Neuropathophysiology Flashcards
What is a stroke?
A disruption of the blood supply to a part of the brain
Ischemic vs haemorrhagic
Ischemic: blockage
Haemorrhagic: blood vessel bursts
What are the risk factors for a stroke (12)
Hypertension Atrial fibrillation Smoking Diabetes High cholesterol Age Gender Diet Excessive alcohol Obesity Lack of exercise Birth control
What is a common cause of an ischemic stroke?
atherosclerosis
-plaque (easy for clot to form)
What are 2 examples of clots forming outside of the brain
- DVT
- Atrial fibrillation
List the symptoms of a stroke (6)
Severe headache Vision change Dizziness Swallowing difficulties Confusion/ speaking difficulties Numbness/ Weakness
What does motor cortex damage lead to?
Paralysis on the opposite side
What does sensory cortex damage lead to?
Partial loss of sensation on arm and leg (opposite side)
Explain a transient ischemic attack (TIA)
- Mini stroke
- few seconds < 24hrs
- hidden problem with blood flow
What is the F.A.S.T. test?
F.ace (droopy smile)
A.rms (one side can’t life)
S.peech (slur/repeat)
T.ime critical (brain damage)
What is the treatment for an ischemic stroke?
Aspirin: within 48hrs w/ clopidogrel (blood thinner)
Thrombolytics (tpa)
Heparin iv
Warfarin (maybe)
What is brain herniation?
- Increased IC pressure pushes brain out of position
- Brain tissue compressed against bone or rigid folds
What are symptoms of brain herniation?
Compression of oculomotor nerve
- Disabled eye movement
- Drop of eyelid + pupil dilation
- Brain stem hernia = death
What is the management of a haemorrhage stroke?
- Airway management
- Avoid constipation
- Correction of coagulopathies
- Blood pressure management
- Surgery (maybe)
What drugs are used for stroke prevention?
- ACE inhibitors (control HBP)
- Statins (lower blood cholesterols)
- Aspirin (blood thinner)
What surgery can assist with stroke prevention?
Carotid endarterectomy
Angioplasty (Stent)
For aneurysm: clipping/ coiling
What are the two primary traumatic brain injury types?
Focal (deep cut/ bruise): single location
Diffuse (concussion/ axonal injury (tearing))
What are 4 secondary traumatic brain injuries?
Increased IC pressure
Ischemia
Edema
Infection
What is a contusion?
A bruise to cortical surface of brain (primary focal injury)
- Can have permanent damage
Why can contusions cause permanent damage?
Bruised dead tissue is phagocytized –> scarring
What is a concussion?
brief loss of brain function (primary diffuse injury)
-Recovery: 24 hrs
Symptoms may last
What is a diffuse axonal injury?
Primary diffuse injury
(stretch/ tear of nerve cell) Microscopic damage to axons in cerebral hemi, corpus callosum, brain stem
What is responsible for most causes of post traumatic dementia?
Diffuse axonal injury
What is a hematoma?
When blood leaks from a blood vessel
-If removed before loss of consciousness prognosis is good
What are risk factors for Alzheimer’s disease
- Genetics
- Smoking
- Type 2 DM
Explain alzheimer’s disease
- Irreversible
- Tau abnormal proteins (beta amyloid plaques) accumulate outside neurons
- Ach neurons affected
- Progressive shrinkage of cerebral cortex (frontal + temporal lobes)
- Grey matter (cell bodies) disappears
Which lobe shows no change in alzheimers
Occipital
What are the stages of alzheimers disease?
- Short-term memory loss
- Confusional stage
- Incontinence, can’t recognise people, loss ability to speak
How do you manage alzheimer’s disease (5)?
-Cholinesterase inhibitors (donepezil)
-NMDA blocks (memantine)
(reduce effects of glutamate)
-Vitamin E (slow degenerative process)
- Anti-inflammatories, activin A (promote stem cell regeneration)
- Some coffee/ alcohol
What is parkinson’s disease
Selective deterioration of Dopamine in basal ganglia/ nuclei
-Increase in cholinergic activity –> causes hypertonia (stiff) + involuntary movement
What are the symptoms of parkinsons?
- tremor
- pill rolling tremor
- rigidity
- stooped posture
- akinesia (difficulty initiating movement)
- braykinesia (slow movement)
- Dementia
How do you manage parkinsons (5)?
- Increase dopamine levels (Levodopa)
- Carbidopa (inhibit breakdown of dopamine)
- Amantidine (release of dop)
- Pergloide + bromocriptine (agonists)
- Deep brain stimulation
