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Patho Test 2 - Neurological Disorders
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71
Anatomy
Graduate
06/16/2016

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Term
Cerebrovascular Accidents (CVA)
Definition
Most common neurologic disorder in the U.S.
Shares risk factors with cardiovascular disease
A condition characterized by the abrupt appearance of a neurologic deficit due a focal vascular disruption
Usually involves infarction of cerebral tissue
Term
Dietary reasons
Ethnic reasons
Habits
Definition
Why is There a Stroke Belt?
Term
Thrombotic
Embolic
Definition
What are the two types of Ischemic Strokes?
Term
Ischemic (Thrombotic and Embolic)
Hemorrhagicm (Intracerebral and subarachnoid)
Definition
What are the two types of strokes?
Term
Thrombotic
Definition
Type of stroke where Clot forms at site of atherosclerotic plaque rupture
Similar to process for acute myocardial infarction
Term
Embolic
Definition
Type of stroke where Clot fragment dislodged from elsewhere
Occludes cerebral vessel
Term
Intracerebral hemorrhage
Subarachnoid hemorrhage
Definition
What are the two types of hemorrhagic strokes?
Term
Carotid
Cardiac
Definition
Where do most of the clots come from in an embolic stroke?
Term
Mural thrombi from atrial fibrillation
Definition
What is the most common cardia source of clots?
Term
Yes, if there is an atrial septal defect
Definition
Can a clot from leg veins or pelvic/abdominal veins cause an embolic stroke?
Term
Often none except for the neurologic deficit
Headache is possible:
Altered consciousness (lethargy to coma) is possible
History of recent TIAs is possible
Definition
List symptoms of an ischemic stroke
Term
Mild
SEVERE
Definition
What kind of headache will a ischemic stroke cause? What about hemorrhagic strokes?
Term
Reduce the size of the infarction, if possible
Provide rehabilitation
Prevent future strokes
Definition
Ischemic Stroke Treatment Goals
Term
Make sure that it is not a hemorrhagic stroke vie CT scan
Definition
What do you do before you try to reduce the infarction?
Term
Anticoagulation with intravenous heparin
Intravenous thrombolytic therapy
Cerebral artery catheterization & angiopasty
Definition
How do you reduce infarction?
Term
Red blood cells
Platelets
Fibrin
Definition
What are the Requirements for a Thrombus:
Term
Plasmin
Definition
What breaks up fibrin?
Term
Enhance plasmin activity
Definition
What do thrombolytic drugs do?
Term
Time constraints (the sooner the better)
Risk of hemorrhage
Definition
What are the drawbacks of thrombolyic drugs?
Term
Recombinant tissue plasminogen activator
Definition
What is alteplase?
Term
Endovascular
Definition
What has better outcomes, thrombolytics or endovascular procedures?
Term
Reduce the chances of repeat embolization
Control hypertension
Control diabetes tightly
Treat atherosclerosis
Definition
How do you prevent future strokes?
Term
Transient Ischemic Attacks (TIA)
Definition
Stroke-like deficits that rapidly and spontaneously resolve
Most are believed due to small emboli
High risk for eventual stroke without treatment
Term
24 hours
Definition
How soon must stroke symptoms resolve before it can be considered a transient ischemic attack?
Term
Consider hospitalization if within 72 hours
Anticoagulation to prevent recurrent TIA and stroke
Definition
How do you treat TIAs?
Term
Silent stroke
Definition
True stroke that produces no obvious motor or sensory deficits
Term
Changes in mood or personality
Can mimic Alzheimer's dementia
VASCULAR DEMENTIA
Definition
A silent stroke will often produce what?
Term
Meningitis
Encephalitis
Brain abscess
Definition
What are the three CNS infections?
Term
Fever, malaise, and alteration of CNS function (abnormal mental status, seizures, sensorial disturbances)
Definition
Signs of CNS infection
Term
Rapid (hours/days)
Definition
What is the clinical course of Acute (Septic, Purulent) Meningitis
Term
Fever, stiff neck, headache, altered mental status
Petechial skin rash also common
Definition
What are the symptoms of Acute (Septic, Purulent) Meningitis?
Term
Streptococcus pneumoniae, Neisseria meningitidis
Also for kids: Group B Strep, Hemophilus influenzae
Definition
What are the causitive agents of Acute (Septic, Purulent) Meningitis?
Term
Longer clinical course (weeks or months)
Definition
What is the clinical course of Chronic Meningitis?
Term
Similar symptoms (but usually less severe) of acute
Definition
What are the symptoms of Chronic Meningitis?
Term
Mycobacteria
Fungi
Treponema
Definition
What are the causitive agents of Chronic Meningitis?
Term
More benign course
Definition
What is the clincal course of aseptic meningitis?
Term
Usually caused by viral infections:
Herpes simplex
Mumps
Enteroviruses
Definition
What is the cause of aseptic meningitis?
Term
Antimicrobial drugs

Preventative:
Vaccines for Neisseria & Hemophilus
Prophylactic antibiotics for close contacts
Definition
How do you treat meningiitis?
Term
Bacterial & fungal: usually fatal
Viral: usually NOT fatal
Definition
What is the meningitis prognosis without treatment?
Term
Most survive
Survivors may have neural deficits
Definition
What is the meningitis prognosis with treatment?
Term
Viruses
Definition
What is the usual causative agents of Encephalitis?
Term
Symptoms due to:
Increase intracranial pressure
Focal neurologic damage
Causative organisms:
Usually polymicrobial
Many potential sources:
Dental abscesses
Sinus infections
Pulmonary infections
Endocarditis
Definition
What are the symptoms, causitive organisms, and potential sources of brain abscesses?
Term
Loss of Dopaminergic Neurons in Substantia Nigra
Reduced Dopamine/acetylcholine ratio in neostriatum
Definition
Pathology of Parkinson's Disease
Term
Idiopathic
Common: 1% after age 65
Usually Begins 45-60 y/o
Definition
What is the primary form of Parkinson's Disease?
Term
Extrapyramidal
Definition
What kind of disorder is Parkinson's?
Term
Corticospinal & corticobulbar tracts
Voluntary muscle control
Definition
Key points of pyramidal system
Term
Reticular formation (pons, medulla)
Modulated by basal ganglia, cerebellum, nigrostriatal pathway
Function to modulate voluntary muscle movement
Initiate, coordinate and provide fine control for voluntary movements
Definition
Key points of extrapyramidal system
Term
Bradykinesia
Rigidity
Tremors (Resting)
Postural Instability
Brief Recovery in Emergencies
Cognitive Impairment
Definition
Main Symptoms of Parkinson’s
Term
Restore Neurons in Substantia Nigra (As yet unrealized goal of stem cell therapy)
Improve Dopamine/Acetylcholine Ratio
Deep brain stimulation
Physical therapy & speech therapy very important
Definition
Treatment Strategies of parkinsons
Term
Help control symptoms but does not slow disease progression
Definition
What is the idea of drug treatment of Parkinsons?
Term
selegiline (Eldepryl)
An MAO B inhibiter
Definition
What drug might slow disease progression?
Term
Enzyme Present in Nerves, Gut, Liver

Inactivates Norepinephrine, Dopamine, Tyramine

Two Isoforms
Definition
What is monamine oxidase and what does it do?
Term
“A”: Degrades Norepinephrine & Tyramine
“B”: Degrades Dopamine
Definition
What are the two forms of monamine oxidase and what do they do?
Term
Tyramine
Definition
Naturally Occurring Adrenergic Agonist
Present in Many Foods

Normally Metabolized by MAO

If NOT Degraded:
Hypertension
Tachycardia
Arrhythmia
CVA
Term
Amyotrophic Lateral Sclerosis
Definition
Most common motor neurodegenerative disorder
Characterized by progressive death of both upper & lower motor neurons in the spinal cord and brain
Term
Weakness & then gradual paralysis of any muscle group
Cognition is usually unimpaired
Common presenting symptoms:
Dysphagia
Unilateral limb weakness
Ambulation difficulties (tripping, unsteady gait)
Death is ultimately due to respiratory failure
Definition
What are the symptoms of ALS?
Term
Death usually occurs in 3-5 years

Occasional cases of long term stabilization
As with Stephen Hawking (>45 yrs with ALS)

Very rare cases of partial remission
Definition
What is the prognosis of ALS?
Term
Myasthenia Gravis (MG)
Definition
Chronic disease of the neuromuscular junction

An autoimmune disorder
Auto antibodies directed against acetylcholine receptors at the neuromuscular junction
Term
3:2
Female: 20 – 40
Males: 50 – 70
Definition
Female to male ratio of MG
Age peaks of MG?
Term
Ptosis
Diplopia
Dysphagia
Definition
What are the normal clinical features of MG?
Term
85%
Repetitive muscle use
Definition
What percentage of MG pt.s progress to muscle weakness?
What is the muscle weakness most notable with?
Term
Thymoma
Hyperthyroidism
Definition
What are the associated disorders of MG?
Term
Thymectomy (If thymoma is present
And if no thymoma is present and patient is between puberty and 60 years old)
Acetylcholinesterase inhibitors
Immunosuppressive drugs
Definition
MG Treatment
Term
No
Definition
Is MG usually a progressive disorder?
Term
Guillain-Barre Syndrome (GBS)
Definition
Syndrome of rapidly progressive motor paralysis

Eventually spontaneous recovery is usual
Term
Autoimmune disorder:
Antibodies against myelin components
4-6 different clinical subtypes

In 70% a trigger event occurs 1-3 weeks before

Triggers events include:
Campylobacter jejuni
Human Herpesvirus infection (esp. CMV, Ebstein-Barr)
Mycoplasma pneumonia
Some vaccinations
Definition
Pathology of GBS
Term
Risk increases with age
M to F 3/2
Definition
Ratio and age of GBS
Term
ascending paralysis
Rapid time course
First symptom is usually leg weakness
Motor loss symptoms >> sensory loss
Facial weakness or paralysis is common
Autonomic system dysfunction can occur
Definition
Key features of GBS
Term
Can be mild
But most require hospitalization

Can be severe
30% require mechanical ventilation
Fatality rate: 1-4%
Pulmonary complications
Cardiac arrhythmias
Definition
GBS Severity
Term
TIME IS OF THE ESSENCE (HOURS MATTER)
Intravenous immunoglobulins (IVIG)
Plasmapheresis
Definition
What is the key aspect of treatment for GBS
Term
Full recovery: 80%

Remain with mild-moderate disability: 10 - 15%

Remain with severe disability: 5 – 10%
Definition
GBS Prognosis
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