Test 2

Question 1

1- What types of cells in the brain are affected in patients with MS? Does MS affect the central or peripheral nervous system?

Answer 1

Oligodendroglial cells
CNS
White matter disease- inflammation of white matter which degrades/ breaks down/ destroys it, forming plaque, causing a loss of myelin, slowing down the brain

Question 2

2- What affect does heat or pregnancy have on patients with MS?

Answer 2

Heat- (Uhthoff’s symptoms)- worsens MS symptoms

Pregnancy- lessens symptoms or puts into remission

Question 3

3- Compare the basic differences between the different courses of MS (e.g. relapse remitting, secondary progression, etc).

Answer 3

Relapsing- remitting MS- 25%, unpredictable relapses during which new symptoms appear or existing symptoms become more severe. Can last for days or months, there is partial or total recovery. Disease may be inactive for months or years. Common among younger people. 1 in 4 people have relapse symptoms

Benign MS- 20%, person has one or two attacks with complete recovery. Associated with less severe symptoms at onset and minimal disability. Does NOT come back

Secondary Progressive MS- most common form 40%, initial pattern may be relapsing- remitting, however this is development of progressive disability later in the course of the disease, symptoms do not go away

Primary Progressive MS- 15%, characterized by slow onset and steadily worsening symptoms. Accumulation of deficits and disability. Least common

Question 4

4- Review effects of genetics and environmental factors on an individual’s chances of developing MS (e.g. temperate climates, race, gender, etc.).

Answer 4

Age of onset- 70% diagnosed between 20-40 years, less common but possible above 60, children are very rare

Race- whites are twice as likely at risk than others, Native Alaskan, Africa, and Scandinavians are extremely low

Gender- females are 2-3 times greater

Environmental- north of equator is 5x at higher risk, if grown up in this area until 16 you are at elevated risk

Genetics- identical twins- 30%, fraternal twins- 4%, 20x (2%) increase risk if immediate family has it

Question 5

5- What are some hypothesized causes of MS?

Answer 5

Auto-immune disease (killer t-cells may attack myelin) and genetics

Question 6

6- What symptoms are associated with MS?

Answer 6

Varies from patient to patient
Vision disturbances, *muscle weakness or stiffness, *coordination problems, spasticity, paresthesia, impairment of pain temperature touch sense, pain, ataxia, tremor, speech disturbances, bladder/ bowel dysfunction, depression, cognitive abnormalities, **fatigue/ malaise (feeling unweel)
Attention/concentration, short term memory, information processing, executive function, perception, speech

Question 7

7- Review frequencies of dementia and cognitive impairment in MS and ALS.

Answer 7

MS- 40-65% have some level of cognitive impairment

ALS- many individuals develop dementia

Question 8

8- Review the basic symptoms of ALS (e.g. fasciculations, dysphagia, muscle weakness, respiratory failure).

Answer 8

Onset is either in the limbs (75%) or bulbar (throat)
Called Lou Gehris’s Disease
Affects pre-central gyrus (motor movement)
Gray matter neuron disease
Weakness (atrophy), cramping, stiffness and tightness (spasticity), twitches (fasciculation), dysarthia (problems producing speech), chewing and dysphagia (problems eating and swallowing), breathing, hyperreflexia (gag reflex)

Question 9

9- What is the difference between familial ALS and sporadic ALS?

Answer 9

Familial ALS- inherited, rarer, 5-10%, can inherit SOD1 enzyme
Sporadic ALS- 90-95%, no family history,
If one parent has SOD1 enzyme, 50% chance it can be passed to the child

Question 10

10- What is the difference between bulbar onset ALS and limb onset ALS?

Answer 10

Limb onset ALS- 75%, symptoms begin in arms or legs
Bulbar onset ALS- symptoms begin with speech or swallowing
Symptoms are a result of muscle weakness and atrophy, they worsen and spread

Question 11

11- Which neurons in the body are affected by ALS? (Hint: think upper motor vs. lower motor).

Answer 11

Grey matter disease
Upper motor neurons- affects precentral gyrus (controls execution of motor movement, betz cells lost)
Lower motor neurons- ventral horn of the spinal cord (afferent signals that tell body to move)

Question 12

12- What is an aneurysm, which neuroimaging technique may by useful in making a diagnosis in a living patient, and what treatments are available?

Answer 12

Aneurysm- weak spot on a blood vessel, usually congenital (born with it), ballooning out of a blood vessel, when it breaks is what causes the hemorrhagic stroke, you want to stabilize it, do not do anything to raise blood pressure
Neuroimaging techniques- CT, MRI, **cerebral angiography
Treatments- aneurysm clip, coiling

Question 13

13- Review the basic differences between embolic and thrombotic strokes.

Answer 13

Thrombotic- stationary clot
Thrombus- buildup of atherosclerosis
Atherosclerosis- happens inside of blood vessels, fatty or plaque buildup, things like high cholesterol, main one*
Stenosis- narrowing of blood vessel
Platelets- they stick together to help stop bleeding
Arteriosclerosis- hardening of arteries, something you see in diabetes or smokers

Embolic- blood clot in motion
Embolus- blockage causing piece of material
Plaque- made up of fat, cholesterol, calcium, and other substances found in the blood
Atrial fibrillation- contraction of the heart that is rapid and irregular, Afib

Question 14

14- Why is it important to treat a stroke patient with drugs as quickly as possible?

Answer 14

To restore blood flow to the brain to prevent sever and permanent damage as well as possible deaths
Medications thin the blood and dissolve the clot for ischemic strokes

Question 15

15- What are transient ischemic attacks?

Answer 15

TIAs- mini strokes, not hemorrhagic in nature typically, usually in older people, usually produce isolated symptoms (tingling, dizziness, smell), symptoms resolve, but can add up and cause larger issues, increases risk for major stroke (20-35%), 50,000 diagnosed each year,
Anterior- motor coordination, muscle weakness, problems speaking
Posterior- double vision, dizziness, neglect
*major warning sign because of the fact that they can add up, should be put on blood thinners

Question 16

16- Is this risk of stroke equal across ethnic groups?

Answer 16

No, African Americans are 2x as likely as Caucasians to have a storke

Question 17

17- What is the difference between anoxia and hypoxia?

Answer 17

Anoxia- complete distribution or stoppage of blood flow and hence oxygen to brain, heart stopping would cause this, massive cell death in 4-6 minutes
Hyoxia- it’s a reduction of oxygen in the blood flow or blood flow to brain. Possible causes would be heart attack, high elevation so reduced oxygen levels, smoking cigs, divers who go down and come back up too quickly, carbon monoxide poisoning

Question 18

18- Review the difference between encapsulated and infiltrating tumors. Review the difference between benign and malignant tumors.

Answer 18

Encapsulated- defined edge, you can see where the tumor is and where the brain is
Edema- swelling
Intracranial pressure- can increase the pressure, will press brain on itself on the skull
Infiltrating- does not have defined boundaries between tumor and brain, goes into brain tissue, causes inflammation, kills neurons
Benign- non cancerous, will not spread, not going to regrow, can be fatal, placement is the biggie
Maligant- cancerous, can spread, often regrow after surgical removal

Question 19

19- Why do some brain tumors result in different symptoms that other brain tumors?

Answer 19

Symptoms vary among patients due to placement and location and size of tumor. If tumor is large and on the left hemisphere it could cause issues such as speech

Question 20

20- On an MRI or CT scan what changes do you see in the ventricles and mid-line in a patient with a brain tumor? Which side is left and which is right on an MRI or CT scan?

Answer 20

Venrtricles seen as asymmetrical and smaller or squished
The midline is shifted past its center line
Left and right are switched on an MRI or CT. so what is left on the scan is actually the right hemisphere in the brain

Question 21

21- What are signs of higher than normal intracranial pressure.

Answer 21

Intracrainial pressure triad- these three symptoms are big indicators
Headache- result of pressure caused by the tumor fluid
Nausea and vomiting
Positive papilledma- swelling of the optic discs

Question 22

22- Review the difference between a glioblastoma multiforme, meningioma, and a metatstatic brain tumor.

Answer 22

Infiltrating
Glioblastoma multiforme- made up of glial cells, typically found after middle age, typically originate in one hemisphere, highly malignant, most patients live 6-12 months after prognosis
Encapsulated
Meningioma- (15%) – tumors coming from meninges (covering of the brain, usually come from arachnoid cells/member), good prognosis, older you get more likely you are to get one, 24,000 cases year of the 80,000, most common primary tumor, usually on surface of brain and press in, fairly easy to remove if on surface of brain, slow growing, more common in women than men, 1 in 5 are in ventricle area and hard to remove, very unlikely to be cancerous
Metastatic tumor- 10x more common than the primary, disease is spread from one organ to another (spreading cancer), usually travels through lymph node system or blood, importance is early detection because its less likely to spread especially to brain, usually in cortex, examples of cancers that cause this:
Bronchogenic carcinoma- lung cancer that spread to brain
Adenocarcinoma of breast- breast cancer and testi cancer can spread to brain
Malignant melanoma- skin cancer, tanning bed and sun bathing

Question 23

23- What is a positive papilledema?

Answer 23

Swelling of the optic discs due to intracranial pressure

Question 24

24- What conditions result in malaise?

Answer 24

Behavioral symptom of brain tumors, also seen in MS

Question 25

25- Briefly review the Glascow coma scale (e.g. what does a low score indicate?).

Answer 25

o	Best Motor Response (6)
o	No motor response
o	Extension to pain
o	Flexion to pain
o	Withdrawal from pain
o	Localizing pain
o	Obeys commands
o	Best Verbal Response (5)
o	No verbal response
o	Incomprehensible sounds
o	Inappropriate words
o	Confused
o	Oriented
o	Best Eye Response (4)
o	No eye opening.
o	Eye opening to pain
o	Eye opening to verbal command
o	Eyes open spontaneously
o	Scoring
•	15 - Normal
•	13-14 - Mild Brain Injury
•	9-12 - Moderate Brain Injury
•	8 or less - Severe Brain Injury

Question 26

26- Review coup vs. contrecoup brain injury.

Answer 26

Coup- when the brain damage happens on the same side where the injury occurs
Countercoup- when the brain dmage happens on the opposite side of where the injury occurs

Question 27

27- In a patient with a head injury, what is edema and what would to expect to see on an MRI? What is it a skull fracture and how would you check for one in a living patient?

Answer 27

Edema- swelling in the brain
MRI- might see a shift in the midline and smaller ventricles
A common method to check for skull fractures is CT scans

Question 28

28- What is a contusion?

Answer 28

Contusion- bruising of brain tissue

Can cause swelling or edema in the brain

Question 29

29- What is the difference between an acceleration head injury and a deceleration head injury?

Answer 29

Acceleration- causes the head to go in motion (getting punched)
Deceleration- the head is in motion and comes to an abrupt stop (car crash, walk into pole)

Question 30

30- Review herniation due to head injuries.

Answer 30

Herniation- when a part of the body gets pushed into something where they shouldn’t be
Foramen magnum- where your spinal cord is
Compression head injury where brain gets pressed down into foramen magnum
*Cranial nerve 3 is pressed
*Causes ipsilateral pupil dilation
Often diagnosed by looking for pupil asymmetry where one pupil is larger than the other