Neurological mechanism of disease Flashcards
1
Q
six disorders that will cause neurollogical disorders
A
- vascular
- neoplastic
- infectious
- degenerative
- neurotransmitter
- seizure disorders
2
Q
T/F arterial blood flow interruption is a common probelm
A
true
3
Q
what determines the symptoms resulting from an interuption in arterial blood flow
A
the vessel affected
length of ischemia
neurologic redundancy
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
5
Q
what are 4 comorbidities associated with CVA
A
HTN
DM I/II
obesity
smoking
6
Q
describe the stroke belt
A
a statistical band across the southeastern US where strokes are more common
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
8
Q
two types of strokes
A
ischemic strokes
hemorrhagic strokes
9
Q
what type of stroke is most common
A
ischemic (85-90% vs 10-15%)
10
Q
two types of ischemic strokes
A
thrombotic
embolic
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
12
Q
two types of hemorrhagic strokes
A
intracerebral hemorrhage
subarachnoid hemorrhage
13
Q
what condition is commonly associated with intracerebral hemorrhage
A
HTN
14
Q
what typically causes subarachnoid hemorrhage
A
bleed from a major cerebral artery in the circle of willis, often from congenital vessel weakness
15
Q
what is the most common location of aneurysm in the brain
A
anterior cerebral or communicating artery
16
Q
two common sources of embolic strokes
A
carotid
cardiac
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
18
Q
what is the most common source of cardiac emboli
A
mural thombi from atrila fibrillation
19
Q
how can thrombopphlebitis (DVT) can an embolic stroke
A
passing between a atrial septal defect
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
21
Q
common ischemic stroke symptoms
A
usually none other than mild neurological deficits, possibly a mild head ache and decreased LOC
22
Q
common symptoms of hemorrhagic strokes
A
“worst headache of my life”
decline in LOC
23
Q
why is stroke prognosis difficult to predict
A
one area can be damaged but other areas can be repurposed to compensate
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
25
what is sequela of stroke that can lead to early disfunction
increased intracranial pressure
26
what are goals of treating an ischemic stroke
reduce the size of infarction if possible
provide rehab
prevent future strokes
27
what methods can be used to reduce infarction
anticolagulation with IV heparin
IV thrombolytic therapy
cerebreal artery catherization and angioplasty
28
what is an important consideration when treating hemorrhagic stroke
anticoagulation and antithrombolytics are contraindicated in hemorrhagic stroke
29
four strategies to prevent future strokes
reduce the chances of repeat embolis
control HTN
control DM
treat atherosclerosis
30
two special categories of CVA
TIA
silent strokes
31
define TIA
stroke like deficits that with occur and resolve rapidly, usuallly within 60minutes
32
what is the maximum time limit before recovery for a TIA
24 hours
33
what is the most likely cause of a TIA
small emboli from heart or carotids
34
what is the risk of TIA
they can progress to a full stroke without treatment
35
silent stroke
a true stroke that causes infarction in a portion of the brain with no obvious motor or sensory functions
36
possible changes associated with recurrent silent stroke
change in mood/personality
vascular dementia
37
most CNS tumors come from what cells
glial cells
38
what is the determinant of symptoms caused by a brain tumor
location and size of tumor
39
what will be the difference in distribution from a primary and secondary CNS tumor
primary will be more localized
secondary will be more diffuse
40
what portion of brain tumors are malignant
how many deaths per year
50%
13000/year
41
what are the risk factors for CNS tumors
radiation exposure
no other risk factors known
42
what are the 3 most common CNS tumor histologies
gliomas
meningiomas
schwannomas
43
three types of gliomas
which is the most common
astrocytoma (common)
oligodendrogliomas
ependymomas
44
5 grades of astrocytomas
which are most common in children
adults
I-IV
I and II most common in children
IV in adults
45
specific name for grade IV astrocytoma
glioblastoma multiforme
46
three general symptoms of a primary CNS tumor
headache (CC in 30%)
sz
nausea
emesis
47
specific symptoms associated with primary CNS tumor
focal neurological deficits dependent of the location
48
symptoms associated with primary frontal lobe tumor
personality changes
decreased intellect
49
symptoms associated with primary temporal lobe tumor
sz
olfactory and gustatory hallucinations
deja vu/jamais vu
50
symptoms associated with primary parietal lobe tumor
sensory or motor deficits
spontaneous pain symdromes
51
symptoms associated with primary occipital lobe tumor
visual field defects
visual agnosia (cant recognize what you are seeing)
52
symptoms associated with primary brain stem or cerebellar tumor
ataxia
nystagmus
cranial nerve palsies
53
what is the preferred imaging method for brain tumor
how might the histology of the tumor be idenified
MRI over CT
tissue biopsy via needle or craniotomy
54
three general treatment options for CNS tumors
surgery, chemo, radiation
55
speficific treatment for prolactinomas
dopaminergic drugs
56
radiation options for CNS tumor treatment
whole brain vs focused radiation (gamma knife)
57
prognosis for:
pituitary tumors
meningiomas
astrocytomas
pituitary good
meningiomas usually good
astrocytomas usualyl bad
58
what is the median survival of a low grade (I-II) astrocytomas
Grade III?
Grade IV?
5-10 years
3 years
\<1yr
59
how can a bioengineered polio virus treat glioblastomas
its been genetically engineered to only be able to infect cancer cells, killing the cancer cells and stimulating the immune response
60
three CNS infections that can cause neurologic symptoms
meningitis
encephalitis
abscess
61
5 types of meningitis
acute
purulent
septic
chronic
aseptic
62
4 key principles of CNS infections
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
common clinical indications of CNS infection
signs of infection (fever, malaise)
alteration of CNS function (AMS, SZ)
64
how quickly will acute meningitis present symptoms
classic symptoms
causes for adults
causes for kids
very quickly
fever, stiff neck, headache, AMS, petechial skin rash
strep pneunmoniae, neisseria meningitidis
strep plus hemophilus
65
differentiate between chronic and acute meningitis
usually a longer clinical course
similar, but less severe symptoms
usually cuased by mycobacteria, fungi, treponema
66
two indications of aseptic meningitis
more benign course
usually caused by viral infection (herpes, mumps, enteroviruses)
67
how is meningitis diagnosed
lumbar puncture and culture
68
how is meningitis treated
antimicrobial drugs
prevention through vaccines or prophylactics
69
prognosis for bacterial or fungal meningitis without treatment
with treatment
bacterial and fungal usually fatal, viral usually not fatal
with treatment most patients will survive but may have deficits
70
three examples of post meningitis deficits
hearing loss
impaired cognition
epilepsy
71
what are the common causes of encephalitis (examples)
viruses
rabies, measels, polio, herpes, west nile
72
T/F CNS tumors commonly form from neurons
false, they usually come from support cells
73
what causes symptoms in brain abcesses
increased ICP
destruction of brain tissue
74
what is the usual source of brain abcesses
what are some potential sources of pathogens that cause brain abcesses
75
what are the two pathological processes related to degenerative neurological disorders
gradual loss of neurons
gradual loss of axons
76
three examples of neuronal loss disorders
dementia
ALS
parkinsons
77
dementia
generalized loss of neurons
78
ALS
amyotrophic lateral sclerosis, loss of upper and lower motor neurons
79
parkinsons disease
loss of extrapyramidal motor neurons
80
examples of neural pathway disruptions
MS
guillain barre
81
what are the symptoms associated with dementia
loss in
memory, reasoning, judgement, abstraction, learning, language
82
four risk factors for dementia
age
female
head injury
chronic disease (athersclerosis, DM)
83
three ways to reduce dementia risk
intellectual stimulation
social interaction and exercise
statins and nsaids
84
three most common causes of dementia
alzheimers
vascular dementia from multiples infarcts
lwey body dementia
85
what is the histological pathophysiology of alzheimers
plaques of beta amyloid
tangles of tau proteins
86
what is expected with alzheimers progession of disease
steady loss of memory, speech, motor function
average life span of 7-8 years
87
what are the current treatment goals for alzheimers
slow the progression of disease
reduce plaques with anti amyloid drugs (possibly not beneficial)
88
prevention of alzheimers
statins may reduce risk up to 50S%
NSAIDs
89
occurance of MS
350,000, 2-1 women to men
90
what age is mostly likely for the onset of MS
20-40
91
what causes MS
areas of demylination in the CNS, followed by inflammation and gliosis (scarring)
92
three types of MS
relapsing-remitting
primary progressive
secondary progressive
93
three characteristics of relapsing-remitting MS
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
three diagnostic indicators of MS
clinical course and neurologic findings
MRI of brain and spine
testing of CSF for oligoclonal bandsof IgG
95
common symptoms of MS
limb weakness, numbness, paresthesia
spastic paraparesis
optic neuritis
diplopia
loss of sphincter control
vertigo
96
four common MS treatments
corticosteriods (prednisone, medrol)
interferon beta 1a
immunosuppresants
IVIG
97
Gullian barre syndrome (acute, idipathic polyneuropathy)
rapidly progressive motor paralysis with likely spontaneous recovery
98
what causes GBS
autoimmune antibodies produced against myelin
99
T/F most GBS has no trigger event
false
100
four triggers for GBS
food poisoning caused by campylobacter jejuni
cytomegaloy virus/epstein barr
mycoplasmic pneumonia
some vaccinations
101
what is the key feature of GBS
ascending paralysis progressing over hours or days
102
what is the first symptom of GBS
how does this progress
usually leg weakness
motor loss comes first, then sensory
103
T/F autonomic dysfunction and facial paralysis can occur in GBS
true
104
what is the treatment for GBS
is this time sensitive?
IVIG
plasmapheresis
yes time is a factor, hours matter
105
describe the course of recovery for GBS
recovery begins 1-4 weeks after onset
can take months or a year to complete
106
how severe is GBS
it can be mild or severe, but most require hosptialization and 30% of severe GBS can require mechanical ventiliation
107
what accounts for the 1-4% fatality rate of GBS
pulmonary complications or cardiac arrhythmias
108
three categories of neurotransmitter diseases
disorders of
deficiency of a neurotransmitter
excess of a neurotransmitter
imbalance of neurotransmitters
109
two diseases caused by a deficiency of a specific neurotransmitter
parkinsons (dopamine)
myasthenia gravis (acetylcholine)
110
what is neurological condition is caused by an excess of dopamine
psychosis
111
two disorders caused by an imbalance of neurotransmitters
chronic depression or psychosis
112
myasythenia gravis
a chronic autoimmune disease caused by antibodies against acetylcholine receptors at the neuromuscular junction
113
three common presenting symptoms of myasthenia gravis
ptosis
diplopia
dysphagia
114
what is the progression of myasthenia gravis
85% will develop generalized muscle weakness notably with repetitive muscle use
115
what is a common accompaniment with lewy body dementia
hallucinations
116
T/F vitamin B deficiency can cause dementia
true
117
10-15% of MG patients have a \_\_\_\_
3-8% will have or will develop \_\_\_\_
thymoma
hyperthyroid (graves disease)
118
three treatment options for MG
thymectomy (if present and the patient is between puberty and 60)
acetylcholinesterase inhibitors
immunosuppresive drugs
119
seizure
abnormal or excessve and synchronized discharge of CNS neurons
120
epilepsy
recurrent seizures with a chronic, underlying cause
121
four causes of isolated seizures
drug withdrawl
high fever
infections
vasovagal or orthostatic syncope
122
two etiology categories of epilepsy
primary and secondary
123
what is the most common type of epilepsy
when does it usually start
primary (idiopathic or constitutonial)
usually before age 20
124
four causes of secondary epilepsy
intracranial neoplasms
post head trauma
post meningitis
others
125
four types of generalized seizures
tonic-clonic
absence
myoclonic
febrile
126
partial sz (retain consciousness)
partial (single muscle group/limb)
complex (sensory hallucinations with increased or decreased motor function
127
four phases of a tonic-clonic seizure
LOC, tonus or clonus, apnea, flaccid coma, post ictal
128
how long does the tonic phase of a tonic clonic sz last
clonic phase
1minute
2-3 minutes
129
four features of the post-ictal phase
headache/confusion
fatigue
muscle soreness
duration of up to several hours
130
three pronged approach to preventing sz
enhance inhibitory CNS influences (GABA)
reduce excitatory CNS influences (glutamate)
modulate ionic conductance
131
non pharmacologic treatment
neurosurgical ablation/excision of lesion
vagus nerve stimulation for partial sz
132
success rates of conventional seizure treatment
70% seizure free on one drug
20% sz on 2 or more drugs
remaining 10% unresponsive
