Neurological Pathologies

Question 1

What is Alzheimers disease & what causes it?

4 marks

Answer 1

A progressive degenerative disorder of the brain, causing memory loss, personality changes & death.
Caused by Plaques & Neurofibrillary tangles in the brain
- Plaques are sticky deposits of protein beta amyloid. It’s produced by many cells in the body but when it accumulates in the brain it stimulates an inflammatory response that kills the brain cells.
- Neurofibrillary tangles of Tau protein - this should support nerve cells but can collapse & become twisted so nerve cell can’t function properly - they shrink & die.
- Also hippocampus of brain that stores new information & knowledge shrinks so pt loses memories & can’t process new information

Question 2

What is peripheral neuropathy & how is it recognised in a pt?

3 marks

Answer 2

Not a disease or condition but a symptom or complication of other underlying conditions. Peripheral nerves are damaged through lack of blood supply, chemical imbalance, trauma or other factors.

• Usually a consequence of injury, infection or systemic disease eg diabetes.
• Symptoms include burning or tingling pain - begins distally & moves proximally, cramping, twitching, hyperesthesia, or autonomic dysfunction - could include problems w/ digestion, HR or respiration, or other systems.

Question 3

What is Parkinson’s Disease & what causes it?

3 marks

Answer 3

A movement disorder involving degeneration of nerve tissue in the brain & reduction of neurotransmitter production in the CNS

• Substantia Nigra cells in the brain degenerate & stop producing dopamine (neurotransmitter), the dopamine usually helps basal ganglia cells maintain balance, posture, motor control & reflexes - co-ordination & controlled movement are lost without it!
• No clear cause for the degeneration - a combination of genetic factors & environmental chemicals eg pesticides, fertilisers, carbon monoxide may be responsible.

Question 4

What symptoms might lead you to suspect that a patient was developing Parkinson’s Disease?

6 marks

Answer 4

> Non specific aches, weariness, weakness & fatigue - slow onset.
Resting tremor - ‘Pill rolling’ in hand, also foot, head & neck - worse at rest, absent in sleep & during activity.
Bradykinesia - difficulty initiating or sustaining movement.
Unco-ordinated movement & poor balance - falling.
Shuffling gait (festinating)
Monotone & expressionless speech
Shrinking, cramped handwriting - poor muscle co-ordination
Sleep disorders
Depression & anxiety
Loss of memory & understanding

Question 5

Describe the main signs & symptoms of Tension Headaches, Migraine Headaches & Cluster Headaches. What symptoms might indicate a serious underlying condition? Give 3 possible serious underlying conditions that may be indicated.

8 marks

Answer 5

• Tension Headaches - episodic or chronic - often bilateral or diffuse. Often described as a tight band around head or deep dull ache rather than a precise focal point for pain.
• Migraine - 2 types w/ aura & w/out aura - both types may have all or any of:
  Throbbing pain on one side, may have same side eye or nostril watering
  Sensitivity to light & noise
  Nausea & vomiting
  Tingling or other sensation changes in extremities.
  May last several hours or days.
  W/ aura 20% - As above but also flashing jagged lights, blurred or lost vision, auditory hallucinations.
• Cluster - Rarer, unilateral may cause same side eye or nostril watering. May last few moments to several hours. Come in clusters eg 1 to 4 headaches a day for 4 to 8 weeks, usually at night, severe enough to wake from sleep.

A serious underlying condition may be indicated when severe, repeating or sudden onset (thunderclap headache), when they appear in a new pattern after age 50, or with gradual onset but with no remission.
Slurred speech, numbness anywhere in body & difficulty w/ motor control.
Possible serious conditions - encephalitis, meningitis, stroke, tumour, aneurysm.

Question 6

What is Multiple Sclerosis?
Briefly describe its atieology & outline its main symptoms & signs.

10 marks

Answer 6

MS is a condition characterised by inflammation & degeneration of the myelin sheath in the spinal cord & brain. Thought to be autoimmune but triggers vary person to person.
- WBCs attack myelin sheaths of nerve cells. Myelin producing cells multiply to repair damage but fail & myelin is replaced with scar tissue which doesn’t conduct nerve impulses well or at all - nerve cells don’t function correctly & may die.
- Often attacks are in flares followed by remission when myelin may regenerate - so symptoms may come & go..
- Some are genetically predisposed but some environmental triggers involved. Incidence increases w/ distance from the equator - Vit D seems to suppress WBCs that promote inflammation.
- Symptoms depend on which areas of nerve tissue affected by inflammation:
> Weakness - nerve transmission slow because myelin disrupted
> Spasms - muscle stiffness or spasm
> Altered sensation - numbness +/or pins & needles
> Eye pain / loss of sight if optic nerve myelin affected
> Incontinence / difficulty urinating
> Sexual dysfunction
> Difficulty walking
> Loss of short term memory & procedural memory
> Nausea / diarrhoea / constipation
> Heat sensitivity
> Fatigue
> Depression

Question 7

What is Motor Neurone Disease (Lou Gehrig disease / Amyotrophic Lateral Sclerosis) & what are its main signs & symptoms?

6 marks

Answer 7

• A progressive & fatal condition that destroys motor neurons in the central & peripheral nervous systems, leading to the wasting of voluntary muscles. Unknown cause.
• 75% affects spinal nerves (as opposed to cranial nerves). Symptoms may include:
  > arms - difficulty w/ fine motor skills - writing doing up a button
  > legs - frequent stumbling
  > Both sides may affected w/ one side more than the other
  > Fatigue, cramping, stiffness & weakness - moves proximally up the limbs to trunk & breathing muscles.
• 25% of cases affect cranial nerve - presents as difficulty w/ speech, swallowing or motor control of tongue, extreme & rapid mood swings.
• There may also be spasticity, exaggerated reflexes, weakness, atrophy, cramps & twitching.
• Although sensory neurones not affected, spasms & gravity may result in pain.

Question 8

What is neuralgia & what causes it?

8 marks

Answer 8

• An intense burning or stabbing pain caused by irritation or damage to a nerve. Pain is usually brief but severe, often shooting along the course of the affected nerve. Pain felt in part of body supplied by the irritated nerve.
• Different types of neuralgia depending on the reason the nerve has been irritated.
  > tooth decay
  > compression due to obstruction or occlusion eg in a joint (sciatica)
  > A virus eg Herpes or Shingles
• Can be caused by systemic disease, inflammation, infection, compression, or physical irritation of a nerve.
• Occipital neuralgia - caused by pinching of occipital nerve.