Week 9 + 10 Nervous System Flashcards
how long does a migraine last
4 to 72 hours
why do women more often have igraines
hormonal differences
diagnostic criteria for migraines (need 2)
-unilateral head pain
-pulsating pain
-pain worsening with activity
- moderate or severe pain intensity
-and at least one of the following: nausea or vomiting, or both, or photophobia and phonophobia.
chronic migraine dx, how many days
more than 15 days per month for at least 3 months
trigeminal autonomic cephalagia
cluster headaches
which headache occurs primarily warily in men
cluster
uncommon headaches occur in clusters for a period of days followed by a long period of spontaneous remission
-extreme pain
-short duration
cluster headaches
headache attack usually begins without warning and is characterized by severe, unilateral tearing; and burning, periorbital, and retrobulbar or temporal pain lasting 30 minutes to 2 hours.
cluster headache
do cluster headaches usually happen on the same side
yes
mild to moderate bilateral headache with a sensation of a tight band or pressure around the head. The onset of pain is usually gradual
tension HA
sudden, transient disruption in brain electrical function caused by abnormal excessive hypersynchronous discharges of cortical neurons
seizure
the recurrence of seizures and a type of seizure disorder for which no underlying correctable cause for the seizure can be found
epilepsy
involve neurons bilaterally
-originate from a subcortical or deeper brain focus
-result from cellular, biochemical, or structural abnormalities of a widespread nature
-consciousness always impaired/lost
generalized seizures
seizure with neurons only unilaterally
focal seizures
involve neurons bilaterally
generalized seizures
-local (focal) onset, and originate from discrete areas usually associated with structural abnormalities localized to the cortical brain tissue
-consciousness may be maintained
focal seizure
occur when there is disruption in the balance of excitation and inhibition of electrical impulses
seizures
long-lasting depolarization of the neuron caused by an influx of extracellular calcium that opens the voltage-dependent sodium channel. The influx of sodium generates repetitive action potentials.
invitation
in epilepsy the sodium potassium channels allow for an influx of too much
too sodium
potassium takes too long to leace
(phase of muscle contraction associated with increased muscle tone)
tonic phase
(phase of alternating contraction and relaxation of muscles)
colonic phase
This inhibition causes an interruption in the seizure discharge, producing an intermittent contract-relax pattern of muscle contractions. The intermittent clonic bursts gradually become more and more infrequent until they finally cease. At this point the epileptogenic neurons are exhausted and the neuronal membranes probably are hyperpolarized.
This inhibition causes an interruption in the seizure discharge, producing an intermittent contract-relax pattern of muscle contractions. The intermittent clonic bursts gradually become more and more infrequent until they finally cease. At this point the epileptogenic neurons are exhausted and the neuronal membranes probably are hyperpolarized.
seizures demand a 250% increase in
and a increase in what
ATP
increase cerebral oxygen need
severe seizures can lead to deficient in
ATP, phosphocreatine, and glucose then occurs,
-lactate accumulates in the brain tissues
Severe seizures thus may produce
secondary hypoxia, acidosis, and lactate accumulation, all of which are imbalances that may result in progressive brain tissue injury and destruction.
state of continuous seizures lasting more than 5 minutes, or rapidly recurring seizures before the person has fully regained consciousness from the preceding seizure, or a single seizure lasting more than 30 minutes.
Status Epilepticus
postictal state
period from when seizure ends and the patient returns to their baseline
The person is still in a postictal state
Status Epilepticus
Status epilepticus most often results from
-abruptly stopping antiseizure medications
-untreated or inadequately treated persons with seizure disorders.
status epileptics medical emergency
-cerebral hypoxia
-Mental retardation, dementia, other brain damage, and even death are serious threats.
-Aspiration risk.
Two types of symptoms often signal an impending generalized tonic-clonic seizure:
- an aura- a partial seizure that immediately precedes the onset of a generalized tonic-clonic seizure
2.prodroma (malaise, headache etc)- an early manifestation that may occur hours to days before a seizure
Two types of symptoms often signal an impending generalized tonic-clonic seizure:
- an aura- a partial seizure that immediately precedes the onset of a generalized tonic-clonic seizure
2.prodroma (malaise, headache etc)- an early manifestation that may occur hours to days before a seizure
signs that seizure is coming on
sudden uncontrollable jerking movements of one or more extremities or the entire body
-Loss of postural tone
-person falls to the ground and the body stiffens in an opisthotonos position with legs and, usually, arms extended;
evaluation for seizures
-health history
-bloodwork (glucose, calcium, blood urea nitrogen, urine sodium, and creatinine)
-EEG
-CSF examination
Of all strokes, 87% are
ischemic (thrombotic or embolic)
(obstruction within a blood vessel to the brain)
greatest risk factor for stroke
high BP
arise from arterial occlusions caused by thrombi formed in the arteries supplying the brain or in the intracranial vessels
thrombotic stroke
development of a cerebral thrombosis most frequently is attributed to
atherosclerosis (thickening, plaque in arteries)
-inflammatory disease processes (arteritis) that damage arterial walls
Transient episodes of neurologic dysfunction (weakness, numbness, sudden confusion, loss of balance, loss of vision, sudden severe headache) resulting from focal cerebral ischemia.
Transient Ischemic Attacks (TIAs)
will people with TIA experience a stroke?
likely within the year
Involves fragments that break from a thrombus formed outside the brain or in the heart, aorta, or common carotid artery
embolic stroke
risk factor for stroke
atrial fibrillation (a fib)
Embolization is usually in the
middle cerebral artery (the largest cerebral artery).
when an area of the brain loses blood supply and becomes ischemic because of vascular occlusion (embolic or thrombotic).
Cerebral Infarction
most common cause of brain occlusion (lose of blood supple)
-Cerebral thrombi and cerebral emboli
-also hypotension and atherosclerosis
when is Thrombolysis given
3-4.5 hours of onset of symptoms
if it is more than 4.5 hours and thrombolysis can’t be given, what is given
antiplatelet agents are administered (Aspirin, clopidogrel, or aspirin plus extended-release dipyridamole)
the progressive failure (an acquired deterioration) of many cerebral functions that includes impairment of intellectual function with a decrease in orienting, memory, language, executive attentional functions, and alterations in behavior. The greatest risk factor is age.
dimentia
mechanisms leading to dementia
- neurodegeneration
- atherosclerosis
- trauma, lesions in the cerebral convolutions
- increased cranial pressure
leading cause of dementia and one of the most common causes of severe cognitive dysfunction in older adults
Alzheimer’s Disease (AD)
most prevalent Alzheimer’s Disease (AD)
Nonhereditary, or sporadic, late-onset AD (70% of cases) is the most prevalent form.
Late onset AD may be associated with
chromosome 19
-involved with the apolipoprotein E gene-allele 4 (apoE4).
in AD formation of neuritic plaques containing a core of amyloid beta protein, the formation of neurofibrillary tangles, and the degeneration of basal forebrain cholinergic neurons with loss of acetylcholine.
-plaques int he brain with alzheimers
in AD failure to clear plaque in the brain leads to
disruption of nerve impulse transmission, and death of neurons.
a microtubule binding protein, in neurons detaches and forms an insoluble filament called a neurofibrillary tangle, which contributes to neuronal death.
tau protein
chemistry behind loss of memory in AD
Loss of acetylcholine and other neurotransmitters
The specific diagnosis of AD is made by
postmortem examination
_____________ are used in mild to moderate AD to enhance cholinergic transmission.
Cholinesterase inhibitors (ChE-Is)
a complex motor disorder accompanied by systemic nonmotor and neurologic symptoms.
Parkinson
main disease feature Parkinson
degeneration of the basal ganglia involving the dopaminergic (dopamine-secreting) nigrostriatal pathway
are men or women more likely to have parkinsons
men
hallmark feature of parkinsons
loss of dopaminergic pigmented neurons in the substantia nigra (SN)
underactivity of the direct motor pathway (normally facilitates movement) and overactivity of the indirect motor loop (normally inhibits movement).
-bradykinesia (slow movement) and rigidity
parkinsons
problems associated with parkinson
mitochondrial dysfunction
-oxidative stress
-abnormal folding and accumulation of alpha-synuclein
-abnormal phosphorylation-
dysfunction of the ubiquitin proteasome system
fibrillar intracellular eosinophilic inclusions,
Lewy bodies
Norepinephrine is thought to be neuroprotective and loss of LC neurons may be associated with a worsening of disease progression and the behavioral symptoms of PD.
Norepinephrine is thought to be neuroprotective and loss of LC neurons may be associated with a worsening of disease progression and the behavioral symptoms of PD.
symptoms appear after a 70% to 80% loss of
pigmented nigral neurons and a 60% to 90% loss of striatal dopamine.
parkinsons
classic motor manifestations of PD
-resting tremor
-bradykinesia/akinesia (poverty of movement)
-rigidity (muscle stiffness)
-postural abnormalities
is the parkinsons tremor with movement or at restq
at rest, tremor stops with mvoement
what mauls are affected with parkinsons
All striated muscles
-eventually muscles of mastication (chewing), deglutition (swallowing), and articulation
Parkinson’s dx symptoms
TRAP
(1) resting tremor
(2) cogwheel rigidity
(3) akinesia,
(4) postural instability
parkinsons treatment
-dopamine agonist
levodopa (l-dopa)
-effective in early PD but can cause motor fluctuations,“off”periods, and dyskinesia in the long term.
is a chronic inflammatory disease involving degeneration of CNS myelin, scarring or formation of plaque, and loss of axons.
Multiple Sclerosis (MS)
genetic link for MS
HLA gene
MR envrimoentla risk factors
Vitamin D deficiency, cigarette smoking, and Epstein-Barr virus infection
The first demyelinating event, or“clinically isolated syndrome”(CIS), is a single episode of neurologic dysfunction lasting greater than 24 hours that can be a prelude to MS.
The first demyelinating event, or“clinically isolated syndrome”(CIS), is a single episode of neurologic dysfunction lasting greater than 24 hours that can be a prelude to MS.
does MS effect white and grey matter
yes
MS-
Autoreactive T and B cells recognize myelin autoantigens and trigger inflammation in the CNS, leading to the loss of myelin sheaths and nerve conductivity and subsequently to the death of neurons
Autoreactive T and B cells recognize myelin autoantigens and trigger inflammation in the CNS, leading to the loss of myelin sheaths and nerve conductivity and subsequently to the death of neurons
classifications of MS
Relapsing-remitting, primary progressive, secondary progressive, and progressive-relapsing.
IN 2/3RDs of MS patients what marker is elevated
CSF immunoglobulin G (IgG)
MS tx
-Acute= corticosteroids.
-oral and injectable disease-modifying drugs are used to decrease the number of relapses
-vitamin D
affects peripheral axons and is the generalized peripheral neuropathy commonly seen
Distal axonal polyneuropathy
-more sensory than motor
cause of peripheral nuropathy
diabetes mellitus
alcohol abuse
the myelin or Schwann cells are affected; occurs far less frequently. Weakness is the predominant sign with far less sensory impairment
Demyelinating polyneuropathy
-autoimmune disease triggered by a preceding bacterial or viral infection
-numbness, pain, paresthesias, or weakness in the limbs
-acute or subacute progressive paralysis.
Guillain-Barré syndrome (GBS)
most common peripheral paralysis of the 7th cranial nerve, the facial nerve, with an onset that is rapid and unilateral
Bells Palsy
virus associated with Bells Palsy
Herpes simplex type 1
sudden, severe, brief, stabbing, and recurrent pain within the distribution of one or more branches of the trigeminal nerve that supplies the forehead, cheek, and lower jaw.
Trigeminal Neuralgia`
is Trigeminal Neuralgia bilateral or unilateral
unilateral
drug for trigeminal neuralgia
anticonvulsant drug carbamazepine.
disorders of spinal nerve roots. As the spinal roots emerge from or enter the vertebral canal,they may be injured or damaged by compression, infection, inflammation, ischemia, or direct trauma whereby the roots are stretched or torn.
Radiculopathies
clinical manifestations of radiculopathies
-Tone and deep tendon reflexes are decreased
-local pain
