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PAS 753 (Molecular Pathophysiology) > Neurological mechanism of disease > Flashcards

Neurological mechanism of disease Flashcards

1
Q

six disorders that will cause neurollogical disorders

A
  1. vascular
  2. neoplastic
  3. infectious
  4. degenerative
  5. neurotransmitter
  6. seizure disorders
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2
Q

T/F arterial blood flow interruption is a common probelm

A

true

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3
Q

what determines the symptoms resulting from an interuption in arterial blood flow

A

the vessel affected

length of ischemia

neurologic redundancy

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4
Q

what is the most common neurological disorder in the US

incidents per year

deaths

A

CVA (stroke)

500,000/yr

150,000 deaths/yr

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5
Q

what are 4 comorbidities associated with CVA

A

HTN

DM I/II

obesity

smoking

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6
Q

describe the stroke belt

A

a statistical band across the southeastern US where strokes are more common

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7
Q

CVA working definition

A

condition resulting in an abrupt appearence of neurlogical symptoms due to focal vascular disruption that usually involves an infarction

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8
Q

two types of strokes

A

ischemic strokes

hemorrhagic strokes

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9
Q

what type of stroke is most common

A

ischemic (85-90% vs 10-15%)

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10
Q

two types of ischemic strokes

A

thrombotic

embolic

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11
Q

differentiate between thrombotic and embolic ischemic strokes

A

thombolic comes from clot formation due to rupture of an artheroscleroctic plaque, similar to AMI

emoblic involves piece breaking off an existing clot and lodging in the cerebreal vessle

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12
Q

two types of hemorrhagic strokes

A

intracerebral hemorrhage

subarachnoid hemorrhage

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13
Q

what condition is commonly associated with intracerebral hemorrhage

A

HTN

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14
Q

what typically causes subarachnoid hemorrhage

A

bleed from a major cerebral artery in the circle of willis, often from congenital vessel weakness

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15
Q

what is the most common location of aneurysm in the brain

A

anterior cerebral or communicating artery

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16
Q

two common sources of embolic strokes

A

carotid

cardiac

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17
Q

what forms carotid clots leading to embolic stroke

what might be heard on auscultation

what is the surgical treatment

A

atherosclerotic lesions

bruits

endarterectomy

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18
Q

what is the most common source of cardiac emboli

A

mural thombi from atrila fibrillation

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19
Q

how can thrombopphlebitis (DVT) can an embolic stroke

A

passing between a atrial septal defect

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20
Q

what side of the face will have deficits from a right sided stroke?

what side of the body>

A

ipsilateral face

contralateral body

right stroke will cause right facial deficits and right peripheral deficits

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21
Q

common ischemic stroke symptoms

A

usually none other than mild neurological deficits, possibly a mild head ache and decreased LOC

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22
Q

common symptoms of hemorrhagic strokes

A

“worst headache of my life”

decline in LOC

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23
Q

why is stroke prognosis difficult to predict

A

one area can be damaged but other areas can be repurposed to compensate

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24
Q

why is time a necessary to determine the fullt extent of damage caused by a stroke

A

the infarcted area can be under perfused so the extent of the infarcted tissue might not be known for weeks

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25
Q

what is sequela of stroke that can lead to early disfunction

A

increased intracranial pressure

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26
Q

what are goals of treating an ischemic stroke

A

reduce the size of infarction if possible

provide rehab

prevent future strokes

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27
Q

what methods can be used to reduce infarction

A

anticolagulation with IV heparin

IV thrombolytic therapy

cerebreal artery catherization and angioplasty

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28
Q

what is an important consideration when treating hemorrhagic stroke

A

anticoagulation and antithrombolytics are contraindicated in hemorrhagic stroke

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29
Q

four strategies to prevent future strokes

A

reduce the chances of repeat embolis

control HTN

control DM

treat atherosclerosis

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30
Q

two special categories of CVA

A

TIA

silent strokes

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31
Q

define TIA

A

stroke like deficits that with occur and resolve rapidly, usuallly within 60minutes

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32
Q

what is the maximum time limit before recovery for a TIA

A

24 hours

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33
Q

what is the most likely cause of a TIA

A

small emboli from heart or carotids

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34
Q

what is the risk of TIA

A

they can progress to a full stroke without treatment

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35
Q

silent stroke

A

a true stroke that causes infarction in a portion of the brain with no obvious motor or sensory functions

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36
Q

possible changes associated with recurrent silent stroke

A

change in mood/personality

vascular dementia

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37
Q

most CNS tumors come from what cells

A

glial cells

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38
Q

what is the determinant of symptoms caused by a brain tumor

A

location and size of tumor

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39
Q

what will be the difference in distribution from a primary and secondary CNS tumor

A

primary will be more localized

secondary will be more diffuse

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40
Q

what portion of brain tumors are malignant

how many deaths per year

A

50%

13000/year

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41
Q

what are the risk factors for CNS tumors

A

radiation exposure

no other risk factors known

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42
Q

what are the 3 most common CNS tumor histologies

A

gliomas

meningiomas

schwannomas

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43
Q

three types of gliomas

which is the most common

A

astrocytoma (common)

oligodendrogliomas

ependymomas

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44
Q

5 grades of astrocytomas

which are most common in children

adults

A

I-IV

I and II most common in children

IV in adults

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45
Q

specific name for grade IV astrocytoma

A

glioblastoma multiforme

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46
Q

three general symptoms of a primary CNS tumor

A

headache (CC in 30%)

sz

nausea

emesis

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47
Q

specific symptoms associated with primary CNS tumor

A

focal neurological deficits dependent of the location

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48
Q

symptoms associated with primary frontal lobe tumor

A

personality changes

decreased intellect

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49
Q

symptoms associated with primary temporal lobe tumor

A

sz

olfactory and gustatory hallucinations

deja vu/jamais vu

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50
Q

symptoms associated with primary parietal lobe tumor

A

sensory or motor deficits

spontaneous pain symdromes

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51
Q

symptoms associated with primary occipital lobe tumor

A

visual field defects

visual agnosia (cant recognize what you are seeing)

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52
Q

symptoms associated with primary brain stem or cerebellar tumor

A

ataxia

nystagmus

cranial nerve palsies

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53
Q

what is the preferred imaging method for brain tumor

how might the histology of the tumor be idenified

A

MRI over CT

tissue biopsy via needle or craniotomy

54
Q

three general treatment options for CNS tumors

A

surgery, chemo, radiation

55
Q

speficific treatment for prolactinomas

A

dopaminergic drugs

56
Q

radiation options for CNS tumor treatment

A

whole brain vs focused radiation (gamma knife)

57
Q

prognosis for:

pituitary tumors

meningiomas

astrocytomas

A

pituitary good

meningiomas usually good

astrocytomas usualyl bad

58
Q

what is the median survival of a low grade (I-II) astrocytomas

Grade III?

Grade IV?

A

5-10 years

3 years

<1yr

59
Q

how can a bioengineered polio virus treat glioblastomas

A

its been genetically engineered to only be able to infect cancer cells, killing the cancer cells and stimulating the immune response

60
Q

three CNS infections that can cause neurologic symptoms

A

meningitis

encephalitis

abscess

61
Q

5 types of meningitis

A

acute

purulent

septic

chronic

aseptic

62
Q

4 key principles of CNS infections

A

not age dependent

follow acute or chronic course

can be lethal or cause long term disability

there are a wide range of possible pathogens

63
Q

common clinical indications of CNS infection

A

signs of infection (fever, malaise)

alteration of CNS function (AMS, SZ)

64
Q

how quickly will acute meningitis present symptoms

classic symptoms

causes for adults

causes for kids

A

very quickly

fever, stiff neck, headache, AMS, petechial skin rash

strep pneunmoniae, neisseria meningitidis

strep plus hemophilus

65
Q

differentiate between chronic and acute meningitis

A

usually a longer clinical course

similar, but less severe symptoms

usually cuased by mycobacteria, fungi, treponema

66
Q

two indications of aseptic meningitis

A

more benign course

usually caused by viral infection (herpes, mumps, enteroviruses)

67
Q

how is meningitis diagnosed

A

lumbar puncture and culture

68
Q

how is meningitis treated

A

antimicrobial drugs

prevention through vaccines or prophylactics

69
Q

prognosis for bacterial or fungal meningitis without treatment

with treatment

A

bacterial and fungal usually fatal, viral usually not fatal

with treatment most patients will survive but may have deficits

70
Q

three examples of post meningitis deficits

A

hearing loss

impaired cognition

epilepsy

71
Q

what are the common causes of encephalitis (examples)

A

viruses

rabies, measels, polio, herpes, west nile

72
Q

T/F CNS tumors commonly form from neurons

A

false, they usually come from support cells

73
Q

what causes symptoms in brain abcesses

A

increased ICP

destruction of brain tissue

74
Q

what is the usual source of brain abcesses

what are some potential sources of pathogens that cause brain abcesses

A
75
Q

what are the two pathological processes related to degenerative neurological disorders

A

gradual loss of neurons

gradual loss of axons

76
Q

three examples of neuronal loss disorders

A

dementia

ALS

parkinsons

77
Q

dementia

A

generalized loss of neurons

78
Q

ALS

A

amyotrophic lateral sclerosis, loss of upper and lower motor neurons

79
Q

parkinsons disease

A

loss of extrapyramidal motor neurons

80
Q

examples of neural pathway disruptions

A

MS

guillain barre

81
Q

what are the symptoms associated with dementia

A

loss in

memory, reasoning, judgement, abstraction, learning, language

82
Q

four risk factors for dementia

A

age

female

head injury

chronic disease (athersclerosis, DM)

83
Q

three ways to reduce dementia risk

A

intellectual stimulation

social interaction and exercise

statins and nsaids

84
Q

three most common causes of dementia

A

alzheimers

vascular dementia from multiples infarcts

lwey body dementia

85
Q

what is the histological pathophysiology of alzheimers

A

plaques of beta amyloid

tangles of tau proteins

86
Q

what is expected with alzheimers progession of disease

A

steady loss of memory, speech, motor function

average life span of 7-8 years

87
Q

what are the current treatment goals for alzheimers

A

slow the progression of disease

reduce plaques with anti amyloid drugs (possibly not beneficial)

88
Q

prevention of alzheimers

A

statins may reduce risk up to 50S%

NSAIDs

89
Q

occurance of MS

A

350,000, 2-1 women to men

90
Q

what age is mostly likely for the onset of MS

A

20-40

91
Q

what causes MS

A

areas of demylination in the CNS, followed by inflammation and gliosis (scarring)

92
Q

three types of MS

A

relapsing-remitting

primary progressive

secondary progressive

93
Q

three characteristics of relapsing-remitting MS

A

intial symptoms resolve or significantly improve over weaks

months or year can go by before a new lesion forms

eventual decrease in remission and increasing disability

94
Q

three diagnostic indicators of MS

A

clinical course and neurologic findings

MRI of brain and spine

testing of CSF for oligoclonal bandsof IgG

95
Q

common symptoms of MS

A

limb weakness, numbness, paresthesia

spastic paraparesis

optic neuritis

diplopia

loss of sphincter control

vertigo

96
Q

four common MS treatments

A

corticosteriods (prednisone, medrol)

interferon beta 1a

immunosuppresants

IVIG

97
Q

Gullian barre syndrome (acute, idipathic polyneuropathy)

A

rapidly progressive motor paralysis with likely spontaneous recovery

98
Q

what causes GBS

A

autoimmune antibodies produced against myelin

99
Q

T/F most GBS has no trigger event

A

false

100
Q

four triggers for GBS

A

food poisoning caused by campylobacter jejuni

cytomegaloy virus/epstein barr

mycoplasmic pneumonia

some vaccinations

101
Q

what is the key feature of GBS

A

ascending paralysis progressing over hours or days

102
Q

what is the first symptom of GBS

how does this progress

A

usually leg weakness

motor loss comes first, then sensory

103
Q

T/F autonomic dysfunction and facial paralysis can occur in GBS

A

true

104
Q

what is the treatment for GBS

is this time sensitive?

A

IVIG

plasmapheresis

yes time is a factor, hours matter

105
Q

describe the course of recovery for GBS

A

recovery begins 1-4 weeks after onset

can take months or a year to complete

106
Q

how severe is GBS

A

it can be mild or severe, but most require hosptialization and 30% of severe GBS can require mechanical ventiliation

107
Q

what accounts for the 1-4% fatality rate of GBS

A

pulmonary complications or cardiac arrhythmias

108
Q

three categories of neurotransmitter diseases

A

disorders of

deficiency of a neurotransmitter

excess of a neurotransmitter

imbalance of neurotransmitters

109
Q

two diseases caused by a deficiency of a specific neurotransmitter

A

parkinsons (dopamine)

myasthenia gravis (acetylcholine)

110
Q

what is neurological condition is caused by an excess of dopamine

A

psychosis

111
Q

two disorders caused by an imbalance of neurotransmitters

A

chronic depression or psychosis

112
Q

myasythenia gravis

A

a chronic autoimmune disease caused by antibodies against acetylcholine receptors at the neuromuscular junction

113
Q

three common presenting symptoms of myasthenia gravis

A

ptosis

diplopia

dysphagia

114
Q

what is the progression of myasthenia gravis

A

85% will develop generalized muscle weakness notably with repetitive muscle use

115
Q

what is a common accompaniment with lewy body dementia

A

hallucinations

116
Q

T/F vitamin B deficiency can cause dementia

A

true

117
Q

10-15% of MG patients have a ____

3-8% will have or will develop ____

A

thymoma

hyperthyroid (graves disease)

118
Q

three treatment options for MG

A

thymectomy (if present and the patient is between puberty and 60)

acetylcholinesterase inhibitors

immunosuppresive drugs

119
Q

seizure

A

abnormal or excessve and synchronized discharge of CNS neurons

120
Q

epilepsy

A

recurrent seizures with a chronic, underlying cause

121
Q

four causes of isolated seizures

A

drug withdrawl

high fever

infections

vasovagal or orthostatic syncope

122
Q

two etiology categories of epilepsy

A

primary and secondary

123
Q

what is the most common type of epilepsy

when does it usually start

A

primary (idiopathic or constitutonial)

usually before age 20

124
Q

four causes of secondary epilepsy

A

intracranial neoplasms

post head trauma

post meningitis

others

125
Q

four types of generalized seizures

A

tonic-clonic

absence

myoclonic

febrile

126
Q

partial sz (retain consciousness)

A

partial (single muscle group/limb)

complex (sensory hallucinations with increased or decreased motor function

127
Q

four phases of a tonic-clonic seizure

A

LOC, tonus or clonus, apnea, flaccid coma, post ictal

128
Q

how long does the tonic phase of a tonic clonic sz last

clonic phase

A

1minute

2-3 minutes

129
Q

four features of the post-ictal phase

A

headache/confusion

fatigue

muscle soreness

duration of up to several hours

130
Q

three pronged approach to preventing sz

A

enhance inhibitory CNS influences (GABA)

reduce excitatory CNS influences (glutamate)

modulate ionic conductance

131
Q

non pharmacologic treatment

A

neurosurgical ablation/excision of lesion

vagus nerve stimulation for partial sz

132
Q

success rates of conventional seizure treatment

A

70% seizure free on one drug

20% sz on 2 or more drugs

remaining 10% unresponsive

PAS 753 (Molecular Pathophysiology) (17 decks)

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