pros Flashcards
types of dementia ( 5 types)
definition of dementia
reversible vs irreversible factors of dementia
- alzhimers
- vascular
- lewy body
- frontotemporal
- CJD
definition: acquired syndrome of decline in memory and other cognitive domains, sufficient to affect daily functioning
reversible
Drugs
Emotional (depression)
Metabolic disturbances
Eyes and ears (sensory)
Normal pressure hydrocephalus
Tumour
Infection (syphillis)
Anemia/ Alcholism (B12 def)
irreversible
5 different types of dementia
alzhimers disease
(clue: 2 hypothesis)
genes:
- chromosome 21 APP (down syndrome –> trisomy 21)
- chromosome 19 ApOE4 (homozygous)
other risk factors:
- hypercholesterol (can worsen amyloid angiopathy)
- lack of physical and mental exercise
amyloid plaques:
beta and gamma secretase cleave amyloid precursor protein (APP)
= insoluble amyloid beta peptides formed
= aggregation
= amyloid beta plaques
= disrupt neuronal communication
= microglial cells activated
= increase in inflammation
= cause further neuronal damage
+ amyloid angiopathy (blood vessel walls)
tau protein hypothesis:
tau protein is hyperphosphorylated
= misfolded tau protein
= cannot form microtubules
= NF tangles
symptoms: (4 As of alzhimers)
amnesia (hippocampus shrinkage)
aphasia
agnosia –> cannot recall (temporal lobe)
apraxia –> cannot do motor tasks (frontal lobe)
gross:
- smaller, atrophied brain
- widened sulci (FP_T) –> temporal is most affected
- hippocampal shrinkage
- primary and secondary motor cortex well preserved until later disease
histo:
- beta amyloid plaques (silver stain
- NF tangles intracellularly
- thickened blood vessel walls (amyloid angiopathy)
limbic system
- what does it do
- what are the structures involved
SR memory: hippocampus (also involved in spatial problem solving)
stress: amygdala
anterior thalamic nuclei
limbic cortex
different lobes of the brain
- their functional areas
- their functions
anterograde vs retrograde amnesia
anterograde: hippocampal lesions –> cannot form new memories
retrograde: temporal lobe lesions –> LR memories are lost
CJD prion disease
prion protein misfolding into beta-sheet rich
= prion aggregation
= amyloid plaques
= neurodegenration
= vacuolization
= spongiform encephalopathy
= rapidly progressive dementia
= myoclonal jerks, visual disturbances, etc
MRI: hockey stick in caudate/ puatmen
familial
iatrogenic
sporadic
variant
schizophrenia (subset of delerium)
dopamine hypothesis
= excessive/too little dopamine neurotransmission
excessive dopamine neurotransmission
= too happy
= positive symptoms (mesoLIMBIC pathway)
= ADHD
- abnormal behaviour (eg. shoot people)
- delusions
- hallucinations
- disorganised thoughts
(+) symptoms: temporal lobe
mesoLIMBIC: VTA –> nucleus accumbens (emotions!)
too little dopamine
= too sad
= negative symptoms (mesoCORTICAL pathway)
= AAaa (imagine someone sighing)
= apathy, affective flattening, asociatlity cognitive impairment
(-) symptoms: frontal lobe
mesoCORTICAL: VTA –> pre frontal cortex (higher order functions)
parkinson’s (most common neurological disease, think tremors etc.)
genes: PARKIN, PINK1, alpha synuclein
genes
= degeneration of dopamenergic neurons in substantia nigra compacta
= neuronal death
= decrease dopamine (since dopamine is produced by the neurons)
= dopamine clears alpha-synuclein, so now alpha-synuclein cannot be cleared
= alpha-synuclein aggregates
= lewy body formation
= even more neuronal death
histo:
- neuronal death in substantia nigra compacta
- alpha-synuclein aggregates
- lewy body formation
symptoms: TRAPM
Tremors (pill rolling resting tremor)
Rigidity (cogwheel, leadpipe)
Akinesia/ bradykinesia (freezing)
Postural instability
Micrographia
treatment:
1. levodopa + carbidopa
- levodopa crosses BBB
= converted to dopamine via DOPA decarboxylase
2. dopamine receptor agonists
= mimic dopamine
- ropinirole
- rotigotine
3. MAO-B inhibitors
- inhibits MAO-B, which breaks down dopamine
sleep
1 cycle: 90-120 mins
N1: theta waves
- easy to wakeup, feeling drowsy
N2: theta, sleep spindles, K-complexes
- decrease HR, temp
N3: delta waves
**GH release + restorative sleep
- parasomnia
- night terrors
- bed wetting
- deep sleep
REM: mixed frequency
- sleep paralysis
- dreams
- memory consolidation
common sleep disturbances
insomnia, sleep apnea, ageing –> decrease REM and N3
narcolepsy: enter REM too quickly
depression: increase REM
drugs for better sleep:
1. melatonin
2. GABAnergics (benzodiazapine)
3. antihistamines
meningitis
common pathogens:
neonates - strep B (strep agalactiae), ecoli, listeria monocytogenes
children and adults: streptococcus pneuomoniae
teens: nisseria meningiditis (think about teens kissing, sharing food)
empirical antibiotic therapy:
- neonates: gentamicin (aminoglycoside), ampicillin
- adults: ceftriaxone, ampicillin
common viruses:
enterovirus, coxsackie, mumps, HSV
pathophysio of meningitis:
infection
= crosses BBB
= infects the meninges
= inflammed meninges
how to prevent meningitis:
conjugate vaccinations
BCG vaccination (TB meningitis)
MMR vaccination (mumps)
pneumococcal PCV13, PPSV23 (step pneumo)
prophylatic antibiotics:
- rifampin
- cipro
- ceftriaxone
encephalitis
inflammation of brain parenchynama
bacteria: meningoencephalitis (spread from meninges to parenchyma)
viral: HSV
virus directly invades the brain tissue
= neuronal destruction
= temporal lobe involvement
= seizures, memory impairment, altered consciousness
can do PCR of CSF
brachial plexus
- branches
- injuries
musculocutaneous: shoulder and elbow flexion
- biceps brachii
- BRACHIALIS
- corocobrachialis
axillary:
- deltoid (shoulder abduction)
- teres minor (lateral rotation)
radial:
- wrist extensors
- triceps brachii
- BRACHIORADIALIS
median:
- thenar muscles
- lateral 2 lumbricals
ulnar:
- FPB (deep head)
supracondylar fracture
fall on outstretched hand
= supracondylar fracture
= triceps brachii pulls the bones together
= median nerve affected
pect minor
medial pectoral nerve (branch from the ulnar nerve)
- anterior to axillary artery, brachial plexus
origin: coracoid process of scapula (does not even touch the humerus)
insertion: 3-5 ribs
cephallic vein
runs through the deltopectoral groove (between deltoid and pect minor)
- drains the radial side of the hand
vein for venepuncture
median cubital vein
biceps brachii
short head: coracoid process of scapula
long head: supraglenoid tubercle of scapula
insertion: radial tuberousity, biciptal aponeurosis
LOAF
lateral 2 lumbricals
opponens pollicis
abductor pollicis brevis
flexor pollicis brevis
flexor carpi radialis
+ which muscles attach at the medial epicondyle
origin: medial epicondyle
insertion: base of 2nd metacarpal
muscles that attach to the medial epicondyle:
cubital fossa
lateral –> medial
RN BT BE MN
bicipital aponeurosis seprates the brachial artery and the median cubital vein (more superior)
triceps brachii
insertion: olecranon process of ulnar
lat dorsi
thoracodorsal nerve (C7)
