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Pathophysiology - Neuropathophysiology I (PPT 4)
Fall Semester - 2010
101
Medical
11/03/2010

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Cards

Term
What disease is the third leading cause of death in the US and #1 cause of neurologic disability?
Definition
Cerebrovascular disease
Term
What is the most important modifiable risk factor for both ischemic and hemorrhagic stroke?
Definition
HTN
Term
What is the intracranial pressure controlled by? Is it independent or dependent on the systemic BP?
Definition
Controlled by autoregulation of cerebral vascular resistance
Independent of systemic BP (unless brain injury affects autoregulation)
Term
What are the four major arteries that provide the majority of blood flow to the brain? What area of the brain do they supply?
Definition
L and R Carotid Arteries supplies the cerebral hemispheres
Two Vertebral Arteries supply brainstem and cerebrum
Term
What part of the cerebral vasculature plays an important role in preventing ischemia due to its collateral circulation in the event of occlusion?
Definition
Circle of Willis
Term
Which artery provides collateral circulation between the internal and external carotids?
Definition
Ophthalmic artery
Term
At what critical cerebral perfusion level does irreversible brain damage occur?
Definition
15mL/100g/min
Term
How do cerebral arteries accommodate when MAP decreases? ... when MAP increases? What else do cerebral arteries respond to?
Definition
MAP Decrease - Arterioles Dilate
MAP Increase - Arterioles Constrict
Cerebral arterioles respond to pH ad blood gas levels
Term
How do cerebral arteries respond to hypercapnia, acidosis and hypoxemia?
Definition
Vasodilation
Term
How do cerebral arteries respond to hypocapnia and alkalosis?
Definition
Vasoconstriction
Term
What condition is described as any sudden neurologic insult that results from restriction or cessation of flow through the arterial system of the brain?
Definition
Stroke
Term
What are the four pathophysiologic reasons for a stroke?
Definition
Blood Vessel Dx (atherosclerosis, thrombosis)
Decrease Perfusion from impaired flow
Blood flow occlusion by an embolus
Vascular Rupture
Term
What is the distinguishing factor between a Stroke and a TIA?
Definition
TIA has complete resolution of sx within short times (minutes to hours)
Term
What is seen as a "warning sign" of impending stroke?
Definition
TIA
Term
Which populations have increased risk TIA incidence?
Definition
African Americans and Men
Term
If sx of TIA include decrease or loss of vision in one eye, what artery is affected?
Definition
Ophthalmic Artery
Term
If sx include contralateral weakness or numbness, which artery is affected?
Definition
Carotid Artery
Term
If sx of TIA include bilateral weakness, vision loss, dizziness and falling attacks, what artery is affected?
Definition
Vertebral-basilar
Term
Which maneuver can cause a vertebrobasilar TIA? What artery is occluded?
Definition
Subclavian Steal
Subclavian artery
Term
What determines an increase in the probability of future strokes?
Definition
increased frequency of TIA
Term
What type of stroke accounts for the majority of all strokes?
Definition
Ischemic Strokes
Term
What causes ischemic strokes?
Definition
obstruction of 1 or more major arteries
Term
What conditions can lead to ischemic strokes?
Definition
Atherosclerosis
Arteritis
Hypercoaguable states (women on OCs, CA pts)
Structural Heart Dx (A-fib, Valvular dx)
Term
With sx including abrupt onset of hemiparesis or monoparesis (usually affecting one arm), contralateral hemianesthesia, homonymous hemianopsia dysphasiaand aphasia, what circulation is occluded?
Definition
Middle Cerebral Artery
Term
With sx including confusion (dementia), contralateral weakness (greater in the leg) and contralateral sensory deficits, what circulation is occluded?
Definition
Anterior circulation occlusion
Term
What sx including bilateral babinski sign, increased DTRs, weakness in one or all of the extremities, brainstem dysfunction (such as intention tremors or vertigo), dizziness, disorientation, syncope, stupor, coma, N/V, ataxia, dysarthria and visual defects (displopia, nystagmus, ptosis), what circulation is occluded?
Definition
Posterior & Vertebrobasilar region occlusion
Term
Where do lacunar infarcts commonly occur?
Definition
Middle Cerebral Artery
Term
Which type of ischemic strokes are the result of hypertensive small vessel disease?
Definition
Lacunar Infarcts
Term
What are the majority of thrombolytic strokes caused by?
Definition
Atherosclerosis with thrombosis (sx evolve over a few days as the flow decreases with the increasing size of the thrombus)
Term
What are the most common sites of thrombolytic strokes?
Definition
Carotid Bifurcation
Origin of Middle Cerebral Artery
End of Basilar Artery
Term
When do the majority of thrombolytic strokes occur?
Definition
during nighttime while pt is sleeping
Term
What type of onset is a thrombolytic stroke? Embolitic stroke?
Definition
Thrombolytic Stroke - Slow onset
Embolytic Stroke - Sudden Onset
Term
Where are the most common origins of the thrombi in Embolytic strokes?
Definition
The heart (MI, A-Fib, Diseased or Artificial Valves, and Ischemic Cardiomyopathy)
Atherosclerotic Plaque - (Most commonly from the Carotids)
Term
When do embolytic strokes typically occur?
Definition
during waking activities
Term
What do patients who have had an embolytic stroke have a higher risk for?
Definition
hemorrhagic stroke
Term
What do cryptogenic strokes present as?
Definition
Present like embolytic strokes
Term
With sx including monocular blindness, hemiparesis, hemiplegia, hemianopsia, and aphasia, what circulation is occluded?
Definition
Internal Carotid Artery
Term
What is the most common cause of intracerebral hemorrhage?
Definition
hypertensive vascular damage
Term
What can lead to hemorrhagic strokes?
Definition
Trauma
ruptured aneurysm
AVM - Atriovenous Malformation
Cocaine and Amphetamine Use
Term
What type of stroke is a seizure indicative of?
Definition
Embolytic Stroke
Term
What type of stroke is a seizure indicative of?
Definition
Embolytic Stroke
Term
What study is "first line" in the dx of a stroke?
Definition
CT Scan
Term
What is effective treatment for ischemic or thrombolytic strokes?
Definition
Aspirin (within 48 hours)
Thrombolytic Therapy (within 3 - Streptokinase, TPA)
Term
What must be avoided in the acute management of ischemic strokes at ALL costs?
Definition
Hypotension
Term
What is the brain's recovery of stroke aided by?
Definition
brain plasticity - the ability of the brain to relearn tasks
Term
At what point is a carotid endarterectomy performed?
Definition
When carotid vessel is over 90% occluded
Term
To prevent strokes in patients with a-fib, what needs to be given to them?
Definition
Anticoagulation Therapy
Term
What condition is a loss of cognitive function involving changes in memory, behavior, learning and communicating that may be caused by disease or trauma?
Definition
Dementia
Term
What disease is primary dementia?
Definition
Alzheimer's disease
Term
What are some secondary causes of dementia?
Definition
Infections
Metabolic Disorders
Nutritional Deficiencies
Space Occupying Lesions
Strokes (Brain Infarcts)
Toxic Substances
Vascular Disorders
Diseases (Parkinson's, Huntington's, Wilson's, depression, head injury)
Term
What is the most common form of dementia?
Definition
Primary Dementia (Alzheimer's Dx)
Term
What condition is described as a degenerative, progressive disease that causes defects in neurons, impaired memory and reasoning and behavior changes?
Definition
Alzheimer's Disease
Term
What are the 3 key processes of nerve cells that Alzheimer's disease disrupts?
Definition
Communication
Metabolism
Repair
Term
Which type of neurons does Alheimer's disease target FIRST? What part of the brain?
Definition
Neurons for memory on the Hippocampus
Term
What neurons are attacked by Alzheimer's following its attack on the hippocampus? What sx of this occur in the patient?
Definition
Neurons in the cerebral cortex are destroyed
Causing loss of language skills, poor judgement, and personality changes
Term
What is the life expectancy from onset of Alzheimer's dx?
Definition
3 to 20 years
Term
What disease is Alzheimer's frequently accompanied by?
Definition
Parkinson's Disease
Term
What are the pathologic findings found in the brain on autopsy with Alzheimer's dx?
Definition
Amyloid plaques and neurofibrillary tangles
Term
What stage of Alzheimer's is associated with signs including emotional outbursts, agitation, wandering, disturbing behavior, incontinence and inability to interact with others?
Definition
Late Stage
Term
What is early or familial Alzheimer's linked to? What is the approximate age of onset?
Definition
Genetic mutations in families; 40 - 50 y/o
Term
What is late or sporadic Alzheimer's linked to? What is the typical age of onset?
Definition
linked to an inherited allele on chromosome 19; Age of onset = 65y/o
Term
What is the confirmatory test for Alzheimer's dx?
Definition
The only confirmatory test is autopsy when amyloid plaques and neurofibrillary tangles are found
Term
What is the primary goal of Alzheimer's treatment?
Definition
To look for reversible causes! (Syphillis, Thyroid dx, Vit B12)
Term
What is a condition with characteristic symptoms including constant uncontrollable writhing, twisting and turning movements that progressively worsen throughout the course of the disease?
Definition
Huntington's Chorea
Term
What does Huntington's disease result from? What is it linked to?
Definition
Genetically programmed neurodegenration of the basal ganglia deficiency of gamma-aminobutyric acid (GABA)
Linked to a deficiency on chromosome 4
Term
Which meds are given to Alzheimer's pts to slow the progression of the disease? What is their MOA?
Definition
Aricept (donepezil HCL) and Cognex (tacrine)
MOA - inhibits acetylcholinesterase
Term
What condition has insidious onset of signs and sx including emotional liability, intellectual deterioration, lack of attention to appearance, forgetfulness, and chorea-like movements?
Definition
Huntington's Chorea
Term
What can be given to a Huntington's pt to minimize chorea?
Definition
Haloperidol and chloropromazine
Term
What is Amyotrophic Lateral Sclerosis caused by?
Definition
Degeneration of Upper and Lower MOTOR neurons
Term
What condition is characterized by muscle weakness, atrophy, fasciculations and total loss of voluntary muscle control?
Definition
Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig's Dx
Term
What occurs to the ALS pt's mental capacity?
Definition
They retain it, they only lose motor function
Term
What is thought to be the cause of sporadic or idiopathic ALS?
Definition
slow latent virus, autoimmune dx or reoccurring severe head trauma
Term
What happens to the sensory neurons in ALS? What does that mean to the patients?
Definition
They are retained; they are still able to sense pain and touch)
Term
What is the direction of degeneration of motor neurons in ALS?
Definition
From top to bottom - Neck, tongue, pharyngeal and laryngeal muscles, then trunk and lower extremities
Term
What is the survival range after dx of ALS? What is the common COD in ALS pts?
Definition
2 - 10 ys
COD from Respiratory failure
Term
Which extrapyramidal syndrome is described as involuntary movement due to excess neuronal activity in one area as a result of unopposed activity in another area?
Definition
Tremor
Term
Which extrapyramidal syndrome is described as tremor occurring at rest but disappearing with voluntary movement?
Definition
Parkinsonism
Term
Which extrapyramidal syndrome is described as an intension tremor that increases with voluntary movement?
Definition
Cerebellar deficiency
Term
Which extrapyramidal syndrome is described as a smooth constant resistance to forceful stretching? What condition is this a feature of?
Definition
Rigidity; Parkinson's
Term
Which extrapyramidal syndrome is described as a movement that may start as an intentional movement but normal progression is lacking and the movement is disorganized?
Definition
Chorea
Term
Which extrapyramidal syndrome is described as involuntary movements combined with instability of posture, slow, rhythmic, writhing, worm-like movements that occur in upper extremities (hands and fingers)?
Definition
Athetosis
Term
Which extrapyramidal syndrome is described as sustained muscle contractions of larger axial muscles causing abnormal postures and involuntary twisting and other repetitive movements, voluntary movements are also seriously impaired and the entire body may go into painful full body spasms? What med is this condition common with?
Definition
Dystonia; Common with Compazine
Term
Which extrapyramidal syndrome is described as involuntary violent movement of a large body area (entire leg, shoulder, pelvic girdle), usually occurring unilateral and often is fatal?
Definition
Hemiballismus
Term
Which extrapyramidal syndrome is described as general term to describe abnormal involuntary movements seen in multiple disorders including Huntington's, Tourette's, Parkinson's and others?
Definition
Dyskinesias
Term
What condition is characterized by symptoms including rhythmic tremors, cognitive/behavioral deficits, bradykinesia, rigidity, sleep disorders, loss of postural reflexes (DTRs affected), speech difficulties and micrographia?
Definition
Parkinson's Disease
Term
Where is the defect of a Parkinson's patient?
Definition
a defect in the dopaminergic pathway that connects the substantia nigra to the corpus striatum (basal ganglia)
Term
Where is dopamine first released?
Definition
Substantia Nigra
Term
What is the HALLMARK of Parkinson's Dx? Where is it found?
Definition
Lewy Bodies found in the substantia nigra
Term
With a defective Parkinson's gene, what doesn't occur? What does this lead to?
Definition
Cell Death does not occur; synuclein accumulates in Lewy bodies and a build up of fibrin tissue occurs
Term
What factor has been found to increase the build-up of synuclein and may explain the co-existence between Alzheimer's and Parkinson's Dx?
Definition
Beta Amyloid
Term
How do you tx Parkinson's Dx with? What is important about the dosing?
Definition
Dopaminergic drugs (Sinemet - combo of Carbidopa and levodopa); Needs high doses b/c it doesn't cross the BBB additionally you will have to increase the doses over the time of the treatment
Term
What type of resting tremor is characteristic of Parkinson's disease? When can these tremors be increased?
Definition
"Pill Rolling" movement; Increased with fatigue and emotional stress
Term
Describe the walking posture and movements of a Parkinson's pt.
Definition
Forward tilt of trunk
Reduced arm swing
Masked Facies (Expressionless Face)
Shuffling gait with short steps
Rigidity and trembling of extremities and head
Turning "en bloc"
Term
What is one of the most common neurologic disorders affecting young patients, especially women?
Definition
Multiple Sclerosis
Term
What is the cause of Multiple Sclerosis?
Definition
Autoimmune attack on myelin sheath of CNS neuron that is thought to be triggered by a virus or environmental toxin.
Term
What are some precipitating factors of Multiple Sclerosis?
Definition
Pregnancy
Infection
Emotional Stress
Injury
Term
What sx is the most common presenting symptoms in pts with Multiple Sclerosis?
Definition
Visual disturbances (including diplopia, blurred vision, blind spots, unilateral vision loss for hrs to days, nystagmus) due to Optic Nerve Tract destruction
Term
What are some sensory disorders characteristic of MS?
Definition
Paresthesias
shocklike sensations down neck and spinal chord
proprioception disorders
Vibratory sensation diminished
Term
What are some mood disorders associated with MS?
Definition
Euphoria
Memory Loss
Dementia
Term
What type of lesions in MS are irreversible?
Definition
lesions occurring in the white matter of the CNS
Term
How is MS treated?
Definition
Syptomatic Meds (ACTH, Immunosuppressants, and glucocorticoids)
Plasmapheresis (has been shown to slow the deterioration of MS)