Term
| Cerebrovascular Accidents (CVA) |
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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 |
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Term
Dietary reasons
Ethnic reasons
Habits |
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Definition
| Why is There a Stroke Belt? |
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Term
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Definition
| What are the two types of Ischemic Strokes? |
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Term
Ischemic (Thrombotic and Embolic)
Hemorrhagicm (Intracerebral and subarachnoid) |
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Definition
| What are the two types of strokes? |
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Term
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Definition
Type of stroke where Clot forms at site of atherosclerotic plaque rupture
Similar to process for acute myocardial infarction |
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Term
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Definition
Type of stroke where Clot fragment dislodged from elsewhere
Occludes cerebral vessel |
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Term
Intracerebral hemorrhage
Subarachnoid hemorrhage |
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Definition
| What are the two types of hemorrhagic strokes? |
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Term
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Definition
| Where do most of the clots come from in an embolic stroke? |
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Term
| Mural thrombi from atrial fibrillation |
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Definition
| What is the most common cardia source of clots? |
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Term
| Yes, if there is an atrial septal defect |
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Definition
| Can a clot from leg veins or pelvic/abdominal veins cause an embolic stroke? |
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Term
Often none except for the neurologic deficit
Headache is possible:
Altered consciousness (lethargy to coma) is possible
History of recent TIAs is possible |
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Definition
| List symptoms of an ischemic stroke |
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Term
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Definition
| What kind of headache will a ischemic stroke cause? What about hemorrhagic strokes? |
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Term
Reduce the size of the infarction, if possible
Provide rehabilitation
Prevent future strokes |
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Definition
| Ischemic Stroke Treatment Goals |
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Term
| Make sure that it is not a hemorrhagic stroke vie CT scan |
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Definition
| What do you do before you try to reduce the infarction? |
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Term
Anticoagulation with intravenous heparin
Intravenous thrombolytic therapy
Cerebral artery catheterization & angiopasty |
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Definition
| How do you reduce infarction? |
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Term
Red blood cells
Platelets
Fibrin |
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Definition
| What are the Requirements for a Thrombus: |
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Term
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Definition
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Term
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Definition
| What do thrombolytic drugs do? |
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Term
Time constraints (the sooner the better)
Risk of hemorrhage |
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Definition
| What are the drawbacks of thrombolyic drugs? |
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Term
| Recombinant tissue plasminogen activator |
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Definition
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Term
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Definition
| What has better outcomes, thrombolytics or endovascular procedures? |
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Term
Reduce the chances of repeat embolization
Control hypertension
Control diabetes tightly
Treat atherosclerosis |
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Definition
| How do you prevent future strokes? |
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Term
| Transient Ischemic Attacks (TIA) |
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Definition
Stroke-like deficits that rapidly and spontaneously resolve
Most are believed due to small emboli
High risk for eventual stroke without treatment |
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Term
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Definition
| How soon must stroke symptoms resolve before it can be considered a transient ischemic attack? |
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Term
Consider hospitalization if within 72 hours
Anticoagulation to prevent recurrent TIA and stroke |
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Definition
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Term
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Definition
| True stroke that produces no obvious motor or sensory deficits |
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Term
Changes in mood or personality
Can mimic Alzheimer's dementia
VASCULAR DEMENTIA |
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Definition
| A silent stroke will often produce what? |
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Term
Meningitis
Encephalitis
Brain abscess |
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Definition
| What are the three CNS infections? |
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Term
| Fever, malaise, and alteration of CNS function (abnormal mental status, seizures, sensorial disturbances) |
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Definition
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Term
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Definition
| What is the clinical course of Acute (Septic, Purulent) Meningitis |
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Term
Fever, stiff neck, headache, altered mental status
Petechial skin rash also common |
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Definition
| What are the symptoms of Acute (Septic, Purulent) Meningitis? |
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Term
Streptococcus pneumoniae, Neisseria meningitidis
Also for kids: Group B Strep, Hemophilus influenzae |
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Definition
| What are the causitive agents of Acute (Septic, Purulent) Meningitis? |
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Term
| Longer clinical course (weeks or months) |
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Definition
| What is the clinical course of Chronic Meningitis? |
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Term
| Similar symptoms (but usually less severe) of acute |
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Definition
| What are the symptoms of Chronic Meningitis? |
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Term
Mycobacteria
Fungi
Treponema |
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Definition
| What are the causitive agents of Chronic Meningitis? |
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Term
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Definition
| What is the clincal course of aseptic meningitis? |
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Term
Usually caused by viral infections:
Herpes simplex
Mumps
Enteroviruses |
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Definition
| What is the cause of aseptic meningitis? |
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Term
Antimicrobial drugs
Preventative:
Vaccines for Neisseria & Hemophilus
Prophylactic antibiotics for close contacts |
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Definition
| How do you treat meningiitis? |
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Term
Bacterial & fungal: usually fatal
Viral: usually NOT fatal |
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Definition
| What is the meningitis prognosis without treatment? |
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Term
Most survive
Survivors may have neural deficits |
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Definition
| What is the meningitis prognosis with treatment? |
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Term
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Definition
| What is the usual causative agents of Encephalitis? |
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Term
Symptoms due to:
Increase intracranial pressure
Focal neurologic damage
Causative organisms:
Usually polymicrobial
Many potential sources:
Dental abscesses
Sinus infections
Pulmonary infections
Endocarditis |
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Definition
| What are the symptoms, causitive organisms, and potential sources of brain abscesses? |
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Term
Loss of Dopaminergic Neurons in Substantia Nigra
Reduced Dopamine/acetylcholine ratio in neostriatum |
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Definition
| Pathology of Parkinson's Disease |
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Term
Idiopathic
Common: 1% after age 65
Usually Begins 45-60 y/o |
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Definition
| What is the primary form of Parkinson's Disease? |
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Term
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Definition
| What kind of disorder is Parkinson's? |
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Term
Corticospinal & corticobulbar tracts
Voluntary muscle control |
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Definition
| Key points of pyramidal system |
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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 |
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Definition
| Key points of extrapyramidal system |
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Term
Bradykinesia
Rigidity
Tremors (Resting)
Postural Instability
Brief Recovery in Emergencies
Cognitive Impairment |
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Definition
| Main Symptoms of Parkinson’s |
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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 |
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Definition
| Treatment Strategies of parkinsons |
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Term
| Help control symptoms but does not slow disease progression |
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Definition
| What is the idea of drug treatment of Parkinsons? |
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Term
selegiline (Eldepryl)
An MAO B inhibiter |
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Definition
| What drug might slow disease progression? |
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Term
Enzyme Present in Nerves, Gut, Liver
Inactivates Norepinephrine, Dopamine, Tyramine
Two Isoforms |
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Definition
| What is monamine oxidase and what does it do? |
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Term
“A”: Degrades Norepinephrine & Tyramine
“B”: Degrades Dopamine |
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Definition
| What are the two forms of monamine oxidase and what do they do? |
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Term
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Definition
Naturally Occurring Adrenergic Agonist
Present in Many Foods
Normally Metabolized by MAO
If NOT Degraded:
Hypertension
Tachycardia
Arrhythmia
CVA |
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Term
| Amyotrophic Lateral Sclerosis |
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Definition
Most common motor neurodegenerative disorder
Characterized by progressive death of both upper & lower motor neurons in the spinal cord and brain |
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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 |
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Definition
| What are the symptoms of ALS? |
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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 |
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Definition
| What is the prognosis of ALS? |
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Term
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Definition
Chronic disease of the neuromuscular junction
An autoimmune disorder
Auto antibodies directed against acetylcholine receptors at the neuromuscular junction |
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Term
3:2
Female: 20 – 40
Males: 50 – 70 |
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Definition
Female to male ratio of MG
Age peaks of MG? |
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Term
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Definition
| What are the normal clinical features of MG? |
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Term
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Definition
What percentage of MG pt.s progress to muscle weakness?
What is the muscle weakness most notable with? |
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Term
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Definition
| What are the associated disorders of MG? |
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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 |
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Definition
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Term
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Definition
| Is MG usually a progressive disorder? |
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Term
| Guillain-Barre Syndrome (GBS) |
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Definition
Syndrome of rapidly progressive motor paralysis
Eventually spontaneous recovery is usual |
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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 |
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Definition
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Term
Risk increases with age
M to F 3/2 |
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Definition
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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 |
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Definition
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Term
Can be mild
But most require hospitalization
Can be severe
30% require mechanical ventilation
Fatality rate: 1-4%
Pulmonary complications
Cardiac arrhythmias |
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Definition
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Term
TIME IS OF THE ESSENCE (HOURS MATTER)
Intravenous immunoglobulins (IVIG)
Plasmapheresis |
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Definition
| What is the key aspect of treatment for GBS |
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Term
Full recovery: 80%
Remain with mild-moderate disability: 10 - 15%
Remain with severe disability: 5 – 10% |
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Definition
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