PATHO EXAM 3

Two components of consiousness

Awareness and Arousal

What causes coma

• Bilateral Hemisphere damage

• Brainstem Lesion

• Metabolic suppression of reticular activating system

Key signs of altered level of consciousness

• Breathing pattern changes

• Pupillary changes

• Motor responses changes

• Vomiting, Yawning, Hiccups

What is Dementia

Progressive loss of cognitive function interfering with daily life (NOT NORMAL AGING)

Causes of dementia

• Neuron Degeneration

• Vascular Issues

• Brain Trauma

• Genetics

Most common dementia

Alzheimer Disease

Alzheimer Pathophysiology

• β-amyloid plaques (extracellular)

• Neurofibrillary tangles (tau protein, intracellular)

Alzheimer’s symptoms

• Memory loss → progressive

• Mood changes

• Poor judgement

• Language problems

Alzheimer’s Diagnosis

• No definitive test

• Diagnosis by exclusion

• Confirmed postpartum

Parkinson’s disease cause

Loss of dopamine neurons in substantia nigra

Parkinson’s key symptoms

• Tremor

• Rigidity

• Bradykinesia

• Postural Instability

Parkinson’s Treatment

• Levodopa

• Dopamine agonists

• MAO- B inhibitors

Huntington’s disease inheritance

Autosomal dominant (chromosome 4)

Hungtinton’s Pathophysiology

• Loss of GABA

• Basal ganglia degeneration

Hungtinton’s Symptoms

• Chorea (jerky movements)

• Mood/ personality changes

• Cognitive decline

ALS

Lou Gehrig’s

What neurons are affected in ALS

Upper and Lower motor neurons

ALS hallmark signs

• Muscle weakness

• Spastic and flaccid paralysis

• Normal cognition and sensation

Cause of death in ALS

Respiratory failure

What is TIA

Temporary ischemia with NO infarction (<1 hr reversible)

Most common cause of TIA

Atherosclerosis

What is a Stroke (CVA)

Brain infarction due to lack of blood flow

Types of Stroke

• Ischemic (occlusion)

• Hemorrhagic (bleeding)

Time to brain damage after ischemia

~5 min

Classic stroke symptoms

• Hemiparesis

• Facial droop

• Aphasia

• Vision loss

• Sudden confusion

Stroke treatment window for tPA

≤ 4.5 hrs

Common bacterial causes for Meningitis

• Neisseria meningitis

• Streptococcus pneumoniae

Classic symptoms of meningitis

• Fever

• Neck stiffness

• Headache

• Photophobia

CSF (cerebrospinal fluid) findings in bacterial Meningitis

• ↑ WBC

• ↓ Glucose

• ↑ Protein

MS

Multiple sclerosis

What type of disease is MS

Autoimmune demyelinating CNS disease

What is damaged in MS

Myelin (oligodendrocytes)

MS symptoms

• Weakness

• Vision problems (diplopia)

• Numbness/ tingling

• Poor coordination

Best diagnostic test for MS

MRI

What is a seizure

Sudden abnormal electrical brain activity

What is an aura

Sensation before seizure

Phases of seizure

• Tonic (stiff)

• Clonic (jerking)

• Postical (recovery)

ICP

Increased Cranial Pressure

Normal ICP

1—15 mmHg

Causes of increased ICP

• Tumor

• Edema

• Hemorrhage

• Excess CSF

Late sign of ICP

Brain herniation

Vasogenic edema

BBB breakdown→ fluid leaks out

Cytotoxic edema

Cell swelling due to Na⁺/K⁺ pump failure

Interstitial edema

CSF leakage in ventricles

What is hydrocephalus

Excess CSF in brain

Types of Hydrocephalus

• Communicating (absorption issue)

• Noncommunicating (blockage)

What causes Syndrome of inappropriate ADH

Excess ADH secretion (often ectopic or CNS related

What does ADH do in Syndrome of inappropriate ADH

Increase water reabsorption in kidneys→ water retention

Key lab findings in Syndrome of inappropriate ADH

• Low serum osmolality (<280)

• High urine osmolality

• Hyponatremia (<135)

Major complication of Syndrome of inappropriate ADH

Cerebral edema

Treatment for Syndrome of inappropriate ADH

• Fluid restriction

• Vaptans (ADH antagonists)

• Demeclocycline

• Loop Diuretics

• Sodium supplements

What is Diabetes Insipidus

ADH deficiency or kidney resistance → excessive water loss

Types of Diabetes Insipidus

• Neurogenic (↓ ADH)

• Nephrogenic (kidneys dont respond

• Psychogenic (excess water intake)

Key symptoms of Diabetes Insipidus

• Polyuria

• Polydispsia

• Nocturia

• Dilute Urine

Lab findings in Diabetes Insipidus

• High serum osmolality (>300)

• Hypernatremia (>150)

Treatment for neurogenic Diabetes Insipidus

Desmopressin (ADH analog)

GH excess before puberty causes

Gigantism

GH excess in adults causes

Acromegaly

GH deficiency causes

Dwarfism

What mediates GH effect

IGF-1

How is GH order diagnosed

• IGF-1 Levels

• GH suppression test

• CNS imaging

Treatment for GH excess

• Surgery (transsphenoidal)

• Octreaotide/ lanreotide

• Pegvisomant

• Cabergolide

• Radiation

Major risks of GH excess

• Hypertension

• Atherosclerosis

• Type 2 Diabetes

• Coronary artery disease

Most common cause of Hyperthyroidism

Grave’s Disease (autoimmune)

Other causes of Hyperthyroidism

• Toxic multinodular goiter

• Toxic adenoma

What is thyroid storm

Life threatening extreme hyperthyroidism

Most common cause of Hypothyroidism

Hashimoto’s thyroiditis

Most common cause of Hypothyroidism

Iodine deficiency

What is cretinism

Congential hypothyroidism→ short stature + cognitive deficits

Hyperthyroidism treatment

• Propylthiouracil

• Radioactive iodine

• Thyroidectomy

Hypothyroidism treatment

Levothyroxine

What is myxedema coma

Severe hypothyroidism emergency

What is diabetes mellitus

Metabolic disorder causing hyperglycemia

Main types of diabetes mellitus

• Type 1

• Type 2

• Gestational

• Maturity onset diabetes of the young

Type one diabetes cause

Autoimmune destruction of beta cells

Type two diabetes cause

Insulin resistance and lowered insulin secretion

Risk factors for type two diabetes

• Obesity

• Age >45

• Family History

• Hypertension

• Dyslipidemia

• Low physical activity

Type one diabetes mechanism

Beta cell destruction → no insulin

Type two diabetes mechanism

Insulin resistance + inadequate insulin

Tests for diabetes

• Fasting glucose

• Glucose tolerance test

• Hemoglobin A1C test

Classic symptoms of diabetes

• Polyuria

• Polydispia

• Polyphagia

• Weight loss

Hypoglycemia causes

• Too much insulin

• Skipping meals

• Exercise

Hypoglycemia symptoms

• Tachycardia

• Sweating

• Tremors

• Anxiety

Hypoglycemia Treatment

• Conscious → sugar

• Unconscious → IV glucose or glucagon

DKA

Diabetic ketoacidosis

Causes of DKA

Lack of insulin→ fat breakdown → ketones → acidosis

Key symptoms of DKA

• Kussmaul Respirations

• Acetone breath

• Dehydration

Labs in DKA

• Glucose >250

• pH <7.30

Treatment for DKA

Insulin

Iv fluids

Electrolytes (watch K+)

Who gets Hyperglycemic Hyperosmolar Nonketotic Syndrome

Type diabetics (Older adults)

Key feature of Hyperglycemic Hyperosmolar Nonketotic Syndrome

Severe hyperglycemia (>600) without ketosis

Symptoms of Hyperglycemic Hyperosmolar Nonketotic Syndrome

• Dehydration

• Neurologic changes

Treatment of Hyperglycemic Hyperosmolar Nonketotic Syndrome

• Insulin

• Fluids

• Electrolytes

Goal of diabetes treatment

Maintain normal blood glucose

Lifestyle changes for diabetics

• Diet (More fiber, less sugar)

• Exercise

Type 1 diabetes treatment

Insulin

Type 2 diabetes treatment

• Oral meds

• Insulin (late)

What is Maturity Onset Diabetes of the Young

Genetic diabetes (<30, autosomal dominant)

What is gestational diabetes

Diabetes during pregnancy

Cushing disease cause

Pituitary tumor → increased ACTH (Adrenocorticotropic hormone)