Neurological And Endocrine Disorders Flashcards
Cerebrovascular accident
- stroke
- sudden disruption of blood flow to the brain that causes loss and neurological functioning
Risk factors of a cerebrovascular accident
- leading risk factor is hypertension
-atherosclerosis (artery hardening)
- heart disease
- diabetes
- cigarette smoking
- heavy alcohol consumption
- obesity
- age
- male gender
- black
- family history of stroke
Types of cerebral vascular accident
- ischemic stroke
- embolic stroke
Ischemic stroke
- most common
- blood clots or other particles block the blood vessels to the brain
Thrombotic stroke
- blockage in the cerebral artery due to a blood clot that developed in an artery in the brain
Embolic stroke
- blockage in the cerebral artery due to a blood caught that developed in the heart or elsewhere in the body and traveled through the bloodstream to the brain
Transient ischemic stroke (TIA)
- blockage of an artery for less than 5 minutes that causes temporary symptoms
- medical emergencies and warning signs for more severe strokes in the future
Hemorrhagic stroke
- due to bleeding that occurs when there is a leaker rupture
Intercerebral hemorrhage
- rupture in a cerebral artery within the brain
SubArachnoid hemorrhage
- rupture in the space between the brain and the membrane that covers the brain
Symptoms of a stroke
- depend on the artery involved
Middle cerebral artery stroke
- usually involved
- contralateral sensory loss
,-contralateral hemiparesis (weakness)
- hemiplegia (paralysis)
- contralateral homonymous
hemianospsia (visual field loss)
-dysarthria (slurred speech)
- aphasia(when dominant hemisphere is affected)
- apraxia and contralateral neglect (non-dominant hemi)
Sxs of Stroke involving posterior cerebral artery
- contralateral sensory loss
- hemiparesis
- contralateral homonymous hemianospsia or other visual impairment
-dysarthria
- nausea and vomiting
- memory loss
Sxs of a stroke involving the anterior cerebral artery
- contralateral sensory loss
- hemiparesis (usually leg)
- impaired insight and judgment
- mutism
- apathy
- confusion
- urinary incontinence
Traumatic brain injury
- Open
- closed
Open TBI
- penetrating head injury
- depend on injuries location in severity
Closed head injuries
- usually cause more widespread damage
TBI symptoms
- loss of consciousness
- anterograde or retrograde amnesia
- nausea and vomiting
- headaches
- sleep disturbances
- depression
- irritability
- aprosodia
- seizures
Anterior grade amnesia
- post-traumatic amnesia when do the TBI
- a good predictor of recovery from other symptoms
Retrograde amnesia
- recent long-term memories are affected more than remote memories
- when lost memories, return those from the most distant past are recovered first
Aprosodia
- kind of car as a result of a TBI, stroke, a progressive neurological disease
- inability to express or understand prosody (variations in rhythm, pitch, timing, and loudness of speech that are used to convey emotional information)
Post-traumatic seizures( PTS)
- occur within one week after TBI
- can be successfully treated with anti-seizure medications
Post-traumatic epilepsy (PTE)
- seizures that occur more than a week after a TBI
- harder to treat
- treatment:
- Vagus nerve stimulation
- Responsive neurostimulation
- Surgery when medication is ineffective
Seizures after TBI
- some evidence that they’re linked to temporal lobe and hippocampal atrophy
Prognosis of TBI
- most recovery during the first 3 months
- substantial additional improvement during first year
- many people continue to have symptoms indefinitely, especially those with moderate to severe injury
Huntington’s disease
- neurodegenerative disorder
- affect, cognitive, and motor symptoms
- caused by an autosomal dominant gene= offspring has a 50% chance of inheritance
- abnormalities in the basal ganglia and abnormal levels of gaba and glutamate
Onset of Huntington’s disease
- 30 to 50 years old
Prognosis of Huntington’s disease
-varies
- effective symptoms often proceed cognitive and motor symptoms
(Manifestation of underlying pathological changes) - as disease progresses, effective, cognitive, and motor symptoms worsen with atheotosis & chorea beginning several years after onset.
- and the later stages, movement disorders are severe, and the person may have trouble speaking, swallowing and may meet the criteria for major or mild NCD
symptoms of Huntington’s disease
- short-term memory loss
- impaired concentration and judgment
- clumsiness
- fidgeting
- involuntary movements
- facial grimacing
Athetosis
- non-Rhythmic, slow, weathering movements
Chorea
- involuntary rapid, jerky, movements in the arms, legs, & trunk
Parkinson’s disease
- neurodegenerative disorder
- produces prominent motor symptoms
- interaction between genetic factors and environmental risk factors
Neurotransmitters and Parkinson’s disease
- loss of dopamine producing cells in a substantial negra and basal ganglia cause motor symptoms
- excessive glutamate activity and basalgamia is implicated in the progression of the disease
- the generation of norepinephrine neurons in the locus cerelius is responsible from non-motor symptoms (depression, cognitive deficits, and sleep disturbances)
Genetics and Parkinson’s disease
-variants of ApoE gene linked to increased risk of NCD due to Parkinson’s disease and other NCDs including NCD due to Alzheimer’s, lewy bodies, and vascular neurocognitive disorder
Primary motor symptoms of Parkinson’s disease
- tremor: when muscles are at rest and begins in hands and includes pill rolling
- impaired balance and coordination
- rigidity and limbs and trunk
- slowed voluntary movements (bradykinesia) that include a mask like facial expression and decreased eye blink frequency
Depression and Parkinson’s disease
- up to 50% of people experience depression at some time during the disorder
- depressive symptoms proceed motor symptoms in about 20% of cases
NCD and Parkinson’s disease
- people eventually developed milder major NCD
Treatment of Parkinson’s disease
- no cure
- symptoms or temporary alleviated in early stages with L-dopa (+ dopamine)
- deep brain stimulation (DBS) used to reduce motor symptoms
Deep brain stimulation
- and planting electrodes that deliver electrical impulses and areas of the brain known to be responsible for motor symptoms experienced and implanting a programmable pulse regulator under the skin and the chest
- when turned on by patient, the pulse generator sends electrical impulses to target areas of the brain which alters brain activity in those areas
- considered when motor symptoms are not adequately controlled by medication and significantly impairing quality of life
- also used to treat essential tremor, dystonia, refractory, epilepsy, and intraceable OCD
Seizure disorders
- caused by abnormal electrical activity in the brain
Focal onset seizures
- beginning a localized area in one cerebral hemisphere and affect one side of the body
- May spread to other parts of the brain
- symptoms depend on location
Focal onset aware seizures
- also known as simple partial seizures
- do not affect consciousness
Focal onset impaired awareness seizures
- also known as complex partial seizures
- involve a change in consciousness and may begin with an aura
Frontal lobe seizures
- second, most common type of focal onset seizure
- often occur during sleeping
- last less than 30 seconds
- kicking, rocking, bicycle pedaling, and other repetitive movements
- abnormal body posturing
- explosive screams or laughter
- trouble speaking with intact comprehension
- autonomic symptoms
Parietal lobe seizures
- tingling, pain, numbness, and other abnormal sensations
- feeling of movement (floating)
- distortions in body image (feeling that a body part is enlarged, shrunken, or absent)
Occipital lobe seizures
- rapid eye blinking
- eyelid fluttering
- involuntary eye movements
- flashing or stationary bright lights, multi-colored circular patterns, and other simple visual hallucinations
- partial blindness, impaired, visual acuity, or other visual impairment
Generalize onset seizures
- affect both hemispheres
- generalize onset motor seizure or generalize onset non-motor seizures
Generalized onset motor seizures
- also known as tonic – chronic seizures or grand mal seizures
- cause a change in consciousness
- include a tonic phase that involves Tiffany the muscles in the face and limbs followed by a clonic phase that involves jerky rhythmic movements in the arms and legs
- when person regains consciousness may be depressed, confuse, fatigue, and have no memory for the events that occur during the seizure
Generalized onset non-motor seizures
- also known as absence seizures or petite mal seizures
- very brief loss of consciousness and a blank or absent stare
- some people’s eyes turn upwards and eyelids. Flutter
Migraines
- intense throbbing pain that is usually on one side of the head
- maybe accompanied by nausea/ vomiting or sensitivity to light or other sensory stimuli
Two types: with or without aura
Migraine headaches with aura
- classic migraines
Migraine headaches without aura
- common migraines
Triggers of migraines
- emotional stressor relaxation after stress
- abrupt weather changes
- alcohol
- certain foods
- missing a meal
Intensity of migraine
- maybe worsen by bending forward , walking, other routine physical activity
Cause of migraine
- not fully understood
- link to low serotonin
Treatment of migraines
- non-steroidal anti-inflammatory drugs
-ergot alkaloids
- SSRIs
- SSRI agonist
- beta blockers
- combination of thermal biofeedback and autogenic training
Hypertension
- two types: primary hypertension and secondary hypertension
Primary hypertension
- also known as essential hypertension
- physiological cause of high blood pressure is unknown
- up to 90% of all cases
- silent killer because it’s often asymptomatic
Secondary hypertension
- high blood pressure is due to a known disease
Risk factors for primary hypertension
- obesity
- tobacco use
- excessive salt intake
-stress
-♂️
- old age
- black
- family history of hypertension
Treatment of hypertension
- emphasizes lifestyle changes
- diuretic, beta blocker, ace inhibitor, or other blood pressure medication and biofeedback or relaxation training
Most common endocrine disorders
- disorders of the thyroid gland
Hyperthyroidism
- caused by hyper secretion of the thyroid hormones
Symptoms of hypothyroidism
- increased rate of metabolism
- elevated body temp
- heat intolerance
- increased appetite with weight loss
- accelerated heart rate
- insomnia
- emotional lability
- reduced attention span
Hypothyroidism
- hypo secretion of hormones
Symptoms of hypothyroidism
- decreased rate of metabolism
- reduced appetite with weight gain
- slowed heart rate
- lowered body temp
- cold intolerance
- depression
- lethargy
- decrease libido
- confusion
- paired concentration in memory
Pituitary gland
- responsible for release of several hormones included antideruretic hormone (ADH)
Antideretic hormone
- also known as vasopressin
- responsible for the amount of water excreted in urine
- low levels can cause central diabetes insipidus
Symptoms of central diabetes insipidus
- frequent and excessive urination
- extreme thirst
- hydration
- constipation
- weight loss
- low blood pressure
Nephrogenic diabetes insipidus
- diabetes insipidus caused by a failure of the kidneys to respond to ADH
Pancreas
- maintains body’s blood glucose balance through control over the release of insulin and other hormones
Hypoglycemia
- pancreas releases too much insulin and blood glucose levels decrease
- can also be caused by a high dose of insulin or other diabetic medication, skipping meals, exercising more than usual, excessive alcohol consumption, severe hepatitis or cirrhosis of the liver, and adrenal or pituitary gland disorders
Symptoms of hypoglycemia
- nervousness
- shaking
- sweating
- hunger
- dizziness
- irritability
- confusion or disorientation
- weakness
- sleepiness
-pallor - blurred vision
- tingling or numb lips and tongue
- headache
- faster or irregular heart beat
- clumsiness
- seizures
- loss of consciousness
Diabetes mellitus
- pancreas releases two little insulin or the body is unable to use the insulin in the pancreas produces resulting in blood glucose levels increasing
- type 1 and type 2
Type 1 diabetes
- autoimmune disease that destroys insulin producing cells in the pancreas
- evidence of a genetic predisposition (primary risk factor)
- autoimmune response can be triggered by a viral infection or other factors
Type 2 diabetes
- more common type of diabetes
- occurs when the pancreas produces an insufficient amount of insulin or the body is unable to use the insulin produced by the pancreas
Risk factors for type 2 diabetes
- genetic predisposition
- being overweight
- sedentary lifestyle
- being over 45 years of age
- risk is higher for native American/blacks, and Hispanic Latinos
Symptoms of type 1 and 2 diabetes
- extreme hunger and thirst
- frequent urination
- unexplained weight loss
- fatigue
- blurred vision
- numbness or tingling in the hands or feet
- frequent infections
Electroencephalography ( EEG)
- used to measure brains electrical activity using small electrodes that are placed in the scalp to assess activity in the brain area adjacent to the electrode
- useful for quickly identifying changes in brain activity and response to stimuli, which can be used to diagnose, seize your disorders, brain injuries, tumors and sleep disorders and also confirm brain death
Neuropsychiatric EEG based assessment aid (NEBA)
- approved by FDA as a diagnostic tool in combination with medical and psychological exams to diagnose ADHD in 6 to 17-year-olds
- excesses the ratio of theta and beta waves which has been found to be higher in adolescents and kids with ADHD
Microelectroids
- used to measure the electrical activity of a single neuron
,- techniques are primarily used in research but have been used to assist with movement disorder surgeries
Neuroimaging techniques
- structural techniques
- functional techniques
Structural techniques
- CT scan
,- MRI - diffusion tensor imaging (DTI)
- IDENTIFY STRUCTURAL CHANGES
CT scan and MRI
- used to identify abnormalities in the density of brain tissue
Advantages of CT scan
- scanners are usually available at a hospital emergency room
- lost less than an MRI
- provides images more quickly than an MRI
Disadvantages of a CT scan
- exposes patients to a ionizing radiation (x-rays
MRI advantages
-produces more detailed, 3D images
- can detect microhemages, contusions, and gliosis (scarring)
-
Disadvantage of an MRI
- Aquarius patients to remain motionless for a long period of of time
- requires the use of ear plugs or headphones because of the noise
DTI
- MRI base neural imaging technique used to assess the structural integrity of white matter tracks. (Myelinated axons) that connect different regions of the brain
- identifies abnormalities in the rate and direction of the movement of water molecules through the axons
- used to evaluate the effects of TBI and concussion and study white matter abnormalities associated with NCD, schizophrenia, autism, epilepsy, MS, and other conditions as well as normal organization and development of white matter
Functional techniques
- provide information about brain activity by assessing glucose consumption or oxygen consumption
- positron emission topography (PET)
- single photon emission computed topography (SPECT)
- FUNCTIONAL MRI (fMRI)
Oxygen consumption
- assessed by measuring regional cerebral blood flow are blood volume
PET and SPECT
- both use radioactive tracers that are injected into the bloodstream to measure brain activity
fMRI
- uses magnetic fields and radio waves
Neuroimaging and diagnosis of NCD due to Alzheimer’s
- not sufficient enough to to diagnose
- use in conjunction with other techniques to insist in the diagnosis by rolling out other causes of cognitive impairments
MRI versus CT
- usually prefer because provides accurate three-dimensional measure of volume of the brain structures
- CT may be used instead because scanners are usually available in hospital ERs and cost less, provides images quicker or because MRI is unavailable
Functional techniques used for diagnosing neurocognitive disorders
-fluorodexyglucose PET (FDG -PET) assesses glucose metabolism and is used for distinguishing between Alzheimer’s disease and other NCDs, especially frontal temporal neurocognitive disorder