NYU PATHO- Week 11- Chronic Neurologic Disorders

Multiple Sclerosis

chronic autoimmune disease that affects the CNS. Involves the demyelination and subsequent degeneration of nerve fibers in the CNS.

Bradykinesia

slow movement

Parkinson's disease

associated with a tremor and slow movement thought to be related to a lack of dopamine.

Can ALS involve cognitive impairment.

Yes much later in the disease

typical signs of of hydrocephalus in neonates

irritability, enlarged head, and feeding difficulties.

Purpose of Glasgow scale

to assess level of consciousness in person with brain injury

CVA

Stroke

cause of communicating hydrocephalus

increased intracranial pressure because of excess CSF

vascular dementia

brain injury resulting from ischemia or hemorrhage.

most common artery involved with a CVA

common carotid artery

does MS follow a predictable pattern of progression in all patients?

no. MS usually fluctuates between remissions and exacerbations

risk factors for stroke

1. hypertension
2. smoking
3. history of coronary artery disease
4. diabetes
5. hypercholesterolemia

ALS

amyotrophic lateral sclerosis

what type of neuron is progressive degeneration occurring with ALS

upper and lower motor neurons

temporary treatment for Myasthenia Gravis

anticholinesterase

one sided paralysis

hemiplegia

quadriplegia

paralysis in all extremities

paraplegia

paralysis in lower extremities

symptoms of hydrocephalus

confusion, papilledoma,

communicating hydrocephalus

impaired reabsorption of CSF (hemorrhage, meningitis, congenital absence of arachnoid villi)

Non-communication hydrocephalus

blockage preventing CSF flow into the subarachnoid space due to lesions (tumor, hemorrhage) or malformations (Chiari, Dandy-Walker)

Congenital hydrocephalus

typically genetically caused and leads to malformations or other faulty development

Acquired hydrocephalus

consequence of some other disease process (infection -meningitis, tumor, head trauma, hemorrhage.)

purpose of CSF

provide buoyancy and protection to the brain.

location of CSF in cranium

in the subarachnoid space between the pia mater and the arachnoid mater

early signs of increased intracranial pressure in adults

1. increased blood pressure
2. altered heart rate
3. vomiting
4. decreased consciousness, papilledema

early signs of increased intracranial pressure in neonates

1. increased head circumference
2. enlargement of
3. sunset eyes
4. difficulty feeding
5. scalp vein distention

duration of transient ischemic attack

1-24 hours.

pathophysiology of transient ischemic attack

partial obstruction of a blood vessel in the brain. (Like Angina.)

aphasia

difficulty speaking and understanding

thrombotic stroke

blood clot (thrombus) within a cerebral artery causing obstruction. Can also be due to atherosclerosis.

embolic stroke

fatty plaque or blood clot (embolism) breaks away and flows to brain where it blocks an artery.

hemorrhagic stroke

break in blood vessel (aneurysm) in brain

is a patient with heart disease likelier to have a thrombotic, embolic or hemorrhagic stroke?

embolic as heart disease can often cause

some consequences of CVA on the temporal lobe

1. memory loss
2. receptive aphasia (difficulty understanding but communicate non-sensically)
3. hearing loss

functions of the frontal lobe

1. higher intellectual function
2. ipsilateral motor control
3. speech production

broca's area

motor speech

occipital lobe

1. vision
2. visual perception

deficits with patients with right hemispherical strokes

1. left sided motor deficits
2.

Functions of Temporal lobe

1. hearing
2. memory
3. speech perception

Functions of Brain stem

1. respiratory & cardiac regulation
2. level of awareness
3. reticular activiating system
4. includes midbrain, pons, medulla obloganta

Wernicke's area

auditory comprehension

modifiable risk factors for stroke

hypertension, hyperlipidemia, smoking, diabetes, atrial fibrilation, carotid disease, coagulation disorders, sickle cell disease, obesity, sedentary lifestyle, heavy alcohol use, cocaine use

non-modifiable risk factors for stroke

older age, female gender, African American race, heredity (genetics)

parietal lobe

primary somatic sensory area

Diencephalon

1. body temperature regulation
2.pituitary hormone control
3. autonomic nervous system responses
4.includes

function of cerebellum

coordination

forms of dementia that present with short term memory loss

1. alzheimers
2. vascular dementia
3. Lewy Body Dementia
4. Frontotemporal dementia

risk factors for alzheimers

1. age
2. inflammation
3. oxidative stress

Manifestations of alzheimers

early: short term memory loss, denial of memory loss, depression
late; personality changes, agitation and sleep disorders, reasoning deficit, delusions or hallucinations, dysphagia

risk factors for vascular dementia

hypertension, arrhythmias, hyperlipidemia, diabetes, smoking, peripheral vascular disease

prevalence of vascular dementia

20-25% of all dementia patients

manifestations of vascular dementia

confusion, agitation, unsteady gait,

risk factors for lewy body disease

parkinson's disease,

pathophysiology of lewy body disease

lack of dopamine (like parkinson's)

manifestations of lewy body disease

parkinson's symptoms (bradykinesia, tremor at res, akinesiat) fluctuation in sleep-wake cycles, hallucinations

risk factors for frontotemporal disease

family history

age of onset of frontotemporal disease

younger- around 40

famous person associated with ALS

Lou Gherig

body parts associated with lower neurons

all lower body parts beneath the neck

body parts associated with upper neurons

all body parts associated with cranial nerves

motor neuron disorders

1. parkinson's disease
2. myasthenia gravis
3. Multiple Sclerosis
4. amyotrophic lateral sclerosis

pathophysiology of myasthenia gravis

chronic autoimmune disease. Antibodies destroying of post-synaptic acetylcholine receptors

pathophysiology of MS

Chronic autoimmune disease. increase in syncytin production which attacks myelin producing cells.

pathophysiology of parkinson's disease

loss of dopamine in basal ganglia

manifestations in parkinson's disease

tremor at rest, bradykinesia, akinesia, rigidity, mask like appearance, shuffling gait

manifestations of MS

loss of balance, present at younger ages, periods of remission and exacerbations

most common cause of death for patients with ALS

respiratory collapse

pathophysiology of ALS

unknown degenerative motor neuron (upper and lower) death; SODI gene

Manifestations of ALS

typically not a cognitive problem, slow progressive ascending weakness/paralysis, spasticity, dysphagia and respiratory complications.

manifestations of myasthenia gravis

skeletal muscle weakness, diplopia and ptosis, facial droop, dysphagia and respiratory complications

difference between myasthenia gravis and MS

MS have much more peripheral symptoms and you can recover from myasthenia gravis while with MS you can't