Pathophysiology exam 4

what are some geriatric neuro considerations (3)

- volume and weight of brain decrease

- BBB is easier to cross

- increased inflammatory response and structural damage

what are some pediatric considerations (3)

- bones are joined by sutures to allow for brain growth

- BBB not fully developed

- more susceptible to drugs/toxins/bacteria

what are the 5 neuro functions to evaluate

- LOC

- pattern of breathing

- pupillary reaction

- oculomotor responses

- motor responses

confusion definition

loss of ability to think quickly and clearly; impaired judgement

disorientation definition

beginning loss of consciousness; disorientated to time/place/self

lethargy definition

limited spontaneous movement or speech

obtundation definition

mid-to-moderate reduction in arousal with limited response to the environment

stupor definition

deep sleep or unresponsiveness

light coma definition

Associated with purposeful movement on stimulation

coma definition

unarousable unresponsiveness

deep coma definition

Associated with unresponsiveness or no response to any stimulation

how does breathing pattern help with assessing neuro function

helps to evaluate the level of brain dysfunction and the level of coma

cheyne-stokes respirations

abnormal breathing pattern; alternating patterns of hyperventilation and apnea

what does pupillary changes evaluate

evaluate the presence and level of brainstem dysfunction

ischemia/hypoxia pupils

dilated, fixed pupils

opiate pupils

pinpoint pupils

what does oculomotor responses evaluate

determines levels of brain dysfunction in coma

what is dolls eyes?

When the eyes go the opposite direction of head movement

what does motor responses evaluate

level of brain dysfunction

what are the 3 patterns of motor response

- purposeful

- inappropriate

- not present

what are 3 other motor responses that are important to know

- vomiting, yawning, hiccupping

--> vomiting w/o nausea before hand = bad sign (direct CNS involvement)

brain death (total brain death)

brain can no longer maintain internal homeostasis; brain cannot keep body alive on its own anymore

cerebral death

irreversible coma; brain can continue to maintain respiratory/cardio/temp/metabolic control

agnosia

the inability to recognize familiar objects.

aphasia

inability to speak or comprehend speech

dysphasia

difficulty speaking

Dementias

progressive brain impairments that interfere with memory and normal intellectual functioning

clinical manifestations of dementia

- impairment of intellectual function, memory, and language

- alterations in behavior

dementia vs delirium

Dementia- slow and non-reversible

Delirium- sudden and can be reversed

Alzheimer Disease

chronic brain condition involving progressive disorientation, speech and gait disturbances, and loss of memory

how do we dx Alzheimer Disease

blood test to detect amyloid and tau proteins = biomarkers of Alzheimer's

what are the risk factors of AD

age, family hx --> familial hx can be early or late onset

what are two pathophysiology of AD

- neurofibrillary tangles

- neuritic plaques

what are the clinical manifestations of AD

progresses from mild short-term memory deficits to total loss of cognition and executive functions

Increased Intracranial Pressure

determined by volume of: blood, brain tissue, CSF

Early manifestations of increased ICP

subtle; confusion, restlessness, drowsiness, slight pupillary changes, slight breathing changes

cerebral edema

an increase in the fluid (intracellular or extracellular) within the brain

what are the 3 types of cerebral edema

vasogenic, cytotoxic, interstitial

vasogenic cerebral edema

most important; fluid moves into interstitial space

cytotoxic cerebral edema

influx of fluid inside the brain cells

interstitial cerebral edema

volume increases around the ventricles

hydrocephalus

excess fluid accumulates within the brain

what causes hydrocephalus

caused by interference in cerebrospinal fluid flow

- decreased reabsorption

- increased fluid production

- obstruction in the ventricular system

paresis

weakness; partial paralysis

paralysis

loss of motor function

diplegia

paralysis affecting like parts on both sides of the body (upper and lower)

lower motor neuron syndromes

impaired voluntary and involuntary movements

flaccid paresis or flaccid paralysis

muscle has reduced or absent tone

hypotonia

decreased muscle tone

hypertonia

increased muscle tone

spasticity

hyperexcitability of the stretch reflexes

dystonia

increased involuntary muscle contraction

rigidity

firm and tense muscle

hypokinesia

decreased movement

akinesia

absence of voluntary movement

bradykinesia

decreased speed of movement

hyperkinesia

excessive movement

paroxysmal dyskinesia

abnormal, involuntary movements that occur as spasms

tardive dyskinesia

A side effect of long-term use of traditional antipsychotic drugs causing the person to have uncontrollable facial tics, grimaces, and other involuntary movements of the lips, jaw, and tongue.

Parkinson Disease

loss of dopamine producing neurons in basal ganglia; leads to dopamine depletion and imbalance between dopamine and ACH

PD clinical manifestations

rigidity, bradykinesia, resting tremor

huntington disease (chorea)

hereditary disorder; severe degeneration of striatum and basal ganglia = depletion of GABA (inhibitory NT)

What are the two types of demyelinating disorders

CNS (multiple sclerosis) and PNS (guillian-barre syndrome)

multiple sclerosis

progressive, chronic, inflammatory demyelinating autoimmune disorder of CNS

clinical manifestations of MS

diplopia, blurred vision, dysphagia/dysarthia, muscle weakness, urinary retention or spastic bladder

Guillain-Barre

PNS; characterized by rapidly ascending progressive limb weakness and loss of tendon reflexes

Guillain-Barre clinical manifestations

symmetric flaccid paralysis, paresthesia and numbness

myasthenia gravis

neuromuscular junction disorder; chronic autoimmune disease which causes a defect in nerve impulse transmission at NMJ

myasthenia gravis clinical manifestations

weakness, fatigue of muscles in eyes and throat = diplopia and difficulty chewing/talking/swallowing

what is cholinergic crisis

resembles myasthenic crisis but weakness occurs 30/60min after taking a anticholinergic medication

cancer is defined as

not a tumor; abnormal growth resulting from uncontrolled proliferation

what is cancer also referred to as

neoplasm; "new growth"

benign tumors

- slow growth

- noninvasive

- well-differentiated

- does not metastasize

malignant tumors

- rapid growth

- invasive

- poorly differentiated

- can spread distantly (metastasis)

- are named according to the tissue from which they arise

what is carcinoma in situ

epithelial malignant tumors; have not broken through basement membrane

- NOT malignant

three prognoses for carcinoma in situ

- can remain stable for a long time

- can progress to invasive and metastatic cancers

- can regress and disappear

cell proliferation

cell division and growth

cell differentiation

cell specialization

apoptosis

programmed cell death

what are the 3 stages of carcinogenesis

- initiation

- promotion

- progression

initiation of carcinogenesis

initial mutation occurs; exposure to carcinogenic agent

promotion of carcinogenesis

process of unregulated and accelerated cancer cell growth

progression of carcinogenesis

permanent malignant changes

hallmark of cancer

uncontrolled cellular proliferation; cancer cells do not obey normal growth signals for growth/apoptosis

- some cancers can secrete growth factors = uncontrolled cellular growth

normal state

tumor-suppressor genes that: regulate cell cycle and proliferation

contact inhibition

when cells come into contact with each other = anti-growth messages are sent to stop cellular growth

anchorage dependence

normal cells will die if they break free from their site of origin

cancer evades growth supressors by

do NOT obey contact inhibition, can break down the basement membrane, and can break free from their site of origin and and spread

genomic instability

Increase tendency of an organism's DNA to acquire mutations

normal cells are not immortal and can divide only a limited number of times; CANCER cells however:

can activate telomeres (protective caps on chromosomes) and this leads to continued division

cancer and angiogenesis

advanced cancers can secrete angiogenic factors to cause a new vessel to grow to give the tumor blood supply

how are cancer cells resistant to destruction

DOES NOT undergo apoptosis

how does inflammation relate to cancer

Chronic inflammation is an important factor in developing cancer --> stimulating wound healing response causes proliferation and new blood vessel growth

What is metastasis?

cancer cells leaving a tumor and invading other parts of the body

invasion = local spread

prerequisite for metastasis; first step in the metastatic process

where does cancer normal spread first

to regional lymph nodes then throughout the lymphatic system

what do cancer cells secrete?

protease = enzyme that digest extracellular matrix and basement membranes (creates pathways)

what are risk factors for cancer

tobacco use, diet, obesity, alcohol consumption, air pollution, radiation, chemical and occupational hazards

what are some clinical manifestations of cancer

paraneoplastic syndrome (due to inappropriate release of hormones by cancer cells), cachexia, compression of adjacent structures, effusions, fatigue/sleep issues, pain, GI issues, hair loss

how do we dx cancer

done via tissue biopsy; involves tumor size, degree to which it has invaded, and extent of spread