Patho Final II Flashcards
Meningitis
Inflammation of the brain and spinal cord meninges
Usually the result of a viral infection or bacterial infection
Inflamm. may involve all three meningeal membranes (dura mater, arachnoid, pia mater)
Acute or chronic
Bacterial Meningitis
Often fatal
Rapidly progressive and affects meninges/subarachnoid space
Acute, may develop in children with CF or severe burns; most common cause is Group B streptococci during first 2 months of life
Clinical Picture of Bacterial Meningitis
High fever, chills, photophobia, severe headache, vomiting, neck stiffness progressing to drowsiness, stupor, seizures, coma
When severe, neck flexion may cause hip or knee flexion - Brudzinski’s sign
May be resistance to passive knee extension while hip is flexed - Kernig’s sign
Tx for Bacterial Meningitis
Responds well to IV antibiotics and corticosteroids
Supportive therapies for dehydration, shock, fever, electrolyte disorders, seizures
Prognosis: Good if recognized early and responds well to treatment, poorer for infants and elderly patients (mortality rate is 70-100%)
Encephalitis
Inflammation of the parenchyma of brain tissue due to direct viral invasion. Often carried by mosquitos
Clinical Picture: fever, headache, stiffness in back and neck
Tx: Supportive antiviral medication
Prognosis: Some forms kill most pts or lead to permanent neurologic impairment
Poliomyelitis
Caused by poliovirus entering via the GI tract and manifesting in the spinal cord
Destroys anterior horn cells of motor neurons causing paralysis
Polio vaccine!
Stroke
(cerebrovascular accident (CVA))
More common in people over age 50
Major cause of sudden death in this age group
A sudden impairment of cerebral circulation in one or more blood vessels interrupting or lessening oxygen supply usually causing serious damage or necrosis of brain tissue.
Effects of CVA depend on its location and extent of ischemia
Cause of Stroke
80% of cases - thrombus or embolus, less often hemorrhage
Third leading cause of death in US
Clinical Manifestations of Stoke
BEFAST
sudden unconsciousness, permanent neurologic disability, death
Common symptoms - dysphagia, confusion, poor cognition, hemiparesis
BEFAST - Balance, Eyes, Face, Arm, Speech, Time
Tx of Stroke
Depends on severity but can included anti-coagulant, hypertensive medication
Long term speech and PT
Changing controllable risk factors: smoking, obesity, inactivity, alcohol use
Prognosis: varies with severity and area of brain affected; disability affects 75% of those who survive stroke
Role of PTA with Stroke
Assist pt in reestablishing body control and movements lost due to CVA
Transient Ischemic Attack (TIA)
An episode of cerebrovascular insufficiency associated with a partial occlusion of a cerebral artery by plaque or an embolus
Clinical Manifestations of TIA
varies - dizziness, weakness of limbs, numbness, slurring of speech, brief or mild loss of consciousness
Tx: surgery if indicated to open vessel, antiplatelet drugs, statins, mod risk factors
Epilepsy
Seizure - abnormal, unregulated electrical discharge occurring in the brain’s gray matter that transiently interrupts normal brain function
60% cases are unknown cause
Tx - anticonvulsive medication
Prognosis - based on effectiveness of medications and severity of condition
Dementia
A loss of mental ability because of the loss of brain cells or neurons. Three different categories: Head Trauma Dementia, Substance-Induced Dementia, and Vascular Dementia
Head Trauma Induced Dementia
Largest rate amongst professional athletes who play football, ice hockey, boxing, rugby, mixed martial arts, wrestling
Trauma causes brain cells to die due to blood flow being impaired or stopping
Substance Induced Dementia
Substance abuse from alcohol or addictive drugs directly affect cells in the frontal portion of the brain. Alcohol as early as 30 but common in people 50-70 years old.
Vascular Dementia
Acute or chronic cognitive degeneration via decreased blood flow due to atrophy and death of brain cells. Usually after age 70 following multiple strokes, Alzheimers
Alzheimer’s Disease
A degenerative disorder of the cerebral cortex, especially the frontal lobe. Accounts for more than half of all cases of dementia. Progressive loss of mental function with pts generally living about 7 yrs following dx.
Characterized by death of neurons and their replacement of microscopic plaques. Affects people 70 or older.
Parkinson’s Disease
One of the most common disabling diseases in the US. Involved slow and progressive brain degeneration. Characteristically produces progressive mm rigidity, akinesia, and involuntary tremor.
Clinical Manifestations of Parkinson’s Disease
Rigid and immobile hands, slow speech, fine tremor of the hands with a “pill rolling” motion of fingers, infrequent eye blinking, expressionless facial appearance, flexed arms, a “bent forward” posture, walking gait that consists of short quick steps
Amyotrophic Lateral Sclerosis (ALS)
Degenerative disease that affects the upper and lower motor neurons. Chronic, progressively debilitating disease that may be fatal in less than 1 year or may continue for 10 years or more depending on affected mms.
Clinical manifestations of ALS
weak and wasted mms with stiff, awkward, clumsy movements, decreased mm strength usually starting in hands, mm cramps, loss of weight and feeling unusually tired, twitch in mms and increase in tone, control of facial expressions difficult, slurred speech
Huntington’s Chorea
Genetic disease affecting half of children in families in which one parent has the dominant gene. Does not appear until middle age.
Symptoms include: progressive brain deterioration, loss of mm control
Chorea - involuntary, irregular, unpredictable mm movements
Multiple Sclerosis (MS)
Progressive autoimmune disease characterized by inflammation, selective demyelination, and gliosis. Affects approx. 400,000 people in the US
Clinical and pathological characteristics of MS
Paralysis, Intention tremor, scanning speech, nystagmus
Incidence of MS
Onset of MS typically between 20-50 years old.
Affects predominantly white populations
MS Pathophysiology
Acute inflammatory attack on myelin gradually subsides, contributing to pattern of fluctuations in function that characterize disease:
Notes as relapses (periods of acute worsening of neurological function) and remissions (periods without disease progression and partial or complete abatement of s/s)
