What does it cause

A

Thiamine —> B1

102
Q

What vitamin deficiency can cause symptoms similar to diabetic neuropathy?

A

B12

103
Q

What is Bell’s palsy? What nerve(s) are affected?

A

Paralysis of CN VII (Facial) usually caused by inflammation of some kind

104
Q

What is Guillian-Barre syndrome?

A

Most common acute paralytic disease of young adults (in the US)

105
Q

Guillian-Barre is idiopathic, but may be a sequela of what conditions?

A
  • acute influenza
  • epstein barr
  • HIV
106
Q

What is tic douloureux?

What is its main symptom?

A

Idiopathic neuralgia

Spontaneous episodes of lighting pain in one or more divisions of CN V (trigeminal)

Systems Path (5 decks)

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